Sports injuries series: pitching and arm pain
By Darryl Viegas, PT
Injury and Sports Physiotherapy
Sports injuries vary in severity as well as their underlying causes. One of the most common non traumatic sports injuries that we see in the clinic is shoulder and elbow pain in baseball players, especially pitchers. In major league baseball there have been a few notable names of the home team over the past few years with missed starts due to shoulder fatigue, elbow pain, low back pain, latissimus dorsi strains and shoulder pain requiring various treatments from rest to physiotherapy to cortisone shots. At a professional level one often hears of pitch counts and a gradual increase in a young pitchers workload in an attempt to prevent this type of sports injury. However clinically we also see these problems in the amateur, weekend warrior and young sports enthusiasts.
Phases of the overhand pitch
Throwing involves more than just the muscles of the shoulder. Pitching is more than just throwing hard.
Pitching can be considered as 6 phases of motion that simplistically link the pitcher’s arm to their shoulder girdle, trunk, hips and legs. The connections between these areas allow for efficient storage of energy during the first 3 phases, release of energy rapidly in the 4th phase and the slowing down of momentum in the final two stages.
The ability to consistently perform the movements influences the ability to consistently locate a pitch and efficiently generate and absorb the 
required forces. Restrictions in range of motion and strength of the hip, pelvis and trunk muscles will require greater deceleration forces at the shoulder and elbow. For example, restricted hip range of motion of the front leg during the stride phase affects foot placement as the lead leg contact the ground. This can cause a greater cross body movement of the pitch requiring greater force absorption through the trunk muscles. This impairs accuracy and endurance. A lead leg that opens up too much at foot contact increases the load on the shoulder muscles and elbow as does biomechanical changes that cause an increase in sideways leaning (Solomito 2015). If left unresolved overloading of the shoulder or elbow musculature can lead to overuse injuries including tendinopathies.
Assessment of a pitcher without pain
Evaluation of a pitcher should not just occur with the onset of pain. Often before arm symptoms develop changes in velocity, location and symptoms in other areas of the body will present. These can be more easily worked on before pain symptoms develop. One recommendation is that evaluation should be done before the start of the season and in high level athletes there should be periodic reassessment during the season (Limpisvasti 2007).
Assessing a pitcher with pain
Assessment of a pitcher with shoulder or elbow pain starts with assessing the painful regions. Diagnosing the pain will in many ways determine the prognosis and whether time off from sport is required. Appropriately diagnosing also influences what conditioning exercises can be done to more rapidly return to sport. and appropriately managing the local joint, tendon or ligament pain and muscular imbalances.
Additionally, a detailed biomechanics evaluation of non painful areas is essential to determining the underlying causes of the problems. These include mobility and strength measures of the shoulder, shoulder blade, spinal mobility, dynamic strength, lower extremity mobility and strength and core strength in order to correct muscle imbalances exercises often start as isolation movements to repattern movements. However, as with any athletic injury, the exercises need to progress towards functional applications and sport specific conditions.
The Family Physiotherapy Approach
At Family physiotherapy our team of physiotherapists and massage therapists work as a team to find the pain and treat the underlying problems that are preventing you from achieving your athletic goals. If pain has been interfering with your season or if you noticed arm fatigue, back soreness, leg symptoms or inconsistencies in your pitching then make the call to see one of our therapists to get you back to where you want to be!
Family Physiotherapy serving the residents of Thornhill, Markham and Vaughan
The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.
References
Chu, Jayabalan, Kibler, Press “The kinetic chain revisited: New concepts on throwing mechanics and injuries” American Academy of Physical Medicine and Rehabilitation 2016
Limpisvasti, ElAttrache, Jobe “Understanding shoulder and elbow injuries in baseball” Journal of the American Academy of Orthopaedic Surgeons 2007
Solomito, Garibay, Woods “Lateral trunk lean in pitchers affects both ball velocity and upper extremity joint moments” American Journal of Sports Medicine 2015