RSM-SPM-020
Written by Hironori Ikeda, MSc Sports Medicine
RSM International Academy · Chiang Mai, Thailand
What Should You Assess When Serving or Spiking Hurts the Shoulder?
Shoulder pain in volleyball may appear while drawing the arm back for a serve, striking a hard spike or repeating attacks late in practice. A comfortable first arm lift does not explain why the shoulder becomes painful later. Nor does an uneven-looking shoulder blade tell you which tissue needs treatment.
I start with the player's specific phase and recent overhead load, then compare shoulder motion, scapular contribution and tolerated cuff loading. Those findings guide palpation and the choice between a small massage trial, a change in training demand and further assessment.
This guide explains the muscle and joint actions behind serving and spiking, how to make practical clinical comparisons, and what to re-check before judging treatment. The aim is to connect the hands-on decision to the player's actual difficulty.
In This Article
- What Should You Assess When Serving or Spiking Hurts the Shoulder?
- In This Article
- 1. Serve or Spike? Identify the Painful Phase and Repeated Load
- 2. Scapular Control: Compare Arm Elevation and Thoracic Contribution
- 3. Cuff Endurance and Posterior-Shoulder Palpation: What Changes the Decision?
- 4. Sports Massage: Choose a Relevant Trial Without Promising More Spike Power
- 5. Re-Test the Same Shoulder Load, then Review Actual Volleyball Tolerance
- Related RSM Clinical Blogs
- Study Sports Massage at RSM
1. Serve or Spike? Identify the Painful Phase and Repeated Load
I first ask which action hurts: a float serve, jump serve or hard spike, and whether pain starts while drawing the arm back, accelerating toward the ball or following through. I also ask whether the first attempts are comfortable and symptoms appear later in practice. These are different starting points for assessment.
During cocking, the upper arm lifts away from the trunk and rotates outward at the glenohumeral joint. Acceleration brings inward shoulder rotation and elbow extension toward contact. The arm then continues into follow-through. I ask the player to identify the familiar phase in a comfortable demonstration or existing training video; I do not require a painful full-speed spike.
A laboratory study of healthy collegiate women found different shoulder loads across volleyball skills, with the off-speed roll shot producing lower measured loads than the hard spikes. That supports recording the actual skill and effort. It does not establish a safe daily spike count or show that changing technique prevents injury.
My load history separates serves from attacks, then records recent changes in count, effort, consecutive training days and recovery. A shoulder that hurts only after repeated hard attacks raises a different load question from one that hurts during an unloaded arm lift. I use that distinction to select a tolerable baseline, after checking for the concerning features described below.
2. Scapular Control: Compare Arm Elevation and Thoracic Contribution
A shoulder blade that moves differently is an observation to investigate. In a cross-sectional study, volleyball players with shoulder pain showed differences in scapular tilt and rotation at contact during a cross-body spike. The association does not tell me whether the movement difference caused pain, followed pain or identifies the tissue to massage.
Serratus anterior runs from the lateral ribs to the front of the scapula's medial border. It helps keep the scapula against the rib cage and contributes to upward rotation and posterior tilt during elevation. Trapezius attaches to the clavicle, acromion and scapular spine; its upper and lower portions cooperate in upward rotation. These actions orient the glenoid as the humerus rises, so pinning the shoulder blades down and back is not my default instruction.
I start with comfortable standing arm elevation slightly forward of the frontal plane, comparing the raising and lowering phases over a small tolerable series. I record familiar pain, its onset and whether range or trunk strategy changes. A late shrug or more visible medial border does not, by itself, measure serratus strength or establish a cause.
For a thoracic comparison, I repeat the lift after a small, comfortable change toward upper-back extension, without forcing a lower-back arch. Alternatively, a trained clinician can gently assist scapular upward rotation and posterior tilt during the same lift. I change one condition at a time: less pain can identify a useful modification, but neither response proves a scapular fault or that hands-on treatment will improve spiking.
3. Cuff Endurance and Posterior-Shoulder Palpation: What Changes the Decision?
I compare active arm elevation and supported passive inward/outward shoulder rotation with a tolerable cuff-loading task before attributing late-session pain to poor endurance. Infraspinatus lies below the scapular spine and runs toward the humeral greater tubercle; teres minor lies along the lateral scapular border and also inserts on that tubercle. Both contribute to outward humeral rotation and, with the other cuff muscles, glenohumeral stability.
Anatomy note: Infraspinatus is not mechanically uniform: cadaver measurements found greater external-rotation leverage in its inferior than superior region with the arm abducted.
For a simple comparison, the player sits with the elbow bent 90 degrees beside the trunk and a small towel supporting the upper arm. They rotate the forearm outward against light, consistent resistance through a comfortable range. I record repetitions, pace, pain and loss of range or control, stopping with worsening symptoms. Pain-limited effort differs from gradual fatigue, and this low-load comparison is not a validated volleyball endurance cutoff.
For palpation, I support the forearm and identify the scapular spine before using broad, light contact over the infraspinatus belly below it. Its fibers converge laterally toward the humerus, where the deltoid overlies the cuff. I begin on the accessible scapular portion and adjust contact to tissue tolerance, keeping contact away from the axilla, where major nerves and vessels pass. Tenderness can guide a small treatment trial but cannot confirm a trigger-point cause or exclude tendon and joint involvement.
A fall or dislocation event, sudden loss of strength, inability to lift the arm, recurrent slipping, painful catching or substantial new restriction changes the plan toward further clinical assessment. Progressive tingling or visible muscle wasting also needs assessment rather than a harder endurance challenge. I do not use local tenderness to explain away these findings.
4. Sports Massage: Choose a Relevant Trial Without Promising More Spike Power
I consider a short massage trial when the assessment identifies a relevant muscular complaint and no finding redirects care. In a posterior-cuff teaching comparison, support the arm and use broad, light contact over the identified muscle belly. Distinguish pressure directed into that superficial tissue from a small tangential component along or across its fibres; the distance the hand travels over the skin is a separate choice. Adjust the direction and amount of pressure to the player's response rather than pushing toward the joint or axilla. Increasing familiar pain or producing tingling stops the trial.
With the pressure reduced, the player can perform a small, comfortable active shoulder rotation while the practitioner follows how the muscle belly changes tension and moves beneath the contact. This observation does not demonstrate an adhesion being released. After contact is removed, the player can practise a comfortable arm lift with the scapula moving around the rib cage and a tolerable contribution from the trunk. Any added support or trunk movement is recorded as a practice variation before returning to the original unassisted baseline.
Timing matters to the decision. Before a match, I avoid introducing an unfamiliar, provocative treatment and check that the original easy arm lift remains comfortable. After training, I still select the area from the assessment instead of treating every muscle around the scapula. If only thoracic repositioning changed the symptom, pressing more deeply into the cuff is not an automatic next step. I also distinguish a comfortable first attack from symptoms emerging late in a permitted set: the latter keeps repeated-load capacity in the plan even if local contact makes the first lift easier.
The sports-massage review found small benefits for flexibility and delayed-onset muscle soreness, without evidence of direct performance gains. I therefore present massage as a possible adjunct for comfort and mobility, not a way to restore cuff endurance or guarantee a faster spike. Repeated-load difficulty may require an individual exercise and workload plan even when the shoulder feels temporarily easier.
5. Re-Test the Same Shoulder Load, then Review Actual Volleyball Tolerance
I repeat the baseline that was relevant: the same arm-elevation series or supported external rotation, preserving range, pace, resistance, repetition count and rest interval. I compare familiar pain and when it appears. If scapular assistance or a thoracic-position change was useful, I record that comparison separately from the original unassisted condition.
A better clinic result does not establish readiness for repeated ball contacts. Where volleyball participation is appropriate, the player and their treating clinician or coach can agree an individual return-to-load plan. I want the log to distinguish float or jump serves from spikes, with count, effort, recovery and symptoms during practice, afterwards and the following morning.
If the shoulder looks smoother or feels less tender but pain still begins at the same attack demand, the important limitation remains. Fewer spikes, lower effort or a different shot may make practice tolerable, but those are changed exposures and cannot prove a massage effect. Persistent deterioration or new weakness calls for reassessment; one comfortable clinic series does not clear a player for a match.
Related RSM Clinical Blogs
Browse all Sports Massage clinical guides
▷ Swimmer's Shoulder Pain: Cuff, Scapula & Thoracic Mobility — Sports Massage · Compare cuff and scapular demands during repeated swimming strokes, where stroke phase and distance shape the complaint.
▷ Scapula Moves Differently in Sport: Dynamic Scapular Assessment — Sports Medicine Massage · Explore how to interpret scapular differences during specific sporting tasks without making appearance a diagnosis.
▷ Shoulder Pain Throwing / Serving: Cuff, Scapula & Training Volume — Sports Medicine Massage · Broaden the assessment of painful throwing or serving through cuff function, scapular contribution and training volume.
Study Sports Massage at RSM
The Sports Massage Course at RSM International Academy in Chiang Mai connects clinical palpation with sports demands and treatment selection. This volleyball example links a specific attack or serve complaint to shoulder loading and a meaningful re-test. See the Course Schedule for upcoming training.
The Trigger Point Therapy Course is the required foundation for Sports Massage. It develops the anatomical landmark, tissue-identification and contact skills needed before choosing pressure around a painful shoulder.
The Dynamic Posture Assessment & Kinetic Chain Training Course adds functional assessment and visual feedback. It develops the skills to compare trunk and limb movement, useful when testing whether a thoracic change alters a specific arm-elevation complaint.
About the Author
Hironori Ikeda, MSc Sports Medicine is the founder and lead instructor of RSM International Academy in Chiang Mai, Thailand. His teaching connects functional anatomy and clinical palpation with specific movement comparisons, treatment selection and re-testing.