Shoulder impingement's when pitching can become a serious problem. I will give you 4 critical steps to preventing a shoulder impingement when pitching. Shoulder impingement's when pitching can lead to rotator cuff and labrum tears. Understanding how this impingement can occur is critical in helping the pitcher keep a healthy arm and a long career.
The reason I found myself with a torn rotator cuff at 18 years old is because of a shoulder impingement that I ignored in hopes it would eventually go away. The biggest mistake any pitcher could make in his career is hoping that an injury will go away. Any injury that occurs during the season must be addressed during the off-season to prevent it from becoming an issue again and again. This is also why it is so critical for pitcher to take a good off-season every single year.
The Misconceptions of the Pitching Arm
Conventional wisdom has taught many pitchers to believe that their arm needs to be worked into this long lanky, loosey goosey, battle tested, throwing machine. Like it needs to be mended into a long piece of leather through overuse and abuse. This is just ridiculous and if you allow yourself to get caught up in this "Old School" mentality, you could end up like the majority of pitchers in this game; with either serious pain or serious injury.
The arm was not built to take the kind of abuse that most pitchers want to put it through. If it was built for this kind of abuse then our arms would look like our legs which were built for wear and tear. This is why our legs heal so much faster than our arms. This is also why any throwing program that includes a ton of throws and little total body strength and conditioning is setting everyone who uses it up for complete failure.
The arm is not a punching bag, it is a fine motor tool to be used mainly for sophisticated movement. Without our arms the human body is almost useless. Studies show that the only way to reduce injury when pitching at a high velocity is by reducing stress to the arm through impeccable timing of optimal high velocity mechanics (1). The study didn't say the only way to reduce arm injury is to throw as many pitches as you can, as far as you can, for your entire career.
What is an Impingement?
When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against or "impinge" on the tendon and the bursa, causing irritation and pain. If the shoulder blade or scapula is protracted or the shoulder is more internally rotated due to tight anterior muscles and weak posterior muscles then the space for the rotator cuff to function is limited and vulnerable to impingement and more serious damage.
Types of Shoulder Impingement's Pitching
Subacromial (External) Impingement - This is the impingement that occurs just below the acromion which is marked in green. Studies show:
Primary subacromial impingement in the young overhead throwing athlete is unusual but may occur with primary hyperlaxity or loss of dynamic stability (2).
Internal Impingement - This is the impingement that occurs just above the humeral head which is marked in red. Studies show:
Posterosuperior glenoid impingement (internal impingement) is one of the most frequently observed conditions in the overhead throwing athlete, and may be caused by excessive anterior shoulder laxity. Throwers with internal impingement occasionally allow their arms to lag behind the scapula (excessive horizontal abduction). This hyperangulation of the arm may lead to excessive strain on the anterior capsule and internal impingement of the posterior rotator cuff (2).
In my previous article called, Studies Prove Hip Mobility Link To High Pitch Velocity, we learned that hyperangulation is the result of poor hip mobility. Learn my by following the link to the article.
Causes of Shoulder Impingement's Pitching
There are two different types of causes that can lead to a shoulder impingement. They are listed below. In the case of my rotator cuff tear I fell into both of these categories.
Primary Shoulder Impingement - This is the result of the persons anatomical structure. The medical field has labeled three different types of the structure of the shoulder. This mainly describes the shape of the acromion which is the bone just above the shoulder towards the posterior side. Here is a diagram labeling the three different types of shoulder structuring. Type 1 is the more flat acromion and type 2 and 3 become more curved. Type 3 having the least amount of space available for the rotator cuff which will cause more impingement's on the rotator cuff. If the person does not have a healthy shoulder, shoulder surgery may be the only option in a type 3 case. I had a type 3 problem.
Secondary Shoulder Impingement Pitching - This type of impingement is caused by activity, poor posture or muscular weakness. In many cases this is the result of pattern overload 0n the rotator cuff muscles. This is the more common cause of most shoulder impingement's when pitching.
Testing for Shoulder Impingement's Pitching
There are several ways to test for shoulder impingement problems. An accurate test of the shoulder joint to help diagnosed a problem is testing for GIRD or Glenohumeral Internal Rotation Deficit. A healthy arm will have around 180 degrees of internal to external range of motion. If the shoulder is around 15 degrees short of 180 degrees, mainly with internal rotation, then the shoulder is vulnerable to damage which can be caused by an impingement. Studies have shown this loss is due to overuse, shoulder weakness and poor mechanics (2).
Reinold et al theorized that the loss of internal rotation and total motion after throwing is the result of eccentric muscle damage as the external rotators and other posterior musculature attempt to decelerate the arm during the throwing motion (2).
4 Critical Steps to Prevent Shoulder Impingements Pitching
Here are 4 critical steps to preventing shoulder impingement's when pitching. Even if you do not have any signs of a shoulder impingement I still highly recommend all pitchers to follow these steps religiously to prevent the problem in the future.
- Shoulder Integrity - Most shoulder impingement's come from joint laxity. This means the joint is too flexible. Yes, too much flexibility is a bad thing for baseball. The problem lies in the scaps. The scaps of a pitcher must be strong but mobile. This means they must be able to decelerate a ton of force to prevent the rotator cuff from taking most of the wear and tear. The 3X Pitching Velocity Program has several joint integrity programs for the entire season of training and it is built around the development of strong mobile scaps to support the high velocity pitcher.
- Total Body Strength - You more than likely have heard me preach the importance of total body strength to developing the healthy high velocity pitcher on this site but you don't have to take my word for it. Here is an excerpt from the study called, Current concepts in the evaluation and treatment of the shoulder in overhead throwing athletes, part 2: injury prevention and treatment, which I have referenced several times in this article already:
The lower extremities are vital in the development of force during the throwing motion. Core stabilization drills and lower body training further enhance the transfer of kinetic energy and proximal stability with distal mobility of the upper extremity. Any deficits in strength, endurance, or neuromuscular control of the lower body will have a significant impact on the forces of the upper extremity and the athlete’s ability to produce normal pitching mechanics (2).
- Optimal Hip to Shoulder Separation - You just can't get enough hip to shoulder separation. Poor hip to shoulder separation causes the arm to take less of the load from the lower kinetic chain which means it has to overcompensate to make up for the loss of force production. This overcompensation causes poor mechanics like hyperangulation which can lead to shoulder impingement's.
- No Overuse - At the end of the day most shoulder injury comes from overuse. The joint is breaking down every time the pitcher throws the ball. Especially when he throws it at a high rate of speed. If the pitcher is not resting and rebuilding the joint in a good and long off-season program then overuse becomes a major problem which is usually the dominate force behind a secondary impingement.
- M.A. Urbin, PhD, Glenn S. Fleisig, PhD, Asheber Abebe, PhD, and James R. Andrews, MD. – Associations Between Timing in the Baseball Pitch and Shoulder Kinetics, Elbow Kinetics, and Ball Speed. – Investigation performed at the American Sports Medicine Institute, Birmingham, Alabama. – Am J Sports Med 2013 41: 336
- Reinold MM, Gill TJ, Wilk KE, Andrews JR. - Current concepts in the evaluation and treatment of the shoulder in overhead throwing athletes, part 2: injury prevention and treatment. - Boston Red Sox Baseball Club, Boston, Massachusetts ; Division of Sports Medicine, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts. - Sports Health. 2010 Mar;2(2):101-15.