Bulletin of Orthopaedic and Neuromuscular Education Series

Problems in Overhead Throwing Athletes

As our children begin to get involved in team sports this spring, we’d like to take this opportunity to talk about the overhead throwing/hitting athlete! These athletes include players in sports like baseball, tennis, volleyball, and handball. As children are learning the form to strike, it is a crucial time to help them build the strength and range of motion they need in order to prevent common injuries in the overhead throwing athlete. 

 

The overhead throwing athlete could experience shoulder or elbow pain that could be related to these diagnoses:

  • Proximal humeral epiphysiolysis/Little League Shoulder (changes in a shoulder bone–the humerus–due to repetitive forces from throwing)
  • Shoulder strain (a tear in the shoulder muscles, like the rotator cuff)
  • Shoulder impingement (the tendons of the rotator cuff are pinched in between two shoulder bones–the humerus and the scapula)
  • Labral tear (a tear in the cartilage of the shoulder)
  • Ulnar collateral ligament tear (a tear in the elbow ligament)

 

In order to prevent these possible injuries, we created a basic and advanced routine to help. Start out with the basic routine, and then you add the advanced routine exercises in addition to the basic routine as the basic routine gets easier.

 

Basic Routine:

  1. Shoulder internal rotation at waist
    This exercise helps to increase strength in the rotator cuff muscles that assist with the follow-through motion of throwing.
  2. Shoulder external rotation at waist
    This exercise helps to increase strength in the rotator cuff muscles that assist with the wind-up motion of throwing.
  3. Prone row
    This exercise helps to increase scapular strength and stability to assist with the wind-up motion of throwing.
  4. Tricep extension
    This exercise helps to increase tricep strength to assist with the control of the follow-through motion of throwing.
  5. Wrist extension
    This exercise helps to increase wrist and grip strength to assist with holding the ball and controlling its release.

 

Advanced Routine:

  1. Diagonal pattern (D2) extension
    This exercise helps to increase strength in the several upper extremity muscles, while doing the follow-through motion of throwing.
  2. Diagonal pattern (D2) flexion
    This exercise helps to increase strength in several upper extremity muscles, while doing the wind-up motion of throwing.
  3. Shoulder internal rotation in 90-90 position
    This exercise helps to increase strength in the rotator cuff muscles, to assist with the strength for the follow-through motion of throwing.
  4. Shoulder external rotation in 90-90 position
    This exercise helps to increase the strength in the rotator cuff muscles, to assist with the strength for the wind-up motion of throwing.
  5. Push-ups
    This exercise helps to increase upper extremity strength and stability for the follow-through motion of throwing.

Frequently Asked Questions:

  1. When should I be concerned and contact Growing Bones?
    If you see any of the following: your child complains of pain in their arm, the pain is not improving over time, or you have other concerns about your child that is affecting their function with their arm.
  2. When should we stop doing the exercises?
    In order to keep gains that are created, it’s important to continue doing the exercises to help prevent issues–this includes before, during and after the season.
    When in-season, perform 1 set of 10 repetitions 1-2 days/week.
    When out of season, perform 2 sets of 10 repetitions 2-3 days/week.
  3. Is it better to keep my child in one sport all year round?
    It is best to allow your child to try different sports during different seasons. It’s important to allow your child to have time off between their sports to allow for recovery.
  4. What’s the difference between muscle soreness and pain?
    Muscle soreness has a typical pattern–you may start to feel the soreness 6 hours to a day later and it may last for 1-3 days. If you feel it during practice and it keeps you from continuing doing the practice or if you feel it longer than a few days, you may be experiencing an injury.

 

 

Citations

Cools AM, Johansson FR, Borms D, Maenhout A. Prevention of shoulder injuries in overhead athletes: a science-based approach. Braz J Phys Ther. 2015 Sep-Oct;19(5):331-9. doi: 10.1590/bjpt-rbf.2014.0109. Epub 2015 Sep 1. PMID: 26537804; PMCID: PMC4647145.

Lin DJ, Wong TT, Kazam JK. Shoulder Injuries in the Overhead-Throwing Athlete: Epidemiology, Mechanisms of Injury, and Imaging Findings. Radiology. 2018 Feb;286(2):370-387. doi: 10.1148/radiol.2017170481. PMID: 29356641.

Zaremski JL, Vincent KR, Vincent HK. Elbow Ulnar Collateral Ligament: Injury, Treatment Options, and Recovery in Overhead Throwing Athletes. Curr Sports Med Rep. 2019 Sep;18(9):338-345. doi: 10.1249/JSR.0000000000000629. PMID: 31503046.

Gokalp O, Kirmizigil B. Effects of Thrower’s Ten exercises on upper extremity performance: A randomized controlled study. Medicine (Baltimore). 2020 Oct 16;99(42):e22837. doi: 10.1097/MD.0000000000022837. PMID: 33080765; PMCID: PMC7571874.