Every year as we come into spring, many individuals prepare themselves for baseball tryouts, practices, and eventually games.  It is estimated that over 20 million individuals participate in baseball as amateurs across the United States.  During the first couple of months of the season, athletes will rush into baseball related activities/workouts without the proper instruction from coaches, parents, or trainers on how to prevent overuse injuries.   There has also been an increase in participation which results in a concurrent rise in the level of competition amongst athletes.  With the increase in competition, emphasis has been placed on performance enhancement which can result in an increased potential for injury.

1.   What exactly is the "Rotator Cuff?"

The rotator cuff is comprised of four muscles which combine at the shoulder to form a thick "cuff" over the joint. These muscles work as a "shunt" muscle and have the important job of stabilizing the shoulder, as well as elevating and rotating the arm. Each muscle originates on the shoulder blade (scapula) and attaches on the arm bone (humerus). The four muscles which make up the rotator cuff are the: supraspinatus, infraspinatus, teres minor, and subscapularis. Often the mnemonic S.I.T.S is used to help remember the muscles that make up the rotator cuff.  

2. What muscles in the rotator cuff are often damaged or overused?

RTC

(View of muscles in the back of the Shoulder) 

Recent literature has shown that of the four rotator cuff muscles, the Infraspinatus and Supraspinatus muscles have increased prevalence of injuries in overhead throwers.  The relationship between flexibility and strength is imperative for proper biomechanical performance at the shoulder joint.  When there is an abnormality in this relationship (i.e. increased flexibility vs. weakness; decreased flexibility vs. tightness) athletes are prone to sustaining an injury.  Often at the rotator cuff, we see breakdown of the Infraspinatus muscle in the participants' throwing shoulder.  Repeated excessive stresses are placed on this muscle during the deceleration phase of throwing in order to slow the athletes' arm down after they have released the baseball.  

The second muscle most susceptible to injury is the Supraspinatus which is located on the top of the shoulder.  This muscle primarily acts to lift the arm out to the side and secondarily acts to control the head of the humerus (upper arm bone) from coming in contact with the acromion process of the scapula (bone located above supraspinatus muscle in picture above).  With the breakdown of the Infraspinatus, many athletes will experience "Secondary Impingement" in their throwing shoulder.  This is a result from muscle imbalances within the rotator cuff and results in the tendon of the supraspinatus being compressed between the head of the humerus and acromion of the scapula.  This often will result in the tendon becoming frayed or torn.    

3.  What are the symptoms of a rotator cuff injury?

The most common symptoms of a shoulder injury include pain and weakness. Pain is not always felt when a shoulder is first injured.  Most people who do feel pain, report that it is a very vague pain which can be hard to pinpoint.  Weakness, on the other hand, seems to be the most reliable symptom of a shoulder injury. Common complaints include an inability to raise your arm above your head, extend your arm behind you, reach behind your back, or reach directly to your side. In severe cases, the larger the tear or damage to the tendons, the harder and more painful it is to move your arm and the injured area. 

4.  What should I do if I suspect I have an overuse injury?

If you have pain or irritation the first step is to rest and apply ice to the affected area.  This will help to reduce inflammation and stress placed on the involved structures.  The next step athletes and/or parents should do is contact a medical professional (i.e. medical doctor, physical therapist, or athletic trainer).  Once you contact a medical professional they will help you determine the appropriate course of action for you.  

5.  How can a Physical Therapist help?

A physical therapist can help by providing a comprehensive screening (evaluation) to an athlete. Some of what the physical therapist will look at is the kinematics of the upper extremity, stability of glenohumeral and scapulothoracic joints, mobility of thoracic and lumbar spine, muscle strength and flexibility.  Once the physical therapist has evaluated the athlete he can provide the athlete with functional strengthening and stretching exercises that are sport specific and target the impairments found during the evaluation. Contact the physical therapists' at Sports Physical Therapy for more information on how to treat an injured shoulder or to suggest a preventative exercise program.

6. What prevention tools are out there?

Current standards have been implemented throughout baseball and softball leagues across the United States. Standards have been put in place by the USA Baseball Medical & Safety Advisory Committee to decrease the prevalence of overuse injuries.  Such standards include: 

1.) Adherence to safe pitch counts which include: limited pitches thrown per a game, limited innings thrown per a week, and establishing a fixed period of rest between each day pitched.  

2.) Modifications of faulty bodymechanics which include: changing the types of pitches thrown by the pitchers. In theory this will reduce the stress placed on the shoulder and elbow, in order to decrease the prevalence of overuse injuries/secondary impingement. 

3.) Interval throwing program which is a functional retraining program aimed to build strength and endurance in the pitchers' shoulder during rehab. 

4.) The Thrower's Ten program which is a strengthening program focusing on the rotator cuff and scapula stabilizers in the athletes' throwing arm.  Click here for Thrower's Ten program or contact Sports Physical Therapy for an extensive evaluation and exercise plan to prevent shoulder injuries.

For additional information, please read the following journal article Shoulder Injuries in US High School Basebal and Softball Athletes, 2005-2008