Delmas Bolin, MD, PhD, FACSM
Director, Performance Medicine of Southwestern Virginia
Head Team Physician, Radford University
Associate Professor, Via College of Osteopathic Medicine
Have you ever come out of a practice and your throwing shoulder just aches? Patients often ask me about these types of shoulder pain and what it means. Am I doing damage? Should I stop and go see a doctor, or just push through it and maybe take a couple of ibuprofen? Here is a guide to common shoulder problems and warning signs to let you know when “pushing through” may not be the right thing to do.
To understand how problems can arise, one needs to understand a little about the mechanics of throwing. Everyone “knows” how to throw a ball overhand. Did you know that the legs and trunk muscles are critical to achieving maximum accuracy and velocity? Image yourself throwing a ball; now imagine doing that with your feet frozen to the ground. You can still throw, but it isn’t pretty is it?
Athletes that don’t properly use their legs and “core” trunk muscles when throwing use their shoulder muscles to make up for the loss of speed. They overuse the shoulder rotator cuff muscles and, over time, the shoulder muscles develop too much stress and can develop several problems including tears of the “rotator cuff” muscles or cartilage tears that lead to instability of the shoulder.
The rotator cuff muscles are protected from rubbing against the collar bone above them by a small sack called a bursa. When you throw too much and get tired, the bursa can get pinched and cause that deep, hard to place ache in the shoulder and on its side. This pain typically gets better with ice, rest, ibuprofen, and importantly, not sleeping with that arm above your head. Bursa pain will often wake people when they roll over on the shoulder. Overhead positions put the bursa in a place where it can get pinched – you’ll wake up sore and stiff.
Rotator cuff damage is worse. If you have torn the rotator cuff muscles, they are no longer strong enough to hold the ball of your shoulder joint in the socket. When you go to sleep, the strong deltoid muscle gradually pulls the shoulder’s ball up and out of the joint where it causes pain that wakes a patient from sleep. Pain that wakes you from sleep consistently should prompt you to stop throwing and seek further medical evaluation.
Sometimes the shoulder pops when moving it. Pops that simply make noise and cause no pain are not cause for concern. Painful pops, particularly when pitching, should be investigated. They can be one sign of a tear of the cartilage “gasket” that goes around the shoulder socket – that “gasket” is called a labrum. Labral tears make the shoulder not quite as stable as it should be – like a wheel that has it’s axel not placed in the center; it will wobble. A wobbling shoulder means that you will notice less control of your pitches, less accuracy, and less speed. If you notice you are losing speed, it’s probably time to get this further evaluated.
Finally, younger pitchers (those under 15) should pay particular attention to night pain. Pain in the shoulder at night while trying to sleep that persists night after night can be associated with stress injuries and fractures through the growth plates. Although softball is generally gentler on shoulders than other throwing sports, parents and coaches should keep an eye out for growth plate injuries in their players who are throwing a lot and start having pain and decreased performance.
Prevention means concentrating on your throwing form. Take time for a good warm-up; don’t throw too hard too quickly. Spend time strengthening your core and lower body as these large muscles allow you to “drive” the ball toward the plate. Training the shoulder muscles will help control the fine-tuning of the pitch (along with the arm and hand). Train both sides of the body to remain “balanced” and to develop good stamina for the trunk and leg muscles. When you play 4-6 games in a weekend, tired core and leg muscles translate into overworked shoulder muscles.
Most shoulder pains are the result of overuse and may last a day or too but should quickly resolve. Signs that might suggest you should see your doctor include pain that lasts more than a week, night pain, or loss of speed and accuracy. Luckily, most problems are readily addressed and prevented by developing good form and good training habits. Building strong leg and core muscles will keep you “driving” the ball toward the plate, and keep you from driving to the doctor.