What a Thrower Looks Like
I recently had a 14 year-old baseball player come in to see me after 6 months of rest and rehab after an elbow injury. His dad is a coach and parents were on board every step of the way. They had followed every recommendation and all the protocols, but 3 weeks into play, he was hurting again.
During our evaluation, we looked at the elbow and wrist, but we mostly looked at the shoulder complex. What we found was a total arc measurement of 107 degrees (External Rotation: 90 + Internal Rotation 17). His non-throwing side showed 165 degrees (External Rotation 105 + IR 60). The literature would point to us to immediately starting the sleeper stretch. I was just as concerned with his external rotation however. Why do you ask? (I did address his internal rotation also. Do not neglect this! I just want to make it a point to recognize the external rotation issue here also! For more on how I addressed his IR, Click Here)
Why External Rotation?
A throwing athlete should NOT have a loss of external rotation. The act of throwing countless times as they develop often creates a torsion of the humerus, leading to increased external rotation and reduced internal rotation. This is a normal adaption and not something we need to intervene with when we see this.
So why was he loosing external rotation? Barring a surgical procedure, it is incredibly rare for a thrower to need to be stretched into external rotation. Doing so, may increase the microinstability often seen in the anterior capsule of the shoulder, which could be catastrophic! Instead, we need to figure out why!
When discussing throwing, we always discuss the posterior rotator cuff as the decelerators and the anterior musculature (pecs and subscapularis) as the accelerators. Over time, these muscles can be impacted with any of them being overused. It is also important to discuss the medial scapula muscles: mid trap, low trap, rhomboids, and even the upper trap. All of these have a roll in scapular stabilization and deceleration of the arm. With overuse or poor muscle balance, the scapula can begin to rotate anteriorly. This creates both an unstable base for the rotator cuff and also effects the athlete’s ability to reach the normal late cocking position of throwing.
Put your arm up in the air in a high-5 position. It should feel relatively normal. Now protract your scapula and try to do it again. You are going to find that you lost about 20 degrees of external rotation. The worst thing you could do is try to stretch the shoulder. Instead, fix the scapula!
(picture shows flexion limited, the same occurs with external rotation!)
Picture Reprinted with Permission: Secrets of the 15 Minute Shoulder Fix — Kaplan 2016
How Did We Fix This? It’s More than Just the Thrower’s 10
Scapular strengthening is incredibly important, but it is only one piece of the puzzle. If the scapula is stuck in an anteriorly rotated position, then your chances of being successful with a strengthening program are limited. Instead, use your soft tissue techniques to improve this. At our company ACE, we use our shoulder mobility home program handout and associated videos. A couple of the videos are shown below. If you would like the handout emailed to you, join our mailing list!
Part 2 will cover proper performance of scapula strengthening next week
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