Don’t Blame the Victim, Part 1: Compensatory Movement, Overuse Injuries and the Importance of Adequate Scapular Upward Rotation in the Overhead Athlete

Throwing a baseball isn’t necessarily difficult. Understanding the anatomy and biomechanics of throwing a baseball often is–take it from me. Despite my stellar little league baseball career (note: I’m only being a little sarcastic, since, at least by my own account,  I had a respectable little league career), my knowledge of what was actually happening anatomically and biomechanically when someone threw a baseball was mediocre at best. I was fortunate enough, however, to  intern at Cressey Sports Performance, the premiere gym in the US for baseball strength and conditioning. During that internship, I learned more than a few things about the anatomy and biomechanics of throwing a baseball.

 

One of the most important takeaways I got from the internship was a better appreciation of just how anatomically complicated throwing a baseball is and the many ways in which a baseball player can get injured from throwing. While throwing a baseball, many joints need to move in a concerted manner in order to produce a biomechanically “sound” throw. Thus, there are many opportunities for things to go wrong. And, at least based on the injury rates, things go wrong fairly often: 50 percent of all MLB starting pitchers will go on the DL at some point each season, as well as 34 percent of all relievers.

 

The obvious question to ask in light of these statistics is “why are the rates of injury so high?” The exhaustive answer to this question is beyond both the scope of this article and my expertise. (If I could answer that question, then methinks I’d be making lots of money.) But there is one piece of this puzzle I can discuss and especially want to discuss because it exemplifies the larger principle of compensatory movement: inadequate scapular upward rotation.

 

As I said earlier, throwing a baseball requires many joints to work together and as a result there are many opportunities for dysfunction. If one link in the proverbial chain isn’t doing its job adequately, then another link (or links) of the chain will try to compensate for the lagging link. Initially, the well-functioning links may be able to safely compensate for the dysfunctional link, but at some point the well-functioning links can get overstressed and “give out” due to overuse. By way of analogy, imagine that three people need to dig a ditch in a certain time period and that one of the people in the group quits part way through the task. Because one of the people quits, the other two people in the group need to increase their output. These two people might be able to sustain this increased output for a while, but eventually they will fatigue and complain of being overworked. The important thing to understand in this analogy is that the root of the problem isn’t the two people complaining of being fatigued; rather, their fatigue is the byproduct of the inadequacy of the other member’s performance. As you may have inferred, this theory can explain a myriad of scenarios, such as why a tight latissimus dorsi may cause ipsilateral medial elbow pain or hypertonicity of the psoas may cause ipsilateral hamstring strains, and Peter and I plan to write about those scenarios in the future.

 

Upward rotation of the scapula is the angle between the medial border of the scapula and the spine.

Bringing this back to baseball, we can imagine scapular upward rotation as being the lazy worker in the above analogy. Peter and I have assessed dozens of people’s scapular upward rotation and we’ve yet to see anyone present with full scapular upward rotation, which is about 55 to 60 degrees. So if scapular upward rotation should be 55 to 60 degrees and someone who can only get 40 is able to get their arms overhead, then they’re likely compensating in other places when they bring their arms overhead. If you’re a pitcher with insufficient upward rotation, then you’re relying on these compensatory pattern every time you pitch. Unsurprisingly, this phenomenon may account for many of the common injuries seen in pitchers. For example, the humerus may migrate superiorly in the socket during their delivery to compensate for the inadequate scapular upward rotation. The consequence of this compensation may be biceps tendon irritation because the biceps tendon is responsible for resisting anterior migration of the humerus. Again, in this scenario the biceps tendon is the victim, not the culprit. Other issues that may be caused by inadequate upward rotation are SLAP tears, since the humerus rides up on the superior rim of the glenoid, as well as  rotator cuff injuries. In all of these instances, the insufficient scapular upward rotation is the culprit, but the painful symptoms manifest themselves elsewhere. A pitcher might decide to ice the front of their shoulder to numb the pain, but they might not make lasting improvements unless they fix the underlying issue.

 

So how do you fix the underlying issue? In other words, how can you increase scapular upward rotation and thus decrease the stress on the rest of the body? First, you want to analyze a person’s resting posture. If they have a flat thoracic spine (which should have a natural kyphotic curve), then the positioning and movement of the scapula will be compromised, since the spine and rib cage dictate the position of the scapula. Thus, restoring a more “neutral” thoracic spine by promoting thoracic flexion may help. Some exercises I like for that are the All Four Belly Lift and PRI Wall Squat with Two-Arm Reach.

 

All Four Belly Lift

 

PRI Wall Squat with Two Arm Reach

 

It’s also important to assess the amount of upward or downward rotation of the scapulae with the arms at the sides. Even though we’re concerned about the end-range of scapular upward rotation, the start position of the scapulae can affect subsequent movement. A neutral alignment is approximately five degrees of upward rotation at rest. If the scapulae start in a positive of, for example, five degrees of downward rotation, then it’s a good bet that they won’t achieve the desired 55 to 60 degrees of upward rotation. Excessive downward rotation at rest may be due to tightness of the rhomboids. Performing soft-tissue work on the rhomboids with a foam roller or a lacrosse ball can help to improve this deficit.

 

Of course, I haven’t yet addressed the obvious solution: strengthening the upward rotators. The three upward rotators are the lower trapezius, serratus anterior, and upper trapezius. I’m worried that someone (e.g., meatheads) might interpret the previous sentence as a recommendation to perform tons of shrugs, since shrugs target the upper trapezius. Let me be clear: I’m not advocating doing shrugs. Instead, we want to strengthen the upward rotators in the positions that best integrate their functions and are specific to the ultimate goal, which is to improve the quality of shoulder flexion. My go-to exercises for this purpose are Wall Slide variations and Trap Raise variations. I usually categorize these exercises as activation drills, so I tend to perform them during the warm-up or at the beginning of the lift in order to improve positioning and movement before I perform higher intensity exercises. I especially like the Serratus Wall Slide with Valslide for recruiting the serratus anterior, which has the added benefit of improving both scapular upward rotation and thoracic flexion.

 

Wall Slides

 

Serratus Wall Slides with Valslides

 

Prone One-Arm Trap Raise

 

Low Incline Prone Trap Raise

 

Once someone has become proficient at some of the above exercises, I like to incorporate Yoga Push-Ups, Feet-Elevated Reverse Inchworms and Landmine Press variations. In addition to being excellent exercises for anterior core strength and general strength and hypertrophy, these exercises integrate the upward rotators as we want them to function. It’s important to perform an active reach at the end-range of the concentric movement to maximize upward rotation of the scapula. If you’re not reaching at the end of the concentric portion and are instead resting at the lockout, then you’re not reaping all the potential benefits of the exercises.

 

Feet-Elevated Reverse Inchworm

 

Yoga Pushup

 

Split-Stance Standing One-Arm Landmine Press

 

It’s also important to mention that just because you aren’t experiencing any pain when you throw doesn’t mean that your mechanics and movement are adequate. Instead, it’s better to take a proactive approach to training. Instead of waiting to change your program until you get injured, it may be better to determine whether or not your scapular upward rotation needs improvement and design your training based on these findings. A little bit of prevention can save a lot of potentially unnecessary suffering.

 

References

http://espn.go.com/mlb/story/_/page/rumblings120601/mlb-season-altering-injuries-just-keep-coming

  1 comment for “Don’t Blame the Victim, Part 1: Compensatory Movement, Overuse Injuries and the Importance of Adequate Scapular Upward Rotation in the Overhead Athlete

  1. October 19, 2014 at 11:53 pm

    Interesting read. I’m going to try some of this over the winter and see if it helps my hammer distance.

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