Shoulder Health in the Baseball Player: A Never-Ending Career Focus!

Posted 11/2/2016 in Physical Therapy Corner | 683 view(s) | 0 comment(s)

Shoulder Health in the Baseball Player: A Never-Ending Career Focus!

Gina Pongetti Angeletti, MPT, MA, CSCS, c-ART, (Co-owner and Sports Medicine Director- Achieve) pictured left,

and Courtney Odelson Dynes, DPT, c-ART (Sports Rehab Specialist, Certified FMS Provider) pictured right


Fall baseball was quite the treat this year for the MLB, especially exciting for Chicago, who had not been to the World Series in decades. As we hear of so many athletes on injured reserve, the push for these young players becomes a concern. Little League play and travel leagues are becoming the norm now and replacing good Old Park district low-stress baseball.  Private pitching and hitting coaches are seemingly standard even as early as grade school, when this was a focus in collegiate and pro athletes.  So, is this push a good thing or a bad thing?

Regardless of the opinion on intensity, health is the main focus, and center of the debate, on either side. For those who think too early is too much, it is because they often do not want to “wear” the kids out, repetition wise, as well as time. However, the focus on playing more and private instruction is also, ironically, a concentration on health, and tends to make the most developmental sense.

In a sport that requires exact angles for efficiency, and minute levels of change that make the difference between pitch types, repeatability and perfection are key. Sure, you could say that about any sport, such as gymnastics due to precision demand, or sprinting in swimming due to often milliseconds that separate winners from the rest of the field. However, the stress on the shoulder and elbow in baseball is second to none. Pitchers try to increased speeds, and have to focus on quality over quantity, to not overwork developing tendons and ligaments. Catchers have to throw an entire game, not only a toss to the mound but also to the bases.  

Injuries in the sport of baseball, whether old or young, happen most of the time because of the high repetitions demanded, with very few variations in motion. There is hitting, throwing hard, and tossing.  The shoulder and elbow are under a great amount of stress, especially in the developing adolescent, when ligaments often work harder than not-yet-developed muscles to stabilize joints.

Many injuries can be prevented, or risk can be lowered, by focusing on impeccable biomechanics, and overall body strengthening.  People often think of swinging a bat as a motion done by the arms. Quite the contrary, the abs work to stabilize and rotate the torso. The gluteals work to start body rotation. The intercostals, which are the muscles between the ribs, help to rotate and allow end range follow through, and more. Similarly, pitching is not just an arm motion. The arm is responsible for accuracy, intended ball location and spin, as well and path. The rest of the body, however, is responsible for strength and power. The back leg propels forward. The front leg catches body weight in motion. The abs and spine work together to provide rotational force to the upper body ending, of course, in the transfer of this energy to the elbow and wrist. The gluteals are so important in stability and rotation of the hip, especially the back leg. In addition, there are so many more intricate muscles involved in the process. Their order of firing, and timing, becomes second nature from childhood to maturity. Of course, this order can be “memorized” by the body properly, leading to success and the mere need to fine tune as the body grows, or it can be done improperly, therefore having to be “undone” and retrained.

Often, the retraining is done after pain starts, and an injury is diagnosed. Unfortunately, this means that the mechanics were off, and the injury was occurring well before the body finally “sensed” the pain, and secondarily had strength issues, or compensations in motion.

Although shoulder-based strengthening and “pre-hab” for prevention is important for the life of a player, the main goal for the developing adolescent is to work from the belly button out for strength, stability, and teach the bigger muscles in the body, which are intended to carry more load and supply more power, to work. Often, shoulder, elbow, and wrist injuries happen because they are simply carrying too much of the stress.

So, what can be done? Here are some pearls of medical wisdom for developing players!

10. Abs, Abs, Abs. A focus on teaching young players a) where their abs are, b) how to engage them, and c) how to strengthen them is one of the best things a coach (or fit parent) can do for their child’s health.  Exercises such as Pilates-based isometric holds, to v-ups for power can be introduced at any age, even starting in grade school.  Important in the mechanics of hitting and throwing is the importance of rotation. Teaching the abs how to rotate while protecting the spine is important. In parallel focus should be the range of motion of the spine, to make sure that the abs are trained to activate from end range all the way to follow through.

9.  Use your booty. As one of the largest sets of muscles in the body, your gluteals work to transfer power from your feet (cleats in the ground) to your torso when hitting. They help to propel you forward and push you into your pitch. They are necessary for sprinting, especially the first few steps of building speed.

8. A good balance of front to back. Many young athletes work on their quads (front of the thigh) and not as much on their hamstrings (back of the legs). Often what sets apart speedy sprinter (whether hitting to first, or stealing bases), is the use and engagement of hamstrings. They help to extend the hip, proving a more powerful and effective stride. They are also used to stand back up again when fielding a ground ball. They are under a great amount of stress in both the back leg of pitching as well as one of the main muscles used to slow down in follow through on the landing leg.

7. Posture. Not only are parents after their kids to stand up straight, but coaches should be, too. The muscles in the spine and between the shoulder blades that pull someone out of that forward-hunched position are the rhomboids, lower trap, mid trap, to name a few. These are important to strengthen to stand up straight, but also to help control and stabilize the shoulder blade, which is the root of many shoulder and cuff muscles. Most importantly, proper posture can help to prevent shoulder impingement, which is simply when mechanics aren’t right, tendons and other tissues run out of room to move! 

Rounded-forward shoulders are often the result of tight pecs, which are developed in part from bench press, push ups, and the simple act of throwing repeatedly. Pecs pull the upper arms forward, and are often a result of school-based study position, as well as the increase in the use electronic devices. Related to baseball, it can impact the need to achieve adequate “cock-up” phase especially for pitchers.

6.  Ribs.  People find it really hard to learn how to use their ribs. They are like bucket handles, in that they can tip forward (bringing the front ones closer together), tip backwards (opening the front, and approximating the back), and they can tip side to side, opening like fans. The muscles between the ribs can be used to stabilize the spine, providing a greater transfer of force from the abs and spine muscles. They can be used to provide rotation. They can assist the abs in throwing, transferring force from the core to the hand through coming closer together. And…so much more!

5. Basic, simple, rotator cuff programming. Everyone has seen someone performing these exercises.  Standing with your arm by your side, holding on to a stretchy band, pulling in and out in good posture. It is a mainstay in upper body sports, especially baseball, gymnastics, swimming, tennis and golf. Simple maintenance reminds the small muscles how to work in focused motions.  The shoulder rotation muscles are as important in concentric work (shortening of muscles, activation) as well as the deceleration phase (often the weakest part of a pitcher’s phase) after ball release. The more the abs and spine work to support the shoulder, the less the shoulder has to whip forward, and the more controlled the motion of the elbow can be.

4.  Stretching! Flexibility is imperative to baseball, which often involves end-range motions such as hip extension with the follow through of throwing, rotation with hitting, and shoulder rotation in pitching, as a few examples.  In addition, fielding requires hamstring and groin flexibility for squatting for balls, side stepping and reaching for the base, and stretching to tag a runner out. Although the sport itself does not demand a player to be able to do the splits, having flexibility in the hamstrings and inner thigh/groin sure can prevent months off from muscle tears and more.

3.  Calves. The muscles in your calves support and control your ankle. They are used all day, every day, from standing, to walking, to squatting in ready position, running and hitting. Let’s break down their job! The calf muscle runs essentially from the heel to the back of the knee. In order to help a joint it has to cross the joint, so the muscles can also help with knee flexion and knee stability as well. The complex helps to point the foot down, which is imperative in starting sprinting. The calf houses the ankle stabilizers that control inversion and eversion (think ankle sprains), so it is used in every side to side weight shift. Each time a player squats, the calf is used to control the shin (eccentrically, or in lengthening). Pitchers use (for example, a righty), the right calf for balance in wind up phase, in stride to push the body forward in motion, in left foot contact to control motion, in the arm acceleration phase to stabilize the left leg and allow the right arm to transfer velocity from the leg, to the spine and abs, arm, and eventually the ball, and finally the follow through to decelerate motion.  Lots of work!

2.  What’s your vert? Yes, vertical jump height has a direct correlation to sprint speed and more so, to the rate of initial acceleration (*).  Athletes who are involved in basketball, soccer, football, skating, and gymnastics often focus on jump height testing. However, it is equally as important for sports that require on-demand acceleration to test and work on jump height and explosive leg power. The relationship between jump and sprint has to do with making the most of each step, or stride, in both distance and velocity increase. The 60 yard dash is mainstay in the evaluation of potential athletes by scouts. Times vary, but on average, scouts looks for under 6.9 seconds to be considered, and the best hit sub 6.6 sec.  After hitting the ball, getting to first base is the goal- as fast as you can. This demands reaction speed from hip and abdominals to reposition the body, start to accelerate. Acceleration is based on leg push off (combine calves for the ankles, quads to straighten the knees, hamstrings for hip extension and knee flexion for turnover, gluteals to dig and plant and push to extend the hips, spine to keep you positioned leaning forward and not fall forward, core to stabilize the hips for any unnecessary motion, arms to swing and counter leg motion, and more!). Whew! Sprint acceleration is essentially a combination of single leg jump height and the ability to lean forward and transfer that vertical energy to velocity. Getting to first base in the very low 4-second range is the goal. Billy Hamilton (Reds), for example, is a lefty hitter (making him one step closer to the base, by the way). He takes, left foot lead to left foot bag step, 15 steps on average. He pushes off of his right leg (lead hitting leg), important in the initial positioning, and “take-off” to plant the left leg, to start the show.  He makes it in 3.9 and change…. Wow!

1.  Conceptually….quantity and quality BOTH matter! You always want to practice with the highest amount of quality to perfect motion. Within each rep, you want to be as closer to perfect as possible. However, because of the length of the season and often the demand on long games, quantity is needed to crease muscular endurance in addition to the above strengthening.  Remember, you play how you practice. Form follows function…. And if you teach your body wrong, and allow it to make mistakes, it will think that pattern is the norm!

The start of a great career, whether adolescent, developmental, collegiate or on to the professional level, begins with a full-body analysis, and ongoing reassessments, of biomechanics, strength, flexibility, joint health, balance, stability, power and more. Achieve Sports Medicine is proud to be the Medical Coordinator and on-site provider for Diamond Edge Baseball Academy and Diamond Edge Sports Performance.  The facility is an all-encompassing training academy with cages, coaches, team workouts, speed and strength programming, specific position coaching and analysis (pitching, hitting, etc.), athletic recovery (compression, cryotherapy, modalities and more), vision and neuro-training, and on-site physical therapy and chiropractic care.  Body analysis is offered in multiple levels- short summary, joint/injury specific, and full-body baseline and progression. Contact Diamond Edge at (630) 601-7171, or visit www.achieveorthosports.com for more information or to schedule! 

* Shalfawi, et. Al.  The relationship between running speed and measures of vertical jump in professional basketball players: a field-test approach. J Strength Cond Res. 2011 Nov; 25(11):3088-92.

** Wisloff, et al. Strong correlation of maximal squat strength with sprint performance and vertical jump height in elite soccer players.  Br J Sports Med 2004; 38:285-288. 

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