Share   Subscribe to RSS feed

Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Tag: pitching injuries

Shoulder impingement is a common problem for many clients. Specifically, some clients will suffer from internal impingement as a result of a significant loss of internal rotation range of motion, also known as GIRD (glenohumeral internal rotation deficit). This has been widely researched in baseball players, and it is a common issue for overhead athletes. Of note, it can also impact those doing repetitive overhead lifts.

It is common to see asymmetry in internal range of motion for the dominant and non-dominant arms. For those clients who have a total shoulder motion asymmetry greater than 5 degrees, it becomes more important to resolve internal range of motion deficits based on the current literature. In my previous post, I revealed how to improve soft tissue mobility. In this post, I will review the sleeper stretch and cross body stretch to improve posterior shoulder mobility while increasing internal rotation.

The video below from my column ‘Functionally Fit’ for PFP Magazine will demonstrate how to do these stretches.

This is a follow-up to my previous post with respect to scapular strengthening for optimal shoulder function. Serratus anterior weakness is a common issue with overhead athletes, especially throwers. It may present clinically as scapular winging, however, it often fatigues quickly with repetitive throwing and contributes to scapular dyskinesia and shoulder dysfunction. Since throwing is an asymmetrical activity, I like to include some unstable and progressive strengthening exercises for the dominant arm.

In the video below (as part of my ‘Functionally Fit’ column for PFP Magazine) I will demonstrate how to use a bottom up kettle bell approach to strengthen the serratus anterior muscle.

To see the full article with progressions and regressions check out the link below:

http://fit-pro.com/article-4136-Unilateral-bottom-up-serratus-punch.html

I work with a lot of baseball players in my clinic.  In many cases, I see similar issues and recurring problems in them, especially pitchers.  Some of these issues include:

  • Scapular dyskinesia
  • Limited thoracic spine mobility (extension and/or rotation)
  • Soft tissue tightness (lats, post shoulder, pec major/minor)
  • Poor muscular strength/endurance in the rotator cuff and scapular stabilizers
  • Glenohumeral internal rotation deficit (GIRD)

I integrate routine mobility exercises for my throwers, as well as other overhead athletes (tennis, swimming, volleyball, etc) to better prepare them for training and their sport, as well as prevent poor mechanics and compensatory motion that may lead to aberrant stress on the rotator cuff and labrum.

The following video reveals five of my preferred exercises using a foam roller to improve thoracic spine mobility, decrease latissimus tightness, and stretch the pec major/minor while facilitating lower trapezius activation.

In order you will see:

  1. Lat rolling
  2. T-spine extension in supine
  3. T-spine extension coupled with lat stretch
  4. T-spine rotation
  5. Retraction and downward rotation

I advise performing 5-10 repetitions of each prior to training and sport. These will help improve performance, optimize overhead mechanics and reduce injury risk associated with overhead sports.

Baseball pitchers who fail nonoperative care for SLAP injuries will undergo a repair if they wish to continue throwing. The injury may occur at ball release as the biceps contracts to resist glenohumeral joint distraction and decelerate elbow extension. The other thought is that injury occurs in late cocking as the result of a “peel back” mechanism when the abducted shoulder externally rotates. Previous research by Shepard et al. published in American Journal of Sports Medicine (AJSM) measured in vitro strength of the biceps-labral complex during the peel back and distal force and concluded that repetitive force in both scenarios likely causes SLAP lesions.

baseball_pitching_motion_2004

Baseball pitching motion 2004“. Licensed under CC BY-SA 3.0 via Wikimedia Commons.

One of the concerns for pitchers after surgery is regaining full shoulder external rotation and horizontal abduction. If too much tension is placed on the glenohumeral ligaments during surgery, regaining motion can be tough. Ironically, external rotation is limited in the early phase of rehab to protect the labral repair which may impair throwing mechanics later on. Appropriate rehab and progression is paramount for long term success.

Laughlin et al. at the ASMI sought out to explore in a labaratory if there are differences in pitchers who underwent a SLAP repair compared to those in age controlled groups without injury.  In a paper published in the Dec. 2014 AJSM, the researchers hypothesized that the SLAP group would exhibit compromised shoulder range of motion and internal range of motion torque during pitching. Of 634 pitchers (collegiate and professional) tested at ASMI from 2000 – 2014, 13 in this group were included in the SLAP group as they had undergone a SLAP repair at least 1 year before their biomechanical testing.


Continue reading…

I see plenty of pitchers in my clinic ranging from 12 y/o travel baseball players to MLB guys. My own son is a left handed pitcher so I am always carefully watching his mechanics, pitch count and arm care. There has been much written about glenohumeral internal rotation deficit (GIRD) and total shoulder motion over the years.

total-shoulder-rom

Today, I wanted to recap a nice article that was recently published in the American Journal of Sports Medicine by Wilk et al. looking at deficits in glenohumeral passive range of motion (PROM) and the increase in elbow injury risk.

This prospective study was done over an 8 year period from 2005-2102 and looked at PROM of both throwing and nonthrowing shoulders of all major and minor league pitchers within a single baseball organization. The measurements were taken with a bubble goniometer during spring training. See images below from the journal article for how measurements were taken:

wilk-total-motion-measurement

In sum, 505 exams were performed on 296 pitchers. Motion was assessed in supine with the arm abducted to 90 degrees and the arm in the plane of the scapula.  One examiner stabilized the scapula, while another measured total rotation and passive flexion. Elbow injuries and days missed because of injuries were assessed and recorded by medical staff. Throwing and nonthrowing measurements were compared, while additional testing was done to find significant associations between shoulder motion and elbow injury, as well as odds of an elbow injury.


Continue reading…