What You Need To Know
- Throwing pain is mostly associated with inflamed rotator cuff tendons, shoulder instability and/or labrum tears.
- It is difficult to diagnose the cause of throwing pain in athletes and determine the stability of the shoulder. A physical examination should be done to evaluate the shoulder, but an MRI or arthroscopy of the shoulder may also be ordered.
- Treatment options vary for baseball-related shoulder injuries depending on the type and severity of the condition and range from non-operative treatments to surgical procedures.
Dr Kaila Holtz Breaks Down What You Should Know About Pitcher Shoulder Pain How To Prevent It How To Treat It
Dr. Kaila Holtz is a Canadian Olympian turned NCAA Pitching Coach turned Sports Medicine Physician. She is currently in her last year of medical residency at the University of British Columbia. Her clinical interests are in shoulder health with a particular focus on overuse throwing and pitching injuries. She recently published a paper in the Orthopedic Journal of Sports Medicine looking at arm health in youth softball pitchers. Follow her on Twitter
Throughout my NCAA career, my arm would ache. Often this pain was from my biceps upward and into the front of my shoulder. Particularly if I threw too many pitches too early in the season. During my sophomore year, I was sidelined by a deep, stabbing pain in the back of my shoulder that got worse the more I threw. My arm felt dead. Nothing seemed to help. I ended up sitting out much of the postseason.
Like me, many softball pitchers have missed practice or competition because of shoulder pain. The prevalence of shoulder pain is high in both high school and college softball. Shoulder pain that persists 12-24 hours isnt something to be ignored. Pitchers with shoulder pain need a full assessment of their pitch counts, biomechanics, muscle imbalances and some scheduled rest to ensure their pain doesnt become a chronic injury.
This article takes you through what structures may be generating pain, why pain occurs and what to do about it.
The Current Approach At Johns Hopkins
Since most cases of tendinitis of the shoulder resolve without surgery, it is important to try everything possible to prevent surgery. Also, the recovery from surgery is not short if the shoulder needs to be tightened up. A careful physical examination of the shoulder is important, and regular radiographs or X-rays of the shoulder should be done. If an MRI is done we recommend an arthrogram, where dye is placed in the joint prior to the MRI.
All of this information is processed to determine whether surgery is indicated. The level of competitiveness of the athlete and where they are in their careers are important considerations when determining if surgery is warranted. A player who is already established and making money from his shoulder is a different consideration than the player who is considering giving up the game anyway. The length of time for recovery is an important consideration as well, since surgery has to be timed to maximize recovery for when the season begins at the level of play the person is involved in at that time.
If there is not so much damage in the shoulder at the time of surgery, then we have been using a thermal capsular shift procedure. While there are no published results on this technique, we think it is best for shoulders that do not have significant labrum or cartilage damage. We tend to use this operation more often in swimmers or volleyball players who have pain but not much damage in the joints.
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Injury Prevention And Strengthening
Pre-game tubing warmup for pitchers:
o Shoulder Extension
o Throwing Acceleration
o Shoulder Flexion
o External Rotation at 90o of Abduction
o Scapular Punch
o Low Scapular Rows
Recommended dosage of the warm-up is 1 set of 30 repetitions per exercise
These 7 exercises were chosen based on the EMG results from a group of 12 showing a greater than 20% maximal voluntary isometric contraction of at least 11 of the 13 tested shoulder muscles.
Translation Into Practice: Practice Pearls/performance Improvement In Practice /changes In Clinical Practice Behaviors And Skills
As most athletes have practice at the same time of day, creating a scheduled exercise program during practice may promote better adherence to the rehabilitation regimen.
Encourage all athletes to continue doing their full rehabilitation program for at least one month once they are fully asymptomatic. Keeping a calendar or diary of asymptomatic days may promote rehabilitation compliance.
Promote the use of some of the rehabilitation exercises, such as scapular strengthening and posteroinferor capsular stretches, as part of everyday warm-up and cool-down.
Enrolling assistance of a throwing coach or enrolling on a throwing program, while not adding significant volume to the number of throws may be a good addition to the technical part of the sport.
Continued use of therapeutic modalities such as ice and electrical stimulation may aid in recovery.
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Types Of Shoulder Pain In A Horse
Shoulder dysplasia can lead to dislocations, and arthritis in more severe cases. Arthritis can also develop from bone disease in cases of abnormality between the bone and cartilage. Cysts will form and the cartilage becomes brittle, eventually resulting in arthritis. Soft tissue injury is another common source of pain for horses.
Other Remedies For Shoulder Pain
In addition to shoulder exercises, you can try home remedies to ease pain and encourage healing.
Follow the RICE method by resting, icing, and compressing your shoulder. When possible, elevate your shoulder above heart level. You can also use a heating pad or take an epsom salt bath.
To ease pain, you may take over-the-counter pain relievers such as ibuprofen or acetaminophen. Or try natural pain relievers such as turmeric, willow bark, or cloves. Apply a menthol rub, arnica cream, or essential oil blend to the affected area a few times per day.
In addition to doing these exercises, you can prevent shoulder pain by following a few simple tips and guidelines:
- Practice good posture and avoid slouching or hunching over while sitting, standing, and doing your daily activities.
- Pay attention to how youre carrying your body throughout the day and make adjustments as necessary.
- Get plenty of rest and take time off from any activity that causes pain.
Take care when you do activities that involve reaching for something overhead, carrying heavy objects, or bending forward. If you have to do these activities as part of your job, decide how you can move your body to minimize discomfort.
If you play sports that cause shoulder pain, make sure youre using proper form and technique.
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Proprioception Restoration Of Involved Shoulder
Neuromuscular feedback mechanisms, specifically proprioception, become interrupted secondary to trauma and microtrauma. The repetitive forces of the throwing motion predispose the overhead athlete to losses in proprioception. Proprioception is important in rehabilitation and restoration of pre-injury levels of performance for the overhead athlete as it allows for awareness of body position and movement to be performed without continuous reference to consciousness. This allows for a level of control which is necessary for later strengthening, performance, and a reduced chance of reinjury.
Proprioception of both the glenohumeral joint and scapular stabilizers are the focus of Phase 1 management. Agonist/antagonist muscle coactivation of the rotator cuff is emphasized through rhythmic stabilization exercises, and proprioceptive neuromuscular facilitation patterns with rhythmic stabilization. For the scapular stabilizers, Mottram et al. described the âscapular orientation exerciseâ, which involves sustained holds of the scapula in ideal postural positions for 10 seconds, repeated 10 times.
Open Rotator Cuff Surgery
Open rotator cuff repairs were, actually, the first style of rotator cuff surgery. It is referred to as open because of the larger incision points required of this surgery.
This type of surgery is usually used on larger and more complex tears.
The cut will typically run about a few centimeters long right over the shoulder joint, right about where the deltoid muscle detaches. This will help them view the rotator cuff better during the procedure.
It is also common to perform this type of surgery when a full tendon transfer is being done. In addition to the tendon transfer, the surgeon may remove bone spurs around the acromion. The process of removing the bone spurs is called an acromioplasty.
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Leg Saver Ting Point Therapy
Our electro therapy treats inflammation at a cellular level, effectively shortening healing time.
That is one of the most important things to remember: when treating shoulder pain, as with all injuries, its important to monitor your horse closely. If you are familiar with what normal looks like for them, you will be able to anticipate injury sooner and apply healing methods quicker. If you have any questions regarding how Leg Saver therapy can help treat your horses shoulder pain, please dont hesitate to contact us!
How Do You Make A Diagnosis
Determining the cause of shoulder pain in the throwing athlete is difficult for several reasons. The truth of the matter is that it is difficult to establish if the shoulder is loose or not. Studies have shown that the shoulder has a certain amount of mobility that is normal, and the problem is that it is difficult to tell upon examination of the shoulder if it is too loose or not. While some surgeons claim that they can tell, studies have shown that this examination is very subjective and probably not very reproducible among examiners. In other words, it is very difficult to push and pull on the shoulder in the office and tell if the shoulder is too loose, despite the claims of some physicians.
The same problem holds true for the detection of labrum injuries in the shoulder. The physical examination of the shoulder is complex due to the muscles covering the joint. Several physicians have reported tests of the shoulder that they think accurately detect labrum tears, but studies by independent observers have largely proven that these tests are not that accurate. Labrum tears do not produce a characteristic set of signs or set of pains that distinguish them from tendinitis pain.
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Urgent Advice: Get Advice From A Gp Or 111 Now If:
- the pain is sudden or very bad
- you cannot move your arm
- your arm or shoulder has changed shape or is badly swollen
- you have pins and needles that do not go away
- there’s no feeling in your arm or shoulder
- your arm or shoulder is hot or cold to touch
- the pain started after an injury or accident, like a fall
- you develop severe pain in both shoulders
- you feel feverish or unwell
These can be signs of something serious, like a broken or dislocated bone, or a torn ligament or tendon.
111 will tell you what to do. They can tell you the right place to get help if you need to see someone.
Go to 111.nhs.uk or .
Go to an urgent treatment centre
Urgent treatment centres are places you can go if you need to see someone now.
They’re also called walk-in centres or minor injuries units.
You may be seen quicker than you would at A& E.
Why Do Some Pitchers Feel Shoulder Pain
In the softball pitching motion, peak forces occur after the front foot lands as the pitching arm accelerates to ball release. At this stage, the arm bone is compressing into the socket with the help of centripetal force as well as the rotator cuff muscles. Pain occurs when the joint behaves in a dysfunctional way putting excess strain on the muscles and tendons.
Shoulder joint compression is usually a good thing. It keeps the ball of the arm bone . However, if the arm and shoulder blade arent working well together or if the sequence of hip and shoulder rotation is off, the direct compressive force instead becomes a shear force grinding the labrum against the glenoid or pinching nearby structures within the joint.
More than 60% of youth pitchers and over 70% of NCAA Division I pitchers report shoulder pain over the course of a season. Pitching too much too early in the season, having a previous shoulder injury, restricted range of motion to internal rotation, and cumulative years pitched are all risk factors for shoulder pain leading to injury.
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The Number Of Weeks Of Physiotherapy Found To Rival Subacromial Decompression Surgery In Success Rate 13
Thats right! In some cases, hard work was just as effective as surgery! Both treatments showed that a majority of the improvement made in the athlete, was made within the first three months.
So how do you know if you should pursue surgery or physiotherapy?
A majority of doctors will agree that if you have not seen any improvement in the shoulder within six months of performing less invasive procedures , then decompression surgery will likely be a better option.
Rehab methods can include:
- Passive and active range of motion exercises
- Selective capsular stretching
- Strengthening of the rotator cuff, deltoid, and periscapular musculature
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Tips For These Exercises
Do these simple exercises three to six times per week to relieve shoulder pain. Start with a 10-minute routine and gradually increase the duration as you get stronger and more flexible.
While doing these exercises, focus on relaxing and releasing any tension in your shoulders and anywhere else you feel tightness.
Stretch only to the degree that is comfortable on any given day. Dont push yourself beyond your limits, and discontinue the exercises if you experience pain that goes beyond mild discomfort.
This exercise helps increase flexibility and range of motion in your shoulder joint and the surrounding muscles. When doing this exercise, lower your arm if you feel any pain in your shoulder.
This exercise is a gentle way to loosen tension in your neck and shoulders.
To deepen this stretch:
Some Shoulder Conditions May Become More Common As You Age
You probably don’t think about your shoulders much, until you suddenly experience pain in one of them. Shoulder pain can make a simple act brushing and drying your hair, reaching behind your back to fasten a bra, or grabbing something overhead seem like a monumental task.
As you age, you’re more likely to experience shoulder pain from a variety of common conditions. “Shoulder problems are very common,” says Dr. Arun Ramappa, associate professor of orthopedic surgery at Harvard Medical School. The pain can come on gradually or abruptly, and it may range from mild to excruciating.
Below are some of the most common conditions you may encounter, and some tips for how to address them.
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How To Relieve Shoulder Pain
Aching Shoulders? What you need to know about your rotator cuff
- Rest and ice frequently. Ice for 10 minutes right on the shoulder joint, even if it aches in your mid arm area.
- Sleep hugging a pillow. This helps to properly space the shoulder joint. Tuck the pillow deep in your underarm.
- Stand up against a wall and gently squeeze your shoulder blades back and together. Dont shrug your shoulders. This helps retrain proper shoulder posture.
- Avoid heavy lifting, carrying groceries on that side and repetitive reaching up overhead, even if it is a light object such as a cup.
- If your pain doesnt go away in 3-4 days, seek help from our physical therapists.
Shoulder Pain After Throwing
Overhand throwing motions trigger high torque and also fuel powerful acceleration forces that can cause significant stress on the shoulder joint. Whether you are a professional athlete or just playing catch with your kids in the backyard, pain or discomfort when throwing can be linked to abnormal shoulder function.
The Motion of Throwing
The motion of throwing comprises four different phases: wind up, cocking, acceleration, and deceleration. Because the shoulder is a mobile joint, different forces, velocity and stress can be generated during each phase. However, there must be a balance between the laxity of the shoulder joint needed to achieve the first two phases and stability to execute the second two phases.
When this balance is improper, damage to the ligaments, muscles and joints of the shoulder is common. Because the phases of throwing occur so rapidly, it may be difficult for athletes to determine which phase of this chain is broken and thus causes pain. To add to the complexity of the problem, 50-60% of the strength generated from throwing comes from the core and lower extremities. Problems in these areas can compound shoulder disorders.
Signs of a Problem
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