|Home||Reference/Search||About Dr. Bragman||Related links||Audio Library||Free Press Column Library|
As a throwing sport, baseball puts tremendous stress on the arm, particularly a pitcher's arm. Although the softball pitching motion is underhand, a windmill pitcher, who brings the arm all the way up and around the head, also puts tremendous stress on the arm and shoulder. Besides the pitcher, other players throw regularly and may also injure their arms. With 38 million Americans playing these sports, that's a lot of sore arms.
Most injuries in baseball come from overusing the throwing arm. The throwing motion can be divided into phases to show what happens to the arm and shoulder.
In the windup, you bring your throwing arm back behind your body. In the cocking phase, you turn your arm to put your hand behind your head. This puts your elbow out in front of your wrist and into extreme external rotation. In the acceleration phase, you move the ball forward while it is still in your hand. A professional pitcher can accelerate a ball from a dead stop to more than 90 miles an hour. In the release phase, your wrist snaps forward as you release the ball. Finally, in the follow-through or deceleration phase, your arm comes down and across your body.
The bulk of throwing injuries are due to stretching the rotator cuff muscles. The rotator cuff muscles were previously thought to be stretched during the acceleration phase of the throwing motion, but recent studies show that they are actually injured during the deceleration phase. Stopping the arm after you release the ball is what tears up the shoulder.
To strengthen the rotator cuff muscles, baseball players should do the home exercise program described in Chapter 6 with light weights. Anything above these weight limits will bring the larger muscles of the shoulder into play and eliminate the rotator cuff muscles.
If your shoulder hurts, it is not necessary to determine whether your rotator cuff muscles are simply stretched or are torn. Both injuries are rehabilitated through the same exercise program. Once you have rehabilitated the rotator cuff muscles and are playing baseball or softball again, changing your follow-through by keeping the arm in the middle of your body and following all the way through may help relieve the pain. Or seek coaching help to improve your mechanics.
A different type of shoulder pain occurs mainly among professional pitchers or amateurs who have pitched for many, many years. The rotator cuff muscles sit in a bony arch in the shoulder. After many years of throwing, the muscles can become overdeveloped so that they don't fit in the arch any more. This requires surgery to enlarge the arch and provide more room for the rotator cuff muscles.
In softball, the normal underhand pitcher's delivery does not cause shoulder problems. But a windmill pitcher may suffer rotator cuff injuries because she comes over the top with her pitch and has to decelerate her arm after letting the ball go. Windmill pitchers should use the standard rehabilitation program for rotator cuff pain.
Baseball players may suffer a tennis-elbow-like syndrome. The flexor muscles of the wrist pull the wrist forward and help turn the hand over as it releases the ball. These muscles are attached to the inner side of the elbow, the medial epicondyle, which can become inflamed and painful from overstress. Baseball coaches and sports doctors used to believe that this elbow pain was caused by throwing too many curve balls. Now we know that it's the repeated flexing of the wrist that causes the stress.
The ligaments that reinforce the inner side of the elbow can also be stretched or torn from throwing. If the pain persists, it may be a symptom of another condition, called osteochondritis dissecans. This is rare, but it does occur among young pitchers.
Pitchers also may experience pain in the back part of the elbow. The severe external rotation of the elbow pushes it to the outside and swings a hook of bone, the olecranon process, to the inside, causing it to rub on the inner side of the elbow groove. This irritation can eventually lead to arthritis or bone spurs in the elbow.
The triceps muscle, in the back of the upper arm, attaches to the olecranon process in the elbow. This is the muscle that extends the elbow to put extra power in your throw. The attachment of the muscle at the elbow can become irritated, as any tendon can from overuse.
Baseball players are also susceptible to Popeye elbow, which is the inflammation of a small bursal sac over the olecranon process.
Little League elbow is a type of pitcher's pain that results from the repeated yanking on a growth center in the elbow, and has become a particular problem among high school pitchers. Little Leagues now limit the number of innings a youngster can pitch, but there is no limitation on high school pitchers. After about 75 pitches, a high school pitcher should be taken out of the game, whether or not he is tired, to protect his arm. Several weeks of rest is the proper way to ease any severe pain.
Unfortunately, subtle pressure is often applied to young athletes, particularly at playoff time. The star pitcher is not told that he has to pitch again right away, but it's put to him in such a way that he can't refuse. As a result, he ends up hurting his arm by throwing too much in one week.
Repeated bending of the wrist from throwing a ball may lead to carpal tunnel syndrome. The carpal tunnel in the wrist carries the main nerve that flexes the fingers and tendons. If you feel wrist pain and numbness in the third and fourth fingers, you must rest your wrist and apply ice.
A head-on blow to the tip of the finger, which often happens to catchers going after foul tips, can tear the extensor tendon in the finger or detach it from the bone. This tendon's job is to straighten the tip of the finger. If it is injured, you will not be able to fully extend your finger. You must see a doctor to make sure that you have not broken a bone and also to get proper treatment.
The most severe baseball injuries to the lower body come from sliding into a base. Catching a foot under the bag may cause a severe ankle sprain by stretching the ligaments on the outside or the inside of the ankle. Usually, it is the front ligaments of the ankle that are sprained, since the front part of the foot gets caught under the bag. You must have the ankle x-rayed to rule out a fracture. If the ankle doesn't give out from sliding into a base, you may break the bones of the lower leg above the ankle.
Almost anyone who has ever slid into a base knows about strawberries. These are huge abrasions on the hip that result from sliding on ground that's too hard. The treatment is to clean and disinfect the reddened area, and then apply an ointment and cover the strawberry with a sterile bandage so that it won't become infected. Sliding pads can help protect against strawberries, but most players refuse to wear them.
Knee injuries are rare in baseball. They most frequently result from a batter's violent rotation when he swings and misses. His knee gives out, and he goes down with torn cartilage.
For me, springtime means young baseball and softball players with heel pain. This is the time of year when they trade in their sneakers for cleats. In young players, heel pain is often assumed to be an inflammation of a growth center in the heel bone, which is called Sever's disease. However, in almost all cases, the actual reason for the pain is foot pronation. When people with foot pronation begin running in cleats, which are much less stable than flat sneakers, their heels roll to the inside, and they feel the heel pain almost immediately.
Put an arch support under the foot to correct the problem. If a child's pain disappears within a few days, then the child does not have Sever's disease. If the pain persists, have a sports doctor investigate the cause.
Baseball players who play primarily on artificial turf are prone to turf toe, which is a sprain of the big toe that results from the hard running surface.
How to Improve Your Game
Baseball is primarily a sprint, rather than an endurance, sport. The longest you will have to run is 360 feet, slightly more than 100 yards, when legging out an inside-the-park home run. In between pitches and waiting to bat, you do a lot of standing around. But when the time comes, you have to run in short spurts. Thus, you don't need to do much distance work, but you do need to practice running sprints. Do 50-yard dashes, resting in between, until you are exhausted.
Even though they know that baseball requires fast bursts, most players don't condition themselves well. Softball players are even worse off since many do not even consider themselves athletes.
Because baseball and softball are running sports, you need to work on your leg strength. Concentrate on the Leg Extension, Leg Curl, and Leg Press (see the strength-training program in Chapter 1), Ankle Lift with weights (see Chapter 13), and 90-90 Wall Sitting (see Chapter 20).
You also need a program of exercises to strengthen your arm. These exercises should include those prescribed for rotator cuff injuries. Doing these exercises in the off-season is a good way to strengthen the shoulder. You can supplement them with shoulder exercises from the strength-training program in Chapter 1.
Baseball players have carefully avoided arm strength training in the past. They felt that it would make their arms muscle-bound and interfere with the fluid throwing motion. With today's stretching programs and techniques of full range-of-motion exercise, this is no longer a valid argument. All baseball players will profit by having stronger arms. Not only will they throw farther and faster, but they will have fewer shoulder and elbow injuries.
Warming up the arm is essential. A good baseball player throws at one-quarter speed, then half-speed, and then three-quarters speed before he throws full out. Baseball is often played in cold weather and players who just go out and throw without warming up may end up with sore or injured arms. When I covered high school games in New Jersey, I don't think I saw more than three or four true first basemen. Almost all of them were sore-armed pitchers who couldn't throw very far.
To improve your arm flexibility, you should stretch your shoulder. Following are three basic shoulder stretches you should do after warming up.
Warm down the same way, with throws at three-quarters speed, then half-speed throws, and finally one-quarter-speed lobs. Then stretch your shoulder again.
After pitching, you should ice your shoulder. Wait 20 to 30 minutes before icing. If you allow the muscles to return to body temperature, the icing is much more effective.
If you notice persistent shoulder pain from pitching, have a pitching coach look at your follow-through. A good pitching coach knows the proper mechanics and can make on-the-spot corrections.
Nearly three out of four injuries to the 40 million Americans who participate in organized softball games result from sliding into a base. Most softball players don't know how to slide properly, and many players decide to slide too late. Being in poor condition and drinking beer on the sidelines may also contribute to the problem.
These injuries could be practically eliminated through the use of breakaway bases instead of anchored bags. A study from Michigan showed that playing softball on fields with stationary bases led to 23 times more injuries than playing on fields with breakaway bases. So if you play in a league or set up your own game, make sure to use bases that move so that you avoid sliding injuries.