5 Minutes of Manual Therapy for Pitchers… Priceless

5 minutes Top 1Over the last few years, I’ve done manual therapy on hundreds of pitchers. One day, my business partner walked up, saw what I was doing and said to me “Nunz, isn’t there a blog in here somewhere? There’s seems to always be a waiting line at the treatment table for this.”

So, this seemed as good a time as any to write about the importance of getting back the Internal rotation (IR) in order to keep shoulder range of motion in “top-notch” shape all year.

Note: This blog is meant to show you how we approach manual therapy, a much deeper form of soft tissue work. Please do not try these on someone unless you are qualified to do so. I will provide “do-it-yourself” versions after each example below.

A big part of what I do during the off-season (and after games in-season with my high school guys) is make sure that they come in so I can get my hands on them after an outing or a bullpen. This accomplishes a few things:

    • Monitor any tightness or pain (post-throwing)
    • Check shoulder and hip ER/IR (total range of motion)
    • Apply soft tissue (manual) therapy to the tight cuff muscles (subscap / teres major / pec minor, etc.)

The majority of pitchers I see generally need work on soft tissue quality.  I believe this is directly related to the cumulative trauma to the cuff musculature that has been left unattended for some time. After throwing, the posterior cuff can get tight causing the arm to lose as much as 10 degrees of IR, even after a single outing or a 30-count bullpen. If soft tissue work is neglected this lack of mobility can become cumulative over the course of a season, greatly inhibiting the ability to decelerate or slow the arm down after ball release.  In turn, this creates a “slam” or a “bang” on the shoulder and cuff which can also negatively affect velocity, location and most importantly total motion.  Left unattended this will ultimately increase the risk of injury.  Please see demonstrations below courtesy of Physical Therapist Mike Reinold:

MR Image

(Non-Throwing arm)            (Throwing Arm)

The shoulder is an already unstable joint so applying old school stretches such as the “sleeper stretch” (seen on almost every ball field in America) and the “cross body stretch” will create unwanted stress on the static stabilizers (such as the capsule) and put them into very provocative positions.  Ultimately this can end up doing more harm than good (McClure JOSPT 2007).

Sleeper Stretch - No

Sleeper Stretch “Just Say No!!”
Cross Body Stretch - No

Cross Body Stretch – “Ouch”

Manual Therapy

Manual therapy is a great way to improve tissue quality and get back that lost range of motion without physically maneuvering or putting the arm and shoulder into a provocative position. Today, we’ll look at two of the internal rotators that we work on to get back that IR after a game. Because these maneuvers should only be done by a qualified trainer, I’ve included “do it yourself” versions that don’t go quite as deep but can still make considerable improvements in regards to improving total motion.

Pec Minor – Any restrictions (shortening) in pec minor length will pull the scapula into a protracted (forward) and anterior tilted position, which has been shown to inhibit strength of the lower trapezius and decrease the subacromial space, negatively affecting the ability to “lay back”.

(Manual Release – Pec Minor)

Do it yourself version:

(SMR – Pec Minor)

Teres Major – The teres major acts as an internal rotator and adductor of the arm. As the teres major gets tight and shortened from overuse and throwing, you can start to see changes in the arms ability to get overhead.

(Manual Release – Teres Major)

Do it yourself version:

(SMR – Teres Major)

The Subscapularis – Subscap is the largest muscle of the rotator cuff allowing it the most IR force at 90 degrees. During the throwing motion the subscapularis helps depress the humeral head to prevent anterior migration of the humerus, but it also contributes to the act of throwing by providing some internal rotation power (pronation) for when your arm starts to rotate at ball release. As a result it can get a bit gritty and tight from throwing. Because of the deep location of the subscap, we do not provide a ”Do it Yourself” version to hit this one, nor do we recommend trying to do it yourself.

(Manual Release – Subscap)

I find that my athletes who come in during the season to work on arm care finish their season as strong as they started.

See ya’ in the gym…

By Nunzio Signore (BA, CSCS, CPT, NASM, FMS)

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