To be clear, there are more than three reasons. Age, Sport, Position are a few of the common things that you might think of at first.
What if you are the same age, play the same sport/s AND also play the same positions?
What are other reasons to provide a custom program designed for each athlete in question?
Shoulder Range of Motion
First things first, let’s define exactly what we are looking at.
Shoulder Range of motion can be tested while laying down face up, and having your arm straight out away from your body. Then while holding the elbow, you can rotate the forearm clockwise and counterclockwise. It shows you how far each athlete can externally and internally rotate, and the difference between the two gives you a total range of motion.
Why do we care? Throwing a ball with high velocity is correlated 1:1 with external rotation.
Soooo… more is better, and the goal is to improve ER?
To find an answer, it is better to find out more about the athlete before we decide.
First, testing an athlete’s non-dominant side for total range of motion is a good way to give us an idea of what “normal” would be for that athlete. If they present with more than 10 degrees less on the dominant side, it likely means there is some limitation and we need to dig deeper.
If the athlete has 225 degrees of external rotation when you test them, but when they attempt to get to that er on their own (passive range of motion) and only achieve 200, then they have more range of motion then they are presenting but can’t actively use it with great stability and control. This is a sign to watch for injury prevention. We need to help that athlete earn that position actively through strengthening, isometrics, or other training methods. If we don’t, it could lead to the next point.
Lack of stability at the end range:
Not having stability at the end range means the rotator cuff won’t be able to fulfill its job of keeping the humeral head of the shoulder in place when the arm is in full er. This would lead to possible impingement, pain, calcium buildup, improper shoulder blade motion and reduced performance.
Back to the question: Is more External Rotation the goal?
If you have no difference in active/passive range of motion, your total range of motion is comparable to your non-dominant arm, and have good stability and control at the end range then the answer is still… maybe.
We have to remember most of the external rotation that presents in the throwing arm that is more than the non throwing arm is due to anatomical changes at the shoulder to allow for that extra layback. We earn that change at a young age as we throw while we develop structurally. So for the most part, we have what we are going to have…
Yes, there are ways to improve your external rotation beyond that. If all the boxes are checked, then working with a quality pitching coach and strengthening program are necessary to push the motion further. In the right athletes, they can better determine the strategy to safely build more ER for you.
One last note on this, it is NOT the lowest hanging fruit and should be only considered at the right age for the right athlete. Increasing your body weight and leg strength would be a safer place to start.
Specifically regarding the Thoracic Spine, or upper back in this discussion there are 2 main differences we see, and then everything in between.
- Kyphosis which is a rounding of the upper back where the thoracic spine is bent more than normal towards the back of the body.
- Flat back where the thoracic spine is making closer to a straight line while looking from the side from neck to hips/waist.
The common teaching has traditionally been to balance your push with pull, or even pull at a 2:1 or 3:2 ratio with pushing for improved posture.
To figure out what is best for you, again, it just requires a deeper dive into shoulder function.
Military posture is often a name given to a flat back individual, as they will present with an upright posture and shoulders back and down. The challenges that this will bring is the shoulder blades will often not be resting on the rib cage, and therefore will have a harder time gliding to upward rotation effectively. Additionally the muscles holding the shoulder blades down and back over time can become tight and overactive. This would lead to other important muscles involved in shoulder retraction/protraction to become less effective like the lower trapezius and serratus anterior respectively. Down the road this means the shoulder blade may have a longer path to upward rotation, or may not truly achieve full motion overhead without an impingement.
This spine presentation may actually benefit from more pressing motions to drive the scapula up and around the ribcage. Therefore performing more pulling exercises than pushing may not prove fruitful for this individual.
I will say, a flatter spine is easier to rotate about so it is understandable that these spine presentations can often succeed in rotational environments despite the drawbacks in other areas.
Kyphosis brings new challenges to the table. Where it does not have the problem of a “floating shoulder blade” like a flat spine, it often will present with the shoulder blades being further apart than desired, and often the humeral head is shifted forward as well. Essentially the shoulder blades never really retract to their resting position.
Throwing overhead requires the ability to simultaneously extend the upper back (make it flatter) and rotate towards the throwing arm. Two things that an extremely rounded spine will have challenges with. What you don’t get with motion in the upper back, you have to make up for in the shoulder or elbow. And remember the shoulder was likely already at a disadvantaged position to start with. You can see why that would be challenging right?
In both scenarios we need to be conscious of how we are loading or compressing the spine. A back squat for example will compress the spine. Find the best way for you to hold the bar/weight that encourages a more neutral position.
Thoracic Spine Mobility
Defined by how well an athlete rotates in their upper back.
The average person should probably have about 50 degrees of rotation, and that would be adequate for their daily tasks. Rotational athletes however really need 70 or more otherwise there can be some power limitations, movement compensations, and of course a higher risk of injury.
Remember how the kyphosis presenting spine has a harder time rotating, here is where we will dive in a bit deeper. When reaching back into external rotation to throw a ball, what you don’t get in motion from the spine, you compensate for in other areas (shoulder, elbow).
Yes, your shoulder/elbow pain could be coming from a dysfunction up the chain. It is always important to consider pain as a symptom, not a cause. Treat the cause and the symptom goes away!
As with shoulder range of motion, it is common that an athlete has more thoracic range of motion passively than they do actively. In circumstances where that athlete is forced into a greater range of motion than they have control of (swinging at a low off speed outside pitch) they are at a higher risk of injury.
While testing an athlete’s motion, if you can provide a small amount of assistance and they gain motion and can then hold it, that athlete is likely missing that active motion and we need to help them earn it.
Proper thoracic mobility is not only arm care in the layback phase and a tool to help with velocity. It also is extremely important in the deceleration phase after ball release! When the upper back can move into flexion and essentially have your shoulder/upper back move towards the target, it lengthens the time allowed to decelerate and allows the force to be distributed over a longer path.
As I write this it is snowing here in MN, so this hits all too close to home. Imagine you are driving your car and suddenly need to stop. Would you rather have 200 feet to stop, or 50 feet?
That is what increasing inadequate thoracic mobility does for your arm care.
- Training is not a one size fits all solution. There is something for everyone though.
- The three considerations discussed do not act independently. Rather effecting or improving one will have an impact on the others
- Be good at asking questions. Why are we doing this? Why does this hurt? How will this help me? Is there anything else I can do?
- Assess, make a plan, follow through, reassess.