Overuse injuries from throwing motion are often related to the shoulder, elbow, and less commonly the wrist. A clear understanding of the biomechanics of throwing is essential for sports medicine specialists, physical therapists, and physicians to effectively care for throwing athletes.
Windup, stride, arm cocking, acceleration, deceleration, and follow-through are the six phases of throwing. Deficiencies at any point may transfer increased stress to the thrower’s shoulder and elbow. To understand how overhead athletes’ overuse problems arise, knowing the dynamic phases of throwing is essential. Each stage places force in a new location on the body, potentially causing harm.
Due to the varying loads experienced during each phase, it is also possible to design exercises specifically for the muscle groups used during a particular phase of the throwing cycle.
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Common injuries in overhead-throwing athletes
Rotator cuff injuries
The shoulder is the body’s most mobile joint, with an incredible range of motion. Rotator cuff injuries can result from overhead movement while bowling, throwing, fielding and wicket-keeping. Depending on the severity of the damage, they are categorized as Grade 1, 2, or 3. Grade 1 is a stretching injury of the muscle, Grade 2 is a partial tear, and Grade 3 is a complete tear.
A labral tear is a disturbance or straining of the glenoid, the shoulder’s structure that surrounds the socket. When the labrum is disturbed or torn, the shoulder becomes potentially unstable since it provides support to the joint.
Glenohumeral Internal Rotation Deficit (GIRD)
This is a loss of the shoulder’s ability to internally rotate, due to the increased amount of external rotation required to throw at high velocity/power. Due to the absence of normal shoulder motion, young athletes are more likely to sustain labral tears and internal impingement of their rotator cuff tendons.
Elbow injuries – UCL tear
Partial, and even complete, tears of the ulnar collateral ligament (ligament connecting the inner arm to the forearm) are seen. Other injuries such as Ulnar neuritis (stretching of the nerve in the inner arm) can occur leading to tingling in the little and ring finger.
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Reduce injury risk in overhead throwing
To get enough sleep is the most crucial thing.. It may be a good idea for athletes to take some time off and cross-train in a non-throwing sport to lower their risk of developing an overuse injury that could lead to burnout. A good rule is to refrain from overhead throwing for at least 2-4 months out of the year. This can be adjusted for age and level of fitness too.
Other methods include
Work with a qualified coach who can evaluate your throwing technique and also identify any mechanical issues and maintain an ideal arm angle to keep the forces about the shoulder and elbow in balance.
Stop playing through pain as it is an indication that there is a structural problem at some level and not always muscle soreness. If anything hurts, it’s preferable to stop, rest, and/or seek medical attention than to continue playing through the pain.
Improve your strength and flexibility by using more muscle groups, particularly larger muscles in the thighs, core, and back, to take the strain off your elbow when throwing. This not only decreases the risk of elbow injuries but also leads to faster pitching.
There are also ways to improve shoulder flexibility, which will decrease injury risk.
Core strengthening allows our bodies to be in the right positions to throw with both speed and accuracy. Plank variations on our hands and toes are simple core exercises that can be readily performed.
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Hip strengthening is important, to attain stability in a throwing position. Being unstable can lead to a decrease in our throwing speed and accuracy with a higher risk of injury. Single-leg strengthening positions are one of the most beneficial forms of exercise we can do to strengthen our hips and our core.
Improving Thoracic (part of the spine between the neck and lower back) mobility is an important part of training when we rotate our midback properly. It helps our shoulders to move properly and reduces the risk of injury.
Warm-up adequately before and cool down post sessions are an integral part of injury prevention as in any sport.
Treatment of Minor Overuse Injuries with Rest, Icing, stretching, and some anti-inflammatory medication for a short period of time can be beneficial. If something feels unstable, if a loud pop/snap is felt, or if there is a significant loss of speed or accuracy, it would be prudent to seek a higher level of care.
About the author: Dr. Sunil G Kini is a Senior Consultant – Joint Replacement/Arthroscopy/Adult Reconstruction Surgery, Manipal Hospitals, Old Airport Road, Bengaluru. All views/opinions expressed in the article are of the author.