Arm Care for Pitchers… Bullet Proofing the Shoulder

Arm Care - Part 1 Top Joint Image

Imagine this, a pitcher’s body that throws a baseball at 80-90+ mph achieves that speed from hand break to finish in 1.5-2 seconds.  That’s comparable to some of the fastest Italian sports cars out there.  Given the nature of this explosive movement, arm care for pitchers has to be at the top of list for every athlete.  However, I think a lot of folks don’t totally understand how to go about it. In this article, we are going to give it a try by discussing the shoulder and how we attempt to bullet proof it through our training programs.

When talking about arm care for pitchers, arm strength and endurance, it’s not just about strengthening each shoulder cuff muscle individually – we have to look at movement as a whole.   Here are 5 different areas that need to be addressed when attempting to bullet proof the shoulder.

    1. Improving Rotator Cuff Strength
    2. Improving Cuff “Firing” Time
    3. Improving Scapular Stability
    4. Mobility in the Thoracic Spine
    5. Proper Breathing Patterns

Let’s take a deeper look into, not only what these points mean to athletes in regards to arm care, but some things we can do from the training side of things to improve performance and help prevent injury. I’ll try and keep the anatomy lesson down to a minimum.

1. Improving Rotator Cuff Strength

The importance here is that we ensure that each of the individual rotator cuff muscles are strong enough independently so that they can help contribute to overall shoulder health.  First let’s meet the “Big 4” and talk a little about their roles.

A. The External Rotators (Infraspinatus, Teres Minor and Supraspinatus)

What they do: The Infraspinatus and Teres Minor make up the posterior cuff, which enables them to produce external rotation, which in-turn (assuming there is no tightness in the int. rotators such as the lat and Teres major), allows you as a thrower to get your arm into external rotation or the “lay back” (gas) position. They also provide compression to the glenohumeral joint in order to resist both superior and anterior migration. Two major culprits of impingements and labral tears.

Arm Care - Part 1 Image 3

Strengthening Exercises for Infraspinatus and Teres Minor:

    • Side Lying ER @ 30 Degrees of Abduction
    • Band “No Money” Drill
    • ER @ 90 Degrees

Training Note: The Side Lying External Rotation with the Arm at Zero Degrees of Abduction does the best job of the three.  Adding a towel between your rib cage and arm allows you to perform the exercise with perfect technique since it provides immediate feedback (thanks Mike Reinold!). The addition of the towel increases the effectiveness of this exercise by 20-25% as indicated by EMG feedback from both the infraspinatus and teres minor (Reinold et al. 2004).

(Side Lying ER at 30 Degrees of Abduction)

The Supraspinatus, while it is an external rotator, also helps initiate the first 30 degrees of horizontal abduction (raising the arms overhead).

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Strengthening Exercises for the Supraspinatus:

    • Band Scaption
    • Prone Trap Raise

Training Note: Another name for the Band Scaption is the “full can”, I much prefer this to the “empty can” mainly because of the provocative position the latter places the shoulder in.                                                   

(Band Scaption)

B. The Internal Rotator (Subscapularis)

What it does: The Subscap is the largest muscle of the rotator cuff allowing it the most internal rotation 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.

MLB Baseball - Philadelphia Phillies at Houston Astros - April 11, 2010

Strengthening Exercises for the Subscap:

    • IR @ 90 degrees of Abduction – Because it’s done at 90 degrees, this exercise has the benefit of not having the bigger internal rotators like the pecs and lats take over, allowing you to target the subscapularis specifically. But be careful with form, this position isn’t as stable compared to the others.
    • Serratus Jabs – I love this one because it not only works on IR (subscap), but it hits the serratus (a major stabilizer we’ll be getting into in Part 2 of this series).

(Band Serratus Jabs)

Training Note: Of the rotator cuff muscles, the subscap is the least likely to be weak due to its size and the fact that it gets used every time you throw – so be sure that you hit the other rotator cuff muscles prior to training the subscap.

2. Improving Cuff “Firing” Time

As a baseball player, you need the rotator cuff to dynamically stabilize the head of the humerus (arm) so that it stays in the glenoid fossa (socket). Not only do we need them to stabilize the humeral head, we need to work on how quickly they do it. The bottom line is, even if you have strong cuff musculature, if they fire slowly, your arm is still going to impinge and end up like this guy.

Arm Care - Part 2 Image 3

Here are some exercises to improve firing time of the cuff.

Great Exercises to Train Firing Time:

(Half Kneeling Shoulder Stabilization)

(Band Distractions)

3. Improving Scapular Stability

If the scapula is not sitting securely on the Thorax (ribcage), then the individual strength of these muscles doesn’t matter. The scapula must be in the right position and provide a strong stable base of support for the rotator cuff muscles to function properly. If not, it’s like trying to shoot a cannon from a canoe.

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There are many muscles that have some type of connection with scapular stability; some have a tendency to become “tight” pulling the scapula out of position causing others to become “long and weak”, allowing for a displaced scapula.

Tight – These are some common muscles that get tight, requiring them to be treated with manual therapy and/or SMR (LAX ball/foam rolling) to help improve tissue quality:

      • Pec Minor
      • Teres Major
      • Latissimus Dorsi (only some of the fibers attach but it’s a good to work on anyways)
      • Upper Traps
      • Levator Scapula

(Pec Minor)

(TRX Deep Squat Breathing)

Long and Weak – The following are some common muscles that need to be strengthened:

    • Trapezius
    • Serratus Anterior

Trapezius – The typical pitcher will lose upward rotation over the course of a season. The Trapezius muscles are a common group that need to be strengthened in order to “re-educate the scapula to upwardly rotate.. They can be divided into an upper, middle and lower portion because the fibers run at different angles and do different actions.

    • Upper Portion – upward rotation and elevation (shrugging motion)
    • Middle Portion – retraction – pinching your shoulder blades together
    • Lower Portion – upward rotation and downward depression

The mid and lower traps are going to be the part of the traps that we are going to focus on the most because they help tilt our scapula posterior-ly as well as external rotation during arm elevation which decreases the chances of a sub-acromial impingement injury.

Exercises for Strengthening the Mid and Lower Traps:

(Band No Money)

(TRX Inv. Row)

Serratus Anterior – The Serratus is another muscle that needs strengthening. Its action is to pull the scapula forward and around the rib cage (protract) – basically, pulling your shoulder blades apart. It also holds the scapula against our rib cage allowing better scapulothoracic movement when trying to get over head. If this muscle is weak, we can sometimes see what is referred to as “winging” from the rib cage, creating sub-optimal movement. A great exercise for the strengthening the serratus anterior are forearm wall slides.

(Forearm Wall Slides)

4. Mobility in the Thoracic Spine

T-spine mobility is imperative for optimal performance as well as avoiding injuries. A kyphotic (rounded) t-spine will not allow the scap to adequately upwardly rotate and in turn, create an “impingement” which can ultimately lead to cuff and labral tears. Likewise, a lack of t-spine rotation can also lead to a whole host of problems such as limiting external rotation while laying back and internal rotation to help decelerate after ball release which can cause problems at the elbow as well.

Microsoft PowerPoint - Arm Care… 5 Musts - Part 3 - Image 3 - 4

The big take away here is that you must work on improving both t-spine extension and rotation. Here are two great ones.

Exercises for Improving T-spine Mobility:

(Quadruped T-Spine Mob.)

(T-Spine Extension)

5. Proper Breathing Patterns

Breathing could be an entire blog in itself. It’s the next frontier in do-it-yourself mobility for the shoulder. We all do it, all day every day, but if we aren’t breathing through our diaphragm (which is most of the athletic population) and instead are breathing into our chests, the rib position displaces the scapula from its proper place. This ultimately can lead to poor scapular upward rotation, excessive tone in the lats and closing down the acromial space causing alignment issues, restricting mobility and possibly causing impingement issues at the shoulder.

Certain breathing drills such as the one below can help deliver quick results in terms of improving shoulder internal rotation (without actually stretching the shoulder, a joint that doesn’t really like to be stretched in the first place). This is especially true in pitchers who are generally already too loose (laxity) in that area to begin with.

(90/90 Hip Shift w/ L. Reach)

Note: Don’t use provocative stretching drills like the one here to fix an alignment issue.

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Use the one below. It’s much easier on the anterior (front) part of the shoulder.

(Side Lying Cross Body Stretch)

See ya’ in the gym…

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