by Neil Gomer, DC at Athlete's Care Mississauga and Oakville
As spring and summer approach, baseball season arrives. No matter what level you play it’s important to think about likely injuries and how to have the best season possible. The most common problem with any ball player is pain or fatigue in the arm and shoulder. With the right information and preparation the chance for injury dramatically decreases and can improve performance.
The two most common reasons for pain and injury are fatigue and tightness. Fatigue can result from throwing too often without adequate rest or throwing with poor mechanics. Tightness can occur in any tissue or muscle associated with the shoulder joint. Most commonly it occurs in the posterior aspect of the glenohumeral joint, in particular the capsule. This structure is best described as a thick ligament-like structure that covers the entire joint and helps hold both bones securely together during movement. When overused or injured it will thicken further thus limiting its ability to stretch and twist appropriately.
It is this structure along with the posterior muscles of the rotator cuff, infraspinatus and teres minor, which sustain extreme amounts of force as they attempt to slow the arm down during ball release. This is the most probable time that injury will occur. The second most likely time when injury occurs is during the late cocking phase of throwing, which can be seen in the image below. Tightness in these structures will cause abnormal stresses about the joint.
It is important to note that it is rarely one single cause that results in injury but often many. Tightness can lead to fatigue and muscle imbalances and muscle imbalances and overuse can lead to tissue thickening and tightness. It’s the chicken or the egg concept and while one issue is usually the initiator all aspects need to be addressed.
The million-dollar question is how do we avoid these issues? Training for any type of baseball season should begin long before the season actually occurs. Pitchers should begin throwing even earlier as it takes time to build up the arm strength necessary to deal with the forces sustained during the throwing motion. Most high-level teams should initiate throwing programs for their pitchers and position players. A basic example is shown below where throwing takes place every other day and strength training occurs on non-throwing days.
From here position players will continue to develop and train on field skills while pitchers will initiate more specific throwing programs incorporating certain pitches and tossing off the mound.
Strengthening should incorporate a well-rounded program of upper and lower body exercises since throwing is a whole body process. There are however some often overlooked exercises and muscles. Everyone who throws knows about the rotator cuff but one muscle players rarely think about is the serratus anterior. Its role is to hold the shoulder blade tightly next to the rib cage. Loss of stability at this area results in poor energy transfer into the arm and then to the ball usually causing the player to over throw. A good exercise is called the push-ups plus and is demonstrated below. Begin in push up position and lower your body towards the floor keeping your core tight. Your shoulder blades should be squeezing together with elbows straight. Then pull your shoulder blades apart as you “push” yourself up away from the floor. Total movement may only be a few inches.
Performing exercises and implementing a throwing program are great if the shoulder is moving the way it should be. The shoulder joint is a paradox in that it requires a large amount of mobility while at the same time needs to be extremely stable to avoid excess motion and possible injury. Generally speaking range of motion of any limb or joint should be relatively equal from left to right. However, in the case of ball players where there is one-sided dominance there is the possibility of a difference. While shoulder mechanics and range should always be assessed by a certified medical professional here are some quick tests that can be performed to determine if your shoulder is more at risk for injury. The first is called an upper and lower Apley’s Test. While variances do exist especially with pitchers, anyone entering a ball season needs to be able to perform this test on both sides as shown above and most importantly without pain.
A second test is assessing total rotation about the shoulder, specifically internal rotation. While there is some debate on how much internal rotation is required there is no denying that any loss of internal rotation relative to external rotation, is the biggest contributor to injury. As a general rule the total amount of rotation of the shoulder needs to be 180 degrees.
It is not unusual to have a larger amount of external rotation (ER) on the throwing side relative to the non-throwing side as long as the internal rotation allows 180 degrees of motion. If your shoulder moves as it does in image C, the loss of internal rotation needs to be corrected, as it can increase your risk for injury. Some recommended stretches are the sleeper stretch and the cross body adduction stretch for all posterior muscles and tissues.
While these stretches and exercises can be helpful to avoid injury and make your season successful it is always recommended to seek the advice of a qualified medical professional before, during and after the season.
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