Baseball Injury Prevention: Is In-season Shoulder and Elbow Exercise Important to Prevent Arm Injury in Overhead Throwing Athletes?

By Dr. John Mishock, PT, DPT, DC 

 

Overhead athletes, such as baseball and softball players, place significant demands on their shoulders and elbows, making them susceptible to injuries. Understanding the biomechanics and implementing preventive strategies are crucial for maintaining optimal performance and reducing injury risk.

In-Season Changes in Shoulder Strength and Range of Motion

Throughout a baseball season, athletes often experience measurable changes in shoulder strength and range of motion due to the repetitive stress of throwing:

• – Range of Motion: Studies have shown that pitchers may experience a loss of internal rotation in the throwing shoulder, a condition known as Glenohumeral Internal Rotation Deficit (GIRD). This loss can be significant and is associated with an increased risk of shoulder injuries.
• – Strength: Research indicates that pitchers can experience a decrease in shoulder strength throughout a season. For example, a study on collegiate baseball pitchers found an average loss of 4.22% periscapular muscle strength during the first half of the season.

The Demands of Overhead Throwing

Throwing a baseball is one of the most dynamic and strenuous movements in sports. During the pitching motion, the shoulder’s internal rotation can reach speeds of approximately 7,000 degrees per second, akin to completing nearly 20 full rotations every second. This immense speed places considerable stress on the shoulder joint and surrounding musculature.

Simultaneously, the elbow endures significant valgus stress in the late cocking phase of throwing, with torque values reaching up to 60 Newton meters, equivalent to about 44-foot pounds of force. This stress level is comparable to holding a 44-pound weight at the end of a one-foot-long lever, emphasizing the importance of proper mechanics and conditioning to withstand such forces.

The Vulnerable Shoulder and Elbow

The shoulder and elbow’s extensive range of motion enables powerful overhead movements but also renders it less stable. Repetitive throwing can lead to:

• – Rotator cuff muscle or forearm flexor-pronator muscle injuries: Overuse can cause tendinopathy or tears.
• – Labral tears: Excessive stress may damage the cartilage rim of the shoulder socket.
• – Impingement syndromes: Inflammation from repetitive motion can narrow the space within the shoulder joint.
• – Scapular dyskinesis: Abnormal movement of the shoulder blade affects shoulder mechanics.
• – Glenohumeral Internal Rotation Deficit (GIRD): Loss of internal rotation increases injury risk.
• – Ulnar collateral ligament (UCL) sprain or tear.

Importance of Strength, Flexibility, and Mobility

Maintaining shoulder and elbow strength, flexibility, and mobility is vital for overhead athletes. A balanced shoulder musculature ensures joint stability, while adequate flexibility and mobility allow for proper mechanics during throwing. These factors collectively reduce undue stress on both the shoulder and elbow joints. Beyond this, the core and lower extremity musculature are key to developing strength and power to reduce shoulder strain.

Recognizing and Addressing Fatigue

Fatigue is a critical factor in the risk of shoulder and elbow injuries among pitchers. A study by Olsen et al. (2006) found that adolescent pitchers who regularly pitched with arm fatigue were 36 times more likely to require elbow or shoulder surgery than those who did not pitch while fatigued. Fatigue can lead to altered mechanics, decreased performance, and increased stress on the arm’s structures.

It’s essential for athletes, coaches, and parents to recognize signs of fatigue, such as:

• – Decreased velocity or control
• – Changes in pitching mechanics
• – Complaints of arm discomfort or soreness
• – General signs of tiredness or reduced performance

Implementing rest periods and monitoring pitch counts can help mitigate the risks associated with fatigue.

The Critical Role of Rest and Recovery

Beyond physical conditioning, adequate rest and recovery are paramount in preventing overuse injuries. Overexertion without sufficient rest can lead to fatigue, compromising mechanics, and increasing injury risk.

Pitch Count Guidelines: Adhering to age-appropriate pitch count limits is essential. For instance, the Pitch Smart guidelines recommend:

• – Ages 9-10: Maximum of 75 pitches per day
• – Ages 11-12: Maximum of 85 pitches per day
• – Ages 13-14: Maximum of 95 pitches per day
• – Ages 15-16: Maximum of 95 pitches per day
• – Ages 17-18: Maximum of 105 pitches per day
• – Ages 19-22: Maximum of 120 pitches per day

Mandatory Rest Periods: Depending on the number of pitches thrown, pitchers should observe rest periods ranging from 0 to 5 days to allow for adequate recovery. For example, a 15-16-year-old pitcher who throws 61-75 pitches daily should rest for 3 days before pitching again.

Keep in mind the above pitch counts are a guide that should be altered based on signs of fatigue during throwing.

Avoiding Overlapping Seasons: Participating in multiple teams with overlapping seasons can lead to excessive throwing without sufficient rest, increasing injury risk.

Offseason Rest: It’s recommended that athletes take at least 2-3 consecutive months off from overhead throwing each year to allow the body to recover fully.

These changes underscore the importance of regular monitoring and targeted interventions to maintain shoulder health throughout the season.

The Mishock Physical Therapy Approach

At Mishock Physical Therapy, we emphasize a comprehensive approach to injury prevention and rehabilitation for overhead athletes. Our programs focus on:

• – Strengthening the rotator cuff and scapular stabilizers to enhance joint stability.
• – Improving flexibility to address muscle tightness and joint restrictions.
• – Enhancing mobility to ensure proper movement patterns and mechanics.
• – Educating athletes on the importance of rest, recovery, and adherence to pitch count guidelines.
• – Monitoring for signs of fatigue to prevent overuse injuries.
• – Assessing and addressing in-season changes in shoulder strength and range of motion to maintain optimal performance.

By tailoring our interventions to each athlete’s specific needs, we aim to optimize performance and minimize injury.

Mishock Physical Therapy can help!

If pain or limited function limits you from doing the activities you enjoy, call Mishock Physical Therapy for a Free Phone Consultation (610)327-2600.  Email your questions to mishockpt@comcast.net. Visit our website to learn more about our treatment philosophy, our physical therapy staff, and our 5 convenient locations in Gilbertsville, Skippack, Phoenixville, Boyertown & Limerick.

Schedule your visit by calling 610-327-2600 or visiting this link.

Gilbertsville – Skippack – Phoenixville – Boyertown –  Limerick

Visit our website to read informative articles, meet our physical therapy staff, and learn about our treatment philosophy. Email your questions to mishockpt@comcast.net

Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania. He has authored two books; “Fundamental Training Principles: Essential Knowledge for Building the Elite Athlete”, and “The Rubber Arm; Using Science to Increase Pitch Control, Improve Velocity, and Prevent Elbow and Shoulder Injury” both can be bought on Amazon and train2playsports.com.