Tag Archives: Pitching

How Effective is Internal Rotation Stretching?

 

I ask myself this question a lot when putting someone on a stretching program.

The most common injuries in baseball players involve the shoulder and elbow, and pitchers are more prone to these injuries than positions players (1). These injuries include SLAP tears, shoulder impingement syndrome, rotator cuff pathology, and Ulnar collateral ligament tears. Researchers that specialize in baseball injuries have found that it is common for pitchers to display a loss of internal rotation and a gain of external rotation in their dominant arm (2). This loss of internal rotation, or GIRD, has been proven to put a player at a much higher risk for injury that can sideline them and possibly require surgery (2,3). There have been several studies with both major league and collegiate players that have shown how beneficial stretching the shoulder can be in reducing the amount of shoulder internal rotation loss for a  (4, 5). However I often wonder if players can actual make changes to their range of motion that are significant and will last.

A significant study came out in 2008 that demonstrated the effects of the “sleeper stretch” immediately on shoulder mobility, however were unable to determine whether or not this would have lasting effects on injury prevention.

The Sleeper Stretch

There is much debate about what causes the change in shoulder mobility, however most people agree there is some component of soft tissue changes, and the defecit can be improved with stretching. A recent study looked at what the long term effects of stretching was on professional baseball players (5) They looked at players after 3 years of being in a stretching program and found them to have better shoulder mobility than those that had been stretching for less than 3 years. Those players were performing a few stretches DAILY for 3 years. Seems like a lot, I know. Their program was the following:1) passive internal rotation stretching 2) cross body stretch

Passive Internal Rotation Stretching

Cross Body Stretch with Scapula Stabilize

 

The most recent study demonstrated that the loss of internal rotation is neither permanent or necessary, and that ideally with stretching the player will maintain the gained external rotation with no loss of internal rotation. Although it may take up to years for these changes to become permanent.

Interesting.

Stick with the stretching boys.

 

House

REFERENCES

  1. Wilk, KE, Meister K, Andrews JR. Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports med. 2002;30(1):136-151.
  2. Bukhart SS, Morgan CD, Kibler WB. The Disabled Throwing Shoulder: spectrum of pathology. Part 1:pathoanatomy and biomechanics. Arthroscopy. 2003; 19(4): 404-420
  3. Dines, JS, Frank JB, Akerman M, Yocum LA.. Glenohumeral Internal Rotation Deficits in Baseball Players with Ulnar Collateral Ligament Insufficiency. Am J Sports Med. 2009; 37(3): 566-570.
  4. Laudner, KG, Spines, RC, Wilson, JT.  The acute effects of sleeper stretches on shoulder ROM. Journal of Athletic Training. 2008; 43(4) 359–363.
  5. Lintner, D, Mayol, M, Obinna, U, Jones, R, Labossiere, D. Glenohumeral Internal Rotation Deficits in Professional Pitchers Enrolled in a stretching program. Am J Sports Med. 2007; 35(4): 617-62

 

 

 

 

 

 

 

 

 

 

Vicente Padilla: Radial Nerve Injury

This is a rare occasion.

Yes, its true I’m going to talk about a Dodger, but only because I find his injury so interesting and something worth talking about. Padilla is a right handed pitcher that has been a starter / long reliever in the majors for over ten years. He has bounced around several teams in that time and also had a battle with injuries over his twelve year career.

His most recent bout of injury has intrigued me. In April of last year (I know this because I’m an uber nerd that keeps track of this kind of stuff), Padilla started complaining of forearm tightness and soreness in his pitching arm. Not an uncommon complaint of pitchers, however the tightness was enough that the Dodgers had to place Padilla on the DL and he was diagnosed with radial nerve irritation. He came back, but struggled with tightness and weakness the entire year, and only started 16 games for the Dodgers (good news for the Giants though… and Aaron Rowand)

This radial nerve irritation kept him sidelined into spring training this year, and in February he had a surgical release of the nerve. By April, he came back to replace the struggling Jonathan Broxton (he’s going to be a whole different blog….) as the dodgers closer, pitched a few games, and then was placed BACK on the DL again MAY 14th  with more “radial nerve irritation.”

The radial nerve passing through the Supinator muscle (Ss being the superficial and Sd being the deep heads of the muscle).

Just to give you a quick anatomy break down, the radial nerve runs through the deep muscles of the forearm, and splits right at the elbow into a deep branch (PIN) and superficial branch (SR). This is the most common site of nerve entrapment because the nerve has to run directly through the Supinator muscle. When the supinator gets inflamed, or overused with repetitive movements, it can compress on the deep branch of the radial nerve and cause severe pain and weakness in the forearm.

I guess the next question would then be; why or how does the Supinator muscle get inflammed? Well, supination of the forearm is the motion that brings your palm up towards you (like you are asking for soup is how I remember it), whereas pronation makes your palm face down. This is important because when pitchers throw a breaking ball (slider, curve, cutter…) his hand is supinated when the ball is released. The opposite would be true for a change up, where the ball would be released with the hand pronated. So he could have caused irritation in that supinator muscle by over throwing breaking balls. Possible. However, a lot of pitchers throw a lot of breaking balls and yet this is not a common injury. The other cause for a muscle getting overused, is the weakness of other muscles, causing one particular muscle to do the work, which is probably more likely his case.

The common treatment for pitchers is for a surgeon to make a small incision, find the place where the nerve has been getting entrapped, and simply make more room for that nerve so it isn’t being compressed. This is what they did with Padilla in February. Now, his nerve has been compressed for some time now (at least since last April), so its no surprise that even after surgery he continues to have problems with it, and had to go back on the DL. However, if he doesn’t address the cause of why this happened to begin with, he will continue to aggravate it no matter how much room they give that nerve.

Hope that makes sense.

By the way…..congrats to FC BARCELONA on the Champions League Title. Someday I will marry David Villa…just saying.

House