May 7, 2024
It’s that time of year again. The snows melted, fields groomed and ready to go: it’s baseball/softball season. There’s no better way to shake off a Maine winter and to start off the spring than tossing the ball around. Let me offer you a piece of advice. Ease back into it will you? It’s a long season and we don’t want to start on the IL (Injured List).
We’ll talk about specific biomechanical injuries in a second. The main culprit or the general umbrella that all injuries fall into is usually a lack of preparation. We do too much too soon. We don’t have a plan. This is clearly depicted in the graph below. We need to ease our way back into things. We’ll talk about how to do this in a bit.
Ability to Adapt Table: The above demonstrates that we have a current ability to meet the demands of our everyday activities (Blue). With this being said, our bodies can also be pushed slightly over our current tolerance and can adapt to this new stimulus (Zone of Adaptation). Now we have a new threshold for activities (orange). When we perform tasks far beyond our current tolerance as well as our ability to adapt, a pain response may occur (Gray).
The shoulder is a complex joint. In order for us to have great movement (mobility), the shoulder sacrifices stability. In order to gain stability, the shoulder relies primarily on active, compressive forces (AKA your muscles, tendons, and ligaments). When these structures work in synchrony together, this is called motor control. If for whatever reason a structure becomes painful, it can inhibit the muscle from contributing to stability, throwing off the biomechanics of the shoulder. This can lead to a whole host of injuries.
Courtesy of Wikipedia.
Types of Throwing-related shoulder injuries
Shoulder Impingement
This is when compressive of the structures of the shoulder occur. There are three types:
Primary. This is a result of compression of the rotator cuff muscles between the top of the upper arm bone and collar bone.
Secondary. These compressive symptoms occur due to an instability of the shoulder joint.
Internal. This occurs due to irritation of the rotator cuff muscles being repetitively put in a throwing type position (the 90/90 position of the shoulder).
Courtesy of College Park Chiropractors.
Scapular Dyskinesis
The scapula is more commonly known as the shoulder blade. When it comes to biomechanics, it is important for it to be placed in a certain resting position. Any deviations from this position can affect the motion of the scapula, which helps assist the shoulder in overhead and throwing type motions. This is known as scapular dyskinesis.
Courtesy of Physiotutors.
Labral Tear
Think of your shoulder joint (AKA you glenohumeral joint) like a beach ball on a seal’s nose. Pretty unstable right? In order to create more stability, the body developed a labrum to increase the surface area between the two bony structures of the shoulder. What can happen to the labrum with repetitive overhead motions and high forces through the shoulder that occur with throwing is that it can become irritated, torn, or both.
Courtesy of Dr. Thomas Obenmeyer
Rotator Cuff Tendinopathy
When you see the term tendinopathy, think inflammation of the tendon. What is a tendon? It is the part of the muscle that becomes thinner as the muscle connects to the bone it attaches to. What happens with tendinopathies is that the tendon either becomes too tensioned (stretched), too compressed, or usually both (compression and tension). This compression and tension leads to friction and shearing of the tendon.
Courtesy of Rehab My Patient
If you have noticed, the majority of these injuries mention something about overuse. This could certainly be the case, but it is most likely a lack of preparation. So what do we do about this?
Treatment for Shoulder Injuries
The first step in treating shoulder pain is finding the root cause. There are also several factors that determine what exercises are chosen such as severity of symptoms, range of motion, strength of the musculature, etc. The following will show a basic progression of how to return to throwing with no unforeseen issues. The goal is to start care below shoulder height, which people usually tolerate well. Going forward the goal then becomes to approach the shoulder height position that mimics throwing.
Example of Phase I Exercises
The goal of this phase is to decrease severity of symptoms, improve range of motion, and introduce exercises that don’t exacerbate symptoms.
Posterior Capsule Stretch with breathing
Scapular Retraction w: External Rotation
Example of Phase II Exercises
The goal of this phase is to improve strength in range of motion captured in phase one and to start to poke into motions approaching overhead.
Example of Phase III Exercises
The goal of this phase is to further build upon phase two where we start to strengthen in sport specific positions along with incorporating rotation of the chest, which is critical to throwing.
Single Arm Pulldown w/ Rotation
Side Plank with Shoulder Rotation
While this exercise progression is essential to ensuring sound transition back to throwing, nothing better prepares you for it than the activity itself. But you must start in the way you get back into it. A great guide to grade back into throwing is through a designed protocol which can be found HERE.
As we mentioned before, shoulder pain can be very complex. There is no better way to understand your pain experience than by consulting an expert in orthopedic physical therapy. Please give Portland Physical Therapy a call at 207-828-4455 to learn more.
Author: Brandon Drinan, PT, DPT, CSCS