Our last blog discussed the importance to an end of season shoulder evaluation. Most of us understand how the arm must be mobile and strong to be healthy to throw at a high level. However, part of this evaluation needs to include an assessment of the scapula, the thoracic spine, and general posture. This topic tends to be ignored as it is much more complex and less easily understood.
The scapula is a triangle shaped bone otherwise known the “WING BONE”. The scapula sits and glides on the back of ribcage otherwise known as the thoracic spine (the mid back). Unlike the shoulder, it is not a true joint – it does not have any fibrous attachments; it glides up and down, front to back, and rotates both upward and downward. It serves as the energy transfer between the power created by the legs to the arm. Power development begins with the legs exerting a force against the ground, and then is transferred through hips and core. This energy is then directed up the kinetic chain to scapula - shoulder complex and finally out the elbow, wrist and to the ball. It’s known that the legs and core can contribute approximately 50-55% of kinetic energy and force to the overhead throwing motion. The trunk and scapula muscular provide 85% activation needed to slow the arm down. The scapula is the “brakes” of the shoulder.
The scapula is unique as it needs to function stabilizer and as a mobile adapter. During throwing, the scapula must act as the stable base of support between the arm bone (humerus) and (thoracic) spine beginning with hand separation, while still allowing for the high degree of movement when the arm moves overhead to ball release. The scapula must move backwards (retract) to facilitate the cocking position followed quickly by moving forward (protraction) to achieve acceleration of the ball and subsequent deceleration of the arm. It also must coordinate arm elevation in sequentially smooth manner; to maintain proper space as the arm moves overhead in order not to impinge on the rotator cuff muscles. Think of the end of the scapula as the golf tee and the head of the arm (the humerus) is the golf ball. If the tee isn’t stable, good luck controlling the golf ball!
What keeps the golf ball on the tee? It is the force couple of the muscles to maintain the proper positioning of the ball and socket of the arm. In fact, 17 muscles attach to the scapula! Alteration in muscular length or strength in ANY of those muscles can become problematic for our throwers. It serves as attachment point for the ribs and anchors the scapula with numerous muscular attachments including the rotator cuff. Weakness in any of the scapular muscles can change create abnormal positioning and movement of the scapula. It is beyond the scope of this blog to understand them, however, collectively it is called scapular dyskinesis.
Scapular dyskinesis can be easily identified as it causes your shoulder blades to stick (like wings) out abnormally either during rest or with activity. The condition itself is usually not painful, but it can leave you at a greater risk of injury. Men between the ages of 18 and 25 are most likely to be diagnosed with scapular dyskinesis. A 2022 study suggest that collegiate baseball pitchers with dominant arm scapular dyskinesis likely are at increased risk of throwing-related shoulder injury. Poor movement patterns and/or deficits in muscle strength at the scapula can lead to uncoordinated movement, instability and pain/injury in the elbow, wrist, and hand as well
Common symptoms of scapular dyskinesis include:
Pain or tenderness around your shoulder blade, especially when you raise your arms overhead or lift something heavy
Feeling of snapping or popping that occurs with shoulder movement
Losing strength in your affected arm and shoulder
Changes in your posture; one side of your shoulder may sag down creating an asymmetrical posture
Shoulder blades sticking out and looking like wings
Assessment of scapula must be observed both at rest and with movement. At rest, we are looking at the overall posture of our throwers. An abnormal position at rest, will ultimately lead to poor movement patterns with movement. Adding a load (even a 5 oz ball is a load) only adds to the problem and over time this will hinder an athlete’s long-term development.
Poor posture creates a scenario where the head projects forward, the shoulders round forward and the natural curve of the mid back collapses. COVID has wreaked havoc on our athlete’s posture; increased sitting time, increased computer work, poor work stations, and a global decrease in activity.
When the normal curves of the spine are changed, this will limit the ability of the arms to fully reach overhead. As little as 5 degrees loss in overhead reach increases injury elbow injury by 2.8 times in baseball pitchers. Athletes who are not able to extend through the mid back will be unable to effectively allow the scapula to rotate and tilt, resulting in less overhead movement. This has an immediate impact on throwing athlete. This limits the players ability reach backwards to obtain the correct position to throw the ball; this not only effects the pitcher, but all position players.
Because most players either throw and bat from one side exclusively, there is an obvious tendency for some sort of postural imbalance. You can’t perform 5,000 right-handed throws and zero left-handed throws during a season and not expect your body to compensate in one way or another. Scapular position is determined by spine position. Rotation at the spine and rib dysfunction may need to be addressed in the off season by a physical therapist.
SO THE QUESTION IS?
If your student spends 6 hours a day like this.
How do they get into this position?
Training the muscle of the scapula can be a little tricky, a trained professional should be working with those who have scapular dyskinesis. The scapular muscles can be easily overpowered by the stronger muscles such as pects, lats, trapezius, and biceps (both heads of the biceps attach here!)
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-Watch your posture. Stand up tall. Keep you spine in neutral position. Use a wall if necessary.
ALIGNMENT before MOBILITY
MOBILITY before STABILITY
-Use your foam roll to stretch your spine and shoulders
-Watch your form. Make sure to squeeze your shoulder blades together not upward (shrugging)
-Use your body weight. Hand planks, forearm planks, push up position with 1 arm movements, bear crawls, downward dog
-Pull up/downs, if you can’t do this activity fully-get some pull-up assist bands
-Utilize pushing and pulling motions
-Ensure you have adequate mobility in the mid back. Often throwers are tight into movement opposite of their throwing arm
-Lay on your stomach or ball, it can help take advantage of anti-gravity strengthening
-Vary hand positions (palm up, palm down, and neutral position) this uses different muscles
-Remember to breathe, this helps your rib mobility!
-If weakness is an issue; one arm may need to be emphasized
Our last blog article in this series will discuss off season hip mobility.
STAY TUNED FOR OUR BIG ANNOUNCEMENT THIS WEEK!!!