By Dr. Rick Morris
As Printed By The National Pitching Association
It’s three weeks before playoffs, your number one starter has control problems, and his shoulder is the cause. Yes, he’s seeing the trainer and the team doctor, but you know how that goes, it may be too little too late. Could you have seen it coming and done something sooner…before it risked post season play?
The answer is often Yes! But, first you have to understand a few things about the shoulder. They’re really pretty simple. Here they are:
- The shoulder is a very loosely held ball and socket joint. Primarily, it’s the muscles that keep it in place. It’s purposely designed this way to allow better movement. In fact, it has better motion that any other joint in the body, but instability is the cost. Why do you think we throw using our shoulder (try using your leg and see what happens)?
- Since we usually throw in front of us, the muscles in the front of our shoulder develop far stronger than those behind our shoulder. Also, because the throwing motion involves a more forceful internal rotation than external rotation, the muscles that internally rotate the arm over power those that externally rotate it.
- What do you think happens to the alignment of the humerus (arm bone) when the muscles in front of the shoulder pull harder than those in back? That’s right, it slides improperly forward (anterior) and traps the rotator cuff tendons between it and a tough, fibrous band of ligaments called the coracoacromial ligament.
You’ve heard it called, “Pitcher’s Shoulder, Rotator Cuff Syndrome or an Impingement Syndrome.” Of course these names make sense but I prefer the term, “Anterior Humerus Syndrome” because it describes the cause of the problem and not just the resulting tissues that are injured. This leads to a more proactive treatment and even the prevention of damage to the rotator cuff.
How Can I Tell If My Athlete Has an Anterior Humerus Syndrome?
It’s simple. In fact, with very little practice you’ll rarely miss it. Just have your athlete lie on his back with his hands (palms up) under his buttocks (Fig 1). Instruct him to let his shoulders fall back comfortably. While he’s in this position, put both of your hands on the front of his shoulders and see if one side is more prominent, rigid (not able to glide backwards) and tender than the other side. Often you’ll see the misalignment without ever having to feel it. As the syndrome becomes more advanced, the athlete may have difficulty even putting his arm in this position.
Now That We Found It, How Do We Treat It?
Of course the basics still apply. If it hurts to throw, don’t throw. Upon returning, the quantity and quality of the throw is increased gradually and proportional to his stage of healing and level of pain. Most importantly, his mechanics need to be corrected so that his body propels the ball more than his shoulder.
Treating an “Anterior Humerus Syndrome” requires lengthening the anterior shoulder muscles and internal rotators, strengthening the back of the shoulder and external rotators and repositioning the humerus back to its proper position. At the same time, the damaged and partially torn rotator cuff muscles must heal and rehabilitate. If the shoulder is not properly repositioned, the cartilage and the bone itself will become damaged leading to surgery and often shortening a career. The point is to correct the alignment, before this happens.
If the cartilage or rotator cuff is severely torn and surgery is necessary, the athlete must still have his humerus alignment evaluated and treated. Do not assume that the surgeon or the trainer will do this. An MRI or X-rays are not currently designed to check subtle alignment changes. Check it yourself!
Finally, The Treatment, Here It Is?
- Use physical therapy (ultrasound, electric stimulation…) to the front and top of the shoulder and pectoral muscles to increase the circulation to the injury and break up adhesions.
- The athlete should stretch their shoulder completely to the side (away from their body) while the trainer massages and lengthens the muscles in front of the shoulder (i.e. pectoralis major and minor and anterior deltoid). The athlete should stretch these muscles on his own, easily, a few times everyday (Fig. 3).
- Gently massage the injured rotator cuff and bicipital tendon at the impingement area to break up adhesions and stimulate healing (Fig.3).
- Perform exercises to strengthen the external rotators of the shoulder, scapula retractors (i.e. teres minor, infraspinatus and rhomboids) and shoulder stabilizers to correct the muscle imbalance (Fig. 4-7).
- If the strengthening and stretching do not do the trick, the adjustment of the shoulder alignment should be performed only by a doctor who has a lot of experience reducing these displacements. This will usually be a chiropractor who specializes in throwing injuries.
- Avoid exercises like push-ups and bench presses that shorten the anterior shoulder and chest until a proper balance is attained.
Checking your athlete’s shoulder alignment throughout the season not only prevents injuries but gives you a “heads up” on bad throwing mechanics and muscular imbalances. The strengthening and stretching program should be incorporated throughout the year and not just during times of injury.
In serious conditions and following surgery, the alignment should be checked and treated by a doctor trained in evaluating humeral alignment.