Your Elbow Isn’t Your Problem Part 2: It’s Your Shoulder!

In the first part of this series, I talked about the concept of regional interdependence and that pain in one part of the body can usually be traced back to other parts of the body. With elbow pain, one of the common sources of this pain can be the shoulder. With any overhead athlete (i.e. Baseball, Softball, Football, etc.), you depend on your shoulder for quite a bit of motion whenever you throw a ball. The most necessary motion of the shoulder for this is what we call External Rotation. Let’s talk about why this motion is important, how we tell if it’s limited, and what we can do to treat it if it is limited!

Why is shoulder motion important?

Numerous research studies have looked into predicting injuries in overhead athletes. Most of these studies suggest that limitations in shoulder External Rotation puts athletes at a higher risk of elbow injury while throwing than those without shoulder limitations. External Rotation of the shoulder is the motion you use when reaching overhead, as if to wind up and throw a ball. The more external rotation you have, the further back your hand is able to go.

As it relates to throwing a ball overhead (i.e. Baseball/Softball players, Quarterbacks, even volleyball and tennis players), this limitation of shoulder motion can cause unnecessary strain on the elbow and lead to irritation. As seen below in the 1st photo, with proper shoulder motion, an athlete will have no issue winding the shoulder back to throw a ball. However, as you can see in the 2nd photo, if your shoulder is limited and can’t go back far enough, most athletes will compensate by pushing the elbow forward to try and create the feeling of bringing your hand back further. This puts more strain on the front of the elbow (ever heard of your “Tommy John Ligament”?) and makes one think the elbow is what needs to be addressed, when in reality the shoulder limitation is the root of the issue. 

(LEFT: No shoulder limitations- this is what it should look like. RIGHT: limitations in shoulder mobility can cause you to compensate by sliding the elbow forward when throwing and lead to elbow irritation)

How do you know if your shoulder is limited?

With any overhead athlete, we’d expect to see slightly more shoulder mobility than the average human as the athlete tends to ask for more out of their shoulder during season. While 90˚ is the standard for how much shoulder external rotation is “normal”, I like for my baseball and softball players to have more than 90˚ to avoid possible injury. To test this, it’s best to look at your motion from the side (either record yourself, or have someone take a picture).

From the side, draw a line straight up/down the middle of your body (it might be slightly tilted depending on how your body is leaning). If your hand goes beyond the line, then your shoulder mobility is good! If you cannot get your hand past the line, there may be some limitations that are worth working on to ensure your body is moving the way it needs to be!

My shoulder is limited, now what?

There are a lot of different things that can possibly limit the motion of your shoulder- joint restrictions, muscle tension, neural tension, etc. The best way to be for sure that you are addressing the true limitation in your shoulder is to have it assessed by a professional (which I’d love to do for you!). However, I’d be doing a disservice to not give you at least one exercise to try out since you’ve stuck with me this far into the blog. One exercise I love to use for working on shoulder mobility is called shoulder half-circles and all you need is a resistance band. Simply take the band behind your back, and alternate moving your arms up and down to create as big of an arch as you can. Be sure to keep your arms in the same plane as your body and not reach your hands too far backwards as this could be uncomfortable on the shoulder.

I usually do these for about 15-20 reps, and are a great warmup before throwing to ensure your shoulders are moving the way they need to. Give these a shot- but if you feel these are difficult or don’t seem to help, please reach out so we can dive in a little deeper to make sure your shoulders aren’t limiting your performance on the diamond!

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