How Can Shoulder Injuries Be Prevented?

I remember back in the day that the worst words a pitcher could hear were “rotator cuff”. Using those two words together was worse than cursing.

Of course, “rotator cuff” on its own is completely harmless — it is an anatomical phrase the loosely describes an area of the shoulder. But when a pitcher heard those words, it almost always was followed by “tear”. And when a pitcher had a rotator cuff tear, his career was over.

Similarly, an elbow injury was the death knell of a pitcher’s career — until Tommy John had the surgery that now bears his name. Elbows, compared to shoulders, are relatively simple, and doctors have figured out how to repair them fairly effectively.

Thanks to the advances of modern medicine, a pitcher’s career isn’t automatically over if he suffers a shoulder injury. At the same time, there’s no guarantee that surgery will put a pitcher back on an MLB mound. Further, the pitchers that do make it back rarely return with the same skill set they had before. For every Chris Carpenter there are 10 (20?) Scott Elartons. Last week, Brian Costa wrote an article titled The Tyranny of Shoulder Injuries, which reviewed the recent rash of shoulder problems hitting New York pitchers such as Johan Santana, Pedro Feliciano, Joba Chamberlain, John Maine, and Damaso Marte, among others. It’s no coincidence, either, that New York pitchers are coming down with shoulder injuries — as Costa writes:

In the last three years, pitchers have made 801 trips to the disabled list, according to Stats Inc. And of those, 258, or about 32%, were because of shoulder injuries, more than any other type of injury.

That’s an alarming number. Why are there so many shoulder injuries, seemingly “all of a sudden” ?

Part of it is the continued “teaching” of poor mechanical technique by people who have no knowledge of, and therefore are not qualified to instruct on, body movements (a.k.a., human kinetics). The high incidence of injury could be due to the fact that we have more knowledge about shoulder injuries than in the past, so the diagnosis is more clear. And that’s a good thing, because the earlier shoulder issues are discovered and treated, the better the chance of a pitcher healing and returning to form. As my friend Angel Borrelli (who is qualified to speak to such matters) explains:

This is why it is so important to detect problems before they become serious shoulder issues. The shoulder always gives you warning signs…and frequently it is in an arm muscle. The long head of the triceps crosses and acts at the rear of the shoulder as a stabilizer; the long head of the biceps does the same for the anterior of the shoulder. Arm problems can be a warning sign; tightness in the anterior of the shoulder is a warning sign; visible atrophy of the rear of the shoulder is a warning sign; and arm-to-body angle that starts to get too low or too high is a warning sign. All of these things happen before there is an injury. If you look, you can see.

Pitchers need to be taught to be more in the driver’s seat with noticing issues they are all of a sudden having. While it is the responsibility of the team to take care of them, the greatest responsibility lies with the pitcher. He needs to know that there are simple solutions; he should not be afraid to acknowledge that something is wrong. The right movements before he pitches, the correct restoration exercises after he pitches, a change in the arm angle by 1/2″…these are sometimes the simple solutions to avoiding a full-blown shoulder injury.

The shoulder is complicated…but its language…the way it talks to its owner…is very, very simple.

As an “old school” guy, I get the whole macho attitude of pitching through injuries and being “tough” for your teammates. But there’s a fine line between bravery and stupidity — and it’s one that should never be crossed when it comes to the shoulder. If there is pain, there is a cause for that pain — and very often, there is a simple correction that can ease the pain and prevent serious injury. Hopefully, in the present and future, pitchers will be aware of their arm, act swiftly when warning signs develop, and get qualified help to keep them healthy.