Blog article: The Shoulder and Elbow in the Overhead Athlete Part II: Common Shoulder and Elbow Injuries and How To Avoid Them

The Shoulder and Elbow in the Overhead Athlete

Part II: Common Shoulder and Elbow Injuries and How To Avoid Them

In part 1, the biomechanics of each phase of the baseball pitch were reviewed along with forces placed on the shoulder and elbow. It is clear that throwing a baseball is an extremely aggressive and violent act in which extreme forces and ranges of motion are placed on the shoulder and elbow. In part 2 I will review the characteristics of a pitcher, common injuries in these athletes and how you can avoid them.

Physical Characteristics of a pitcher’s dominant arm vs non-dominant arm:

Range of motion disparity

  • dominant shoulder has excessive external rotation and limited internal rotation

 

Laxity

  • excessive glenohumeral capsule laxity, which is an acquired laxity from repetitive strain

 

Osseous adaptations

  • Increase shoulder retroversion (rotated backwards)

 

Strength

  • weak external rotators, strong internal rotators
  • strong scapular protractors and elevators

 

Posture:

  • scapula protracted, anteriorly rotated at rest
  • increased scapular upward rotation during abduction of the shoulder

 

Glenohumeral Internal Rotation Deficit (GIRD)

GIRD-glenohumeral-internal-rotation-deficit

 

This develops throughout a season or over years of repeated throwing and is characterized by a significant loss of internal rotation of the shoulder. Many pitchers have a natural loss of internal rotation which is usually off-set by an increase in external rotation range of motion. GIRD becomes an issue when there is a larger loss of internal rotation than there is a gain in external rotation. If not addressed, this puts the athlete at increased risk of developing some of the shoulder injuries that will be discussed below. Also, most pitchers maintain a very similar total range of motion in the dominant and non-dominant shoulders but at times an uncompensated GIRD can lead to differences of 10-15 degrees or more.

As discussed in the previous article, most injuries occur during the late cocking, acceleration and the deceleration phases of the pitch.  To get a better understanding of why these injuries occur during specific phases, review part I to get an idea of the stresses at the shoulder and elbow during each phase.

 

Late Cocking Phase Injuries

Anterior Glenohumeral Instability. This is an umbrella diagnosis that can include the following:

 

SLAP Lesions:  Injury to the upper labrum of the shoulder. There are 4 common types. Types II and IV involve the origin of the long head of the biceps. When the biceps anchor is involved there tends to be an increase in shoulder instability. Type II is most commonly seen in the overhead athlete in which the “peel back” forces on the biceps tear the labrum and the biceps anchor.

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Bankart Lesion: Injury to the anterior-inferior (front-bottom) part of the labrum. The head of the humerus will translate forward in the shoulder socket due to this injury.

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Biceps Long Head Instability: When the shoulder is in the cocked position (90 degrees of abduction and external rotation) the long head of the biceps is placed anteriorly to the head of the humerus. With repetition of this movement and if the athlete has GIRD or a labrum lesion, the biceps tendon takes one excessive strain due to anterior movement of the humeral head. This leads to further instability. It can initially present as tendonitis and develop into tears, ruptures.

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Internal Impingement, Subacromial Impingement: Anterior instability leads to compression of the posterior and/or superior rotator cuff tendons. It can also include compression of the superior labrum.

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Acceleration Phase Injuries

UCL Injury: Sprain or tear of the ulnar collateral ligament of the elbow due to violent extension, valgus force, pronation and a traction force on the elbow. Athletes usually feel a pop followed by immediate intense pain.

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Valgus Extension Overload:  This injury is exclusive to overhead athletes and is caused by repeated forceful hyperextension and valgus stress of the elbow. There is compression of the lateral part and distraction of the medial elbow. This injury is characterized by soft tissue swelling, development of osteophytes (bony overgrowth) in the elbow and at times fractures of the elbow can occur.

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Little League Elbow:  This is characterized by the same forces on the elbow seen in valgus extension overload but occurs in preadolescents. It can lead to changes in the growth of the medial epicondyle of the humerus, tears of the wrist flexor tendons or even stress fractures of the humerus growth plates.

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Deceleration Phase Injuries: These include all of the acceleration phase injuries along with rotator cuff tendonitis and tears.

 

So now you know all of the bad things that can happen to your shoulder or elbow with repeated pitching. Did it make you want to do everything that you can to prevent these from happening?…. I hope so.

I am going to go over some things that I do with my patients in therapy, along with our clients at SPI to help decrease their risk of developing one of these shoulder or elbow injuries.

 

Posterior Shoulder Mobility

As described above, anterior instability leads to many shoulder injuries. That’s why it is extremely important to maintain good mobility and soft tissue quality of the posterior shoulder to prevent excessive anterior movement of the humeral head.

 

Modified Sleeper Stretch

This works on improving internal rotation and stretching the posterior cuff muscles. The traditional sleeper stretch involves the body and arm being at a 90 degree angle, this however reinforces the compression of the tendons in the shoulder. The modified stretch has the body rotated back at 20-30 degrees to avoid this.

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Modified Cross Body Stretch: The athlete stabilizes the scapula on their side and restricts external rotation at the elbow.

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Posterior Cuff Mobilization: Using a lacrosse ball the athlete mobilizes the posterior rotator cuff. They can perform circles using their trunk to move while maintaining pressure, they can also perform active shoulder movements.

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Thrower’s Ten / Advanced Thrower’s Ten: We utilize these shoulder strengthening programs developed by Kevin Wilk; a sports physical therapist who works with Dr. James Andrews and many MLB players to develop shoulder strength, stability and prevent injury. These exercises strengthen the shoulder while challenging the core by performing most on a stability ball.

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These are just a few examples of what we do. There’s a lot of ways we work on the shoulder and elbow using techniques proven through sports medicine research. I can’t give away all of the goods. I can give you an idea of what else we work on….. CORE AND POSTERIOR CHAIN.

Some tips for decreasing injury risk while training:

1. don’t do overhead presses – they reinforce the shoulder impingement mechanism

2. limit back squats – or if you do back squats, use a safety bar to prevent anterior shoulder strain. I prefer front squats or hip thrusts.

3. limit bench pressing – it “locks down” your shoulder blades. Do pushups instead, there’s a ton of ways to progress pushups to make them more challenging.

 

What else can you do to help prevent injury?….. don’t throw year round. Nowadays we see athletes playing in leagues for almost the entire year!  This continues to be the number one risk factor for developing injuries.

If you would like to learn more on how you can prevent shoulder and elbow injuries, properly strengthen and stabilize your shoulders and train like the pros then contact mike@spiutica.com

Blog Article – Hip Pain in the Athlete

Hip Pain In The Athlete 

Football player most stressed joints

As a physical therapist and sports performance trainer I get to work with a good deal of athletes. One common issue that I have been coming across lately is hip pain.

Hip pain can have many different causes but most commonly there’s soft tissue (muscle, tendon, cartilage) involvement.  Lately I am seeing a major contributor to these patients and clients coming in the door with hip pain, and that is muscle imbalances. 

Too many athletes these days are “living in an anterior pelvic tilt”. I am seeing this issue in so many of my athletes. Anterior pelvic tilt can cause pain in the front, back or in both areas of the hip. Anterior pelvic tilt is caused by tight hip flexors and lower back along with weak abdominals and glutes. This presentation is called pelvic or lower crossed syndrome.

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Anterior pelvic tilt puts the athlete at increased risk for common sports injuries such as groin strains, hip flexor tendonitis, hip impingement. It can also lead to issues above and below the hip such as low back pain, IT band syndrome and increase risk for knee injuries.

I always stress to all of my athletes that they need to have a strong core and posterior chain to become elite. This will help even out these “imbalances”. I work on these areas in every single session. I used to find it shocking that many of my athletes (even college level) can’t do a proper plank, squat or lunge without some sort of deviation. I now know to look for these deficits right away and to work on correcting before it becomes a big issue.

Here are some examples of what we have our clients do:

 

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one of the best ways to strengthen your glutes and hamstrings, they have been found to activate your gluteus maximus more than traditional back squats

 

TRX Deep Squat Lat Stretch

 

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great way to work on hip mobility while stretching out the back, adding in     diaphragmatic breathing in the squat position will also engage your core

 

 

 

 

Half Kneeling Hip Flexor Stretch 

 

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an effective way of lengthening the hip flexors, make sure not too “over-stretch” or the muscle will increase in tone due to excessive strain.  Tighten up your glutes on the down leg and you’ll really feel it. As shown in the picture, adding an overhead kettle bell press hold will also engage the core and shoulder stabilizers

 

 

Dead Bug with Band Pull Down

 

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A great progression of the traditional dead bug exercise, really works the lower abdominals and adding in the band pull activates your lats and shoulders, key is maintaining the low back flat against the ground while kicking out, it’s harder than it looks

 

email mike@spiutica.com if you are having sports related hip pain or if you think these exercises look cool and want to become a bad-ass athlete.

SPI YouTube Channel

We are excited to announce here that our YouTube channel is now up and running. Please be sure to check it out. We will be adding daily videos of all the great training both at our SPI Fitness center, along with team training with the Utica College Athletics program.

https://www.youtube.com/channel/UCvwhYnnrfT5qA2auaSqL5zQ

CNY High School Football Combine

SPI Fitness (Sports Performance Institute) will be hosting the 1st annual CNY/Utica High School Football Combine on August 1, 2015 at our facility inside the Field of Dreams Sports Complex.

More information coming soon.

 

Athlete Spotlight: Joe Perrotta 8/22/14

SPI Fitness: Athlete Spotlight 8/22/14 from SPI Fitness on Vimeo.

Check out our athlete spotlight video on Joe Perrotta a Frontier League Pitcher making his come back from Tommy John Surgery!