With baseball season in full swing, pitchers across Central New York are putting great demands on their shoulders. High-speed throwing represents the pinnacle of function for the human shoulder, balancing mobility, strength and stability. Unfortunately, this balance is easily disrupted; in fact, shoulder pain is the most common complaint in the throwing athlete.
For athletes, throwing creates repetitive stresses that can result in changes in both the soft tissues and bone. Most critical are the changes that allow greater external (backward) rotation of the arm during windup – particularly, a gradual stretching of shoulder ligaments in the front of the shoulder – and a loss of internal (forward) rotation. These changes initially improve performance, but ultimately can result in abnormalities that disrupt the shoulder’s perfect balance. These abnormalities may include instability (excessive “looseness” of the shoulder joint), rotator cuff injuries, and labrum (cartilage) tears inside the shoulder. These injuries all may result in pain, decreased control and velocity, and impaired performance. Because of this, the diagnosis and treatment of throwing injuries can be quite challenging.
Although most injuries respond to a good rehabilitation program, the most effective treatment for throwing injuries is PREVENTION. Every competitive thrower, from the little leagues to the major leagues, should maintain a regular, structured regimen of stretching and strengthening. Adequate rest days should be provided between throwing sessions. For younger pitchers, specific recommendations for pitch count and pitch type exist. These include age-based limits on the number of throws per game and per week, and should be closely followed for all adolescent pitchers. It is also thought that certain pitches (especially curveballs and sliders) may increase the risk of shoulder injury in children and teenagers who have not yet finished growing. Specific pitch and pitch count recommendations are available through various online sources – including the American Orthopaedic Society for Sports Medicine and the American Sports Medicine Institute.
Similarly, once a problem occurs, appropriate rehabilitation and physical therapy are usually the solution. These programs focus on reducing pain, restoring and maintaining range of motion and concentrating on strengthening, with particular emphasis on the rotator cuff and the muscles around the shoulder blade. One well-established, proven program is called the “Thrower’s 10 Program,” and is also widely available online.
Surgery is rarely a quick fix, as the recovery process is typically quite long regardless of the specific surgical procedure. Because of this, surgery is generally the last treatment option, and is reserved for those who fail to improve after an extended course of rehabilitation, or those with clear structural abnormalities, such as a cartilage or rotator cuff tear. After surgery, a rigorous course of physical therapy is needed, followed by a very gradual return to throwing with strict adherence to proper throwing mechanics. In many instances, it can take 9-12 months to return to competitive throwing. Unfortunately, many studies show that after shoulder surgery, less than 50% of players ultimately return to their pre-injury level of performance. This is one more reason prevention is so important!
Dr. Battaglia is an orthopedic surgeon specializing in sports medicine and arthroscopic surgery of the shoulder and knee. He is in practice with Syracuse Orthopedic Specialists, PC. For further information, Dr. Battaglia may be reached at 315.251.2100 or at www.ToddBattagliaMD.com.