Shoulder trouble - video


#1

Would you take a look at this and see if you can identify what may be causing Nolan’s shoulder pain?

Thanks.


#2

The first thing that comes to mind is how, after breaking his hands, he takes his PAS hand behind his back (toward 1B). This can place a lot of strain on the muscles at the front of the shoulder.

I would prefer that after he broke his hands he took his PAS hand more directly back toward 2B.

It could also be due to a lack of conditioning of his shoulder and some overuse.

How old is he?

If he’s older than 15 or 16, you might want to consider having him do the “Throwers Ten” conditioning program.


#3

Where on the shoulder is the pain? Front? Back? Top?


#4

[quote=“hoseman18”]Would you take a look at this and see if you can identify what may be causing Nolan’s shoulder pain?

Thanks.


[/quote]

Is the pain on top of the shoulder? I’m speculating because of how violently his followthrough takes the arm and hand laterally & downward across his body, and then snaps back. This action could severely stress the Supraspinatus tendon.

Here’s a link to an anatomy diagram.


#5

The pain is on the top of the shoulder just where the small muscle crosses the cap, a suspected impingement. Going to an orthopedic doc today to find out.

Nolan is 14, is in his second year working with his pitching coach using the Ron Wolforth system, which includes lots of tube work, medicine ball and weighted ball work. The issue didn’t present until he started using a wrist curl excercise unrelated to what he has been doing in pitching. His speed and agility training includes pushups and these things where the kids have to lay on their side, then raise themselves up onto their elbow and hold their bodies straight, with the shoulder taking nearly the entire load. I don’t like that particular excercise, and wonder if that has something to do with it.

His shoulders are exercised well and often, supervised by his coach whom I have confidence in. Nolan has never had any pitching-related injury before.


#6

Yes, the pain is at the top. I and his pitching coach have been trying to get him to decelerate the arm more effectively, especially since I’ve been reading this forum. Nolan hasn’t paid much heed.

Here’s a 3/4 view with a little better arm deceleration


#7

Unfortunately, I sincerely doubt that there is a more efficient way to decelerate the arm from the lateral/centrifugal forces generated earlier in the motion. You or someone else can tell him he needs to do so, and indeed he does, but that doesn’t mean he accomplish it, athletically. What instructions are you’re giving him that you think will fix the problem?


#8

wow, he has a lot of external rotation, more than i’ve ever seen for a 14 year old


#9

There’s no question that he’s really bringing it.

Maybe mid-70s or more.


#10

I took another look at this and continue to think that the problem is related to the height of his PAS elbow. It’s quite high as he gets close to the High Cocked position.

Compare the height of his PAS elbow to the height of Greg Maddux’s in the photos below…

Maddux’s PAS elbow is much lower throughout his motion.


#11

Chris,

You are mistaken. In the pics you posted the subscapularis is actively contracting and is operating well within it’s normal range of motion. It’s working to lift the upper arm.

The problem occurs when this muscle ends up exceeding it’s maximum length. If it’s contracted, in this position, it’s not even close.


#12

Good call.

Since there are other activities going on beyond just pitching, there’s a good chance the problem could have occurred during one of those other activities and is aggravated by the pitching.

Nothing in your son’s mechanics really jumps out at me that I would attribute the pain to - especially pain on top of the shoulder. He’s got pretty good mechanics.


#13

[quote=“Coach45”]In the pics you posted the subscapularis is actively contracting and is operating well within it’s normal range of motion. It’s working to lift the upper arm.

The problem occurs when this muscle ends up exceeding it’s maximum length. If it’s contracted, in this position, it’s not even close.[/quote]

I know that.

The problem is that hoseman’s son’s elbow is significantly higher than is Maddux’s.

Based on the problems that I have seen with other pitchers, and the fact that the MD is talking about an impingement injury, I think that may be the root cause of the problem.


#14

[quote=“Chris O’Leary”][quote=“Coach45”]In the pics you posted the subscapularis is actively contracting and is operating well within it’s normal range of motion. It’s working to lift the upper arm.

The problem occurs when this muscle ends up exceeding it’s maximum length. If it’s contracted, in this position, it’s not even close.[/quote]

I know that.

The problem is that hoseman’s son’s elbow is significantly higher than is Maddux’s.

Based on the problems that I have seen with other pitchers, and the fact that the MD is talking about an impingement injury, I think that may be the root cause of the problem.[/quote]

With the elbow even higher the subscapularis contracts even more. This does not cause damage. In all likelihood the lower elbow is indicative of previous subscapularis damage. This muscle assists in lifting the upper arm. Even when fully contracted it is not in harms way during upper arm external rotation. It’s on the other end of the spectrum, when it’s the longest, that it’s in danger.

Based on conversations I’ve had with two highly respected orthopedic surgeons, I think ‘impingement’ is a myth. I’m not a doctor but I’ve talked to a bunch. It’s very clear that they know a great deal about fixing problems and very little about preventing them. They know anatomy very well and seem to have very limited understanding of anatomy in motion. As a layman, if someone diagnosed my son with this problem, I would seek another opinion.


#15

Took Nolan to the foremost ortho office in Seattle, they take care of all our professional and D1 basketball, football, and yes baseball teams…surgeons and preventative specialists.

Doc says impingement, rest and Aleve and ice (he’s a big believer in ice, take that as you may). he’s also a High School sports specialist and coaches runners. The office says they send their teenage patients to him first, and if he decides they need further work or diagnosis he sends the kid to one of the specialists in the office.

I’ve had my dealings with doctors. A couple saved my life, and another tried to ruin my career (he was just not very good, not malicious), and everything in between. I don’t trust docs easily, but I feel this guy is “in the know” and straight up. So it’s ice, Aleve, and PT with the guy who works with the Mariner pitchers. We’ll see how it goes, and if you like, I’ll keep you informed.

thanks for all the input, and if you have anything further to add, please do! I’ll be watching the thread.


#16

The doc recommending Aleve and ice tells me there is some imflammation. Did the doc have any idea what caused it (assuming my interpretation is correct)?


#17

Repetitive stress. Since Nolan is doing strength and conditioning, weight training, and other non-baseball activities, the Doc wouldn’t hang the injury solely on pitching. And to tell the truth, my son is working that shoulder a lot. He also recommended more stabilization exercises for his shoulders since Nolan inherited his dad’s loosie-goosie shoulder girdle. Roger hit it on the head there.


#18

If you can get the clip to stop at 00:02 you will see that his hand is clearly on the outside of the baseball at release. He is supinating and not staying behind the baseball. It is IMPOSSIBLE to diagnose anything looking at these clips in their present form. It is also impossible to diagnose what grade of “impingment” this kid has if it even is that, regardless of video, that rings ture for Dr. Chris too!. At footplant hes solid but he is coming around the baseball opposed to staying behind it. This can stress the biceps tendon which can result in some pain on the top of his shoulder this is where the bicpes originates. The whipping action of his arm can rattle the tendon within the bicpital groove on his humerus. Do to location alone the supra. is almost always involved with any type of tendonitus, impingment etc. His elbow slot is doing nothing in terms of injury Coach 45 is dead on. He is well within the range of any stress to his subscap.


#19

I’m no expert but it looks like he’s throwing all arm.Watch as he comes threw the arm action is there but nothing with the legs and he finishes very up right.Just look at the three pitchers at the bottom of the page they are using alot more of there upper body and back leg. Chinmusic is right on about the hands,you have to stay behind the ball.Just some thoughts, good luck to you hope this can help.


#20

He has a natural tendency to supinate that we’ve been aware of and dealing with since we started throwing together while waiting for the kindergarten bus lol

I didn’t notice it on this clip, but I’ll address the issue with he and his coach. Thanks.