The Labrum List

height of ball

What if neither are above the shoulder. In your opinion... is it specifically elbow above shoulder at foot strike?

 

If your asking if it is specifically the elbow above shoulder height at foot strike that leads to the wringing out effect, I would answer yes if the hand is below the elbow at this point.

If the hand is below the elbow (imagine upside down W or L) this is internal rotation of the shoulder. With this internal rotation and the combined elbow above the shoulder (abduction), you have created a traction and twisting/wringing moment at the bicep tendon (which attaches at the labrum).

 

Add...

me to the list at age 44 (((((((( Now it is my ulner/elbow is gonna get cut next!!!!!!!!!!! That is on top of Joe Montana surgery ten years ago ALLL from baseball and a little golf of course! ATC do you know of an EXCELLENT orthopedic surgeon to recommend in the mtns of NC?

 

Orthos in NC mtns

I am unfamiliar with specific orthopedists in the NC mountains. The only name that comes to mind is "Blue Ridge Ortho" or something like that. Can't speak to their specialties or reputations.

 

Yeah

That answered my question a little more specifically. I don't know if completely agree with you on this one. I think that you are absolutely correct in the fact that that specific movement will cause the wringing or twisting moment at the bicep tendon.

In my opinion, you could break a million specific movements down and say that they could cause a specific stress on the shoulder. More importantly I think that the problem may have stemmed from a problem with internal rotation and the flexibility, or lack there of, that goes along with it. I would argue that the majority of pitchers at some point pass through that "scap load" position. The one in which the elbow is higher than the shoulder.

 

ATC:

First of all, I'd like to thank and commend you for the valuable information you've already provided readers here during your short tenure. I hope you'll post frequently.

Having gone back and read your initial post in this thread, I note that you used the phrase "most pitchers" when you introduced the concept of the "inverted W." When I'd first read it, I'd mistakenly thought that you considered the "inverted W" a necessary condition for a labral tear. This is of significance to me because my son is currently rehabilitating from arthroscopic repair of his labrum.

He did, in fact, suffer an unfortunate incident while warming up for his first regular season appearance this year (His bullpen catcher turned his head to the field as he was in mid-motion, causing him to hold on to the ball instead of releasing it. As soon as his arm deceleratd, he felt a sharp pain in his shoulder.) However, not knowing whether the incident had simply exacerbated a pre-existing condition or created the tear, your comments and related articles sent me to the numerous pictures that I have of his throwing motion.

I found it interesting that in no case could I find a photo showing his elbow higher than his shoulder; so, my lingering question would go something like this: Assuming that the articles are correct, that the "inverted W" can lead to SLAP tears, is it also a NECESSARY element (barring accidental incidents)? Put another way, are there other mechanical mistakes that can also lead to labral tears in the absence of the "inverted W."

Thanks, again, for the insights.

 

There are some ways
you can assure yourself of never getting hurt playing baseball. Dont play!
For those that choose to play there are ways to help reduce your chances of getting hurt.

Dont dive for balls.
Dont try to throw the ball too hard to get anyone out.
Dont pitch.
Try to suck so you will ride the bench.
Try to suck so bad the coach wont let you even practice.

LOL at Kenny May!!! You are the best.

 

Andro

Great point about the lack of flexibility into IR. That is exactly the issue that gets pitchers in trouble during elbow higher than shoulder positions. If the posterior shoulder isn't flexible enough then the humeral head is being pulled (in effect) into ER (due to lack of IR flexibility). With that decreased IR flexibility and the addition of a "forced" IR, combined with the traction of hyper-adbuction (elbow higher than shoulder), the labrum is placed in a very compromising position.

Scap load is important IF the scap is loaded into a retracted and depressed (down and back) position. If the scap is "loaded" in a retracted and elevated (up and back) position (i.e. upside down W and inverted L), then impingement has an environment to flourish.

Great dialogue!!!

 

Prepster

Mechanical, in the sense of how the shoulder blade sits, yes. Mechanical, in the sense of pitching mechanics, the W & L issue is what my experience has revealed.

 

Labral Tears

Prepster,

This is my opinion. Take it for what its worth.

I agree with several things that ATC is saying. I think his insight is right on with how the injuries occur.

I believe that labral tears can also occur from a couple of things that are not related to a pitchers natural "mechanics", but could directly affect those specific mechanics. These specific topics that I'm talking about all lead back to the same thing. Undue stress or wear and tear on a joint that would not normally happen if these were better.

Alignment of the hips, shoulders and spine- I don't need to get into this too far, but simply put if these are out of line there will be problems. Unfortunately, based on your genetic make up, some people were built to be in line and others must work everyday to stay in line. There is a necessary compensation by a muscle or muscles to do what the pitcher is telling it to do. Many athletes not knowingly, have alignment issues. (in my experience it has been the hips that pitchers are most prone to moving out of place)

Flexibility and Flexibility Balance- ATC has eluded to this in several of his posts. i.e. If a pitcher has tremendous external rotation he must be able to match that flexibility internally! If there has been a past injury, this could affect the flexibility balance as well. Most athletes will again, compensate for it. An example of this would be an inactive worker who is getting close to retirement. He's just buying his last days out... You don't have the heart to let him go. Instead of doing that, you decide to pick up the slack. In turn, your work suffers.

Strength Balance- If a muscle or group is too developed ie the quads and gluts from doing squats. Your body has to compensate for lack of strength in your hamstrings.

- With all of these things you have heard a common theme. Compensatation. When the body compensates for something, whatever it may be, a muscle group, tendon or ligament has to work harder. When one or all of those work harder, it puts undue stress on the closest joint. In a long enough timeline, there will be a break down.

My recommendation would not be to change the pitchers natural mechanics. It would be to push the envelope in preparation with Flexibility and Strength Balance, have your son tested for alignment issues. Hopefully in turn his body works more efficiently.

I know what I just said is going to lead to some questions. I'll try to get back on all of them. This is a good discussion.