15 Aug Shoulder Health for the Overhead Throwing and Striking Athlete
The glenohumeral joint receives a great deal of attention in professional baseball, and rightfully so. The pitcher and position player repetitively perform an overhead throwing motion during the course of a game. This repetitive movement is a total body action requiring optimal mobility and stability within the structures associated with the glenohumeral joint.
Addressing the shoulder goes beyond the baseball athlete and comprises the tennis player, golfer, lacrosse athlete, quarterback in American football, ice hockey player, and basically any throwing or striking athlete. What we must recognize with these athletic populations is as follows The athletic actions performed by these individuals are repetitive in nature. Think for a moment the number of pitches a starting pitcher at the Major League Level executes during the course of a start, a seven day period, or entire season. The same could be said of the number of tennis serves performed by a USTA athlete, or the number swings by a PGA Tour professional. The number of repetitive athletic actions are excessive and result in what is termed “repetitive movement trauma”.
Repetitive movement trauma is the stress placed upon the kinetic chain due to an athletic action executed over an extended period of time. Let us use a starting pitcher as the example to explain Repetitive Movement Trauma. A starting pitcher at the MLB level will pitch competitively every fifth day during the course of the season. An average pitch count for a pitcher will be in the 85-110 pitches during a game. In addition to this number a warm up session prior to the start of the game is performed. This warm up session could include anywhere from 20-40 pitches in the bullpen. If we add these two number together a pitcher will throw approximately 120 pitches per game.
In addition between every start, the pitcher will perform a bull pen session. This bull pen session will encompass anywhere form 20-30 pitches off the mound. If we take these numbers, a pitcher over the course of 7 days will throw approximately 160 pitches (140 pitches game day + bull pen). Extrapolate this number out over the course of an entire season and numbers get big. The starting pitcher is only one example as the professional tennis player, golfer, or quarterback will perform similar workloads of a repetitive movement over the course of a season.
What we must recognize is these repetitive athletic actions utilize the same kinetic chain structures over and over again to execute the athletic actions associated with the sport. These repetitive movements over time result in fatigue on the body. And over time if the body is not properly equipped to handle these workloads fatigue and injury will most likely to occur.
In order to counteract repetitive movement trauma in these athletic populations a number of areas must be addressed. First and foremost the efficiency by which the athlete executes the athletic actions is imperative. The more efficient the throwing or striking motion is by the athlete, the less stress placed upon the kinetic chain each and every pitch, swing, or serve. Developing efficient movement patterns of the athletic actions is imperative to reduce the loads upon the kinetic chain.
Secondly, in order to support efficient athletic actions, the kinetic chain must support the movement patterns. Movement pattern support is achieved via the development of the proper soft tissue extensibility, joint mobility, and stabilization capacities within the kinetic chain. This provides the athlete with the opportunity to perform an efficient athletic action.
Finally, outside of the appropriate structural components of extensibility, mobility, and stability the kinetic chain must have the required levels of muscular endurance, strength, and power production to execute these actions appropriately over an extended period of time. If the athlete does not develop these components, the ability to execute a repetitive movement over an extended period of time will most likely be impeded due to fatigue occurring.
Noting these required components for the athlete to successfully execute a repetitive athletic action we can turn our attention to the maintenance of the shoulder for health and durability for the overhead throwing or striking athlete. Recognize the structures encompassing the shoulder complex are used extensively and repetitively in the throwing and striking motion. Typically, an “arm health” or “shoulder program” will typically focus on the rotator cuff. The rotator cuff consists of 4 muscles (subscapularis, supraspinatus, infraspinatus, teres minor) stabilizing the humerus in the glenoid fossa and additionally are responsible for a varying number of movement patterns associated with the arm in the throwing and striking motion.
The development of endurance and strength within the rotator cuff muscles is very important in shoulder health, though it is only one component of a comprehensive program. Recognize in addition to muscular strength and endurance of the rotator cuff musculatue, the glenohumeral joint which the rotator cuff is associated with is classified as a ball and socket joint. A ball and socket joint has a large intended range of motion and in order to execute overhead throwing motions and striking actions, this intended range of motion must be maintained in order to efficiently execute throwing and striking motions.
Outside of developing the endurance and strength capacities of the rotator cuff, shoulder health must address maintenance of the range of motion components of the glenohumeral joint. This component of the program is achieved through the implementation of soft tissue extensibility and joint mobility modalities.
Extrapolating beyond the glenohumeral joint and rotator cuff, shoulder health is contingent upon additional upper body structures. A very important component of of upper body transverse orientated movement patterns is the thoracic spine. The thoracic spine a segment of the spine of the upper and mid back located between the shoulder blades. These vertebrae (T1 – T 12) have the capacity to rotate in the transverse plane. This component is important for the throwing and striking athlete as these motions incorporate transverse plane movement patterns during execution. If the thoracic spine is limited the ability to efficiently rotate in the transverse plane will be impeded. These limitations will reduce the efficiency of these motions and subsequently place undo stress on other segments of the kinetic chain thus increasing the potential for injury.
As a result, shoulder health will necessitate expanding beyond the glenohumeral joint and implementing modalities to address and maintain thoracic spine mobility. The final component of a comprehensive program of shoulder health incorporates the scapular region of the posterior chain. The scapula (shoulder blades) are located on the posterior chain and connects the humerus with the clavicle. The scapula form the posterior portion of the shoulder girdle and essentially have a gliding pattern of movement to allow for proper functioning of the humerus during elevation, depression, abduction, adduction, lateral, and medial rotation.
Improper gliding of the scapula during throwing or striking motions can result in impingement and points to importance of addressing the scapula and the 15 muscles which attach to it within a comprehensive shoulder program. This type of programming will address extensibility of these tissues in addition to maintaining motor patterns, endurance, and the strength capacities required for repetitive movement patterns.
In summary, maintaining optimal shoulder health and wellness for the overhead throwing and striking athlete goes well beyond the shoulder joint. A comprehensive program will address the rotator cuff, glenohumeral joint, thoracic spine, and scapular regions of the kinetic chain. The modalities incorporated in such a program will utilize a combination of soft tissue extensibility, joint mobility, motor patterning, strength, and endurance exercises. All of which combined will assist in providing a solid base by which the kinetic chain can execute a repetitive athletic action performed by these athletes.
About Performance Coach Sean Cochran: Sean Cochran, one of the most recognized performance coaches in sports today. A career spanning positions with 2 major league baseball organizations, over 10 years on the PGA Tour and work with top professionals including three-time Masters, PGA, and British Open Champion Phil Mickelson, future hall of fame Trevor Hoffman, and Cy Young award winner Jake Peavy provides Sean a proven track record of success. He has been involved in the production of numerous performance videos and authored books including; Performance Golf Fitness, Complete Conditioning for Martial Arts, and Fit to Hit. He has been a presenter of educational seminars for numerous organizations including the world renown Titleist Performance Institute.
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