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How to Prevent Throwing-Related Injuries

How to Prevent Throwing-Related Injuries

How to Prevent Throwing-Related Injuries

As an essential skill for many sports, overhand throwing is oftentimes an unavoidable part of being an athlete. However, repetitive overhand throwing can strain the arm's muscles, ligaments, and tendons, resulting in serious injury. While throwing-related injuries are most common for baseball pitchers, athletes from a variety of other sports like volleyball and tennis can also suffer these injuries. In this article, we'll look at why throwing can be harmful to an athlete's shoulder and elbow, how to avoid throwing injuries, and throwing injury treatment strategies.

Why Is Throwing Bad for Your Shoulder?

Why Is Throwing Bad for Your Shoulder?

Overhand throwing puts a great amount of stress on the shoulder. Repeatedly throwing can shake the stability of the shoulder and cause a variety of overuse injuries. To understand why too much overhand throwing can be harmful, we need to look at the anatomy of the shoulder. The shoulder is a ball-and-socket joint that involves three bones. The humerus is the upper arm bone, which connects to the scapula, or shoulder blade. The final connecting bone is the clavicle, also known as the collarbone.

Along with those three key bones, the shoulder joint relies on these essential parts to function:

  • The glenoid: The glenoid refers to the rounded socket within the shoulder blade that the humerus fits into.
  • The labrum: As a lining of strong and fibrous tissue, the labrum surrounds the glenoid to help deepen the shoulder socket and stabilize the joint. Many shoulder ligaments attach at the labrum.
  • The shoulder capsule: The shoulder capsule consists of strong connective tissue that acts as the ligament system keeping the head of the humerus centered in the glenoid socket. Shoulder capsule tissues cover the shoulder joint and attach the upper end of the humerus to the shoulder blade.
  • The rotator cuff: The rotator cuff tissues are made up of muscles coming together as tendons and cover the head of the humerus to provide greater shoulder stability.
  • Upper back muscles: Muscles located in the upper back, such as the trapezius, rhomboids, levator scapulae and serratus anterior, are considered scapular stabilizers because they control the scapula and clavicle bones.

Because the shoulder joint relies on so many moving parts to operate properly and remain healthy, there is a large margin for injury when it comes to throwing. Repeatedly throwing at a high speed can place significant stress on the anatomical structures that secure the humeral head in the center of the glenoid socket.

Once one part of the shoulder, such as the shoulder capsule, becomes weakened from repetitive stress, other parts must compensate to handle the overload. Putting additional stress on shoulder structures that aren't accustomed to certain demands can lead to a wide range of shoulder injuries for throwing athletes.

What Are Common Shoulder Injuries From Throwing?

While the rotator cuff and labrum are the shoulder components most vulnerable to harm from throwing, there are numerous types of shoulder injuries. Below are the most common shoulder injuries due to throwing:

  • SLAP (superior labrum anterior to posterior) tears: A SLAP injury occurs when the top part of the labrum that attaches to the biceps tendon gets injured. A SLAP tear usually includes pain with certain movements and a catching or locking sensation in the shoulder.
  • Rotator cuff tendinitis and tears: Overworking a muscle or tendon can cause it to become inflamed with tendinitis. Frequent throwing makes the rotator cuff especially prone to tendinitis, which results in radiating pain along the upper arm. With more damage, a rotator cuff tendon may tear, meaning it will no longer be fully attached to the head of the humerus.
  • Bicep tendinitis and tendon tears: Repetitive throwing can also inflame the upper biceps tendon, causing biceps tendinitis. This form of tendinitis typically involves pain and weakness in the front of the shoulder. With continued harm, the biceps tendon can tear.
  • Internal impingement: When extending the arm back to throw, the rotator cuff tendons near the back of the shoulder can become pinched in between the glenoid and the humeral head, which is known as impingement. Impingement can lead to a partial tear in the rotator cuff tendon or damage the labrum by causing a portion of it to peel away from the glenoid.
  • Glenohumeral internal rotation deficit (GIRD): The extreme external rotation required for throwing at a high speed usually causes the front ligaments of the shoulder to gradually stretch and loosen over time. As a result, the soft tissues in the back of the shoulder begin to tighten and the flexibility needed for internal rotation is lost. This puts throwers at a higher risk for rotator cuff and labral tears.
  • Scapular rotation dysfunction (SICK scapula): Throwing repetitively uses the scapular muscles, which can cause the muscles that affect the position of the scapula to change. Changes in these muscles increase the risk of shoulder injuries like scapular rotation dysfunction, which is when the affected shoulder droops, causing pain in the front of the shoulder near the clavicle.
  • Shoulder instability: Instability of the shoulder is caused by dislocation, which is when the head of the upper arm bone slips out of the shoulder socket. Chronic shoulder instability refers to when the shoulder regularly moves out of place. Shoulder instability gradually develops from years of repetitive throwing that slowly stretches the ligaments and increases their laxity until the shoulder joint slips off-center during a throw.

Why Is Throwing Bad for Your Elbow?

Why Is Throwing Bad for Your Elbow? 

Repetitive throwing can negatively affect the elbow joint in addition to the shoulder and cause a variety of overuse injuries. Similar to the shoulder, three bones meet at the elbow. The humerus connects to the radius, which is one of the forearm bones. The other forearm bone is the ulna.

Because the elbow is a combination hinge and pivot joint, it relies on a collection of anatomical structures to bend, straighten, twist and rotate. This means thick ligaments are needed on both the outer and inner sides of the elbow to hold the joint together and prevent dislocation. The main ligament is the ulnar collateral ligament (UCL), which runs along the inside of the elbow and stabilizes the joint during overhand throwing motions.

Repeatedly throwing at high speeds excessively stresses the elbow joint by placing a concentrated amount of force on the inner elbow. Because pitching requires hours of overhand throwing, pitcher's elbow is one of the most common elbow injuries. Pitcher's elbow typically involves pain and swelling along the inside of the elbow due to stretched or pulled ligaments. This can limit the range of motion and lead to more serious injuries.

What Are Common Elbow Injuries From Throwing? 

Here are three elbow injuries that can result from repetitive throwing:

  • Ulnar collateral ligament (UCL) injury: A UCL injury is the most common ligament injury for pitchers and throwers. UCL injuries usually start with pain on the inside of the elbow and can range from slight inflammation and minor damage to a complete UCL tear.
  • Flexor tendinitis: Repeated overhand throwing can inflame the flexor and pronator tendons that attach to the humerus bone, resulting in tendinitis. Flexor tendonitis will cause pain on the inside of the elbow while throwing, and in severe cases, pain while at rest.
  • Ulnar neuritis: When the elbow bends back to throw, the ulnar nerve stretches. Repetitive throwing can stretch the ulnar nerve to the point of slipping out of place, which causes painful snapping and irritation of the nerve that is known as ulnar neuritis. Ulnar neuritis can cause pain similar to the feeling of an electric shock, tingling, numbness, or pain in the fingers.

What Are the Risk Factors for Throwing Injuries?

When it comes to throwing-related injuries, there are certain factors that can put athletes at a greater risk of injury. Some of these factors are unavoidable, while others can be easily corrected with the right amount of practice. These are the main variables that affect an athlete's likelihood of developing a pitcher's elbow or another throwing-related injury:

  • Age: Younger athletes, particularly those under the age of 14, are at a greater risk of throwing-related injury because their joints, growth plates, bones, and ligaments are still developing. In addition, older athletes may have a reduced ability to recover from repeated throwing, which can lead to an overuse injury.
  • Sport: Of course, those who participate in sports that involve a lot of arm movements, such as baseball, softball, tennis, golf, javelin, and football, are at a greater risk of developing a throwing-related injury. These sports put repeated stress and force on the upper arm and elbow, which can lead to injury.
  • Improper technique: Although some sports naturally involve more repetitive throwing and arm movements, practicing the proper technique can help protect joints and prevent injury. Improper throwing form can cause pitcher's elbow and other throwing-related injuries.
  • Overuse: Even with the right technique, throwing too frequently can result in injury. In fact, research has found that overuse is one of the biggest factors in injury among pitchers and pitching more than 100 innings per year can be harmful to a young athlete's health. For this reason, the Little League has strict pitch count rules to protect players.
  • Curveballs: Throwing curveballs and breaking pitches put an additional amount of stress on the growth plate that can result in the pitcher's elbow. To avoid injury, these types of pitches should be limited, especially for younger athletes.

How to Avoid Throwing Injuries

How to Avoid Throwing Injuries

Despite the risk factors listed above, there are certain measures athletes can take to protect themselves from throwing-related injuries. Follow these guidelines for pitcher's elbow prevention to avoid elbow, shoulder, and other throwing injuries:

  • Warm-up properly: Always be sure to warm up thoroughly by stretching, running, and easing into throwing before engaging in more intense physical activity.
  • Limit pitching: Adhere to the proper pitch count guidelines and don't pitch on consecutive days.
  • Rotate positions: Split your time by occasionally playing positions other than pitcher and catcher, both of which put a great deal of stress on the arm ligaments.
  • Take breaks between seasons: Try not to tax your arm by playing year-round or pitching on multiple teams with overlapping seasons.
  • Focus on the fundamentals: Make sure you master the basics of pitching and establish good mechanics, control, and accuracy before attempting anything more advanced like the change-up or breaking pitches.
  • Ditch the radar gun: Although a radar gun doesn't directly harm a pitcher, the pressure to hit a certain number may cause them to throw beyond their normal comfort level and put excess strain on their arm. Young pitchers should be especially cautious of using a radar gun.
  • Monitor pain: Regularly communicate with your coach about how your arm feels and never pitch if you are experiencing elbow or shoulder pain. If the pain persists, speak with an athletic trainer or sports medicine professional.

How to Relieve Pain From Throwing Injuries

While the best strategy for reducing pain from throwing injuries is a proactive injury prevention plan, there are plenty of effective throwing injury treatments. Catching a throwing injury early is key to limiting the overall damage it causes, so be sure to seek medical attention as soon as you experience symptoms such as a limited range of motion, a pop or tearing sensation.

Rehabilitation and preparation for the next practice or competition should begin immediately after a practice session ends. Managing the physical stress brought on by a pitching session or other intense throwing practice through stretching, icing and other treatments can help reduce the chances of injury. By being proactive and addressing minor pains early, athletes can avoid more serious injuries.

In the case of more persistent elbow pain, the first step is to rest from throwing and allow the elbow or shoulder to recover from inflammation. For more severe throwing-related injuries, an involved treatment option may be necessary. The following are your three main options for treating throwing injuries:

  • Physical therapy: Physical therapy is a viable treatment strategy for both shoulder and elbow injuries. It typically involves various movements and exercises to help restore and improve the mobility of the affected joints while strengthening the supporting muscles to prevent potential re-injury. The phases of physical therapy progress from pain treatment to movement enhancement before finally releasing players to return to competition.
  • Throwing analysis: Because repeated throwing with improper mechanics can cause recurring pain even after treatment, having a qualified trainer or physical therapist examine and correct an athlete's throwing form can help prevent future injuries. Using simulation and video analysis to spot abnormalities in a pitcher's throwing motion can be a great pitcher's elbow treatment for getting long-lasting results.
  • Surgery: On rare occasions, physical therapy and making technical adjustments are not enough to completely heal a throwing injury and keep pain at bay. In these cases, surgery may be recommended to reconstruct damaged ligaments.

When Do Throwing Injuries Require Surgery?

Oftentimes, surgery for throwing injuries can be avoided through proper rest, prevention techniques, flexibility exercises, and physical therapy. However, severe injuries may involve ligament damage that requires reconstructive surgery. Without surgery, a ligament tear can worsen, and continuing to throw with a torn ligament could lead to permanent damage.

Although surgery should be a last resort, it may be a necessary procedure for serious throwing injuries. Athletes whose injuries have not responded well to other treatment approaches who continue to experience symptoms for a year may want to consider surgery to correct their torn elbow or shoulder ligaments.

The most well-known pitcher's elbow treatment for UCL reconstruction is the Tommy John surgery. The Tommy John surgery repairs the UCL by taking a tendon from the patient's own body or from a cadaver to reconstruct the torn UCL. Full recovery from a Tommy John surgery can take up to a year or more, which is why it is best to exhaust all other rehabilitative options before resorting to surgery.

If You've Experienced a Throwing-Related Injury, Contact Dr. Mufaddal Gombera Today

If You've Experienced a Throwing-Related Injury, Contact Dr. Mufaddal Gombera Today

If you have suffered an elbow or shoulder injury due to throwing, Dr. Gombera is ready to help get you on the road to recovery. As a board-certified, fellowship-trained orthopedic surgeon, Dr. Gombera is an expert on throwing-related injuries. In fact, Dr. Gombera's specialty is providing personalized treatment plans for athletes with sports-related injuries to help them return to competition as soon as possible. 

Through using modern and minimally invasive techniques, Dr. Gombera regularly helps athletes return to peak performance. Our practice is conveniently located in the heart of Houston at Fondren Orthopedic Group and Texas Orthopedic Hospital. With the help of Dr. Gombera and our team, you can get back to playing the sport you love.

To find out more about how Dr. Gombera can help you overcome your throwing injury, contact us today or book an online appointment.

American Academy of Orthopaedic Surgeons The American Orthopaedic Society for Sports Medicine Arthroscopy Association of North America american shoulder and elbow society international society for hip arthroscopy