By Dr. Robert T. Bents
This article appeared in the Summer 1996 issue of HardBall Magazine
The purpose of this article is to prevent, or at least minimize, the nagging shoulder ache that nearly every ballplayer experiences from time to time. This article will not deal with more drastic injuries such as separations, dislocations, tendon ruptures or nerve damage. Instead, we will focus on a common cause of shoulder pain in baseball players: rotator cuff impingement.
The shoulder is the most mobile joint in the human body. To allow for this mobility, however, the joint is relatively unstable. Some have compared it to a golf ball on a tee. Three layers of ligaments, tendons and muscles function in an intricate balance to keep the joint in place.
The outer layer is the largest—the deltoid and pectoralis muscles. The second layer is the rotator cuff, four smaller muscles that surround the shoulder socket and "fine tune” the major motions caused by the outer layer. The third layer is the head of the upper arm bone (humerus) and its socket (the glenoid) and the ligaments that connect them.
Since the rotators work in a small space between two bones, they may become pinched (impinged) during throwing, causing stiffness, inflammation or pain. Moreover, years of repetitive throwing can cause tiny tears in the rotator cuff muscles or tendons.
Warm-up and Stretch
Proper warm-up, stretching, strengthening and throwing mechanics are essential to the prevention and healing of shoulder injuries. For those who play once or twice a week, warm-up is especially important. A good warm-up (five minutes of jogging following by jumping jacks, horizontal arm circles, etc.) increases the temperature in the joint and lubricates the tissues.
After warming up, stretch before throwing. A stiff shoulder is a painful shoulder! Many players have developed a tight posterior capsule, which can lead to pain in the follow-through. Cross-arm stretching (figure 1) can relieve this tightness. Anterior stretching (figure 2) keeps the front of the shoulder flexible. See online http://youtu.be/Ud0W8KYGIqY
Correct throwing mechanics reduce wear and tear on the shoulder joint. Outfielders should retreat a few extra steps on fly balls, then catch the ball coming forward and use that momentum ("crow-hop”) to assist with the throw. Infielders should avoid using "all arm” by keeping the left shoulder "closed” and flexing the knees, thus allowing the legs and trunk to provide power for the throw.
Pitchers need to concentrate on trunk rotation, follow-through and flexing the front leg to absorb shock, especially in late innings when fatigue sets in.
Rotator cuff conditioning should begin in the off season and continue year-round. Utilizing surgical tubing, bungee cords, pulleys or light weights, a complete program requires about 15 minutes per day. You should perform three or four sets of 15 reps for each of the following exercises.
Figures 3a and 3b (above) demonstrate external rotation exercises, which strengthen the posterior rotator cuff (important in follow-through mechanics). If rubber tubing is not available, you can lie on your side and perform the same exercise with light weights.
Figures 4a and 4b show the starting and ending positions for internal rotation, which builds the anterior cuff. To correctly isolate the rotator cuff, it is important to keep the elbow tight against the body during the entire exercise.
Figures 5a and 5b (above right) demonstrate supraspinatus strengthening. Begin with the hand at the thigh and lift arm until it is parallel to the ground as shown. Keeping the arm straight and the thumb down will isolate the top portion of the cuff. Combine these exercises with a traditional free weight routine for complete upper body conditioning.
Proper warm-up, stretching and throwing mechanics are crucial to maintaining a healthy arm. Rotator cuff strengthening will prevent injury and/or rehabilitate the muscles involved in throwing. If shoulder pain persists despite ice, Tylenol or aspirin and a few days' rest, it's probably best to take 2-4 weeks off to let the shoulder heal. As the pain diminishes, gradually work back into light tossing and the exercises described above. Fifteen minutes per day is a small investment to make to be able to keep playing hardball.
References and Acknowledgements
1. Roy, S & Irvin, R. Sports Medicine: Prevention, Evaluation and Rehabilitation. Prentice-Hall, Inc. 1983. 2. Delee, J.C. & Drez, D.D. Orthopaedic Sports Medicine: Principles and Practice, Volume 1, W.B. Saunders Company, 1994.
About the Author
At the time this article was first published, Dr. Robert T. Bents was a Major in the U.S. Air Force and Chief Resident of Orthopedic Surgery at Wilford Hall Medical Center, Lackland Air Force Base. He played shortstop for the Cardinals in the San Antonio MSBL.
In 2004, Dr Bents returned to his native Oregon and established himself as one of the premier surgeons in Southern Oregon. He is actively involved in research and has numerous publications in prestigious journals. He specializes in arthroscopic and reconstructive procedures, with a focus on shoulder and knee surgery. He has surgical privileges at Rush Medical-Surgical Center, Grants Pass Surgery Center, Three Rivers Community Hospital, and Ashland Community Hospital.