Armed and Dangerous Why ‘Overhand Athletes’ Are Prone to Shoulder Injury

No one ever called Curt Schilling a conformist.

Still, Dr. Jonathan Fallon said, sometimes it’s better to go with the crowd.

He spoke specifically of Schilling’s 1995 season as a starting pitcher for the Philadelphia Phillies, about seven years into his major-league career. After the team doctor instructed all the pitchers how to do a certain stretch in their shoulders, Schilling was the only one who decided to be noncompliant.

“He tore his labrum,” Fallon said. “Everyone else was just fine.”

Fallon, an orthopedic surgeon with Hampshire Orthopedics & Sports Medicine Inc. in Northampton, recently joined Andrea Noel-Doubleday, supervisor of Physical Therapy Services at Cooley Dickinson Hospital, to deliver a talk on the management and prevention of upper-extremity overuse injuries — in layman’s terms, the shoulder and arm injuries common to athletes who employ an overhand motion, such as pitchers, swimmers, and tennis players.

The program was intended for parents and coaches of young athletes in such sports, but the advice is applicable to anyone who taxes those muscles on a regular basis, Fallon said.

“It’s more than just pitchers who get these types of injuries,” he told the attendees at Northampton High School, noting that baseball and softball third basemen, shortstops, and catchers — all of whom throw the ball across the diamond — are susceptible, but not softball pitchers, who throw underhand.

“About 40{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of elite swimmers will have shoulder pain that requires orthopedic evaluation,” he continued. “And look at racquet sports — you can’t tell me this is a natural motion.”

Fallon discussed some common overuse injuries in the upper extremity, including rotator-cuff tear, labral tear, rotator-cuff fatigue, and valgus overload of the elbow, and spoke in general terms about the reasons why athletes who use a throwing motion are susceptible to injury. One reason has to do with the arc of motion of a typical throw, which pits more external motion against less internal motion in the joint; it’s a much more unnatural motion than an underhand softball pitch.

As for elbow injuries, much of the risk stems from the position of the elbow in space, which in turn has much to do with how the hips and trunk are positioned. “If you get the hips out too soon, you require the elbow to do more lateral rotation,” Fallon explained. “In truth, an elbow problem starts more centrally than that, with the core and the shoulder.”

Form and Function

Noel-Doubleday addressed what she called the ‘thrower’s paradox.’ Noting that the tremendous forces generated by a thrower place very high stress on the shoulder, she said the joint must be lax enough to allow excessive external rotation, but stable enough to prevent dislocation or other injury.

This can be achieved partly through proper form. She discussed scapular asymmetry, a condition in which the shoulder blades aren’t lined up — not an uncommon condition, but one that is often prominent in throwing athletes. By identifying asymmetry, a doctor or trainer can help identify muscle weakness that may exist, which can pose additional injury risk. The condition may be improved by targeted exercises.

After explaining the muscles used in the throwing motion and how they interact, Noel-Doubleday then introduced a series of exercises and stretches that such athletes may undertake to lower their risk of injury.

“Dynamic stretching, both before play and then again at the end, is important,” she said. “But you need to be stretching the right muscles.”

At the end of the program, an audience member asked about the benefits of exercising with a weighted ball, and Noel-Doubleday explained that throwers should work on their form and endurance, rather than building sheer arm strength, because that’s where consistent performance and injury avoidance begin.

For instance, she said she encourages players who want to weight train to start with lighter weights and strive to build endurance, not mass. “A lot of times, they’ll say, ‘this is so easy,’ and I say, ‘keep going. I’ll time you.’ After 30 seconds, they’re starting to get fatigued because they don’t have endurance in those muscles. They’re surprised how quickly they end up fatigued.”

Fallon agreed. “It’s not about strength, it’s about endurance,” he said. “If you’re using the weighted ball to strengthen your throwing motion, if you sacrifice the endurance and form for strength, it’s not going to be nearly as beneficial as creating a stable base and developing muscles that don’t fatigue over time.”

He noted that when pitchers run into trouble, it’s usually later in the game, when they’re tired and their endurance is taxed.

“Either they’re getting whiplash watching the ball go over the fence, or they get a sore shoulder,” he said. “You don’t want to sacrifice endurance. It’s not about building muscles; it’s more a skill than it is a power sport, whether it’s swimming or throwing that you’re talking about.”

Weight and See

Fallon concluded that overall core fitness will do more for throwing athletes than they sometimes realize because that’s what influences proper form when using the overhand motion.

“It’s all about the arc of motion,” he said. “You want core strength. It all begins in the middle. If you have a jelly belly, you won’t be pitching long. Unless you’re David Wells.”