Pain When Throwing?

Do you get a throbbing pain or a ‘dead arm’ feeling when throwing a ball? Do you getting a snapping sensation that leaves you with soreness? Maybe you have a shoulder impingement. More specifically, an internal impingement.

This picture burns my eyes:

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In the physical therapy world, shoulder impingement is probably the most common shoulder injury we see. This is when the supraspinatus (one of the rotator cuff muscles) gets pinched in the joint, and can lead to fraying and eventually tearing.

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A much lesser known subtype of impingement is ‘internal impingement’. This is very common in the throwing population. Both types of impingement affect the rotator cuff, but where the problem occurs is different. Having the correct diagnosis can significantly speed up and improve your outcome from rehab.

So what is it exactly? Picture the ball and socket joint. On the top part of the socket, there is a rim. The glenoid rim specifically. Both the supraspinatus and infraspinatus (rotator cuff muscles) pass over this rim to insert onto the humerus. If there is something off with your mechanics, these muscles grate on the rim and get irritated. This will lead to that dead arm feeling, a deeper, inside the joint kind of feeling. It’s usually on the top and back side of the shoulder.

This view is the back of the shoulder


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So there is good news and bad news. The good news is that it’s usually treatable with rehab and probably won’t need surgery. The bad news is that you have to do rehab. Don’t google the exercises because it’s just not that simple. You need a good physio to determine what is ‘off’ with the mechanics. Here are some probable causes:

    • Glenohumeral instability

    • Scapular dyskinesis

    • Capsular stiffness

    • Anterior instability

    • Incompetent subscapularis

    • Decreased elevation of scapula in cocking phase

    • Weak scapular muscles

    • Glenohumeral Internal Rotation Deficit (GIRD)

The shoulder is inherently an unstable joint. Classic knowledge tells us to stretch what hurts. More and more, we are finding this to be untrue. Just blindly stretching it may exacerbate the problem. This is a problem that has to be assessed and the treatment should be custom tailored with your specific problems. Google can’t do that. Not yet.


Christopher EllisComment