The last few months, I have been discussing different shoulder injuries. To wrap up our series on shoulder injuries, let us take a look at some interesting facts on the different throwing sports and their particular shoulder injuries.
To have an efficient throw, there needs to be maximal efficient transfer of energy from the lower body across the core and pelvis to the upper extremity. Overhead throwing sports include, baseball, softball, lacrosse, volleyball, football, track and field sports (discuss, javelin, shot put and hammer), handball and cricket. In the NCAA, there are over 140,000 male and female athletes participating in a overhead throwing sport at the levels of division I, II and III. The shoulder is the most common area of injury in the throwing athlete (21). Depending on the sport, the stresses placed on the shoulder may be slightly different, but, combined with the repetitiveness of those stresses, there is a great impact on the glenohumeral joint.
- A cricket “bowl” or throwing motion is very similar to javelin throw, there is a run leading up to the throw.
- Fast cricket bowlers have higher overall injury rate.
- Spin cricket bowlers have a higher overall shoulder rate of injury due to the greater amount of internal rotation while the arm is circumducting through the throw leading to shoulder impingement.
- Fast cricket bowlers tend to have an increased risk for low back pain due to the compressive and shear forces created from the greater activation of the lumbar spine paraspinals and gluteal muscles with increased speed.
- Fast cricket “bowlers” tend to have similar injuries to Amercian football quarterbacks, which include biceps and rotator cuff tendonosis.
- The initial phase of the javelin throw includes an approach run. This creates maximal transfer of momentum of forces created in the lower body and transferred to the throwing upper extremity.
- To create increased distance, the javelin thrower must maintain external rotation to create a high eccentric load prior to the throw.
- High eccentric loads repetitively can lead to microtrauma in the rotator cuff tendons.
- The volleyball serve and spike are very similar to the baseball throw. With the exception in the volleyball serve, there is an approach and take-off.
- The volleyball serve is about 1800-2500degrees/sec, about 5000d/s slower than the high level baseball pitch.
- Common v-ball injuries include RC tendonosis, muscle strains, glenohumeral subluxation/dislocation, subacromial impingement and labral tears.
- The biomechanics of a football throw are a bit different than in baseball. Due to the larger mass of a football compared to a baseball, quarterbacks will throw with a greater bend in the elbow and use more horizontal adduction and get more spinal rotation.
- Because quarterbacks rarely throw more than 30-40x in a game, the risk of shoulder injuries in football are a lot lower compared with baseball.
- The speed of a football throw tends to be about 2000 degrees slower than the average baseball pitch.
- Quarterback common shoulder injuries include biceps and rotator cuff tendonosis.
- Glenoid internal impingement- common cause of posterior shoulder pain in the pitcher
- SLAP lesion-common to occur at the “peel-back “ position due to stress on the Long head of the biceps at the superior labaral rim. The LHB twists in this position and may cause excessive stretch.
- The speed of external rotation in a baseball throw is upwards of 7000 degrees/sec.
- Little league shoulder- proximal humeral epiphysiolysis – common occurrence with weak scapular stabilizers allowing RC or labral fraying.
- In the deceleration phase, the muscle are contracting to slow the arm as it moves through adduction and internal rotation, increasing the risk of injury of SLAP and LHB tendon. In addition, there can be thickening of the posterior capsule leading to GIRD (glenohumeral internal rotation deficit).
- Baseball players that continue to pitch with arm fatigue have a 36x more likelihood of injury when compared to those that stop at the onset of arm pain.
- Increased risk of injury occurs with pitching with RC weakness, pitching with GIRD, pitching on consecutive days, and pitching with higher velocity.
- Core weakness results in the inability to transfer forces from the lower extremity to the throwing arm. The muscles of the arm, will then need to create greater forces inorder to produce the same velocity of throw. Stronger core, increased the efficiency of the throw.
- Warm weather pitchers have a higher risk of injury due to the ability to pitch year round, compared to their cold-weather counterparts.
Prior to practice or competition, all throwing sport athletes need to do a comprehensive, dynamic warm up to ensure the body and the arms are ready to go. And this doesn’t just mean, pulling on the band in external rotation in the dugout. A well researched baseball warm up, the Yokahama 9, can be used in other throwing sports as well. When incorporated into a team’s warmup, the Yokahama 9 decreased the incident of medial elbow injuries by 50%.
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