This past February, I attended the Combined Sections Meeting for Physical Therapists (CSM) in Anaheim. Many of the lectures I attended were specific to baseball players and upper extremity athletes. Let’s dive into what I learned and how Physical Therapy can benefit these athletes.
Obviously, the biggest area of concern for overhead athletes is the shoulder. However, there can often be overlooked aspects and causes of shoulder injuries, especially as it pertains to baseball. Since baseball season is only a couple weeks in, it would be great to look at other contributing factors and areas where injuries occur.
For baseball, everyone hyper focuses on the shoulder for pre-season prevention and in-season arm care. However, throwing is much more involved than just the shoulder and is not always a pitcher-specific injury. Dr. Mullaney, Reinold, and Macrina discussed the “Other Half of the Game” highlighting abdominal, hamstring, and the batters’ shoulder.
Batters' Shoulder
A newer injury that is becoming more apparent in position players is called “Batter’s Shoulder.” This typically occurs in the lead shoulder of the hitter and often presents as pain in the posterior shoulder. The repetitive nature of the lead shoulder movement can create a shearing force in the back of the shoulder. Batting practice usually consists of hundreds of repetitions throughout the week, which can further stress the shoulder.
While symptoms vary depending on chronicity, treatment focus should be broken down into phases:
- Managing the acute injury with respect for tissue healing
- Restore Stability
- Functional strength by identifying areas of “weakness”
- Return to sport
Players will present differently based on how their muscles and joints present, so their individual presentation should dictate how their treatment plan is formuated. The position and training schedule of the player must be taken into account as well.
Abdominal Injuries
Abdominal injuries are also becoming more common in baseball players and other overhead athletes because the act of throwing is not a pure shoulder motion. If an athlete is only using their shoulder for their sport, then they may present with an injury at the shoulder or at another area along the arm due to overuse. For most athletes, they are utilizing their whole body; throwing is multi-planar with a huge rotational component at the trunk.
As physical therapists, we usually see injuries/complaints of pain along the side of the torso and below the ribs, indicating some involvement of the obliques, the muscles that help to rotate your trunk. Unfortunately, causation is still not very well understood as there is a divide to what is causing these injuries, specifically in baseball. Possible causes include under trained/over trained obliques, other physical limitations, or high work load. It is likely multifactorial and can also be influenced by high repetition practices and the athletes' rigorous training schedule.
Again, treatment should be specific to the player, sport and position:
- Manage the injury/tissue healing process
- Gradual load introduction
- Sport specific movement patterns
- Return to sport
Hamstrings Strains
The hamstrings are unique because this does not typically come to mind for a sport like baseball when compared to soccer or football. Baseball involves short burst sprints where players track a fly ball, steal a base, or stretch a single into a double. It is multi-directional and explosive in nature.
The hamstring can be injured in a multitude of ways but typically will be caused by rapid and extreme muscle lengthening such as sprinting or eccentric muscle contractions. Other factors can include fatigue and work load, especially with a full 120 game season, spring training, and off-season training.
Again, the framework for the rehabilitation process is similar but should be individualized for each athlete. In general:
- Respect tissue healing
- Gradual load progression
- Training full ROM
- Return to run/plyos
- Sport specific/Sprint progression
Understanding the different sprints baseball players do for their sport and incorporating these movements into the treatments will help better prepare them for returning to play and prevent injury. Runners sprint in a square, outfielders drop step and run, run downs require stop and pivot, etc.
Remember to reach out to your PT or schedule an appointment with us if you are unsure where to start, feel plateaued with your recovery, or want to prevent these injuries during your season!
Dealing with a current or past injury? Don’t wait until it sidelines you. Schedule a 1-on-1 evaluation or movement assessment with our physical therapy team to address pain, instability/balance, or mobility issues
