When you spend so much time peaking your baseball players for tryouts and the start of their season, it's easy to lose sight of the importance of injury prevention. Of particular concern are shoulder and elbow injuries.
Compared to the general population, baseball players on average have shoulder external rotation 10 to 20 degrees higher and internal rotation of about 30 degrees lower. Glenohumeral Internal Rotational Deficit (GIRD) is a loss in internal shoulder rotation, typically 10 percent of the total rotational motion of the opposite shoulder or a 25 degree difference between shoulders. This can be caused by a posterior inferior capsular contracture, tightness of the external rotators or bone adaptations of the glenoid and humerus.
We also tend to overlook the global changes and compensations that occur from a local, dysfunctional joint. The latissimus dorsi attaches to the anterior aspect of the humerus. The latissimus dorsi assists with internal rotation of the shoulder. The origin of the latissimus dorsi share a "connection" with the thoracolumbar fascia of the low back, which, in turn, shares attachment to the opposite gluteus maximus. Moving on, the gluteus maximus shares an attachment with the IT Band and TFL, with the IT Band finally crossing the knee joint.
We must take into account that restricted range of motion of the right shoulder may be due to a protetive spasm or trigger point of the left gluteus maximus through its shared connection with the right latissimus dorsi. Similarly, if the gluteus maximus is in a shortened, protected state from being quickly overstretched, we may notice excessive external tibial rotation (the toes turn out) and/or valgus collapse (the knees cave in) during a squat pattern or single-leg stance. This is a potential example of how addressing poor thoracic extension (arms fall forward when in the overhead position) can improve the overhead squat pattern in the Functional Movement Screen.
So what does the literature say about injury rates in high school baseball and softball athletes?
The overall rate of injury is highest during the first month of the season, followed by the third and second months, respectively. The occurrence of shoulder injuries was highest in the first month of the season, whereas the rate of elbow injury was highest in the third month of the season.
We need to address certain areas of training during the off-season if we expect our athletes to maximize off-season strength and conditioning programs, peak for spring tryouts and decrease the chances of non-contact injuries. Specifically, by addressing mobility, stability and motor control patterns through movement preparation strategies, we can place our athletes in the best position to succeed and remain healthy for a successful season.
Below are some sample exercises that will be great additions to your athletes' strength and conditioning program:
1. Full-Body Foam Roll — Use the body stick for specific trigger points. Duration: 8-12 minutes.
2. Ankle Drives — Increases ankle mobility. Maintain good posture, a slight forward bend of hips and gentle push of the knee over the toes. Do not allow your heel to lift. Sets/Reps: 3x10 each side
3. Quadruped Rotations — Improves thoracic mobility. Inhale on the inward rotation, exhale on the outward rotation. Keep your stationary arm in a locked-out position. Make sure to breathe through your belly. Sets/Reps: 3x10 each side
4. Shoulder/Hip Separation — Improves thoracic mobility. Use your top hand to maintain knee contact with the ground. Inhale when your palm touches the ground and exhale when the back of your hand touches the ground on the rotation. Let your breathing increase as you rotate. Sets/Reps: 3x15 each side
5. Deep Squat to Standing Extension — Improves thoracic mobility and extension. Perform a full, deep Squat while inhaling deeply through your belly. Hold your breath for 2 seconds and exhale when driving out of the Squat. This may be performed stationary or within a dynamic warm-up. Sets/Reps: 1x8
6. Supine Leg Raise with Pulldown — This move activates the core. Start by holding a resistance cable with your arms shoulder-width apart and flexed to 90 degrees. Lift one leg as high as possible while simultaneously pulling both hands down to the sides of your hips. You should notice your belly button becomes tighter and your abdominals flexed. Slowly lower your leg while returning your arms to the starting position. Maintain a slight downward pressure with your low back to the floor/table. Sets/Reps: 2x10 each side
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- Huffman GR Tibone JE McGarry MH Phipps BM Lee YS Lee TQ. "Path of glenohumeral articulation throughout the rotational range of motion in a thrower's shoulder model." American Journal of Sports Medicine, 2006;34:1662‐1669.
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- Shanley E, Rauh M, Michener L, Ellenbecker T. "Incidence of Injuries in High School Softball and Baseball Players." Journal of Athletic Training, 2011:46(6):648-654.
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