The importance of shoulder motion is the focus of our 3rd and 4th blogs in our 5-part series on injury prevention in throwers. Do we need a lot of shoulder motion and if so, in what directions? There has been a lot of discussion and research on this topic over the last 10-20 years in baseball. Previously though, it was thought that too much lifting would make an athlete too tight and thus it was recommended that baseball players should only stretch and limit lifting. Luckily, we have mostly dispelled those myths with most baseball players working on strengthening regularly. When it comes to throwing, there are 3 upper body motions that I tend to look at the most: shoulder external rotation; shoulder internal rotation and shoulder elevation (combination of flexion/ abduction). Let’s look at shoulder elevation to start.
Shoulder elevation is essentially the ability to raise your arm in front of you. We can measure it in multiple planes (front, side, diagonal). In a general sense, it assesses how tight or loose the Latissimus Dors or Lats are. Your Lats are large muscles visible as a V shape on your back, they wrap around the outside of your shoulder blade and attach under your arm. If you cannot raise your arm overhead fully (active motion) or if a clinician cannot raise it (passive motion) it indicates that your lats are tight and is a sign that you are at increased risk for a medial elbow injury such as a UCL sprain (Tommy John ligament). It is usually the first motion I check when someone complains of medial elbow pain. Lat tightness will generally contribute to a drop in your elbow when pitching and throwing, thus putting more stress on your elbow. Tightness in your Lats can occur for multiple reasons including poor core stability, poor breathing patterns, and weakness in the hips. It can also occur due to poor scapula position and strength. Stretching your Lats is generally a good idea to keep your shoulder healthy, but it is important to find the cause of the tightness before it contributes to an injury.
I’m not a big fan of pull ups or dead arm hangs for throwers as this increases tension in the Lats and can also increase Lat tightness. One easy way to stretch your Lats is to do a modified hang with your arms overhead and keep some of your weight on the floor. You should feel a stretch under your arms and hold for extended period of time while you are slowly breathing.
Baseball and softball players can usually stretch this by holding on to the top of the dugout or if at a gym, you can use a pullup bar. Incorporating Lat stretching and preventing Lat tightness is an important component of prevention, performance and rehab in all throwing athletes.