In the game of baseball

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
www.fyzicalomaha.com