Throwing Athletes at Risk for Shoulder Injury; Corrective Exercise Can Help!

I am team teaching a Performance Enhancement Specialist Workshop for the National Academy of Sports Medicine in Houston Texas this weekend with the Director of Reconditioning for Cal Berkley, Ken Miller. We are having a great time and plenty of fun with the class.

We have put the students through the ringer with; dynamic flexibility, speed, agility and quickness workouts and will cap of the physical activity with a total body circuit workout. Hopefully they aren’t too tired after to focus on the program design lecture:)

Ken and I have had some great conversations about athletic preparation, recovery and performance enhancement. I always look forward to teaching with Ken, we don’t get to see each other often enough on the road since we are based on opposite coasts. Here is a pic of Ken outside of Lupe Tortilla where we had a great dinner Friday night;

During some down time I found a new research article published in the Journal of Bone and Joint Surgery that was just published 4/4/09!

Shoulder Injuries in the Throwing Athlete

Sepp Braun, MD1, Dirk Kokmeyer, PT, SCS, COMT2 and Peter J. Millett, MD, MSc1

1 Steadman Hawkins Research Foundation, 181 West Meadow Drive, Suite 1000, Vail, CO 81657. E-mail address for P.J. Millett:
2 Howard Head Sports Medicine Center, 181 West Meadow Drive, Vail, CO 81657

The Journal of Bone and Joint Surgery (American). 2009;91:966-978.
© 2009 The Journal of Bone and Joint Surgery, Inc.

This is not new information to most people in the corrective exercise, rehabilitation and performance enhancement fields, but it is great to see this information in print in a peer reviewed quality publication.

It reminded me of the post I did on the red Sox throwing program and also made me think of the Trouble that Troy Glaus is having after having suffered a set back during rehabilitation from his shoulder surgery

The authors’ conclusions were basically;

*Pathologic conditions in the shoulder of a throwing athlete frequently represent a breakdown of multiple elements of the shoulder restraint system, both static and dynamic, and also a breakdown in the kinetic chain.

*Physical therapy and rehabilitation should be, with only a few exceptions, the primary treatment for throwing athletes before operative treatment is considered.

*Articular-sided partial rotator cuff tears and superior labral tears are common in throwing athletes. Operative treatment can be successful when nonoperative measures have failed.

*Throwing athletes who have a glenohumeral internal rotation deficit have a good response, in most cases, to stretching of the posteroinferior aspect of the capsule.—sound familiar:)

One of my favorite quotes from the article is “While a single traumatic event may cause injury, more commonly it is repetitive overuse that leads to failure of
one or more of these structures.”

Think about the 6 phases of throwing and how stressful they are pn the shoulder complex;

“The six phases of the throwing motion. Phase 1 is the wind-up phase. Phase 2 is the early cocking phase, ending with planting of the striding foot.
Phase 3 is the late cocking phase, in which the arm reaches maximum external rotation. In Phase 4, the ball is accelerated until Phase 5 starts with
release of the ball and deceleration of the arm. Phase 6, the follow-through, rebalances the body until the motion stops.”

“The arc of motion of the throwing shoulder is shifted posteriorly, with increased external rotation and decreased internal rotation of the abducted shoulder.”

Phase number three with the shoulder abducted and externally rotated can be very strenuous.

“Internal impingement of the undersurface of the rotator cuff against the posterior
aspect of the labrum in maximum external rotation and abduction.”

“Left: With the arm in a position of abduction and external rotation, the humeral head and the proximal humeral calcar produce a substantial cam effect of the anteroinferior aspect of the capsule, tensioning the capsule by virtue of the space-occupying effect. Middle: With a posterosuperior shift of the glenohumeral contact point, the space-occupying effect of the proximal part of the humerus on the anteroinferior aspect of the capsule is reduced (a reduction of the cam effect). This creates a relative redundancy in the anteroinferior aspect of the capsule that has probably been misinterpreted in the past as microinstability. Right: The superimposed neutral position (dotted line) shows the magnitude of the capsular redundancy that occurs as a result of the shift in the glenohumeral contact point.”

The goal is to minimize these repetitive movements and microtraumas with corrective exercise;

soft tissue work, stretch short muscles and stressed joint capsules

activate/strengthen weak muscles and work on the body’s coordination to make it all stick!

It takes diligence and precision to keep an athletes healthy.

1 + 1 can only = 2, not = 3

#1 is injury prevention
#2 is athletic longevity
#3 is athletic performance enhancement which will only come if you have 1 plus 1 and then 1 plus 2!

Prevention, longevity and then improvement!

Thanks for reading!

Eric Beard
Athletic Performance Enhancement Specialist
Corrective Exercise Specialist

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This entry was posted in injury prevention, injury rehabilitation, myofascial release, red sox, rotator cuff, shoulder injuires, throwing athltes, troy glaus. Bookmark the permalink. Post a comment or leave a trackback: Trackback URL.

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