Play Ball: Avoiding Shoulder and Elbow Injuries
Now that spring is finally in the air, it is time to play baseball. When it comes to baseball and other overhead sports, health care professionals like myself typically think about shoulder and elbow injuries and their rehabilitation. With the start of baseball season, a large number of visits to the doctor are for injuries to the shoulder and elbow. Seeing as how the season is still young, the best sort of medicine is preventative medicine, or avoiding injury altogether.
Since the year 2000, baseball injures have risen five to six fold with an overabundance of them coming in the form of shoulder and elbow injuries. The most common injuries associated with overhead throwing sports, particularly baseball, are rotator cuff tears, rotator cuff tendonitis or tendinopathy, rotator cuff impingement, and sprains and strains to the inside of the throwing elbow. In order to understand how these injuries can be avoided, a brief overview of the injuries themselves is helpful.
Rotator Cuff Tear
A rotator cuff tear is a common cause of pain and disability in the adult population. The rotator cuff is a group of four muscles and their tendons. These four muscles (supraspinatus, infraspinatus, subscapularis, and teres minor) originate on the shoulder blade (scapula) and together form a single tendon that covers the upper end of the arm (the head of the humerus). The rotator cuff functions to stabilize the ball of the humerus in the socket as well as lift and rotate the arm and shoulder. Tears to the supraspinatus are the most common, but tears to other parts of the cuff are also possible. When a tear exists, pain is often associated with movement such as lifting, pushing or pulling. Severe tears can lead to the inability to lift the involved arm.
Rotator Cuff Tendonitis
Tendonitis most simply stated is inflammation (‘itis’) of a tendon. When referring to the shoulder, the rotator cuff tendons, primarily the supraspinatus, becomes inflamed. There are several reasons that inflammation can develop such as overuse, muscle imbalance, decreased flexibility, rotator cuff weakness, or poor throwing mechanics.
Rotator Cuff Impingement Syndrome
Rotator cuff impingement is one of the most common forms of shoulder pain in the adult. The acromion is a portion of the shoulder blade that extends over the rotator cuff tendons at the shoulder. Shoulder impingement occurs when the arm is lifted and the cuff tendons become pinched or rub against the underside of the acromion. This pinching action produces pain when the arm is lifted, classically through an arc of movement. This rubbing and pinching of the cuff tendons can lead to inflammation, fraying or tearing of the tendons.
Little Leaguers Elbow
A relatively common elbow injury in the overhead throwing athlete is referred to as “Little Leaguers elbow.” This injury presents as pain on the inside portion of the throwing elbow, immediately adjacent the boney bump. This pain develops from repetitive strain from the throwing motion resulting in degeneration of the tendons and ligaments that attach to the inside of the elbow. The high stresses that these structures absorb can lead to tearing of the ligaments, fraying of the tendons, or even the tendon pulling parts of the bone away. When this happens, it can interfere with normal boney development of the young skeleton and lead to deformity.
The overwhelming belief amongst the medical community is that prevention is key. Dr. James Andrews is the nation’s most trusted shoulder and elbow surgeon at the American Sports Medicine Institute (ASMI) in Birmingham, Alabama. In a recent interview, citing a recently published research study from ASMI, Dr. Andrews stated that the number one risk factor associated with shoulder and elbow injury was fatigue. Their study revealed a 36 times increase in the incidence of shoulder and elbow injuries when an athlete is fatigued. Another significant concern on the part of Dr. Andrews was the severity of injuries at young ages. According to Dr. Andrews, the younger an athlete is that requires surgery, the harder it is to get them back to that sport. He also states that injuries that occur in the earlier developmental stages of life often result in multiple surgeries.
There are numerous factors that lead to FATIGUE of the shoulder and elbow in the overhead throwing athlete.
As mentioned before, preventative medicine is the best medicine, so follow these guidelines in order to prevent a throwing injury. Start by addressing flexibility of the whole body. The throwing motion is a complex aggressive total body motion. Having adequate flexibility helps prevent injuries to the muscles, tendons, and the joints that they cross over. Starting a rotator cuff strengthening and scapular stabilization program is essential. And when available, ask for feedback on the actual throwing motion in attempt to identify biomechanical flaws that may not be causing pain at the time, but may lead to premature breakdown in the future.
By following these guidelines and suggestions, you can practice preventative medicine this baseball season. If you have any further questions, or for a complete assessment of flexibility, strength, and a rotator cuff strengthening program, contact the specialists at COAST Physical Therapy.
Dr. Andrews' recommendations for the prevention of shoulder and elbow injuries for a young baseball player
Little League Baseball Pitch Count Guidelines Pitch count restrictions based upon age:
Pitchers age 7-16 must abide by the following REST requirements:
Pitchers age 17 -18 must abide by the following REST requirements: