Posts tagged arm injuries
Influence of Posture on Shoulder Function and Pain
shoulder pain-posture-range of motion-strength

Shoulder pain is the 2nd most common orthopedic reason patients seek out medical care behind low back pain.  Shoulder pain has many causes including lack of mobility, shoulder blade and rotator cuff weakness, but posture is often criticized as a risk factor for shoulder pain.  Clinicians and patients believe a poor posture places structures such as the rotator cuff at risk for injury or the posture changes the function of muscles in the upper body.  In our practice, we often find stiffness or a lack of mobility in the middle back (thoracic spine) either precipitates or perpetuates a patient's shoulder symptoms.  Poor mobility in the thoracic spine requires more of the neck and shoulder during a given functional movement.

A recent review article searched the available evidence to determine posture's role on shoulder pain and function.  Barrett and colleagues examined 10 studies to determine if posture influences shoulder range of motion or the development of shoulder pain (Man Ther. 2016).  They found moderate evidence showing no difference in thoracic posture between those with and without shoulder pain.  Conversely, the did find strong support that better posture allows for greater shoulder range of motion compared to a slumped posture.  Their final conclusion stated no significant contribution of thoracic posture on the development of future shoulder pain, but further research is needed.  

Biomechanics and Stresses of Baseball Pitches

As we move through the Spring and into Summer many of our Boulder youth athletes are into their competitive baseball seasons.  With increased games come increased pitch counts, arm fatigue, and over use injuries.  From the literature we know there are some specific risk factors for future arm injury including pitching with a fatigued arm, pitching more than 80 pitches in a game, and pitching more than 8 months a year.  Thankfully many of these risk factors are manageable with proper education of athletes, coaches, and parents.  One of the debatable risk factors for injury involves utilization of different pitch types and their impact on future arm injury.  

Previous authors have studied the biomechanics of different pitches including fastballs, change ups, and curve balls (Fleisig et al.).  The authors have not shown increased arm stress during a curveball compared to other pitches.  A recent study confirms these findings.  Fleisig and colleagues studies 111 healthy pitchers across all levels of baseball from youth to the Minor and Major Leagues.  The authors were studied in an indoor biomechanics lab as they threw these 3 different pitch types.  The authors concluded a lack of support for the theory that curveballs are more stressful for young pitchers.

It is important to note the analysis involved healthy, non fatigued baseball pitchers with relatively low pitch counts.  It is possible the healthy pitchers have modified and corrected known risk factors and/or demonstrate adequate strength and mechanics to avoid injury.  Baseball pitchers are encouraged to work with a local PT to address risk factors, pitching mechanics, and muscle imbalances to ensure a successful and healthy end to their baseball season.