Arm Care for Baseball
To better understand arm care for baseball players, one really needs to understand the complexity of the shoulder. There are 4 joints (glenohumeral, acromioclavicular, scapulothoracic and sternoclavicular) that assist in the movements of the shoulder and there are 17 muscular attachments alone that connect to the scapula. This combines for a number of nerve, soft tissue, and vascular structures in a small area. The reality is that the shoulder has the most mobility of any joint in the body and also means it’s the most lax joint.
What you will see with most arm care approaches is the excessive fatigue of the rotator cuff and little to no intent of structure/posture. While most athletes are told to do endless internal and external rotation to strengthen the rotator cuff, what they are really doing is placing more fatigue to the dynamic stabilizers which leads to faulty arthrokinematics (we will discuss later in presentation). This is only leading to more instability of the glenohumeral joint and increased anterior and superior glide/migration.
Proximal to Distal (Ball in socket)
When it comes to trauma, most believe that the location of pain or injury is the actual issue. In regards to the shoulder, the location of trauma is the result of poor structure or posture. The ideal shoulder movement in any direction involves a scapulohumeral rhythm and congruency of the ball in socket (humeral head in glenoid fossa). This all starts with a proper structure or stable foundation moving proximal to distal (spinal stability→rib cage control→scapular movement→humeral head placement). You see, structure is what dictates function or dysfunction (structure→function→dysfunction→injury). Efficient overhead movement begins with a stable lumbo-pelvic and spine position. Without this, we have poor rib cage control that leads to inefficient scapular movement and then negative stress inside the glenohumeral joint leading to possible labral tears, rotator cuff fraying and tears, impingement, etc. Too much repetition using compensatory movement will lead to microtrauma and ultimately macrotrauma. An interesting statistic suggests that youth baseball players use their stabilizing muscles (rotator cuff + long head of biceps) 3x more than professional baseball players. Further, professional baseball players use their larger, force producing muscles over 2x more than youth baseball players. This suggests that youth athletes are unfortunately trying to produce force with their stabilizing muscles and further fatiguing them and potentially doing more harm than good.
Rotator Cuff and Arthrokinematics
The dynamic stabilizers of the shoulders are called the rotator cuff muscles (RCM). These muscles are responsible for holding the head of the humerus inside of the glenoid fossa. At any given time, stronger and more forceful muscles (pec major, latissimus dorsi, deltoid, etc) are acting against the RCM and pulling the humeral head in different directions. When the RCM become fatigued, they cannot do their job to the fullest extent which increases the arthrokinematic movement inside the joint. In most cases with baseball, athletes will incur anterior and superior glide of the humeral head and impingement of the posterior rotator cuff during the arm cocking, acceleration and deceleration phases of the throwing/pitching motion. The more the humeral head glides and moves away from the ball in socket congruency, the more instability gained. As was mentioned before, this compensation will potentially lead to micro or even worse, macrotrauma. These specific issues or movement impairments stem from inefficient patterns and control and are not congenital. With an appropriate assessment and training program, athletes can improve their front to back and top to bottom balances to decrease the likelihood for pain or injury.
It is important to understand that all players need an individual assessment. With different heights, arm lengths, resting postures, throwing mechanics, etc., baseball athletes will have items to work on that won’t necessarily be the same as their teammate or anyone else for that matter. If a player presents with depressed shoulders, they will need correctives or preparation exercises that are different than someone who has more elevation in their shoulders. Also, some mechanical issues and inefficient patterns may take longer to correct which is another reason individually assess each athlete while keeping a close eye on their progress.
As was mentioned before, the shoulder is very complex. Without an understanding of how the 4 joints work in and around the shoulder, many athletes tend to impose inefficient postures and positions leading to dysfunction. The SAID principle (Specific Adaptations to Imposed Demand) is a perfect description of why overtime we tend to fall into faulty patterns. Most programs do not have a progressive development of ability before skill and we form the patterns due to what we feel works and is easiest in the moment. This doesn’t necessarily mean that what feels easiest/best is correct. For overhead athletes, it often lends into a specific shoulder syndrome of which we can assess and correct with the right movements and balance. The shoulder syndromes that are commonly seen during assessments include the following:
Scapular downward rotation syndrome
Scapular abduction syndrome
Scapular adduction syndrome
Scapular depression syndrome
Scapular winging + tilting syndrome
Humeral anterior glide syndrome
Humeral superior glide syndrome
Shoulder medial rotation syndrome