“My left shoulder hurts when I have to go backward and hit a ball that is over my head.”

The speaker was a handball player whose shoulder started to ache from playing the sport.

I didn’t know anyone played handball anymore. I remember my father taking me to the YMCA in Portland for a swim and a sauna. We would walk through the ‘Y’ and see men playing handball.

I had not seen anyone play handball since then. It has been replaced by racket sports such as squash and racquetball.

It is a shame handball has lost its popularity. It is a purely bilateral sport. Unlike in racket sports, you hit the ball with either hand. The only equipment is gloves to protect your hands. Handball is played on indoor and outside courts.

You have to develop hand-eye coordination with both hands. It is also a great cardiovascular workout. Being a bilateral sport, you do not overdevelop muscles on one side of your body.

The player with the sore shoulder is a senior athlete. He played Division I college basketball and has participated in sports all his life.

Handball is now his sport of choice. He plays in tournaments throughout New England, New York and New Jersey.

His shoulder started to hurt after playing in a tournament. The pain was on the top and back of his shoulder. Reaching over his head aggravated it.

No pain radiated into his arm. The left side of his neck is also very tight.

My examination found a tall man with an elevated left shoulder. His posture revealed a forward head translation. There was muscle spasm in the trapezius and the left cervical spine. His shoulder range of motion was excellent.

I tested the muscles of the rotator cuff tendon. They were all strong. His shoulder blade was externally rotated. There was muscle spasm between his shoulder blade and spine.

The shoulder is a complex joint. It has a tremendous range of motion. All the muscles need to be in perfect balance to maintain this motion. Many of the muscles originate in the neck and attach at the base of the skull. These muscles connect into the shoulder blade and upper spine.

If these muscles are out of balance, it is hard for the shoulder and its three bones to work in harmony. When this imbalance occurs, trigger points will arise resulting in inflammation and pain. If it lasts for an extended period of time, arthritis may occur.

My impression of his shoulder pain was overuse syndrome from postural imbalance. I wanted to treat the pain but also the cause of it. If we did not address the imbalances in his posture and muscles, the pain would return each time he played.

A treatment of manipulation of the shoulder blade, upper thoracic spine and cervical spine was used. This was essential because the muscles of the shoulder are innervated from the nerves of the neck and upper back. This would help with the cause of the muscle spasm.

We also applied ultrasound to the muscles to reduce the inflammation.

Another area we needed to address was his posture. Even though he was an athlete, his head dropped forward and his core was not in very good condition. We gave him some core exercises to do each day.

Visualization techniques were described to teach the patient to hold his ears over his shoulders.

Not all shoulder issues are rotator cuff tears. Posture plays a large role in shoulder tension and pain.

Dr. Robert Lynch is a former president of the Maine Chiropractic Association and head of the Lynch Chiropractic Center in South Portland. “Staying in the Game” appears every other Thursday in the Press Herald. Contact him at:

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