Baseball players and all overhead athletes (softball, swimming, water polo, volleyball, etc.) rely on shoulder mobility and stability. Mobility is defined as the degree to which a joint can move before being restricted by surrounding tissues and stability is defined as the ability to maintain or control joint movement or position through its range of motion. Players who have a deficiency in either of these are at much greater risk of injury as well as a decrease in performance. So how can we improve the mobility and stability of the shoulder before it becomes a problem?
The first thing players and coaches can do is assess the shoulder. Prior to the start of a season or an offseason program it is vital to see where each player is so that coaches are not guessing how much load a player can handle during training or playing. How many times have we seen that pitcher go from throwing 85 mph at the beginning of the season to 79 halfway through? Or the players who complain of arm pain after one week of practice? We can prevent those things from happening as often with a basic assessment that takes just a few minutes. Here is one for shoulder flexion.
1. Shoulder flexion
A decrease in shoulder flexion (lifting the arms in front of you up to your ears) by 5 degrees or more has been found to increase the likelihood of an elbow injury occurring during the season by 2.9 times (https://www.ncbi.nlm.nih.gov/pubmed/28865566). It will also limit the thrower’s ability to reach full cock position and release position. Here’s how to assess it:
Have the player stand and raise both hands overhead. Look for 3 things: the inability to raise both arms to 180 degrees, his/her head to move forward, and/or his/her rib cage to flare up. The left picture illustrates the last two occurring.
If the player has a compensation or restriction the next step is to lay the player down either on the ground or on a table/bench if possible and see if the arms can lay flat behind their head with some assistance.
If the player still is unable to bring the arms to 180 degrees with light assistance by the assessor, the player has a mobility issue. That is, there is restriction in the soft tissue preventing the mobility of the shoulder. If the player had compensation while standing but was able to bring the shoulders all the way down while laying down with assistance then the player has a stability issue. That is, the player is unable to maintain joint movement through its range of motion even though there is no soft tissue restriction.
If the player has a mobility issue there are a few things coaches can have players do during their practice or offseason routine that requires hardly any time. Players can use a lacrosse ball, baseball, or foam roller to work out the pectoral muscles (chest), lats, teres major, and subscapularis muscle. They can also use that same foam roller to lean into thoracic extension (pictured below).
Incorporating those into a pre-practice routine or bullpen routine is quite easy, requires hardly any time, and can have a huge impact on players’ performance and health.
2. Stability Solution
To increase stability through shoulder flexion I will describe three basic exercises that can be used during the season. The first is a serratus anterior wall slide using a foam roller. The serratus anterior is a muscle that runs along the front and side of the ribs before inserting onto the scapula. It is one of the main shoulder stabilizers. To perform, place a foam roller on a flat surface in front of you while standing. Place forearms onto the foam roller and while pushing into the foam roller (imagine trying to push your body away from the wall) roll the foam roller up the wall.
The second exercise is a yoga push up which is just a regular push up with a second part added involving pushing the hips up and shrugging the shoulders at the top to protract the shoulders.
The third exercise involves core strengthening which instead of having the players perform sit-ups or crunches, have them perform front planks and side planks with a neutral spine. This will increase their core control and stability which will then help increase their shoulder stability.
We know through research that every time a player throws and especially after pitching there is a loss of range of motion. If players can incorporate mobility and stability exercises into their offseason and in-season training not only will the likelihood of an overuse injury go down, but performance will also go up. As coaches, it is our responsibility to make sure we do not run our players into the ground by pitching or playing them when they are at an increased risk of injury. Injuries are most commonly seen in early season practices and games so it is vital to assess them early before something happens.
Pain is also an indicator that something is wrong and even though players and coaches want to push through the pain sometimes it is usually a better idea to step away and look at the big picture. If a player is experiencing pain during practice, a game, or even during the previously discussed shoulder flexion assessment that player needs to be seen by a medical professional. Dr. Ryan Hamilton is one option for players and coaches in the Bay Area as he is a soft tissue specialist, chiropractor, and high school baseball coach. Other options include physical therapists, orthopedists (for severe pain), or other chiropractors trained in soft tissue therapies. At Hamilton Chiropractic we can do a very thorough assessment, treat mobility and stability issues, and answer any questions you may have if something just doesn’t look or feel right. Don’t guess, assess!