Part 2 - In-season and Off-season Shoulder Rehab

In the first baseball blog, hope you learned a little more about upkeeping your body as a pitcher. Pitching is the most dynamic movement in sports, and moving a body part 8500 degrees per second, which is when the arm can spin 24 times per second if nothing is stopping it, is pretty amazing. With that said, the cocking position in pitching is the weakest position to place your shoulder into. Something dynamic on a possible unstable foundation usually displays poor outcomes. In orthopedic testings, we perform a shoulder instability test called the Apprehension test (passively putting you into a throwing position) then afterwards confirming the Apprehension test with the Relocation test (practitioner’s hand acts like a labrum). In combination of throwing torque and positioning of the shoulder when throwing, I believe finding care during and after the season is essential to give yourself the best chance to have a longer career.

As a pitcher throws more and more over their lifetime, the anterior capsule of the shoulder becomes more laxed due to the head of the humerus shifting forward repeatedly. That is why I am an advocate of resting the shoulder after a long season to give the anterior capsule a break, spend time to improve the surrounding tissue quality, and encourage performing exercises that will stabilize the shoulder during off season. Rehabbing muscles that cross the anterior shoulder like the subscapularis, biceps, coracobrachialis, pecs, and even supraspinatus is recommended. Based on other pitchers’ experience and my own, it takes about 2-4 weeks of throwing to find “it” or the release point to throw an accurate baseball. So don’t worry about losing your mechanics and losing control. It’ll come back!

Another movement that shifts the head of the humerus forward is shoulder extension. Go ahead and stand up straight and move your elbows straight back or extend your shoulder. What happens? Yes, the head of the humerus moves forward just like externally rotating the shoulder in an abducted position. Quick couple exercises/stretches that pitchers should AVOID are: tricep dips, wide-grip squats, partner stretches that involves external shoulder rotation and extension, and regular bench presses.

If you like the joint-by-joint approach by Gray Cook like myself, the scapular region should be a more stable joint and it should still move! During a throwing motion, the scapula will upwardly rotate to to keep the ball in its socket so you can position your arm into the throwing slot (this motion will decrease throughout the season due to hypertonic lat muscles). When the arms moves, the scapula should move too right? Let’s take a look at the traditional bench press. You grab your 80lbs dumbells, lay supine on the bench, have both shoulder blades locked to the bench, then you move your arms, right? Not knowingly, you are creating dysfunction in your throwing motion by not allowing the scapula to move with the arm! Here is a good alternatives:

If I were to summarize a goal for a pitcher during the season; that would to get the MOST rest days with FULL range of motion between starts as possible. Lets take an example of a high school’s ace that starts every 5 days for 10 straight weeks and who throws about 65-80 pitches a game. After his start, he runs poles, puts some ice on his shoulder for 10 mins, lightly throws during practices, and does band work on the side. He is sore and tight for three days and expects to be throw a quality outing two days later.  If we assume the pitchers gets about two days worth of rest with full ROM between their 12 starts, that’s about 24 days of rest with full ROM for the season right?

How can we get more days rest with full ROM you may ask?

After a start, the pitchers should have their posterior chain released like the posterior capsule, rotator cuffs, rhomboids, lats via Graston/FAKTR/Active Release and then mobilize their joints that got “locked up” through the pitching process. With this rehab program, the pitcher can gain one (if not two!) more full days of rest with full ROM between starts.

Would you rather have 24 days of rest or 36 days of rest in a season?

Would your chances of getting burnt out at the end of the season decrease?

Would you be more fresh for the high school state playoffs?

Would injury rates decrease?

I’ll have you answer those questions! If you have any questions, thoughts, or concerns, please comment below or email Dr. Jason at drjason@activesportsandspine.com .

References: Eric Cressey, Dave Rak, Anatomy Train