Beyond the Dynamometer: Reimagining Strength in Overhead Athlete Rehabilitation

For overhead athletes in volleyball, baseball, and football, strength is the bedrock of performance and longevity. However, when managing Rotator Cuff Related Shoulder Pain (RCRSP), a narrow focus on isometric maximum force testing often fails to capture the clinical picture. While strength is protective and vital for health, isolated metrics from hand-held dynamometry (HHD) or manual muscle testing (MMT) frequently reflect a patient’s pain levels or motivation rather than their true functional capacity.

The Shift to Functional Performance

For an athlete, the ability to generate peak force in a static, clinical setting is rarely the "compass" for recovery. Instead, clinicians should prioritize testing that aligns with the high-velocity, multi-planar demands of sport.

Meaningful metrics include:

-Repetitions to fatigue: Assessing endurance during sports-specific movement patterns.

-Pain-free force output: Determining the threshold of comfortable loading.

-Real-world tasks: The ability to perform functional movements—such as lifting weight to an overhead shelf—with confidence.

Conclusion: Tool, Not Compass

Strength matters, but in the context of RCRSP, "feeling better" does not always require "more force." Resistance exercise remains essential, but we must stop over-relying on isolated strength testing to predict recovery. By focusing on functional requirements rather than symbolic metrics, we ensure that strength remains a powerful tool in the toolkit rather than a misleading guide for treatment.

Source: https://www.tandfonline.com/doi/epdf/10.1080/10669817.2026.2663623?needAccess=true

Tim Cook, Jeremy Lewis, Jared Powell