Understanding Pitcher's Shoulder


Understanding Baseball Pitcher's Shoulder Pain


-Dr. Andy Harmon, DC



If your child has experienced shoulder pain, particularly related to throwing sports such as baseball, the rotator cuff may be involved. You may have heard a variety of medical terms related to the shoulder, like rotator cuff tendinitis , rotator cuff tear, or impingement syndrome. But what does this mean to you and your young athlete?


The first piece of good news is that shoulder pain, like most other sports-related injuries, rarely requires surgery [insert your sigh of relief here]. Perfect. Now that we are hopeful that surgery will not likely be required, what can we do to alleviate the shoulder pain and prevent it from coming back?


Before discussing treatments for shoulder pain, a basic understanding of the anatomy of the shoulder may be helpful.


The shoulder joint is a special type of joint called a "ball-in-socket" joint. This type of joint allows for a tremendous amount of motion. The rotator cuff is made up of 4 muscles that assist in holding the shoulder in place throughout motion. The major action of these muscles is rotation of the shoulder. The rotator cuff passes immediately beneath a bony structure called the acromion.


Causes of Rotator Cuff Injuries


The shoulder joint is often injured in the throwing sports, such as baseball, because it has a greater range of movement than any other joint in the body. Shoulder muscles and ligaments bare a tremendous amount of stress throughout the throwing motion.


When you raise your arm up above your head, as occurs during the cocking and acceleration phases of the pitching motion, the rotator cuff muscles can be pinched under the acromion, causing irritation and occasionally sharp pain felt on the front or top of the shoulder. This situation is referred to as "shoulder impingement' or "impingement syndrome".


Deceleration -  A good throwing technique requires the athlete to use his body weight and the large muscle groups of the legs, back and trunk to generate kinetic energy across the shoulder in the direction of the thrown object. After the ball is released, the retained energy in the throwing arm needs to be dissipated back to the large muscles which then absorb it. Stated more simply, after a ball is thrown, the arm must decelerate. The large muscles of the back and trunk, as well as the triceps and the rotator cuff all assist in deceleration of the arm.


A tremendous amount of stress can be placed on the rotator cuff muscles as they assist in decelerating the arm after the ball is released. This is particularly true in pitchers who don't follow through all the way. By not following through, deceleration must occur abruptly, increasing the amount of stress that is placed on the smaller and more easily injured rotator cuff muscles.


Biomechanics - As stated above, when a pitcher has poor biomechanics, undue stress can be placed on the soft tissue structures of the shoulder. Different biomechanical flaws place stress on different structures. Volumes have been written on the subject. What is important to remember here is that pitchers with poor throwing biomechanics place undue stress on the smaller rotator cuff muscles, compared to the stronger muscles of the back and trunk.  Ensuring that your child learns proper throwing technique is a worthy investment in the health of your young athlete's arm.


Overuse - Overuse is the most common source of throwing related injuries. Most importantly, it is avoidable. Paying close attention to pitch counts and giving kids ample rest is the best way to prevent overuse injuries. It is important that kids are allowed to come out of a game at the first sign of shoulder discomfort or soreness, even if it is not convenient to the goal of winning the game that day.


Specific Conditions Defined


Rotator cuff Tendinitis: (AKA. Swimmer's shoulder; Pitcher's shoulder; Shoulder impingement syndrome; Tennis shoulder) Rotator cuff tendinitis is an inflammation (irritation and swelling) of the tendons of the shoulder. 


Rotator cuff tear: The rotator cuff muscles and/or tendons can be torn by an acute injury, or over time due to repetitive stress. Often times, a tear begins as a smaller injury or inflammation as seen in cases of tendinitis. Failure to rest and rehabilitate small injuries can often lead to increased inflammation, tissue damage and eventual tearing. Small tears can often be rehabilitated conservatively. Larger tears and smaller tears that fail to respond to conservative treatments may require surgery.


Impingement Syndrome: Impingement syndrome refers to the scenario by which one or more of the rotator cuff tendons are physically pinched under the acromion process. This condition goes hand in hand with rotator cuff tendinitis because the pinching causes the inflammation in the rotator cuff tendon.





Conservative treatment for a rotator cuff injury and/or impingement syndrome includes 3 Phases of Care:


(1) reduction of inflammation

(2) breaking up scar formation (myofascial adhesions)

(3) stretching and strengthening exercises.


(1) Reducing Inflammation - typically involves the following steps:



-anti-inflammatory medication may be recommended by your child's medical doctor



(2) Myofascial Release - When muscle tissue is injured, scar is formed. Scar formation (also called myofascial adhesion) is the body's way of patching an injured area. The problem with scar is that it is tough and fibrous, whereas healthy muscle is supple and elastic, like a rubber band.

Myofascial Release Technique is used to break up scar formation and restore the muscle's elasticity, or rubberband-like characteristics. Once the rotator cuff muscles are painfree and myofascial adhesions are broken, therapeutic exercises are essential to a complete recovery. It should also be noted that myofascial release technique can increase throwing velocity by optimizing the elasticity of the throwing muscles.



(3) Stretching and Strengthening Exercises - Stretching and strengthening of the rotator cuff is crucial to completing shoulder rehab and remaining pain free. A few simple rotator cuff exercises will strengthen the muscles, resulting in injury resistance and optimal performance.


You'll notice that college and major league pitchers perform rotator cuff exercises on a regular basis, even when they are not injured. This speaks volumes to the importance of a healthy rotator cuff in pitchers, as well as other athletes whose sport involves repetitive stress on the shoulder.



The above three-step treatment of shoulder pain is likely to solve the problem before it gets worse or requires surgery. A thorough biomechanical/orthopedic evaluation with a sports injury specialist is always recommended for any type of shoulder pain, prior to proceeding with treatment. Throwing through pain is never recommended in youth sports.


-Dr. Andy is a sports chiropractor in Boulder, CO who specializes in the diagnosis and management  of soft tissue injuries. More information can be found at 



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