Upper Extremity Injuries
Spring is almost in the air in the Northeast of the US. Temperatures are slowly climbing and with that brings America’s pastime, baseball. In the next few months, we will start getting an onslaught of shoulder and elbow evaluations from these very same baseball players.
To combat this, we have been running baseball pre-participation screens for the past 7 years. My most recent screen came from a perennial state contender who sends athletes to D-1 Schools regularly. We looked at 30-40 players and found 2 common trends: Internal Rotation loss and anteriorly rotated scapula. If these are not corrected, there are great odds that we will see some of those athletes in the clinic this spring.
This week, we are going to discuss the IR loss and hold off on the anteriorly rotated scapula for a few weeks.
When Glenohumeral Interal Rotation Deficit (GIRD) was first discussed in the early 90’s, the concomitant gain in external rotation in throwers was not accounted for. Further research showed that a normal throwing shoulder showed what is called an arc shift: A reduction in internal rotation with an equal gain in external rotation compared to the non-throwing contralateral side (See below for Kevin Wilk’s diagram1). This is typically due to a normal boney adaptation of the humerus in a throwing athlete. This is not to be confused with a problematic shoulder!
However, when there is a loss of internal ROM without the same gain in external rotation, it is highly problematic in overhead athletes, especially pitchers! Odds of a pitcher experiencing an injury is 1/5. Odds of a pitcher experiencing an injury climbs to 2/5 if there is a loss of of motion.2
I educate coaches on this by asking:
“What happens if one of your starters goes down? Can you still make it through the season?”
“What happens if two of them get hurt?”
Maybe a team can survive the loss of one, but when 40% of your starting rotation gets hurt, you are destined to struggle that year.
The prescribed fix for internal rotation loss has always been the sleeper stretch and/or a horizontal adduction stretch. The sleeper stretch is effective and I do prescribe it to athletes who show a loss of internal rotation (without an associated gain in external rotation). Here’s the thing. We have a fix that may be even quicker! To understand this, we need to consider why the athlete looses the motion. Literature shows that this rarely a glenohumeral joint mobility issue like we often see in many other shoulder pathologies. This is strictly soft tissue, and often the posterior rotator cuff. So let’s address that!
I challenge you to try a sleeper stretch. Then also try what I recommended. See what works best. I often do both with my athletes and have found more rapid success. Feel free to share your results!
Ari Kaplan, PT, DPT, SCS, CSCS, Cert MDT is the Co-Founder of the Association of Clinical Excellence (ACE), an education company focused on building the physical therapy community and developing the complete professional. ACE has three primary areas of developmental focus: Leadership, Clinical Skills, and Personal Mastery. He co-published his first book, Modern Day Management: A Short Guide to Successful Meetings in March of 2015.
- Wilk KE, Obma Padraic, Simpson II CD, et al. Shoulder injuries in the overhead athlete. J Orthop Sports Phys Ther. 2009;39(2):38-54.
- Wilk KE, Marcina LC, Fleisig GS, et al. Correlation of glenohumeral internal rotation deficit and total rotation motion to shoulder injuries in professional baseball pitchers. American Journal of Sports Medicine. 2011;39(2):329-335
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