Volleyball shoulder pain usually comes from spiking and jump serving, which swing the hitting arm overhead at high speed hundreds of times a week. The common sources are the rotator cuff tendons, the back of the shoulder joint and labrum, and a nerve at the back of the shoulder blade (the suprascapular nerve). Most overuse cases settle over 6 to 12 weeks with fewer full-effort swings, technique changes and strengthening.
A nerve problem at the back of the shoulder is more common in volleyball than in most sports, and it can be painless.
Key takeaways
- The swing is the main load: spiking and jump serving cock the arm fully back, then slow it after contact.
- Common problems: rotator cuff tendinopathy, internal impingement at the back of the shoulder, labral irritation and suprascapular nerve irritation.
- The nerve problem can be painless: weakness turning the arm outward, or a hollow above or below the ridge of the shoulder blade, may be the first sign.
- What helps: fewer full-effort swings for a while, more power from the legs and trunk, and strength for the back of the shoulder and shoulder blade.
- Typical timeline: many players see clear change in 6 to 12 weeks; nerve and labral problems can take 3 to 6 months or longer.
The common problems, and what sets each apart
Shoulder
- Rotator cuff tendinopathy: an ache at the side of the upper arm during and after hitting, often worst at contact and when blocking with the arms overhead.
- Internal impingement: pain at the back of the shoulder at the moment the arm is fully cocked, just before the swing forward. Many hitters lose some ability to turn the arm inward on the hitting side.
- Labral irritation or tear: a deep pain with clicking, catching or a dead-arm feeling in the swing, sometimes with lost hitting power.
- Shoulder blade control problems (scapular dyskinesis): the shoulder blade does not move smoothly, often seen as the inner edge lifting off the ribs as the arm lowers.
The suprascapular nerve
The suprascapular nerve runs from the neck, across the top of the shoulder blade, then wraps around a notch at the back of it to reach two rotator cuff muscles: the one above the ridge of the shoulder blade (supraspinatus) and the one below it (infraspinatus). The repeated stretch and whip of the spiking arm can irritate the nerve where it wraps around the bone, or a small cyst from a labral tear can press on it.
- What it feels like: often a deep, dull ache at the back or top of the shoulder. In some players there is no pain at all.
- What sets it apart: weakness turning the arm outward and a hollow over the back of the shoulder blade as the muscle wastes.
- How it is found: a doctor or physical therapist may notice the wasting or weakness. Nerve conduction tests and an MRI scan are often used to confirm it and look for a cyst.
- How it is managed: most cases are managed first with load changes and strengthening over 3 to 6 months. Surgery is sometimes considered when a cyst is pressing on the nerve or there is no change after a full rehabilitation program.
Upper back
- Upper back stiffness: a stiff mid back limits the arch and trunk rotation of the swing, so the shoulder does more.
Early warning signs
- Lost hitting power: your spikes or serves feel weaker or you start tipping more.
- Pain at the back of the shoulder: a deep ache when the arm is fully cocked.
- A hollow on the shoulder blade: a teammate or coach notices a dip above or below the ridge on your hitting side.
- Next-day pain: an ache after training that is still there the next morning.
A shoulder that has lost strength without hurting still has something to tell you.
Load and technique changes
- Count your swings: cut full-effort spikes and jump serves by about half for 2 to 4 weeks.
- Use the whole chain: the approach, jump and trunk rotation should drive the swing, with the arm finishing it.
- Strength work: two to three sessions a week of rotator cuff exercises, especially external rotation, plus shoulder blade work such as rows.
- Keep internal rotation: a gentle cross-body stretch or sleeper stretch, if comfortable and a PT has shown you how.
A return plan by stage
- First 1 to 2 weeks: passing, setting and defense if comfortable. No spiking or jump serving. Start strength work.
- Weeks 2 to 6: easy swings at a lower ball, then standing spikes, then approach spikes at half effort, building by about 10% a session if pain stays mild and settled by the next morning.
- Weeks 6 to 12: full-effort spikes, jump serves, then full match play.
- Ongoing: most players return to full play over 2 to 3 months; nerve and labral problems can take 3 to 6 months or longer.
Where else this could be coming from
- The neck: a pinched nerve in the neck (cervical radiculopathy) can cause pain over the shoulder blade or top of the shoulder, often with tingling, numbness or weakness down the arm toward the elbow, wrist or hand.
- A rotator cuff tear: weakness that comes on after one hard swing or a fall, with pain, can be a tendon tear rather than a nerve problem.
Call your local emergency number or go to the emergency department if
- Chest symptoms: chest pressure, breathlessness, sweating or nausea with shoulder, arm or upper back pain during or after play.
- A dislocation: the shoulder looks out of place after a dive, a block or a fall and you cannot move the arm.
- A collision with neck symptoms: a hard fall or collision with neck pain, numbness or weakness in the arms or legs. Keep still and call for help.
See a doctor today if
- Sudden weakness: you cannot lift the arm after a pop or a hard swing.
- Fever: a hot, red, swollen shoulder with fever or feeling unwell.
Get it checked soon if
- A hollow or wasting: a dip above or below the ridge of the shoulder blade on the hitting side, with or without pain.
- Weakness turning the arm out: even if it does not hurt.
- No change in 2 to 3 weeks: pain is not easing despite cutting full swings.
- Catching or dead arm: clicking, catching or a dead-arm feeling when hitting.
More on this area: neck and shoulder pain by job and sport.
Most volleyball shoulder pain responds to fewer full swings and a stronger back of the shoulder, and painless weakness is worth checking early.
Written by Louise Yow, Neck & Shoulder Physio.