How Can Chiropractic Therapy Help Treat Overhead Throwing Injuries in Athletes?
- Julian Simpson
- Jun 8
- 7 min read
How Can Chiropractic Therapy Help Treat Overhead Throwing Injuries in Athletes?
Let's Discuss the shoulder joint
The shoulder is a complex anatomical structure that is comprised of multiple bones, joints, muscles, tendons, and ligaments. The bones that make up the shoulder are the humerus, scapula, and the clavicle. The shoulder has three bony (glenohumeral, acromioclavicular, sternoclavicular) articulations and one soft tissue articulation (scapulothoracic)
The primary shoulder muscles are the deltoid and the four muscles that make up the rotator cuff (supraspinatus, infraspinatus, subscapularis, and teres minor)
There are also multiple secondary muscles that contribute to the motion of the shoulder and scapular stabilization such as the biceps brachii, triceps, latissimus dorsi, trapezius, rhomboids, and levator scapula
There are five general bursa (subacromial-subdeltoid, supra-acromial, subscapular, subcoracoid, and coracoclavicular) that help protect the muscles and tendons from injury from adjacent bony prominences
What happens to the shoulder when we throw a ball?
The four phases in football are known as Early Cocking, Late Cocking, Acceleration, and Follow Through
The biomechanics of throwing a baseball or softball overhead adds the Windup and Arm Deceleration Phases
The Windup Phase begins with the first movement as the athlete transitions from a static balanced position with the athlete’s feet and arm set. The Windup Phase is completed when the lead leg reaches maximum knee height, which varies depending on whether the athlete is throwing from a fielding position, pitching from the windup, or utilizing a slide step from the stretch. The shoulder starts in a static, internally rotated position so that the hands are together (paired with a gloved contralateral hand in baseball) holding the ball in front of the chest. The shoulders may be flexed forward to bring the hands and ball overhead during a windup but do not bring the hands and ball overhead during a throw/pitch from the stretch position
Stride/Early Cocking Phase and prepares the arm for the throw. The scapula will rotate upward in a retracted position to allow the deltoid and rotator cuff to begin to abduct the arm in the Early Cocking phase. During this phase, the Throwing Shoulder will undergo extreme external rotation (ER) that stretches the anterior musculature in preparation for a forceful contraction.
As the body moves forward, the trunk will rotate so that the lead shoulder will be directed toward the target. This phase ends when the lead/stride foot contacts the ground toward the target
During the Late Cocking Phase, the shoulder will reach maximal external rotation (MER). In order to achieve MER, the scapula remains retracted as the shoulder abducts to 90–110° and externally rotates between 50 and 185°. Additionally, in order to reach MER, there is coordinated eccentric contraction of the subscapularis, latissimus dorsi, and the pectoralis major and concentric contraction of the infraspinatus, teres minor, and deltoid. The shoulder abducts 90–100° as MER is achieved, ending the Late Cocking Phase
The next phase is known as the Arm Acceleration Phase and progresses from MER into a forceful internal rotation (IR) until the ball is released, the Arm Acceleration Phase is one of the fastest human movements in sports. During the acceleration phase, the rotator cuff muscle activity is three times greater for the amateur pitcher compared to professional pitchers
The Arm Deceleration Phase begins as the ball is released and the thrower attempts to decelerate their arm movement and transition into the Follow Through Phase and to complete the entirety of the throwing motion. Maximal Internal Rotation (MIR) is achieved during the Arm Deceleration Phase. During this phase, the shoulder also horizontally adducts as the arm comes across the body into the Follow Through Phase
Arm deceleration is achieved through the coordinated scapular stabilization by the rhomboids and the serratus anterior in conjunction with the eccentric contraction of the posterior deltoid, infraspinatus, and teres minor
What are some risk factors for shoulder injuries in throwing sports?
Risk factors for baseball pitchers.
• Pitching while fatigued |
• Throwing too many innings over the course of the year |
• Not taking enough time off from baseball every year |
• Throwing too many pitches |
• Not getting enough rest |
• Pitching on consecutive days |
• Excessive throwing when not pitching |
• Playing for multiple teams at the same time |
• Pitching with injuries to other body regions |
• Not following proper strength and conditioning routines |
• Not following safe practices while at showcases |
• Throwing curveballs and sliders at a young age |
• Radar gun use |
What tests can Chiropractors do to assess your shoulder?
The physical examination will still also include standard assessments for range of motion (ROM) of the cervical spine and shoulders. Abnormalities in the ROM of the shoulder can be predictive of injury. It is a common finding in overhead throwers to have a shoulder with an increased ER and reduced glenohumeral internal rotation (GIRD) .
There is a positive predictive value for shoulder pain due to GIRD if there is a difference of more than 17 degrees of IR compared to ER
Other tests are :
Neer Impingement, Hawkins, Empty Can, O’Brien’s, and apprehension tests
Injuries of the shoulder in sports & overhead throwing
The pathologies of the rotator cuff are more common in adult collegiate and professional throwing athletes compared to youth and adolescent athletes
Although injury to the rotator cuff can occur while throwing, it is more commonly due to a trauma when trying to field the ball or slide into a base in baseball or softball as well as during a tackle in football.
The primary theory for rotator cuff injury (RCI) is known as external impingement (EI). There are multiple contributing factors that lead to EI including poor muscle control of the rotator cuff muscles and the subtle instability of the glenohumeral joint (GHJ). The decreased muscle control of the rotator cuff leads to a deficiency in the compressive forces that are necessary to provide stabilization of the humeral head and the glenoid during overhead movements
Signs and Symptoms of rotator cuff problems
The overhead-throwing athlete will typically present with a chief complaint of shoulder pain that is worse with throwing and other overhead activities. The pain can be acute following a traumatic event or can gradually increase over time with chronic repetitive microtrauma. The pain may be local or radiated down to the lateral deltoid. The athlete may complain of weakness as well as loss of ROM of the shoulder. The pain or weakness may occur when trying to lift or carry a heavier object.
Return to play
The return to play (RTP) of overhead-throwing athletes should occur only after there is resolution of symptoms at rest and with overhead activity.
Shoulder instablity caused by labral problems and dislocations: What are they and how can we assess :
The shoulder is one of the most unstable joints of the body with a shallow cavity surrounded by a labrum. The glenoid labrum is a fibrocartilaginous ring that is attached to the outer rim of the glenoid and plays a vital role in shoulder stability. The anatomy of the GHJ allows for significant multidirectional mobility that is necessary for throwing. Disruption of the labrum alters the balance between mobility and stability. Injuries to the labrum are frequently due to trauma or overuse injuries from repetitive motions such as throwing.
An acute traumatic event is the most common cause of a labral tear and shoulder dislocation. The location of the tear of the labrum is due to the forces exerted on the labrum based on the insulting trauma. The impact of the trauma will cause the disruption of the labrum, and the shoulder may dislocate at the time of the trauma or be susceptible to a future dislocation due to the tear caused during the trauma. The labral tears are known as SLAP, Bankart, and GLAD
SLAP lesions
SLAP injuries are due to attrition over time, which is the most likely mechanism of injury in the overhead-throwing athlete and has been described as a peel-back mechanism. During the throwing motion, the arm is in an abducted and externally rotated position during the Late Cocking phase, and the combination of the bicipital force and the posterior humeral glide causes the posterosuperior quadrant of the glenoid and posterior labrum to begin to peel off
Can also be caused by a fall on an outstretched arm with the shoulder in varying degrees of abduction and is now known as a compression-type injury
GLAD lesions
Glenolabral Articular Disruption (GLAD) lesions are an infrequent (1.5–3%) type of traumatic labral tear. GLAD lesions are a combined glenoid cartilage and labral injury due to trauma. The typical presentation is a complaint of anterior or global shoulder discomfort.
Bankart lesions
A Bankart lesion develops when the glenoid labrum, most commonly the anterior-inferior labrum, is torn with associated tearing of the associated ligaments. When the anterior-inferior rim is disrupted with the addition of an avulsed bone fragment or a glenoid rim fracture, it is known as a bony Bankart
What are the signs and symptoms of Labreal Tears and Injuries?
An athlete with a labral tear and/or dislocation will frequently present with shoulder pain. An athlete with an SLAP lesion typically has less acute pain than a patient with a dislocation. The pain is typically worse when the shoulder is in specific positions or when doing certain activities. These symptoms may present as a dull or aching pain in the shoulder, particularly overhead lifting. Other times, it may present as a painful feeling of clicking, popping, or grinding in the shoulder during movement.
The throwing athlete may report that they have a “Dead Arm” due to a transient loss of sensation and/or numbness in the involved extremity
A posterior dislocation will typically present with signs and symptoms such as a loss of ER of the shoulder along with prominence of the humeral head on the posterior shoulder.
Return to play
As always, a customised rehabilitation program should be developed for every patient. However, there are certain components that are universal, although they may vary in frequency and intensity. The RTP rehabilitation program should include isometric to isotonic exercises for the scapular stabilizers (the serratus anterior, and the pectoralis and latissimus dorsi muscles) and rotator cuff muscles. These exercises can then be advanced throughout the spectrum of the program as the overhead athlete progresses.
Eventually, the exercises can then be progressed to integrative and functional activities specific to the overhead athlete’s sport
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De Luigi AJ, Raum G, King BW, Bowers RL. Osteopathic approach to injuries of the overhead thrower's shoulder. J Osteopath Med. 2024 Dec 2. doi: 10.1515/jom-2024-0031. Epub ahead of print. PMID: 39611387.
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