The baseball season has long been considered to be one of the most grueling in all of sports, as it is common for games to be played on consecutive days with few days off while in-season. This schedule can be hard on the body and can lead to changes in range of motion that may impact performance as well as player health. Pitchers may be at a higher risk of these changes due to the fact that they are performing a high number of maximal effort throws repeatedly throughout the course of a game and season.
At the conclusion of the cocking phase, a baseball pitcher will externally rotate the shoulder to about 180 degrees (1). As they transition to the acceleration phase, the shoulder internally rotates from this position at approximately 7,000 degrees per second prior to ball release, making it the fastest motion in all of sports (1). What’s often forgotten, however, is that the pitcher must also decelerate the throwing arm from these speeds after every single pitch. This combination of extreme ranges of motion and extreme rotational velocities can place a lot of stress on the throwing arm when the deceleration phase is reached, which can begin to lead to structural changes.
In a study performed by Mike Reinold and colleagues, 67 baseball pitchers’ shoulder and elbow ranges of motion were evaluated prior to throwing a 50 to 60 pitch bullpen at maximal effort (4). Following this performance, the pitchers were reevaluated to see if any measurable changes had taken place. It was found that immediately after their pitching performance, pitchers experienced a significant reduction in shoulder internal rotation and elbow extension (4).
Average range of motion changes were as follows:
· Internal rotation: -9.5 degrees
· Elbow extension: -3.2 degrees
What’s interesting is that these changes in range of motion were still present 24 hours after the completion of the bullpen session. These findings are worth paying attention to, as a loss in range of motion at the shoulder may predispose a pitcher to an increase in injury risk (3,4).
Author’s Note: Before going into how to address these potential range of motion restrictions, I wanted to note that we should not just assume these changes are occurring after a pitching performance. We should instead examine the athletes to be sure. In a perfect world, we would have measurements taken prior to the season we could reference during this process. This would help us to restore the athlete’s range of motion back to baseline rather trying to make them “normal.” This is important because many baseball pitchers develop adaptations in range of motion that give them a competitive advantage and taking these adaptations away may negatively impact their performance.
Combating Soft Tissue Changes
One possible cause for pitchers losing shoulder internal rotation and elbow extension after an outing is the eccentric demand placed on the soft tissue surrounding these joints during the deceleration phase (4). Research shows that eccentric exercise increases passive tension in the muscle, which can restrict the amount of motion at a joint. In fact, one study showed that muscle stiffness more than doubles after eccentric exercise and remains elevated for four days (6). During the pitching delivery, the shoulder external rotators and elbow flexors are the primary muscle groups in charge of decelerating the throwing arm after ball release. Increased tension and stiffness in these muscles can limit shoulder internal rotation as well as elbow extension.
Another effect that has been observed after eccentric exercise is inflammation (6). As we know, inflammation is the first step in the recovery process, followed by the proliferative and remodeling phases. If we are able to increase blood flow to the area, we can speed up this healing process to restore the damaged tissue back to its original state more quickly.
One of my favorite ways to increase blood flow and decrease tone in soft tissues is with self myofascial release techniques. For the shoulder external rotators, I prefer to use a lacrosse ball to achieve this. This can be performed standing against a wall or while lying on the ground. To perform this exercise on a wall, place the lacrosse ball on the back of the shoulder just above the arm pit and roll around the area until you find a tender spot. Once you find a tender spot, maintain pressure on the area for 10 to 20 seconds before resuming the rolling motion.
To perform this exercise while lying on the ground, place the ball in the same position and roll around until you find a tender spot. Hold the ball in this position for 10 to 20 seconds before actively internally and externally rotating the shoulder to gently pin and stretch the muscle. The key word here is gentle. Do not crank on the shoulder while performing this exercise.
Body tempering, which I first learned from Donnie Thompson, can be a great self myofascial release option for the bicep. Start by lying on your back with a barbell resting over the belly of the bicep. Roll the barbell up and down until you find a tender spot. Once the tender spot is found, hold the barbell in that spot while actively flexing and extending the elbow. This exercise can be a little intense the first time you try it and may leave you sore the next day. Less is more in this scenario. Take your time as you introduce this for the first time.
Combating Capsular Changes
Another potential cause for a loss in shoulder internal rotation may be capsular tightness. Throwers historically have more posterior shoulder tightness than do nonthrowing athletes, which some authors have attributed to the repetitive microtrauma resulting from the deceleration phase (3). Posterior capsule tightness has been associated with a loss in internal rotation. In a study by Myers et al, it was found that for every 1 cm change in posterior capsule tightness, there was a loss of 4.7 degrees of internal rotation (3). Another drawback to posterior capsular tightness is alterations in the arthrokinematics at the shoulder. Posterior capsule tightness can lead to anterior and superior translation of the humeral head, which can impinge the posterior cuff and bicep tendon with overhead activities (2,3).
A great option for decreasing posterior capsule tightness, as well as improving shoulder internal rotation, is the cross-body stretch (2). Performing the cross-body stretch for 5 sets of 30 seconds has been shown to make significant amounts of change in the throwing shoulder (2). Performing this exercise in a side lying position can help to block the scapula in order to limit accessory motion and maximize the stretch.
Restoring Neuromuscular Control
Once new range of motion is given to a pitcher, we must next teach them how to actively control it. This is what we will refer to as neuromuscular control. A great option for teaching shoulder neuromuscular control is with supine active external/internal rotation. Start by having the athlete lie on their back with their upper arm resting on a towel to achieve a neutral shoulder position. Next, have the athlete rotate their hand back towards the ground as far as they can without compensating at the shoulder joint. Once the end range position is achieved, hold it for 3 to 5 seconds before repeating this process in the opposite direction.
We can progress this exercise by performing it in a prone position.
Controlled articular rotations (CARs), which have been popularized by Functional Range Conditioning, are a great option for teaching neuromuscular control at the elbow joint. Start by having the athlete rest their arm on a barbell that is about shoulder height with their thumbs pointed towards the ground. Next have them rotate their hands toward their face while flexing the elbow up as far as possible. Return to the starting position by performing the opposite motion.
Summary
The baseball season can be hard on the body, specifically for pitchers, who experience a significant amount of stress on the throwing arm. Of particular concern are the shoulder external rotators and elbow flexors, as they are asked to decelerate the throwing arm after each pitch. The eccentric demands placed on these muscle groups have been shown to lead to changes in shoulder internal rotation and elbow extension range of motion after a pitching outing. In order to combat these changes, we can implement soft tissue, mobility, and neuromuscular control exercises. By following this formula, we can help the pitching athlete to maintain healthy tissue quality in order to maximize performance and mitigate the risk of injury.
Resources
1. Dillman CJ, Fleisig GS, & Andrews JR. Biomechanics of pitching with emphasis upon shoulder kinematics. J Orthop Sports Phys Ther. 1993;18(2):402-408.
2. McClure P, Balaicuis J, Heiland D, Broersma ME, Thorndike CK, Wood A. A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther. 2007 Mar;37(3):108-14.
3. Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM. Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med. 2006 Mar;34(3):385-91.
4. Reinold MM, Wilk KE, Macrina LC, Sheheane C, Dun S, Fleisig GS, Crenshaw K, Andrews JR. Changes in shoulder and elbow passive range of motion after pitching in professional baseball players. Am J Sports Med. 2008 Mar;36(3):523-7.
5. Ruotolo C, Price E, Panchal A. Loss of total arc of motion in collegiate baseball players. J Shoulder Elbow Surg. 2006 Jan-Feb;15(1):67-71.
6. Proske U, Morgan DL. Muscle damage from eccentric exercise: mechanism, mechanical signs, adaptation and clinical applications. J Physiol. 2001 Dec 1;537(Pt 2):333-45.
7. Werner SL, Fleisig GS, Dillman CJ, Andrews JR. Biomechanics of the elbow during baseball pitching. J Orthop Sports Phys Ther. 1993 Jun;17(6):274-8.