Sport Specific Injuries: Baseball

Extreme range of motion and tremendous force generation are necessary to perform the overhead throwing motion which places great stress on the shoulder/elbow joint and surrounding structures thus increasing the likelihood of injury. Common injuries seen in the baseball/softball athlete are listed below.

Rotator Cuff Tendonitis - The rotator cuff is a group of four small muscles that form a cuff around the upper part of the humerus (upper arm bone) and act as a primary stabilizer of the inherently loose shoulder joint. Due to both the high force produced and the repetitive nature of the throwing motion, injury to this vital structure is common. Tendonitis can be caused by repetitive overstress to a tendon or overstrain to the tendinous fibers causing an inflammatory process which will cause pain and limit function. Treatment often includes rest, anti-inflammatory measures (ice, physical therapy modalities or medication prescribed by your doctor), stretching and strengthening activities for the muscles of the rotator cuff and shoulder blade stabilizers to restore normal joint function. Addressing any biomechanical cause that may be present which can be identified by your doctor, therapist or athletic trainer is crucial in the prevention of chronic or recurring problems.

Rotator Cuff Tears - Overload to the tendon to the point of rupture, trauma or untreated chronic tendonitis can lead to failure of the rotator cuff structures. Due to the relatively poor blood supply to the rotator cuff structures and repetitive strain with daily activity a tear of the rotator cuff will not heal on its own. Therefore, surgery is often indicated to restore pain free function especially in the athletic population. Significant rehabilitation and healing time is necessary post-operatively and gradual reintegration into activity is required at the appropriate time after surgery. Post-operative care will be directed by the sports medicine team.

SLAP Tear – A SLAP (stands for Superior Labrum Anterior to Posterior) Tear is a disruption of the cartilage in the shoulder. There are several types of SLAP tears possible and will be diagnosed by your doctor. The most common in the overhead athlete involves the bicep muscle as it attaches to the top part of the shoulder joint and labrum(cartilage). Overload will pull the labrum away from the bone which will result in a decrease of joint stability and lead to pain and disruption of function. Surgery is also often indicated in this instance as well. Again, significant rehabilitation and healing time is necessary post-operatively and gradual reintegration into activity is required at the appropriate time after surgery. Post-operative care will be directed by the sports medicine team.

GIRD – GIRD stands for glenohumeral internal rotation deficit. This is a loss of range of motion common in the overhead athlete which can develop without proper stretching activities. Loss of internal rotation motion due to tightness which develops gradually in the back part of the shoulder capsule will lead to altered mechanics of the shoulder during the throwing motion culminating in pain and loss of function. Treatment includes rest, anti-inflammatory measures (ice, physical therapy modalities or medication prescribed by your doctor), posterior capsular stretching and strengthening activities to restore normal joint function. The sleeper stretch is especially important in the correction of GIRD which will eliminate the localized tightness and allow pain free return to functional activity.

SICK Scapula – SICK scapula is an overuse muscular fatigue syndrome causing alteration of the resting position of the scapula which alters upper extremity mechanics leading to eventual pain and limitation of function. Decrease in muscle function gives the appearance of the shoulder blade of the throwing shoulder being lower than the non-throwing shoulder and will often involve complaints of “dead arm” feeling with throwing activities. Treatment includes rest, anti-inflammatory measures (ice, physical therapy modalities or medication prescribed by your doctor), stretching and aggressive strengthening activities for the muscles which stabilize the shoulder blade in a program designed by your physical therapist or athletic trainer.

Medial Epicondylitis – The muscles that flex the forearm attach at the inside aspect of the elbow. Overuse or overstrain will result in an inflammatory process in the common flexor tendon causing pain at the medial elbow and limiting function. Treatment often includes rest, anti-inflammatory measures (ice massage, medication prescribed by your doctor), forearm and shoulder stretching, forearm and shoulder strengthening activities, cross friction massage and other inflammatory control modalities such as iontophoresis which can be administered by your physical therapist. Medial epicondylitis can also be accompanied by ulnar collateral ligament sprain which will be addressed by your physical therapist as well.

UCL Tear – Overload of the ulnar collateral ligament can result in failure and tearing of the ligament producing pain and instability of the elbow joint limiting function. Surgical repair is indicated in this situation. The “Tommy John” procedure requires significant rehabilitation and healing time post-operatively. Gradual reintegration into activity is required at the appropriate time after surgery. Post-operative care will be directed by the sports medicine team.

Considering the chain of motion that takes place from the ground to the hand involving the entire body, proper training techniques for the upper extremity, core and lower body are necessary to minimize the risk of the injuries described above. For more information on these injuries or to learn about our baseball/softball specific training programs (available for review in our baseball retail store) which can aid in the prevention or rehabilitation of these injuries please contact Adam Kerley PT, ATC, CSCS at contact@championsportstraining.com or at Champion Sports Training 865-454-2876.