The Nuts & Bolts Of Sports Injuries: Baseball Shoulder Injuries And How To Prevent Them

As spring training and little league seasons are getting underway we wanted to provide healthy solutions to players at all levels.

Baseball, as it has been said by many coaches, is “90% preparation and 10% action”. However, it is a sport of repetition and requires precise execution. Shoulders are the biggest body part topic in the sport.

Generally speaking, this is for shoulder injuries like rotator cuff tears, AC joint dysfunctions, shoulder bursitis and tendonitis of the rotator cuff and biceps muscles. Why do these injuries happen and how could they happen? Many patients say they work out and do everything from stretching to having a mechanics coach, but the real issue is whether you are working effectively and efficiently to protect the shoulder while we stretch and strengthen.

Let’s first start with a quick anatomy lesson. The shoulder is a ball and loose “socket” joint. Think more of a ball on a saucer plate; it isn’t all that stable. The stability comes from everything else. It is held together by a group of muscles and ligaments. The strength and stability of the joint relies on a cartilage surface called the labrum and the connecting muscles made to withstand rotational forces. It is also held together by tissues and a shoulder capsule that keeps the contents inside the joint nice, healthy and happily lubricated.

All these structures provide torque and stability; just imagine a stainless steel cable in its helix twist. The muscles and capsules all hold it together but what if the stress constantly occurs in one place and is overused? We will explore how we lead to the breakdown below.

I, myself, had my baseball career cut short with a torn labrum, two rotator cuff tears and two ligaments torn on my throwing arm. I have had many years to reflect. This is how I would have done it differently.

Causes of Shoulder Injuries

Although I am listing the top four chronic reasons for shoulders to breakdown there are so many more weird ways and freak accidents shoulders can be hurt. If you can manage and address these issues first then you are well on your way to be as safe as possible.

1. Instability of the shoulder socket

Stability and, more specifically, dynamic stability is the key component to a healthy moving shoulder. As mentioned above, our anatomy sets us up for a loose joint inherently. It is the muscles that need to be addressed with the exercises below that will keep it rotating and well lubricated.

2. Faulty throwing mechanics

There are all kinds of weird throwing patterns that people choose to emulate or adopt. It's usually what seems to work best for them for power and accuracy. Shoulder mechanics rely on three body parts. Your shoulder blade is the most important, then it's your clavicle aka collarbone and, finally, your actual shoulder. These move together and sync up while each takes up a third of your throwing or overhead motion. Check it out! Nolan Ryan did it best and is one of the most efficient pitchers of all time. He used all three all the time. Hence how he could pitch 27 years and throw as hard as he did!

If one has over-developed pecs or forward shoulders, they will be guaranteed a shoulder injury for the self-inflicted abuse via faulty mechanics.

Of course, your leg mechanics and core muscles are instrumental but we will engage in this in other baseball blogs.

3. Habits: sleeping posture and poor standing performance postures

In this day and age of computers/electronic devices, you're set up for rounded shoulders and a forward head. I ask all of you to try this (obviously, stop the motion when you feel tight or pain): sit in a bad posture and slowly try to raise your arm. Now, sit in a good posture and try to raise your arm. When you're in a good posture, you have much more range of motion! So now, imagine being a baseball player that constantly hucks a ball in poor posture. Talk about a big ouchie! Even the slightest degree of a poor starting posture will set you up for impingements, inflammations, and irritations within the joint.

Also, sleeping on your shoulder in a side-lying position and on your stomach will wind that shoulder up and is another source of repetitive strain.

4. Repetitive stresses on top of instability = wear and tear

Give your body a break! Playing ball year-round is just too much on someone’s body. Even pro players have a four to five month off season in which they rehabilitate and work on strength, coordination, balance, and core strength.

Repetitive stresses not only strain but under faulty mechanics start the inflammation process which then occupies space. Remember our body doesn’t have a whole lot of space! Compounding effects increase the pressure exponentially if you don’t take care of it.

Here are our top 5 exercises to protect or rehabilitate the shoulder and address our four issues above.

Shoulder Blade Clocks: One-third of your shoulder mechanics is your shoulder blade. Believe it or not many of you will not have control of the shoulder blade. Moving it in all directions offers so many degrees of freedom. Be smart and do it right and see how much harder and faster your arm whips.

Clavicle Stabilization (Cover Position): This is a progression exercise to the shoulder setting (next video) and begins to set not only your shoulder but your clavicle (collarbone) and shoulder blade.

Shoulder Setting: This is straight-up one of the best shoulder exercises out there. This helps address and encourage our top four issues for stability and activate the rotator cuff which we need to keep the shoulder in its socket. Imagine holding a bucket of water straight-armed out in front of your vs hugging that bucket. Which one is easier? There you go. This is the way to engineer efficiency.

Inferior Capsule Stretch: If you happen to compress or sleep on your shoulder you can give it some space by lightly stretching the connective tissues that connect and hold the shoulder. This also allows for some light coat of lubrication called the synovial fluid.

Modified Pec Stretch: If you're sitting in bad postures, that pec major and pec minor pulls your shoulder forward and changes up the mechanics and length-tension.

You can see throwing isn’t that simple when you break it down to the nuts and bolts.

Happy shoulders this upcoming season!

Dr. Justin C. Lin