12U pitcher with shoulder pain

My son will be 12 next week and has recently started to complain about shoulder pain when pitching. FYI…he has not pitched much in the past due to control problems and does not even touch a baseball from August until January. In addition, there is no lingering pain…it is only while he is pitching which is why I feel confident that it is not an injury but a flaw in his delivery that is causing problems. I am not in to checking his velocity with radar guns or anything but when he attended tryout last fall for his current team…they said he was consistently at 64 with top end of 66. Any help/advice would be greatly appreciated.


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What does he do to warm up?

Ed

Trying to diagnose pain issues is difficult next impossible. Every individual has a different physical makeup in terms of mobility, range of motion, connective tissue, etc., etc. His pain could simply be due to his physical makeup (shoulder complex).

That being said what stood out to me is his very high elbow slot (I don’t like to use arm slot because I think the path the elbow more accurately describes the motion). There’s nothing wrong with a high elbow slot IF the body (posture) supports it. I don’t see the postural support that I would like to see in your son’s delivery.

Your son has very good extra rotation (looks like almost 180°). This poses the potential for subluxation of the shoulder joint i.e. the head of the humorous wants to move out of the glenohumeral joint. It’s possible that the high elbow slot i.e. elevating the shoulder complex aggravates this.

Something else you mentioned with regard to your son not picking up a baseball from August to January. There have been a number of studies that show that continual throwing of young players creates physical adaptations such as increased range of motion due to actual structural changes of humorous. And it’s speculated that these physical adaptations are what allows more mature pitchers to not only throw harder but to minimize the risk of injury.

This is not to say that players should throw to the extent of creating overuse injuries. It simply means that as would exercising three times a week create a change in the physical mass of muscle so would it create changes in connective tissue and bone structure. In other words continual stress and in this case I’m talking about a positive stress i.e. stress that doesn’t lead to overuse injury will create physical adaptations.

I’m glad you provided some velocity numbers because I would expect your son to have a very good velocity with the amount of extra rotation that he creates. I also believe that with some adjustments in terms adjusting the body posture to better match his arm slot that he could easily add another 5-7 mph and reduce the amount of stress on the shoulder.

Again some educated speculation/guesswork.

[quote]Shoulder Instability

Injuries > Shoulder > Shoulder Instability

(Also known as Anterior Instability, Posterior Instability, Inferior Instability, Multidirectional Instability, Recurrent Subluxing Shoulder)

What is shoulder instability?

Shoulder instability is relatively common condition characterized by loosening of the connective tissue (ligaments and joint capsule) surrounding the shoulder joint therefore enabling the bones forming the joint to move excessively on each other.

The shoulder joint is a ball and socket joint. The shoulder blade gives rise to the socket of the shoulder, whilst the ball of the shoulder arises from the top of the humerus (upper arm bone). Surrounding the ball and socket joint is strong connective tissue holding the bones together known as the shoulder joint capsule (figure 1) and its associated ligaments. In addition, a group of muscles known as the rotator cuff cross the shoulder joint and collectively help to hold the shoulder joint in position increasing the shoulder’s stability.

During certain movements of the arm (such as throwing or falling on an outstretched arm), stretching forces are applied to the shoulder joint capsule and ligaments. When these forces are traumatic or repetitive enough, stretching or tearing of the connective tissue may occur. As a result, the connective tissue supporting the shoulder may become loose and unsupportive, allowing the joint to move excessively and resulting in an “unstable” joint. This condition is known as shoulder instability and may result in the upper arm bone (humerus) moving subtly or completely out of the socket during certain arm movements (subluxation or dislocation).

Shoulder instability normally presents in one shoulder. Occasionally, however, it may exist in both shoulders, particularly in those patients who have general ligament laxity (i.e. loose connective tissue), or in those patients who perform repetitive overhead activities on both sides of the body (such as swimmers).
Causes of shoulder instability

Shoulder instability most commonly occurs following a traumatic incident that partially or completely dislocates the shoulder (such as a fall onto the shoulder, or outstretched hand, or, following a direct blow to the shoulder). This frequently occurs in contact sports such as rugby or football (Australian rules). The usual movements involved are a combination of shoulder abduction (side elevation) and excessive external rotation (outer rotation of the humerus) (figure 2).

Shoulder Instability may also occur gradually over time (atraumatically) due to repeated stresses to the shoulder joint associated with repetitive end of range shoulder movements (such as throwing or swimming). This may occur in association with abnormal biomechanics such as poor throwing technique or a faulty swimming stroke and commonly occurs in sports requiring repeated overhead activities such as baseball pitchers, javelin throwers, cricketers, swimmers and tennis players.

Occasionally, shoulder instability may be associated with generalized ligamentous laxity throughout the body. This may be something that is present from birth and is commonly referred to as being ‘double jointed’.
Signs and symptoms of shoulder instability

Patients with shoulder instability may experience little or no symptoms. In atraumatic shoulder instability, the first sign of symptoms may be an episode of the shoulder subluxing (i.e. partially dislocating) or shoulder pain or ache either during, or following, certain activities.

In post-traumatic shoulder instability the patient usually reports a specific painful incident that caused the problem. Commonly the shoulder will have dislocated or subluxed, often with the arm in a position of combined abduction and external rotation at the time of injury (figure 2). Following this incident, the patient may experience pain during certain activities or after these activities with rest (especially at night or the next morning). The patient usually reports that the shoulder has never felt the same since.

Patients with shoulder instability will often notice a clicking, clunking or popping sensation within the shoulder during certain movements. There may be a loss of power in the affected shoulder and a feeling of weakness during certain activities (e.g. overhead activity). Patients may also experience tenderness upon firmly touching the front or the back of the shoulder joint and a feeling of apprehension that the shoulder may dislocate with certain end of range movements (particularly the combination of abduction and external rotation) (figure 2). Patients may also experience pain or a sensation of the shoulder joint moving out of place when sleeping on the affected side.

In severe cases of shoulder instability, patients frequently experience recurrent episodes of subluxation or dislocation of the shoulder. This may be associated with shoulder pain and occasionally, a ‘dead arm’ sensation which typically resolves after a few minutes rest. In these instances or in patients with multidirectional instability, the patient may be able to voluntarily sublux or dislocate the shoulder. In more severe cases, relatively minor activities such as yawning or rolling over in bed may result in a subluxation or dislocation. [/quote]

There is possibly a more probable reason for your son’s discomfort, rotator cuff impingement:

[Quote ]Rotator cuff is a common source of pain in the shoulder. Pain can be the result of:

Impingement. When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against (or "impinge" on) the tendon and the bursa, causing irritation and pain.[/Quote]

Thanks for feedback Coach. I just sent you a pm.

@Ed…we do a thorough warmup (I have a grad degree in exercise science) including some static stretching along with dynamic/mobility work.

He is stressing his shoulder because his rhythm is off. His rhythm is off because he is TRYING to stride to far. Have you been working on long stride? Thats why his accuracy is off.

I am speaking from personal experience. I have a Master’s in Computer Science - my coursework doesn’t apply here :smiley:

I have subluxation and had a high arm slot and had a partial rotator cuff tear after many years of pitching. I used to work out in the gym with free weights and had to stop bench pressing to avoid pain in the shoulder.

With my son, we adopted band work and other exercises from a combination of sources (Nyman and Wolforth) and my son is pain free. He complains occassionally but this is usually after he’s thrown several days in a row.

What do you do to warm up? We start with band work and these other exercises before even touching a ball. Then start by throwing from a short distance and get progressively longer. I know you have a degree in exercise physiology etc but I’ve seen many pitchers/players who start throwing too hard too soon and from too long a distance.

You said he shuts down from August until January. Is it possible he went too fast too soon?

Ed

[quote=“oldman”]I am speaking from personal experience. I have a Master’s in Computer Science - my coursework doesn’t apply here :smiley:

I have subluxation and had a high arm slot and had a partial rotator cuff tear after many years of pitching. I used to work out in the gym with free weights and had to stop bench pressing to avoid pain in the shoulder.

With my son, we adopted band work and other exercises from a combination of sources (Nyman and Wolforth) and my son is pain free. He complains occassionally but this is usually after he’s thrown several days in a row.

What do you do to warm up? We start with band work and these other exercises before even touching a ball. Then start by throwing from a short distance and get progressively longer. I know you have a degree in exercise physiology etc but I’ve seen many pitchers/players who start throwing too hard too soon and from too long a distance.

You said he shuts down from August until January. Is it possible he went too fast too soon?

Ed[/quote]

Sorry Ed…was not trying to throw my degree around. We use J-bands (Jaeger) and a combination of static and dynamic/mobility work (use a lot of stuff from guys like Cressey). We then use a progressive throwing program. I don’t think the pain that he was experiencing was due to layoff as I would expect that to be more soreness then anything else. We actually threw last night but made some changes based on the feedback here and a couple of local guys and he had no pain but a little post throwing soreness. We just had him pitch using the pause/balance drill with his arm in the high-cock position. It is obviously going to take some time because as soon as he tried to go from windup…shoulder hurt and I could tell that his upperbody was behind his lower body or as Plaz said…his rhythm was off.

Thanks for taking the time to comment Ed.

Larry

No problem… we’re all here to hopefully share ideas and help one another.

As a precautionary measure you may want to visit an orthopedic doc…

I don’t know enough about Cressey… have to do more research there, I think he’s alot about using Olympic lifts to make pitcher stronger.

Good luck,

Ed

Paul,

Would you mind commenting on what you see in the way of scap loading?

Thanks!

[quote]Paul,

Would you mind commenting on what you see in the way of scap loading?[/quote]

From the two clips posted. What “I see”.

He gets very little out of the early part of his windup, from initiation to high cocked position. And of course some of you know that I have little or no use for going to the high cocked position because it disrupts the flow of the delivery.

I see very little scapula loading again I believe part of the reason is because of going to the high cocked position and then “stalling there”. There is some scapula action as the shoulders begin to rotate but it’s not an active scapular action it’s the result of the inertia of the arm dragging behind the shoulder. Which is also potential issue with respect to shoulder discomfort i.e. tending to want to hyper flex the shoulder joint.

And then the worst is yet to come with a very high elbow slot which is not really supported by the plane of rotation of the shoulders.

You can see this in the follow-through where the continues to go almost in a straight line towards home plate. This is a result of trying to push the ball to home plate which I believe creates additional stress on the shoulder.

As an aside, I’m in the process of putting together a detailed explanation/evaluation of the inverted W.

What’s interesting to me is the simulations that I’ve done which show how brutal any throwing processes on the shoulder joint. Primarily because the shoulder joint has a very limited range of motion.

Those who think that the inverted W put stress on the shoulder/arm really don’t understand the limitations of the shoulder joint and how much the scapula complex protects the shoulder joint. The shoulder joints can only support a maximum of 90° horizontal abduction at approximately hundred degrees of external rotation (normal individuals).

In other words it’s virtually impossible to consciously lift the upper above the shoulder joint or externally rotate more than about 100-110°.

One of the tests for this is to place the non-throwing hand on top of your throwing shoulder to hold the scapula (Hand placed on top and fingers over back of the shoulder) and down hard enough so that the scapula cannot move upwards. And then hold your throwing arm straight out to your side and try to raise it up above your scapula (top of your shoulder).

If you’re not cheating i.e. allowing the scapula/official the complex to elevate you cannot raise your arm typically more than 90° i.e. arm sticking straight out sideways.

In order to elevate the upper arm above the horizontal (90°) the shoulder complex (scapula and associated parts) must elevate.

What the critics of the inverted W think they are seeing is the upper arm rising above what they think are horizontal shoulders. In reality what is happening is that the upper arm may be approaching 90° but what then takes over is the elevation of the shoulder complex itself which contains the glenoid portion of the glenohumeral joint.

The other part of the problem is that what they think is actually elevation is really much more of a horizontal abduction of the scapula.

What is not also understood that maximum stress on both elbow and shoulder occurs just before maximum external rotation. At the time that the elbow is allegedly above the shoulder there is very little stress on either the shoulder or the elbow as compared to what happens just prior to maximum extra rotation.

Bottom line is this player is exhibiting very little scapular action and much more upper arm hanging up there and it is my belief that he may be bordering on hyper-lexion.

Has very little if anything to do with rhythm and everything to do with how we learn how to throw the baseball.

In the second video, look at where his arm is at about the 5.5 sec mark. His arm is angled back, with the ball being “shown” to an area in right-center field. Most pitchers I’ve seen “show” the ball closer to the SS after hand break.
Try putting yourself in his position. Put your throwing arm straight out to the side, 3 o’clock. Now, without moving your upper body, move your arm back, to 4 o’clock. Where do you feel tension rising? In the shoulder, right? I would try changing his arm position during the part of the motion I described. Have him “show” the ball to the SS vs. right-center during a pitching session, and see if that helps.

Coach - Do you have any recommendations on drills that might be helpful in correcting? It sounds like you don’t like the high cock position drill and your reasoning makes perfect sense to me. However, it has been the only way that I can get him throwing without shoulder discomfort.

Thanks for your detailed feedback.

[quote=“coachxj”][quote]Paul,

Would you mind commenting on what you see in the way of scap loading?[/quote]

From the two clips posted. What “I see”.

He gets very little out of the early part of his windup, from initiation to high cocked position. And of course some of you know that I have little or no use for going to the high cocked position because it disrupts the flow of the delivery.

I see very little scapula loading again I believe part of the reason is because of going to the high cocked position and then “stalling there”. There is some scapula action as the shoulders begin to rotate but it’s not an active scapular action it’s the result of the inertia of the arm dragging behind the shoulder. Which is also potential issue with respect to shoulder discomfort i.e. tending to want to hyper flex the shoulder joint.

And then the worst is yet to come with a very high elbow slot which is not really supported by the plane of rotation of the shoulders.

You can see this in the follow-through where the continues to go almost in a straight line towards home plate. This is a result of trying to push the ball to home plate which I believe creates additional stress on the shoulder.

As an aside, I’m in the process of putting together a detailed explanation/evaluation of the inverted W.

What’s interesting to me is the simulations that I’ve done which show how brutal any throwing processes on the shoulder joint. Primarily because the shoulder joint has a very limited range of motion.

Those who think that the inverted W put stress on the shoulder/arm really don’t understand the limitations of the shoulder joint and how much the scapula complex protects the shoulder joint. The shoulder joints can only support a maximum of 90° horizontal abduction at approximately hundred degrees of external rotation (normal individuals).

In other words it’s virtually impossible to consciously lift the upper above the shoulder joint or externally rotate more than about 100-110°.

One of the tests for this is to place the non-throwing hand on top of your throwing shoulder to hold the scapula (Hand placed on top and fingers over back of the shoulder) and down hard enough so that the scapula cannot move upwards. And then hold your throwing arm straight out to your side and try to raise it up above your scapula (top of your shoulder).

If you’re not cheating i.e. allowing the scapula/official the complex to elevate you cannot raise your arm typically more than 90° i.e. arm sticking straight out sideways.

In order to elevate the upper arm above the horizontal (90°) the shoulder complex (scapula and associated parts) must elevate.

What the critics of the inverted W think they are seeing is the upper arm rising above what they think are horizontal shoulders. In reality what is happening is that the upper arm may be approaching 90° but what then takes over is the elevation of the shoulder complex itself which contains the glenoid portion of the glenohumeral joint.

The other part of the problem is that what they think is actually elevation is really much more of a horizontal abduction of the scapula.

What is not also understood that maximum stress on both elbow and shoulder occurs just before maximum external rotation. At the time that the elbow is allegedly above the shoulder there is very little stress on either the shoulder or the elbow as compared to what happens just prior to maximum extra rotation.

Bottom line is this player is exhibiting very little scapular action and much more upper arm hanging up there and it is my belief that he may be bordering on hyper-lexion.

Has very little if anything to do with rhythm and everything to do with how we learn how to throw the baseball.[/quote]

Brian - Please correct me if I am wrong but is that not what we are doing when we have him throw from the high cocked position? When he throws from this position right now, he has no discomfort whatsoever. I am not well versed on proper pitching mechanics so please let me know if you are referring to something else.

Thanks.

[quote=“Brian179”]In the second video, look at where his arm is at about the 5.5 sec mark. His arm is angled back, with the ball being “shown” to an area in right-center field. Most pitchers I’ve seen “show” the ball closer to the SS after hand break.
Try putting yourself in his position. Put your throwing arm straight out to the side, 3 o’clock. Now, without moving your upper body, move your arm back, to 4 o’clock. Where do you feel tension rising? In the shoulder, right? I would try changing his arm position during the part of the motion I described. Have him “show” the ball to the SS vs. right-center during a pitching session, and see if that helps.[/quote]

You need to post clips of him throwing from the high cocked position so that we can see the difference between his regular delivery and the throwing drill from the high cocked position.

I do not like to see picthers hang their arm up and any drill that promotes that type of delivery I’m against. But I’m talking about the regular delivery i.e. game delivery. Any drill that achieves the desired goal is a good dril. IF practicing from the high cock achieve the desired goal, then it’s a good drill.

My concern is that the mechanics that he establishes over the next year or two will probably (95% probable) be the mechanic said he carries for the rest of his pitching career. What will happen until get bigger and stronger and so the efficiency of the front process will appear to get better but in reality it is physical maturation that is getting better.

This is why you have the 20-year-old, 6’3", 200 pound pitcher, who should be throwing 95 mi./h but is actually throwing 85 mi./h.

One of the reasons why your son can throw so hard is because he has excellent external rotation. But that same amount of external rotation can place stress on the shoulder especially if arm and shoulder are not lined up properly.

Need the video clip from the same angles of him performing the drill it doesn’t cause him pain.

Will try and get some video this afternoon.

It’s the arm position at this point I’m referring to. Try putting yourself in this position. You will most likely feel discomfort in your shoulder area.

Brian - I agree. Right now we are having him throw using this drill which has eliminated any discomfort. I am going to get some video of him throwing again but my wife has a pneumonia right now so things are a little hectic around the house. I will get something this weekend and post.

So…feel like an idiot because I had never taken the time to find out specifically where discomfort was until last night. I had just assumed based on the way he kept grabbing the front of shoulder and rotating arm that it was anterior shoulder. Come to find out the pain is occuring on backside of shoulder just above scapula of throwing shoulder and there is some discomfort in the tricep as well. I know that the suprascapular nerve runs through that area along with the supraspinatus muscle. Also know that the supraspinatus is one of the rotator cuff muscles that abducts the arm. Now…just have to try and piece all of this together. Again…will get some video of him throwing from the high-cocked position this weekend.

Thanks for all the help.

Here are two vids from throwing session this afternoon. The first clip is from the stretch and there was discomfort when throwing the pitch. The next clip was immediately following the previous. Had him throw from high-cocked position and there was no discomfort at all. Feedback/thoughts?