By: Dr. Jordan Ganther, PT, DPT
While we can’t see it now, the weather is going to start to change in the next few months. For some people, that means baseball practices are starting up soon. This can be a wonderful time, but some kids might experience shoulder pain while training ramps up. I have worked with a lot of throwers over the past few years, and I generally get an uptick in shoulder related pain in the Spring. This is primarily due to either an over training over winter or a severe uptick in the demand of our shoulder joint once practices start. I personally have experienced plenty of shoulder pain and a tear in my ulnar collateral ligament during my high school pitching days. This hopefully can provide the guidance that I did not have during that time.
What causes shoulder and elbow pain in throwers?
It is well documented in the literature that elbow and shoulder injuries in adolescent throwers are on the rise. This is despite much research being done in treatment and prevention. Fatigue continues to be one of the greatest predictors of injury. With most of these injuries, a simple imbalance between supply and demand on the shoulder is present. These can include but are not limited to:
Glenohumeral Internal Rotation Deficit (GIRD)
Rotator cuff strength deficits
Humeral torsion
Soft tissue adaptions
Changes in hip range of motion
The reason that overhead throwing is cause for concern is that small impairments can create injury due to the violent nature of the action. While there are common physical impairments that lead to injury, there are certain throwing mechanics that can lead to injury if not addressed. These are too complex to be covered thoroughly in a blog post. The injuries that I commonly see in throwers are rotator cuff strains, labrum tears, impingement syndrome, bursitis, and medial epicondylitis. Identification of the previously mentioned impairments can hopefully limit the chance of your child missing time due to injury.
So, your child is having shoulder or elbow pain. How do we treat it?
Addressing the symptoms is first and foremost the most important goal of treatment. Usually this includes a period of rest with physical therapy designed to address the impairments. This primarily focuses on improving shoulder internal rotation range of motion, posterior capsule tightness, improving rotator cuff strength, and addressing any mechanical issues that may be identified during a throwing evaluation.
After your child has passed all return to sport tests, the biggest challenge is prevention of future injury. This is, in my opinion, the most important part. Throwing is something that only gets more demanding as the season goes on due to the lack of availability of rest. If your child is starting baseball or softball practice soon, I would be happy to evaluate their shoulder to address any potential issues.
References:
Cools AM, Johansson FR, Borms D, Maenhout A. Prevention of shoulder injuries in overhead athletes: a science-based approach. Braz J Phys Ther. 2015;19(5):331-339. doi:10.1590/bjpt-rbf.2014.0109
Salamh P, Jones E, Bashore M, Liu X, Hegedus EJ. Injuries and associated risk factors of the shoulder and elbow among adolescent baseball pitchers: A systematic review and meta-analysis. Phys Ther Sport. 2020;43:108-119. doi:10.1016/j.ptsp.2020.02.013
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