Strengthening the Rotator Cuff: an Introduction to the Functional Anatomy & Strengthening Exercises SPORT & EXERCISE SCIENCE, Vol.2, No.5
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SPORT-SPECIFIC CONDITIONING CONSULTANTS ‘Sport-Specific Conditioning is our Focus, Performance is our Goal’ - PERFORMANCE NUTRITION - ATHLETIC TRAINING - ATHLETE DEVELOPMENT- PERFORMANCE PSYCHOLOGY – MANAGEMENT & CONSULTING - Strengthening the Rotator Cuff: An Introduction to the Functional Anatomy & Strengthening Exercises SPORT & EXERCISE SCIENCE, Vol.2, No.5 Written by Stefanie Bronson, Athletic Conditioning Consultant A review of baseball and softball specific injuries and the amount of playing time missed because of injury suggests that the rotator cuff (RC) is an extremely important muscle group, particularly for pitchers. Currently, in Major League Baseball (MLB), Jeremy Sowers of the Toronto Blue Jays, Brad Lidge of the Philadelphia Phillies, and Brandon Lyon of the Houston Astros have yet to pitch this season due to injury in this area (4). When considering the bony configuration of the shoulder, the rates of muscle contraction, angular velocities, shoulder and arm acceleration / deceleration profiles, tensile strains generated, and the repetitive nature of these physical demands on a pitcher’s arm, it is easy to see that the load placed on the rotator cuff muscles can be extremely high, and that for optimal pitching performance, requires specific strength and conditioning attention. When viewed from the perspective of the shoulder as being an integral part of the linked kinetic chain that is the arm, and that the strength, stability, and endurance characteristics of the shoulder influence the physical loads within the elbow, it becomes evident that every ball player from Little League (basic pitch and over use limitations) to the majors (sophisticated training programs) should be involved in a shoulder and RC strength training program. A review of the literature concerning baseball injuries reveals that 19% of all baseball injuries are to the shoulder, with 8% in the elbow (3). The purpose of this article is to explain the anatomy of the RC muscles, to provide an explanation of possible injury causes, and to suggest exercises and stretches to the ball player, coach, and parent that can be done to prevent or rehabilitate rotator cuff injury. The RC is a collection of 4 muscles situated around the glenohumeral (or shoulder) joint. It consists of the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. These muscles originate on the scapula and insert on the humerus. They are considered the primary stabilizers of the shoulder joint. All 4 of these muscles are concentrically and eccentrically active during the throwing motion, where it is reported that the most common rotator cuff injury in throwing athletes is a tearing at the junction of the supraspinatus and the infraspinatus (2). Figure 1: The Rotator Cuff Muscles It has been reported that pitchers at the collegiate and professional levels may have total pitcher counts over 150 (including warm-up and game pitches) for a single game. A more detailed review of the throwing motion illustrates concentric contraction occurs during the beginning or ‘cocking phase of a throw to elevate the shoulder and to position it into external rotation. Throughout the throw and ball release phase, the muscles contract eccentrically to minimize the stress exerted on the joint (1). In professional baseball pitchers, humeralangular velocities of 7000 to ‘Training is our Focus, Performance is our Goal’ [email protected] Brampton Ontario Canada SPORT-SPECIFIC CONDITIONING CONSULTANTS ‘Sport-Specific Conditioning is our Focus, Performance is our Goal’ - PERFORMANCE NUTRITION - ATHLETIC TRAINING - ATHLETE DEVELOPMENT- PERFORMANCE PSYCHOLOGY – MANAGEMENT & CONSULTING - 8000 deg/s are observed during a pitch (2). It is that the RC acts to counteract these forces in order to maintain stability and the health of the joint. Injury to the RC takes place as the result of either i) a 1 time throwing motion that exceeds the tensile strength capacity of either 1 of a collection of RC muscles, or ii) as a result of repetitive high velocity, high force, throwing actions, that over time (which can be 1 game, or 1 season etc.) exceed the strength and endurance characteristics of the shoulder musculature and cause microtraumas or impingement of the glenoid margin (the underside of the posterior half of the supraspinatus and superior half of the infraspinatus), in the RC muscles and lead to a muscle or ligament tear, inflammation, or some other repetitive strain injury (tendinitis, bursitis etc.). Athletes are strongly advised to incorporate concentric and eccentric shoulder strengthening exercises into training programs in order to gain stabilization strength and to prevent injury to the RC area. A suggested training program has been outlined in Table 1. This program can be used as a preventive measure or as a rehabilitation program for injured athletes. The commencement of a rehabilitation program should not occur until an athlete has been cleared by the doctor to begin exercise. The goal of the program is to train for endurance as opposed to power or muscle hypertrophy. When beginning a program of this type, it is recommended that only body weight resistance be used and that one set of 25 to 30 repetitions is completed (1). Once able to complete the set without experiencing discomfort in the muscle, an increase of one or two pounds, or increase in difficulty of exercise band should occur. As the strength and endurance profile of the ball players shoulder increases, it is also suggested that they begin to incorporate upper body plyometric exercises, as these have been shown to increase the shoulders ability to generate greater arm strength and acceleration as well as greater tolerance to deceleration loads. Strengthening of the shoulder girdle musculature will help prevent injury and is important in a rehabilitation program to restore original movement. If the suggested training program is being used for rehabilitation, it is important that the program is not initiated until after the acute phase of the injury has passed and after a stretching schedule has been put into action. Loss of internal rotation is a common side effect of rotator cuff injuries. It is therefore important to incorporate stretches of the posterior capsule into training routines. The following stretches (Figures 1 & 2) can be used to help maintain or regain mobility in the rotator cuff muscles. Stretch position should be held for at least 30-seconds. Tension in the muscle should be felt, but the athlete should not experience any pain. ‘Training is our Focus, Performance is our Goal’ [email protected] Brampton Ontario Canada SPORT-SPECIFIC CONDITIONING CONSULTANTS ‘Sport-Specific Conditioning is our Focus, Performance is our Goal’ - PERFORMANCE NUTRITION - ATHLETIC TRAINING - ATHLETE DEVELOPMENT- PERFORMANCE PSYCHOLOGY – MANAGEMENT & CONSULTING - Table 1: General Rotator Cuff Strength & Conditioning Program Workload Set and Repetition or Workloads should be specific to the athlete. However the general recommendation is 2-3 sets of 15-20 repetitions in Off-Season, with repetition loads decreasing in the In-Season. Exercise(s) Standing External Shoulder Rotation 90o / 90o External Shoulder Rotation Internal Shoulder Rotation Integrated Lateral Shoulder Raise Scaption Bent-Over Lateral Shoulder Raise Figure 2: Inferior Capsule Stretch Figure 3: Posterior Capsule Stretch ‘Training is our Focus, Performance is our Goal’ [email protected] Brampton Ontario Canada SPORT-SPECIFIC CONDITIONING CONSULTANTS ‘Sport-Specific Conditioning is our Focus, Performance is our Goal’ - PERFORMANCE NUTRITION - ATHLETIC TRAINING - ATHLETE DEVELOPMENT- PERFORMANCE PSYCHOLOGY – MANAGEMENT & CONSULTING - For a more detailed discussion on and specific exercises for Shoulder Strength and Conditioning for Baseball please review an original PTS research paper titled “An Etiological Review of Ulnar Collateral Ligament Tears in Baseball Pitchers and a 12 Month Rehabilitation Protocol” which can be downloaded at http://www.performancetrainingsystems.net/Resources/An%20Etiological%20Review%20of%20Ulnar%2 0Collateral%20Ligament%20Tears%20in%20Baseball%20Pitchers%20and%20a%2012%20Month%20Re habilitation%20Protocol.pdf References: 1.Brumitt, J. (2005). Preventing Rotator Cuff Injuries for Pitchers. NSCA’s Performance Training Journal, 4(1), 7 – 9. 2.Dobson, C.C., Brockmeier, S.F., & Altchek, D.W. (2007). Partial-Thickness Rotator Cuff Tears in Throwing Athletes. Operative Techniques in Sports Medicine, 15, 124 – 131. 3. Lachowetz, Tony., Drury, Dan., Elliot, Robb., Evon, John., & Pastiglione, Jamie. The Effect of an Intercollegiate Baseball Strength Program on the Reduction of Shoulder and Elbow Pain. The Journal of Strength and Conditioning Research. 1998. 12(1). 46-51. 4.MLB.com. (2011). Retrieved from http://mlb.mlb.com/index.jsp. 5.Wooten, J.N. (2011). Stretche Exercises. Dimensional Wellness and Chiropractic. Retrieved from http://www.dimensionalwellness.com/StretchExercises.htm. More Baseball, and Baseball specific exercises can be found at the home of PTS Baseball at www.performancetrainingsystems.net/PTS_Baseball&Softball.php Performance Training Systems is an athletic conditioning consulting firm based out of Brampton, ON, Canada. We provide athlete development, exercise nutrition, performance psychology, athletic training, and management and consulting services to clients within the greater Toronto area and around the world. We are committed to ethical sport values based training, and promote sport as a vehicle for developing healthy bodies, healthy minds, and healthy communities. ‘Training is our Focus, Performance is our Goal’ [email protected] Brampton Ontario Canada .