Joint Pain in the Shoulder


#1

My 17 year old son has been pitching since he was 8 years old. He does not have issues with his mechanics however he has pain in his should multiple times. We had MRI on his shoulder a few times and nothing is showing up. We have gone to the best doctors and they can’t get to the bottom of it not saying it is joint pain. He does not over pitch, he always stretches and does bands prior to pitching. He gets the proper rest with his arm, goes to physical therapy, tried acupuncture., he even had surgery to remove a floating Bennett’s Lesion and clean up any fraying around his labrum. There wasn’t anything seen regarding his bicep tendon during surgery. How does he continue to pitch through the pain. He is an unbelievable lefty pitcher that doesn’t want to give up and is extremely frustrated.


#2

At about 14 years old and again at 15 years old I had issues with growth plate separation in my throwing shoulder.

Dont let him give up.


#3

Where in the shoulder is the pain?

Sounds like your son has had plenty of medical analysis so, even though you said he has no mechanical issues, maybe a mechanical analysis is in order?

Also, have him do a good dynamic warm-up (including bands) before pitching and save the stretching for afterwards. And make sure he’s not doing any joint-loosening stretches.


#4

You don’t say if your doctors have been orthopedic surgeons trained in sports medicine. If not, or you are not sure, I would contact Dr. Glenn Fleisig at ASMI. He can recommend specialists in your area. Click here.


#5

My question also.


#6

Yes it was a top surgeon at HSS in New York.


#7

If you are pressing down in the middle of the shoulder (where it debts in) he says it’s deep in the middle.


#8

He had top coaches do an analysis of his pitching mechanics and they said he has some of the best mechanics they’ve seen. We have been looking at everything from his release to his angle to his feet - you name it. Very frustrating.


#9

Alicat,

“17 year old son has been pitching since he was 8 years old.”

This means his throwing arm Humerus is now shorter than his glove arm Humerus because of growth plate disturbance that prematurely closes the elbow growth centers. Nobody avoids this and the earlier youth pitchers start adrenaline assisted competitions the more time for this pathology to emanate.

“He does not have issues with his mechanics”

This must be what you are told by your traditional pitching coaches who have little or no understanding as to why throwing pathologies occur, kinda like most orthopedic surgeons!

“however he has pain in his should multiple times.”

Most shoulder issues start with laxity then lead to protracted joint injuries because of alignment mechanical problems between the Shoulder (acromial line) and the longitudinal axis of the Humerus throughout the whole delivery.

“We had MRI on his shoulder a few times and nothing is showing up.”

Without contrast these are about a waste of time but sometimes helpful when injuries are fully developed .

“We have gone to the best doctors and they can’t get to the bottom of it not saying it is joint pain.”

Most shoulder pathologies emanate the same way and accumulate to increased symptoms.

“ He does not over pitch, he always stretches and does bands prior to pitching. “

None of these eliminate joint pathologies and static stretching exacerbates laxity. Pitchers should drop all those crazy, past end of range of motion static stretches you see on the field.

Dynamic stretching only!

“He gets the proper rest with his arm”

Humans recover over night if they do not cause pathologies in their throwing motions.

Rest is never the problem. We do not suffer from “lack of capacity”.

“goes to physical therapy, tried acupuncture.”

If your pitching coach can not tell you exactly why and be able to mitigate the problem you might need to move on.

“he even had surgery to remove a floating Bennett’s Lesion and clean up any fraying around his labrum.”

This is what I mean by Orthopedic surgeons not having expertise in “sports kinesiology”! He did not give you the mechanical answer out of this problem, only how to heal the melody.

“There wasn’t anything seen regarding his bicep tendon during surgery.”

The Bicep tendon inserts into the lip of the Labrum and thru to the bone and will eventually succumb to pathology from the same mechanic.

“How does he continue to pitch through the pain.”

He can take this approach or change the pathomechanic that produces the injury.

Very few change the mechanic because they are instructed to continue with their perfect mechanics.

“He is an unbelievable lefty pitcher that doesn’t want to give up and is extremely frustrated.”

Give him the choice to make a change! At least he would have the information if he chooses to at sometime in the future. It’s actually an easy tenet to learn.

The pathomechanical action;

When an overhead thrower starts their ball and glove split many of them intuitively take their ball arm back by looping it back behind their posteriors, off the field driveline (the imaginary line running from the target back to the thrower and thru in a straight line to second base) leaving the Humerus out of alignment with the acromial line (imaginary line running from acromion tip to acromion tip) and in a overly hyper horizontal (some know this as “scapular loading”, for them it is a positive and taught) abduction. This has the head of the Humerus pulled away from the glenoid cavity and angled. At this time traditionally trained pitchers start their rotational acceleration phase before their Humerus is fully outwardly rotated and ready to throw. This action has the muscles that drive the arm forwards pulling the Humeral head right into the labrum perimeter anteriorally (front) and into the insertion of the biceps tendon while trying to contract the Humerus around from a disadvantageous position. At this point the head of the Humerus now slides back to the posterior side of the glenoid causing collision at the posterior (back) region of the Glenoid cavity when the forwards acceleration phase starts.

Again this all is gets started with “laxity” then irritation and inflammation then the eating away of the labrum at both side and sometimes above.

The mitigation mechanic;

One of Dr. Mike Marshall’s main Pathomechanical busting tenets is “alignment of the Humerus and Acromial line throughout the delivery” where the head of the Humerus stays centered in the glenoid cavity from the start of the pendulum swing drop in thru full body recovery where the Humerus is still in line with the shoulders going into defensive drop step posture.

The que here is throw your hand into your back ball side pocket or as close as you can get.

Always get your Dr’s release to train before making any corrective moves!


#10

Thank you very much for your thorough response. I will have him read this over and also talk to his coaches about it. He may need to rest his arm until the pain subsides. Then slowly come back. Pitching is everything to him.


#11

Is this change in his throwing mechanics something he can do on his own or does he need help from a non- traditional lurching coach. Is there someone you recommend he could see to help him? Also should he get an mri with contrast first?


#12

I meant non-traditional pitching coach.


#13

Alicat,

“I will have him read this over and also talk to his coaches about it.”

Ask them if they are aware of any of this info?

“He may need to rest his arm until the pain subsides.”

The labrum is connective tissue very tough but the perimeter is vulnerable, it is not well vascularized so take all the time your Dr. asks for.

“Then slowly come back. Pitching is everything to him.”

I ask all my clients to stop performing competitively in the late summer, fall and Winter. They only train and it is daily. The 16 thru 19 byo’s perform a 120 day HS“sport specific” interval overhead throwing training program. We started 2 weeks ago, the kids on scout teams must perform their wrist weight holds and the rest of the work out right before their ballistic performance so as to not break training. They always attract a crowd.

“Is this change in his throwing mechanics something he can do on his own”

Absolutely !! he only need desire to learn.

“does he need help from a non- traditional lurching coach.”

The only eyes he needs to understand this is yours and his! fathers who take the time to learn this find numerous ways and opportunities to help them. He will have to start understanding physiology, Kinesiology and exercise science. It’s a long road but always positively cumulative when practiced as understood in utilitarian approach.

“Is there someone you recommend he could see to help him?”

No, it best he learns all the pathomechanical call outs and their mitigation’s to then glean himself of them, it’s actually very easy by being very methodical.
The only resource I have used for almost 20 years now can be found for free at Drmikemarshall.com and it’s all free. I have found that if you blend in some of the traditional bottom half mechanics with some adjustments, you can still perform most of the top half mechanics that make you more powerful and lateral movement to both sides oriented. You can always just ask questions here as long as I am welcome.

”Also should he get an mri with contrast first?”

Let your Dr. decide ? he may be part owner in the service (many are) and will want both MRI’s.