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Pitcher's Shoulder: Protecting Young Athletes

It doesn't take too many bright, sunny days hinting of Summer to stir thoughts of baseball. But wait! That long baseball layoff over the winter has left many of us ill-prepared to deal with the shock that playing baseball brings to our body especially the trauma caused to young athletes' shoulders during the throwing motion, most stressed when a young person pitches.

After sorting out common shoulder problems, I'd like to focus specifically on how we manage sore pitcher's shoulder. While anybody who throws any type of ball repeatedly may experience soreness in the shoulder, young athletes are particularly vulnerable to injury due to the great demands they place on rapidly developing and growing neuromuscular systems of the shoulder. The resulting damage could curtail and possibly end their playing careers.

The Mechanics of Pitching

To better understand the stress endured by the shoulder during a pitcher's motion, we can segment that fluid kinetic motion into five stages. The pitcher starts with a given stance and proceeds to the cocking phase, in which the trunk swings backward and the shoulder is brought to maximal external rotation (90 degrees), with the elbow flexed at varying degrees. At this point, the anterior (front) shoulder area is under maximal stress.

Cocked and ready, the shoulder muscles contract violently during the next phase: acceleration, when the shoulder moves from extremes of external rotation to internal rotation as the forearm and hand snap forward. While the "lashing forward" is fundamentally the same, several variations can occur at this point:
the straight overhead style, the 'three quarters' position, the sidearm and even the 'submarine' pitch. Regardless of technique, however, that shoulder is feeling the stress as the arm rapidly accelerates.
Next, the pitcher's trunk rotates as the arm is brought across the chest and the ball is released. Different pitches can cause varying degrees and types of shoulder stress. For example, a slider requires that the forearm is violently supinated (or turned outward) as the ball is released. This motion puts extreme torque on the elbow and shoulder, as opposed to a curve ball, in which wrist motion and grip affect the ball's movement

Finally, the pitcher completes the pitch with the follow-through phase. Here, again, the shoulder muscles contract violently to keep the "humeral head" -the round part of the upper arm bone-in its socket.

Any injury that disrupts the total body rhythm-such as tendinitis, muscle strain or rotator cuff weakness-has a negative impact on pitching effectiveness. For this reason, as well as the concern for protecting young athletes, prevention remains the key to success.

Preventing Pitcher's Shoulder Injuries

To understand the mechanics of pitching allows us to better appreciate how the shoulder can get injured. More importantly, it gives us a head start in preventing injuries.

Three key elements lie at the core of preventing 'pitcher's shoulder': rest, proper technique and conditioning. In most leagues, especially in Little Leagues, regulations restrict the number of innings a player may pitch in a week and specify rest periods between outings. These rules are directly linked to patterns of growth and the stress that pitching puts on growing bones. Avoiding overuse injuries is perhaps the greatest preventive measure a young athlete can take. Equally critical is to avoid playing in pain. Simply put, if your shoulder hurts, stop pitching! Rest and apply ice until a thorough evaluation can be undertaken.

Proper techniques should be encouraged to reduce the stress and risk for injury. If the young pitcher is pitching with these proper techniques he or she will be more effective and will be around for the "long haul."

Muscle imbalance in the shoulder is another factor that can shorten a pitching career. Proper conditioning concentrates on the flexibility and balanced strength of more than 20 muscles in the shoulder complex that are essential for a successful pitch.

A comprehensive flexibility program encompasses all major musculo-tendinitis groups, including those of the shoulder, elbow and wrist. A combination of techniques-such as stretching and holding is used to build flexibility and strength.

In the off-season, training with weights can build muscle strength and endurance. During the season, strength training should focus on strength maintenance, which is achieved by lifting sufficient amounts of weight to challenge the shoulder's muscle group through a full range of motion without causing fatigue. Consulting a credentialed sports medicine professional is a good place to start when designing a program that's right for you.

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We serve Lea and Eddy Counties in New Mexico, as well as Yoakum and Gaines Counties in West Texas.