Why Shoulder Injury Prevention Programs Are Failing
May 6, 2013 | Tony Gentilcore
With the competitive baseball season now officially underway, it's a safe bet that many athletes are looking to keep their bodies healthy so they can stay on the field and perform at a high level.
To say it's a long season would be an understatement. We can highlight several areas that relate to baseball players, but let's be honest: it's all about arm care. Which makes sense, because throwing a baseball isn't remotely "healthy" for anyone's arm. The arm is placed under a tremendous amount of stress with every pitch off the mound or throw from the outfield.
As an example, the force of each throw yields roughly 7200+ degrees of internal rotation (the equivalent of 20 full rotations!) in the shoulder. In addition, in the layback position—where the lower arm is parallel to the ground, just before the ball is released—the valgus stress placed on the elbow is analogous to hanging a 40-pound dumbbell on a string from the wrist to the ground. Ouch!
Suffice it to say, if you don't take care of your arm, a lot of bad things can happen.
At Cressey Performance, I work with many overhead athletes, especially baseball players. It's no coincidence that we deal with, address, work around and (hopefully) fix a lot of shoulder issues, ranging from the acute (e.g., external or internal impingement) to more "oh crap" scenarios (e.g., shoulder separations and post-surgery situations).
The word "acute" is not meant to downplay things like impingement, as anyone who's had to deal with a chronic case might think. Rather, it's to put things in perspective. Some shoulder pathologies require more attention and TLC than others.
But here's the rub: what does it mean to follow an "arm care" program?
To the point, I'll answer the question with a fantastic quote from physical therapist Eric Schoenberg, of Milford, Mass. "If you throw with just your arm, then do an arm care program."
In short: if you're working only on "shoulder and arm care," you're missing the big picture. It's a garbage term, and it really doesn't shed light on the fact that in order to throw a baseball efficiently, let alone hard, you must involve your entire body.
Similarly, I remember reading an article by renowned strength coach Mike Boyle regarding "ACL prevention programs." That term is also a misnomer. What is an ACL prevention program, anyway? At the heart of the matter, any properly designed (and progressed) program should take care of that. If you regularly assess your knee, address postural deficiencies and muscular imbalances, place a premium on posterior-chain strength and core stability and learn proper deceleration mechanics, then in theory, you're "preventing" ACL injuries. There really is no magic formula.
The same can be said about upper-body training, and in particular, preventing shoulder injuries.
Thinking that an "arm care" program that depends solely on how many band external rotations can be squeezed into a five-minute crapshoot completely misses the point. Never mind that fatiguing the rotator cuff with dozens (if not hundreds) of repetitions of band exercises on a daily basis—or worse, right before a bullpen session or a game situation—isn't the smartest thing to do (since research has consistently shown that it promotes impingement syndrome). It doesn't take into consideration that the body is an advanced "kinetic chain," and that throwing a baseball involves much more than just the shoulder.
Regardless of that logic, consider that most guys absolutely butcher technique, compensating with lumber hyperextension, forward head posture and other no-no's, which defeat the purpose of performing shoulder exercises in the first place.
You'd be surprised by how many players who live and die by their "arm care" programs (usually consisting of band work) have rotator cuffs weaker than a wet paper towel.
When it comes to keeping the shoulder healthy (and athletes on the playing field), there's a whole host of other things to consider that I'd argue are more important:
- Thoracic spine (mid-back) mobility.
- Rotator cuff strength. Is it up to snuff? HINT: Almost never. Despite doing band work until they're blue in the face, most guys do it wrong.
- Scapular (shoulder blade) stability. For many, it's less than great, and 99% of the time, a "shoulder issue" can be directly associated with the scapulae not being optimally positioned or aligned. If that is the case, force production is compromised. It's like shooting a cannon from a canoe.
- Exercise technique on basic things such as Push-Ups and Rows. If it's not solid, there could be serious injury ramifications. You'd be surprised how many professional athletes can't do a Push-Up properly, let alone for a certain number of repetitions.
- General programming parameters? Are you doing too much pressing as opposed to pulling? Are you doing a lot of (straight bar) back squatting, which places the shoulder in the "at risk" position? What about overhead exercises? Should you even attempt to perform anything overhead?
- Other things like acromion type, soft tissue restrictions and breathing patterns. All undoubtedly come into play insofar as the shoulder is concerned.
Let's address the big, pink elephant in the room: band work. I'm not adamantly opposed to it. I just don't feel it's the end-all, be-all component of "arm care" programs.
As I alluded to above, training the rotator cuff to fatigue increases superior humeral head migration. (For those not up to snuff in their geek speak [don't worry, I'm not judging], when the rotator cuff is fatigued, the humeral head [part of the arm bone that attaches to the shoulder] shifts upward towards the acromion process [the upper part of the shoulder blade that helps to form the shoulder girdle], increasing the likelihood of shoulder impingement.
So contrary to popular belief, all of those 50- to 100-rep sets of band external rotations you're doing—poorly—to keep your shoulder "healthy" are not doing you any favors. In fact, you could be doing more harm than good.
What's more, training the rotator cuff in this fashion doesn't really take into account its true function—especially in the context of throwing a baseball. If we were to open an anatomy book and look up the main actions of the rotator cuff muscles, we would see things like:
- Internal and external rotation of the shoulder
- Elevation of the arm in scapular plane
- And maybe, if we're lucky, it would say something about humeral depression
If I didn't lose you with more anatomy talk, these aren't inherently wrong, and they do describe the roles of the rotator cuff. And shockingly enough, they dictate how most baseball players go about structuring their arm care programs.
But that's just a piece of the entire picture. The main function of the rotator cuff is to keep the humeral head centered on the glenoid fossa. Translation: what we don't want is for the humeral head to rattle around the glenoid fossa like a marble in a bottle. It needs to stay centered, even during excessively dynamic activities like throwing a baseball.
To that end, your garden-variety band external rotation exercises aren't ideal. Instead, incorporate rhythmic stabilization exercises like the following:
- Assume all fours position.
- Place one hand on a medicine ball.
- "Pack" your shoulders by pulling them down and back.
- Have a partner kneel next to you and gently tap your arm for roughly ten seconds.
- Resist the tapping and keep the joint centered as much as possible. (The key word here is gently! There's no need to go all Mr. Miyagi and try to dislocate something.)
- Shoot for 2-3 sets of 10-15 reps on each side (you do have two shoulders even if you only throw with one) as part of a general warm-up before throwing.
This is a great addition to any strength training program. Perform it two to three times per week, especially in-season.
Everyone—not just baseball players—needs appropriate upward rotation and full shoulder flexion/abduction to get their arms over their head. And they must be able to do this with a neutral spine (no compensating). But for any number of reasons, most people have really poor core strength, stiffness or control; and their lats, for lack of a better term, are all "gunky"—or, to get scientific, they lack length.
We need ample core stiffness (and lat length) in order to get our arms over our heads, especially if we're expected to throw a baseball repeatedly.
So with that in mind, here are some other drills to focus on:
This is an excellent drill that loosens up the lats and the long head of the triceps. It also promotes t-spine extension.
- Kneel down and prop your elbows on a bench.
- Grab a broomstick or a piece of PVC pipe.
- "Rock back" onto your heels and "dip" down so that you feel a nice stretch in your lats.
These help promote more posterior pelvic tilt, increase lat length and teach you to keep your rib cage down as you extend your arm and opposite leg. Use the floor for feedback, and make sure your lower back stays flat the entire time.
These do an amazing job of creating more anterior core stiffness, while simultaneously promoting lat length.
In this fantastic tutorial (video above) by my business partner, Eric Cressey, he explains some of the core progressions we use with our athletes and discusses some common mistakes.
These are similar to Rollouts, but more advanced for those who want more of a challenge.
All of this is not to say that what you're currently doing to keep your arm healthy is wrong, but rather to inform you that there's more than one road to travel to any given destination.
As a strength coach, I'm a bit biased. I think it's still important to get strong and to strengthen your active restraints (muscles) to take some of the burden off your passive restraints (soft tissue like labrums, ligaments and tendons).
Much like Boyle's ACL rant, an "arm care" program should be much more comprehensive than performing random band exercises, crossing your fingers and expecting it to cover all your bases. That's a delinquent mindset. I hope this article has piqued your interest, and that it has helped you understand that taking care of your arm is more comprehensive than we've been led to believe.
Photo: USA Today