There is nothing more important than the shoulder joint. The precise coordination of the shoulder allows us to deliver the ball to its intended target with proper velocity to get desired results. Stress on the glenohumeral (shoulder) joint with repeated overhead use can result in injury. It is over twice as common in pitchers compared to position players. Shoulder pain comprises up to 69% of baseball injuries. This can lead to lost playing time and cost of care to return to prior level of function. Injury is preventable; however, it is not so simple. You must have the flexibility to perform the movement involved, while maintaining dynamical stability to prevent injury. Physical Therapy can help to prepare your shoulder, and the rest of your body, for the dynamic movement that is involved in the baseball throw.
Studies show four common factors in predicting injury. First is pitching/throwing on consecutive days. Pitch counts need to be observed. On top of that, pain needs to be reported to coaches, and activity needs to be stopped. Playing through throwing painwill only make matters worse. The second factor is throwing at higher velocities, which is expected as athletic performance goes up. The third factor is easily preventable—rotator cuff weakness. The rotator cuff must keep the shoulder joint stable while maintaining high torque with overhead throws, and is responsible for slowing down your shoulder in the follow through. Fatigue alters mechanics. Research shows that higher pitch counts, more innings played, and longer seasons statistically result in an increase in injury. The fourth most common factor is GIRD (glenohumeral internal rotation deficit)—decreased ROM rotating inward, or downward, commonly reached in follow through. Overuse or strain can result in posterior shoulder capsule tightness that results in this tightness. Another study among professional pitchers show that if your throwing arm doesn’t have more than 5 degrees more external rotation (cocked back position), then you are 5x more likely to have shoulder surgery.
Shoulder strength and flexibility are strong predictors in preventing injury, but you have to look at the whole body to get the whole picture. Breakdown in the proximal segments (core) puts more demand on the distal segments (upper extremity). The power that is required to throw the ball starts in the lower extremities, is carried out through the core, and released through the arm. Over 50% of the energy stored in the lower extremity is released through the arm. Any decrease strength or flexibility in that chain can result in poor performance or injury. That’s why both core strength and flexibility must be adequate. You must rotate your trunk to complete the act of throwing. Research shows that higher core strength will statistically increase your throwing accuracy. Lower extremity strength is extremely important. Your hip adductors transfer weight from one leg to the other with throwing. If you watch a pitcher throw, most of the action only has one foot on the ground. Balance and proprioceptive stability, along with hip strength allow for a powerful and smooth dynamic movement.
To work on shoulder strength, I recommend searching the “Thrower’s Ten Exercise Program.” There are many variations of the exercises, but essentially they will all work on rotator cuff and scapular strengthening. To combat GIRD, most professionals will perform the “sleeper stretch” before and after competition. You may want to see a professional coach if the timing of your sequence of throwing is off, especially if you are a pitcher. If you do become injured start Physical Therapy as it will decrease pain, normalize ROM, delay atrophy, and re-establish muscular balance in the acute phase. As you progress, your Physical Therapist will look to improve dynamic stability of the shoulder while increasing power and endurance. Finally, they can recommend a sport specific throwing program to return to full activity.
One of the best ways Physical Therapists can screen possible impairments, and set you up with a personalized plan to prevent injury is on a system called TRAZER which is used by collegiate teams, and physical therapy businesses like FYZICAL Therapy & Balance Centers of Omaha.
Metrics gathered by TRAZER objectively measures movement and response data of athletes in a simulated gameplay environment to assist in targeted rehab and Return to Play decisions. This includes musculoskeletal, neuromuscular, visual, vestibular and cardiorespiratory systems.
The athletes reaction time and decision making skills are tested through interactive challenges. This produces direct, reproducible, and reliable measurements of the athlete’s capabilities. TRAZER has many other applications including concussion rehab, baselines, senior health capabilities and more! The bottom line is there are easy and accessible ways to help prevent sports injuries. Do your research and make time for it, you’ll be better off in the long run.
Scott Bahe PT, DPT
Certified Dry Needling Specialist
FYZICAL Therapy & Balance Centers
“I arrived at Fyzical with a whole host of diagnoses for my hip pain (from prior PT). Shannon at Fyzical diagnosed quickly and had me feeling better than I had in months! Very Thankful!!"
— Lonnie G
“I had a great care and a great outcome at Fyzical. The staff was kind and knowledgeable. They worked with my very busy schedule and I discharged from their care feeling great!"
— Tracy L.
“Initially I came in basically unable to walk. I could not put any weight on my left leg at all. After approximately 7-8 visits I was back to playing basketball. The staff was nice and friendly. They were absolutely amazing."
— Christian S
“When I first came in I was so Dizzy I wasn’t able to walk straight and was so bad I was also having trouble sleeping. After the first treatment I was better. The staff has been wonderful and has been very concerned with my wellbeing. I’m a true success story!
— Mona R.
“When I first started at Fyzical I was recovering from fractured tibia. I was using a walker after having been in a wheelchair for about 3 months. I was able to graduate to a cane and now an able to go without the cane around the house or short distances. I only use the cane when walking longer distances. The staff at Fyzical are all very caring and professional. They are friendly and encouraging."
— Diane B.
“I had rotator cuff surgery in the spring. Following that surgery my shoulder was very weak and I was unable to move it without pain. I began me therapy with Fyzical and was amazed at how quickly my quality of movement improved with their help. I am now able to move with almost complete range of movement and have most of my strength back. I honestly believe I could not have attained this in less than 6 months with the staff at Fyzical."
— Nancy B.
“When I first went to therapy my foot hurt so bad I could barely walk on it. This limited the things I could so and made my job at work difficult to do. After six weeks of therapy I am able to walk with little to no pain. Thank to Everyone at Fyzical."
— James M.
“Came in after a bad car accident. Couldn’t put my socks on, my back hurt so bad. After 2 months of seeing Heidi & Scott I’ve regained all my mobility & have finally got back into the gym. Night and day difference from when I started."
— Gregory E.
“Riley was diagnosed with torticollis at 1 month old. He is a twin and the tight quarters only favored looking one direction so much he developed a knot in his neck muscle that was very visible as well as a flat spot on the side of his head. With PT it has made a huge difference in his behavior and interaction! By starting right away when we were diagnosed and working a lot with him at home it only took about 5 months and his back to normal with his head control and development. Krysta gave us stretches and exercises that were easy to do throughout the day with a busy house of 3 kids."
— Riley B.
“Since starting therapy I am sleeping better, less headaches and an overwhelming feeling of energy again. I was going through a depression due to headaches and neck pain. When I first started my therapy at Fyzical, with Amy’s help I finally understand what was the cause of the headaches. The entire staff were so helpful and patient with me. I would recommend Fyzical to my friends needing physical therapy."
— Judy K
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