Shoulder pain, particularly related to throwing sports such as baseball, involves the rotator cuff. You may have heard a variety of medical terms related to the shoulder, like rotator cuff tendinitis, rotator cuff tear, or impingement syndrome. But what does this mean to a baseball athlete?
The first piece of good news is tha shoulder pain, like most other 
sports-related injuries, rarely requires surgery. Now that we are hopeful that surgery will not likely be required, what can we do to alleviate the shoulder pain and prevent it from coming back?
Before discussing treatments for shoulder pain, a basic understanding of the anatomy of the shoulder may be helpful. The shoulder is a complex joint. There are three bones and two joints that contribute to shoulder function– the humerus, clavicle, and scapula are the bones. The ball and socket joint of the shoulder is between the humerus and the scapula. The acromial clavicular joint between the scapula and clavicle moves with forward elevation of the arm and helps stabilize the shoulder on the chest wall. The shoulder is the most mobile joint in the body and because of this it is easily injured.
Causes of Rotator Cuff Injuries
The shoulder joint is often injured in the throwing sports, such as baseball, because it has a greater range of movement than any other joint in the body. Shoulder muscles and ligaments bare a tremendous amount of stress throughout the throwing motion.
When you raise your arm up above your head, as occurs during the cocking and acceleration phases of the pitching motion, the rotator cuff muscles can be pinched under the acromion, causing irritation and occasionally sharp pain felt on the front or top of the shoulder. This situation is referred to as “shoulder impingement’ or “impingement syndrome”.
Deceleration
A good throwing technique requires the athlete to use his body weight and the large muscle groups of the legs, back and trunk to generate kinetic energy across the shoulder in the direction of the thrown object. After the ball is released, the retained energy in the throwing arm needs to be dissipated back to the large muscles which then absorb it. Stated more simply, after a ball is thrown, the arm must decelerate. The large muscles of the back and trunk, as well as the triceps and the rotator cuff all assist in deceleration of the arm. A tremendous amount of stress can be placed on the rotator cuff muscles as they assist in decelerating the arm after the ball is released. This is particularly true in pitchers who don’t follow through all the way. By not following through, deceleration must occur abruptly, increasing the amount of stress that is placed on the smaller and more easily injured rotator cuff muscles.
Biomechanics
As stated above, when a pitcher has poor biomechanics, undue stress can be placed on the soft tissue structures of the shoulder. Different biomechanical flaws place stress on different structures. Volumes have been written on the subject. What is important to remember here is that pitchers with poor throwing biomechanics place undue stress on the smaller rotator cuff muscles, compared to the stronger muscles of the back and trunk. Ensuring that an athlete learns proper throwing technique is a worthy investment in the health of their arm.
Overuse
Overuse is the most common source of throwing related injuries. Most importantly, it is avoidable. Paying close attention to pitch counts and giving athletes ample rest is the best way to prevent overuse injuries. It is important that athletes are allowed to come out of a game at the first sign of shoulder discomfort or soreness, even if it is not convenient to the goal of winning the game that day.
Treatment and Prevention
Reduce Inflammation – Using the RICE method: 1) Rest; 2) Ice; 3) Compression; and 4) Elevation
Myofascial Release – When muscle tissue is injured, scar is formed. Scar formation (also called myofascial adhesion) is the body’s way of patching an injured area. The problem with scar is that it is tough and fibrous, whereas healthy muscle is supple and elastic, like a rubber band. Myofascial Release Technique is used to break up scar formation and restore the muscle’s elasticity, or rubberband-like characteristics. Once the rotator cuff muscles are painfree and myofascial adhesions are broken, therapeutic exercises are essential to a complete recovery. It should also be noted that myofascial release technique can increase throwing velocity by optimizing the elasticity of the throwing muscles.
Stretching and Strengthening Exercise – Stretching and strengthening of the rotator cuff is crucial to completing shoulder rehab and remaining pain free. A few simple rotator cuff exercises will strengthen the muscles, resulting in injury resistance and optimal performance. You’ll notice that college and major league pitchers perform rotator cuff exercises on a regular basis, even when they are not injured. This speaks volumes to the importance of a healthy rotator cuff in pitchers, as well as other athletes whose sport involves repetitive stress on the shoulder.
If you are shoulder pain due to a sports injury, please call me at 425-823-400 or email me at [email protected] to schedule an appointment.
