Overhand throwing can cause overuse injuries to the shoulder if proper form and conditioning are not maintained. The document discusses shoulder anatomy and biomechanics related to pitching, statistics on youth pitching injuries, common trouble areas, and preventative exercises to address mobility, strength imbalances, scapular positioning, and proprioception. It recommends coaching attention to fatigue and complaints to prevent injury and stresses being proactive by including preventative routines.

1. Michael D. Satterley PT, DPT, CIMT, CSCS Tidewater Physical Therapy, Inc. Oyster Point Physical Therapy Clinic in Newport News, Va. www.tpti.com THE THROWING SHOULDER: PREVENTING OVER-USE INJURIES

2. AGENDA Statistics on Throwing Injuries Anatomy of the Shoulder Girdle Biomechanics of Pitching Overuse in Throwing Common Trouble Areas Preventative Exercises

3. STATISTICS ON THROWING INJURIES High Incidence of Arm Pain in Youth Baseball Pitchers Each year 6 out of 10 young pitchers injure their elbow Approx 50% of participants in 2002 study of youth pitchers reported elbow or shoulder pain at least once during season 15% of college-level pitchers say that troubles in their current performance are based on injuries they received when they played youth baseball Number of Throws and Length of Season Increases Risk of Pain and Surgery Risk of pain increases if threw more than 75 pitches per game and more than 600 pitches per season Pitchers who averaged more than 80 pitches per appearance were nearly 4 times more likely to require surgery Pitchers who pitched competitively more than 8 months per year were 5 times more likely to require surgery

4. ANATOMY OF THE SHOULDER GIRDLE Joints Glenohumeral Joint Scapulothoracic Joint Thoracic Spine Sternoclavicular Joint Acromioclavicular Joint

5. Ball and Socket Joint Allows for large ROM in the shoulder girdle Glenoid Fossa Head of Humerus Acromion Supraspinatus Tendon Subacromial Bursa Latissimus Dorsi Impingement Syndrome GLENOHUMERAL JOINT

6. Not a true joint Positions the Glenohumeral Joint for overhead throwing Rotator Cuff Muscles Supraspinatus Infraspinatus Subscapularis Teres Minor Teres Major Serratus Anterior SCAPULOTHORACIC JOINT

7. Posture Needs to extend and rotate well Many muscles used in throwing at the shoulder girdle originate on the spine Rhomboids Lower Trapezius Upper Trapezius Middle Trapezius Interplay with ribs THORACIC SPINE

8. Not a huge contributor Connects to shoulder girdle via clavicle STERNOCLAVICULAR JOINT

9. Connection of Clavicle to Acromion ACJ Sprain Shoulder Separation ACROMIOCLAVICULAR JOINT

10. Windup and Stride Early Cocking and Stride Late Cocking Acceleration Deceleration Follow-Through BIOMECHANICS OF PITCHING

11. Positions body to optimally generate forces and power required to achieve top velocity If pitcher’s body and momentum fall forward prematurely, kinetic chain will be disrupted and greater shoulder force will be required to propel ball at top velocity WINDUP AND STRIDE

12. Begins once lead leg reaches max height and ball is removed from glove Ends when lead foot contacts pitching mound Stride allows for longer time for trunk motions to occur, which allows for increased energy production for transfer to upper extremity Front foot is planted slightly to third-base (RH) Pelvic rotation followed by upper trunk rotation Shoulder externally rotates and trunk arches Stance leg glute max fires to maintain slight dominant-sided extension and provide pelvic and trunk stability during coiling EARLY COCKING AND STRIDE

13. Occurs between lead foot contact and point of max ER of throwing shoulder Pelvis reaches max rotation and upper torso continues to rotate Max shoulder IR torque occurs just before max shoulder ER Increased amounts of shoulder ER help to allow the accelerating forces to act over longest distance, allowing greater pre-stretch and elastic energy transfer to ball during acceleration As shoulder approches max ER, subscapularis, pec major, and lats are eccentrically contracting, applying stabilizing anterior force to GHJ, and halting ER Upward rotatation of scapula important for 80 to 100 degrees of humeral abduction in throwing position – no impingement LATE COCKING

14. Time between max ER of shoulder and ball release Trunk continues to rotate and tilt, initiating transfer of potential energy through upper extremity Increased forward trunk tilt allows pitching extremity to accelerate through a greater distance, allowing more force to be transferred to ball Subscapularis reaches max activity during this phase along with pec major and lats, producing violent IR Serratus anterior protracts scapula to maintain stable base as humerus undergoes violent IR ACCELERATION

15. Occurs between ball release and max humeral IR and elbow extension Most violent phase of throwing cycle, resulting in greatest amount of joint loading encountered during throwing Posterior shoulder soft tissues (teres minor, infraspinatus, and posterior deltoid) dissipate these enourmous forces during acceleration phase as arm continues to adduct and IR Likely responsible for posterior capsular and soft tissue retraction commonly seen in throwing and for GHJ IR deficit seen in pitchers Trapezius, rhomboids, and serratus anterior assist in stabilizing scapula DECELERATION

16. Body continues to move forward with arm until motion is ceased Culminates with pitcher in fielding position Unlikely culprit for injury due to decreased joint loading and minimal forces FOLLOW-THROUGH

17. OVERUSE IN THROWING Fatigue Pitch Count

18. Pitchers rely less on lower body and more on arms as they fatigue Less maximum shoulder ER and knee flexion at ball release Slightly more upright trunk position at ball release As low as 2 MPH difference in velocity from 1 st to last inning considered significant Poor ball location FATIGUE

19. Should also be used as a guide in determining fatigue Little League Baseball pitcher regulation Catcher is a repetitive throw risk too Pitcher throwing 41 pitches or more cannot catch for remainder of day Catcher for 4 or more innings not eligible to pitch for that calendar day PITCH COUNT Age Pitches per Day 17-18 105 13-16 95 11-12 85 10 and under 75

20. COMMON TROUBLE AREAS Shoulder ROM Joint Laxity Scapular Position Muscular Strength Proprioception

21. Most overhead throwers display excessive ER vs. decreased IR at 90 degrees abduction Adolescent players Most dramatic at 13-14 years of age Why? Bony adaptations Anterior capsule laxity, posterior capsule tightness Large eccentric forces in external rotators during deceleration phase Infraspinatus and teres minor SHOULDER ROM

22. Excessive motion usually found in GHJ Excessive ER due to anterior capsule laxity Repetitive throwing or congenital JOINT LAXITY

23. Alterations in resting position may contribute to injury Anterior tilt and protraction Protracted and anteriorly tilted position May be normal adaptation to throwing and can be progressive Correlated with increase in shoulder IR Correlated to significant decrease in significant decrease in serratus anterior and lower trapezius strength SCAPULAR POSITION

24. Rotator Cuff Fatigue Loss of abduction strength through season Inability to center and stabilite GHJ Subacromial impingement Timing must be considered when assessing strength Profound weakness on manual strength testing 2 days following a start Also at end of season Again pitch count and rest days are important as season continues MUSCULAR STRENGTH

25. Where various parts of the body are located in relation to one another Those with capsular laxity and excessive ROM must rely on this to dynamically stabilize the GHJ Especially important at end ranges of motion Significantly decreases after throwing to fatigue Deficits return to normal within 10 minutes after throwing PROPRIOCEPTION

26. Goal is to prevent repetitive injury, not to necessarily improve performance Must focus on trouble areas Proper Shoulder/Spinal ROM Scapular Positioning/Stability Balanced Strength Proprioception PREVENTATIVE EXERCISES

27. PREVENTATIVE EXERCISES Proper Shoulder/Spinal ROM Sleeper Stretch Standing Cross-Arm Stretch Seated Mid-Back Rotational Stretch Quadruped Opposite Elbow/Knee Touches

28. Sleeper Stretch 3x for 30 seconds Do not stretch through pain PREVENTATIVE EXERCISES

29. Standing Cross-Arm Stretch 3x for 30 seconds Do not stretch through pain PREVENTATIVE EXERCISES

30. Seated Mid-back Rotational Stretch 3x for 30 seconds Do not stretch through pain PREVENTATIVE EXERCISES

31. Quadruped Opposite Knee/Elbow 2 sets of 10 reps Slow and in control Be sure to actually touch the elbow to the knee PREVENTATIVE EXERCISES

32. PREVENTATIVE EXERCISES Scapular Positioning/Stability Bodyweight Rows Bent Over Rows Band Standing Rows Prone Shoulder Circuit

33. Bodyweight Rows 3-4 sets of 10 reps PREVENTATIVE EXERCISES

34. Bent Over One Arm Rows 2 sets of 10 reps Focus on bringing your elbow back Making the medial part of your scapula go towards your spine PREVENTATIVE EXERCISES

35. Standing Band Rows 2 sets of 10 reps Trying to squeeze your shoulder blades together PREVENTATIVE EXERCISES

36. Prone Shoulder Circuit Y T W L 2 sets of 10 reps Hold at the top for 2 seconds Trying to squeeze shoulder blades on each PREVENTATIVE EXERCISES

37. Prone Shoulder Circuit Y T W L 2 sets of 10 reps Hold at the top for 2 seconds Trying to squeeze shoulder blades on each PREVENTATIVE EXERCISES

38. PREVENTATIVE EXERCISES Balanced Strength Pull-ups/Hangs Reverse Shrugs/Chair Dips High Rows Push-ups/Bosu Bench Presses Shoulder Presses Plank Holds

39. Pull-ups/Hangs If you can’t do more than 5 pull-ups at a time, try hangs 5 times for as long as you can Ideally, 3-4 sets of 10 reps Great exercise to battle impingement PREVENTATIVE EXERCISES

40. Reverse Shrugs/Chair Press Ups Great for promoting scapular stability If reverse shrugs are too easy with heavy resistance band, try chair dips 2 sets of 10 reps Can do chair press-ups for a hold PREVENTATIVE EXERCISES

41. High Rows Focusing on scapular squeeze Make sure elbows are getting behind the torso 2 sets of 10 reps PREVENTATIVE EXERCISES

42. Push-ups/Bosu Push-ups Nose to floor 2 sets of 20 If too easy, try Bosu Push-ups PREVENTATIVE EXERCISES

43. Bench Presses Bar or Free Weights Free Weights harder Makes you stabilize independently Try alternating arms or holding 1 high, while repping the other 4 sets of 10 reps PREVENTATIVE EXERCISES

44. Shoulder Presses Bar or Free Weights Alternating or Holds 3-4 sets of 10 reps PREVENTATIVE EXERCISES

45. Plank Holds Focus on getting in solid, stable position and holding Great for the core and shoulder girdle Can do 2 sets of 10 with at least 10 second holds Or, can do 3-5 minutes total and hold for as long as you can PREVENTATIVE EXERCISES

46. PREVENTATIVE EXERCISES Proprioception Rhythmic Stabilization Drills Weightbearing Quadruped Position Non-weightbearing Late Cocking Acceleration Deceleration Plyometric Deceleration Ball Flips

47. Weight-bearing Rhythmic Stabilization Alternating forces applied to all sides of the arm to try to slightly push the athlete off balance Non-specific pattern Usually done for time 30 – 60 seconds PREVENTATIVE EXERCISES

48. Non-Weightbearing Rhythmic Stabilization Late Cocking Acceleration Deceleration PREVENTATIVE EXERCISES

49. Plyometric Deceleration Ball Flips Start with very light baseball-sized med ball Progress to weight that is pain-free and maintains fluid motion in deceleration and flip back 4 sets of 10 reps PREVENTATIVE EXERCISES

50. SUMMARY Overhand throwing is a very violent motion We need to make sure all joints are moving correctly and have well-balanced strength “ Coaches have to watch for what they don’t want to see and listen to what they don’t want to hear.” John Madden We must pay attention to athletes’ verbal complaints as well as signs of fatigue to avoid injury Be proactive and institute preventative exercises into your warm-up routines Staying injury free is the key to a successful sports season

51. COMMENTS AND QUESTIONS

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