Rotator Cuff Fatigue

vhs,

I've heard of it (rotator cuff fatigue), but not experienced it with two pitching sons. I hope everything gets better for your son quickly. HS tryouts and season is right around the corner.

I do know my college pitching son did a lot of exercises in the garage and at the gym (during winter break) every other day specifically for shoulder and rotator cuff muscles. The coach gave him a workout routine that he did religously that included J-bands and longtoss. There was no mound work just throwing. He told me it is all about flexibility and working with light weights for many repititions. He showed me the exercises and the shoulder specific stretching that I could us for my tennis game.

I guess if I was you, I would get the sports doctor or physical therapist to clear/approve the "home routine" your son is doing. Then ask for specific exercises to strengthen the shoulder & rotator cuff that he could possible do on the off days of the elbow physical therapy....just an idea.

Here is 4 exercises he showed me, and he did as a warm up to the other exercises. Again, I would probably want to clear this with the Dr or PT.Rotator Cuff Exercises

Yardbird will probably come on and tell you it's for some reason or another but my suggestion is that you shouldn't ask for medical opinions on a message board. PT's are not doctors.

If you are unsure seek a second opinion from a qualified sports doc. I am not sure why you didn't seek out in the first place.

Go with the PT that is recommended to you by the Dr. You can go to ASMI.org and or google "throwers 10" and get a series of RC exercises. We have a player who is a non pitcher who has been told he has a muscle imbalance and is going through PT doing similar stuff. Good luck.

quote:

PT's are not doctors.

And most doctors don't know much about musculoskeletal injuries. That's where a physical therapist or athletic trainer come in so handy. Both of those professions are specialists in musculoskeletal injuries such as this.

Going to an orthopedic surgeon may be warranted to check the elbow though..

My son had some elbow sorness fall of 2009. Went to a doctor to check it out. He prescribed PT and they discovered the same thing you are talking about. His pitching shoulder was a little weaker than the other. Did the PT they prescribed and he has been doing bands and light dumbells to keep his shoulder strong ever since then. He has not had shoulder or elbow pain since then.

Like BOF said, follow the instructions of the PT guys. I could be wrong, but I think when your shoulder weakens, it interupts the kinetic chain of throwing. The arm tries to compensate for it and the elbow suffers as a result. There are others here far more knowledgable than me, so they can correct me if I'm wrong. Just wanted to let you know, we had been through something similar.

quote:

Originally posted by bballman:
My son had some elbow sorness fall of 2009. Went to a doctor to check it out. He prescribed PT and they discovered the same thing you are talking about. His pitching shoulder was a little weaker than the other. Did the PT they prescribed and he has been doing bands and light dumbells to keep his shoulder strong ever since then. He has not had shoulder or elbow pain since then.

Like BOF said, follow the instructions of the PT guys. I could be wrong, but I think when your shoulder weakens, it interupts the kinetic chain of throwing. The arm tries to compensate for it and the elbow suffers as a result. There are others here far more knowledgable than me, so they can correct me if I'm wrong. Just wanted to let you know, we had been through something similar.

I happen to agree with the above, I really do beleive that son's elbow problems may have been related to is past shoulder issues, but that was determined by a doctor, not the athletic trainer and PT.
OP has to clarify a bit, was it a doc or a PT who diagnosed his problem? If not, how do they know EXACTLY what is going on in the elbow or the shoulder?

They (a local doc and trainer) told son he had elbow tendinitous, until they actually did a test on his ulnar nerve and an MRI, they were wrong. The year before they said it was a loose capsule (did all od these excercises for nothing ),when it was an enlarged cortacoid bone. These diagnosis were by specialist, with specific tests done to determine the problem.

I guess I should have started the discussion with we did go to a Sport Medicine Ortho, evaluated the elbow (tennis elbow), referred to PT for rehab. It was during the PT exam, that the weakness in the throwing shoulder was discovered.
The home routine we have is from the PT and his instruction is to not throw until March 1.
There was no pain with the shoulder or elbow (which is good) upon exam and manipulation by the PT.
We were surprised because he does work out with strength training prescribed by his pitching instructor and had not thrown a ball since mid November.
Ironically, though he plays left handed, he is actually right handed and some difference is expected in the non dominant hand.
Thanks for all the great posts and information.

Thanks for clarifing the situation.

Great advice on working with a good PT. My wife is a PT and she is the one that decides what exercises are appropriate for the given condition. The doctor only helps in identifying what the issue is and will usually send you to a PT. The other point here is that a lot of shoulder and elbow issues are a result of poor throwing mechanics. Might be good idea to go and have pitching lessons from a good instructor to see what is going on.

BOF - That is some good stuff. Thanks.

Vhs-02-2012,

quote:

“We took our son to the physical therapist for intermitten pain in his pitching elbow”

How old biologically is your son, not chronologically?
Was the pain at the outside of the elbow (lateral)?
Was the pain at the inside of the elbow (medial)?
Was the pain at the back of the elbow (posterior)?

quote:

“the PT said he had some "rotator cuff fatigue" - pitching shoulder was weaker than the other”

This usually means he did a laxity test on him that tells you he actually has a loose shoulder capsule always diagnosed as weakness helped caused by static stretching and overuse by youth pitchers. Always the more used shoulder will actually be stronger but all youth pitchers have this problem to some degree and do not train for shoulder fitness especially “sport specific “ fitness performed by overload training.

quote:

"looseness" in his elbow tendon”

This is impossible to determine being that there are many tendons in the elbow and all are life trained differently so you can not cross check the right side against the left side for comparison!! Ligaments determine range of motion not differing tendon length The flexor tendons either micro tear (pain) fully tear (severe pain) or avulse by detaching from the bone (severe pain).

quote:

“While we expected a diagnosis on the elbow”

If he has medial pain he is unfit to perform with the pronator flexors to with stand the stress.

The fix is to keep using this muscle group and strengthen them.

If he has lateral pain he was not fit enough to perform a bad mechanic with the supinator flexors. Since you have now said “tennis elbow”also known as LL elbow we now know how he performs his mechanics and how to fix them, read the next paragraph and his pain will disappear.

The fix is to quit supinating all pitches!!!! and quit using this muscle group because it leads to other mechanical problems like slamming ballistically the Olecranon process against the Humeral Fossa (hyper eccentric extension) causing loss of range of motion in both directions, bone spurs and bone chips that are actually later hardened pieces of cartilage that break off and lodge between bone plus this resulting inflammation and pain.

If he has posterior pain he uses his supinator flexors to pitch with that slams two bone at the back of the elbow together, the Humerus and the Ulna.

This can easily be fixed by having him strengthen his pronator flexors in the forearm that attach with tendons at the elbow by voluntarily pronating every pitch he throws and exercising “sport specifically” with wrist weights and iron balls with the correct mechanic. This injury is a direct result of supinating the Curve ball, fastball Cutter or Slider slurve and is entirely mechanical and fixable.

quote:

“the shoulder discovery was a surprise”

All kids have this problem and it has nothing to do with elbow problems! If the shoulder was stronger the elbow would have been delivered more stress not less. The ability for the elbow to withstand any amount of stress is mechanical because if you supinate your drive the elbow hyper extends instead of hinges. This is why centripetal mechanics are so injurious at the elbow.

quote:

”We have a at home routine and he will be seeing the PT 3x a week in preparation for the spring HS season”

While he is an athlete and over biologically 16 he should never shut down this training.
If he remains with the same mechanic expect a repeat of the same.

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”Interested to hear if anyone has experience with a similar condition”

The diagnosis and explanations you were given are typical and do nothing to change the mechanic that is the real problem here.

TPM,

quote:

“Yardbird will probably come on and tell you it's for some reason”

If no injuries other than muscle pulls were produced by the traditional pitching motion, I would have no reason to post!

Standballdad,

quote:

“The other point here is that a lot of shoulder and elbow issues are a result of poor throwing mechanics.”

This is really the only point! If the mechanic is non-injurious even unfit athletes can perform without problems other then muscle fatigue.

quote:

“Might be good idea to go and have pitching lessons from a good instructor to see what is going on”

This will only solidify the problem in that most instructors still teach the destructive traditional centripetal supination mechanics but I must admit things are changing faster now with some? Give it another 5 years and it will be 50/50 guaranteed.

Yardbird - Thanks for the information you shared. I will review it with him. Some of the answers are as follows:

He is 17 and 3 months. Not sure what you mean by biological age
Pain is medial (inside) and intermitten.

The forearm exercises ordered by the PT include band work and wrist "up and downs".

Will check back in after review with him and report on progress.

Thanks again....Great information

Vhs_02_2012,

quote:

“He is 17 and 3 months.”

This is his chronological age, the number from his date of birth. This number tells diagnosers little about the players biological makeup to make decisions about training especially with pitchers whom perform ballistically.

quote:

“Not sure what you mean by biological age”

Biological age in males is the rate at which his growth rate and maturity are gained.
With males this rate is determined by the width of his growth plates and his outwards appearance in puberty.
This rate is extremely different by as much as 6 years from the judging from the middle out forwards and backwards. There are Advanced maturers, Equated maturers and delayed maturers. This is a critical piece of information when giving any kind of advice.
If your son has been pitching for a long time his pitching elbow will be biologically older than his glove elbow when compared for growth plate width that has retarded the growth of all pitchers Humerus, Ulna, and Radius. At chronological 17 y. and 3 mo. he may be only biologically 15 or 16, he may be biologically 18 or 19, It matters when you can increase the stress because all the growth plated are completely solidified in the elbow with a n equated maturer at biological age 16. He is probably safe to train like an adult now?

quote:

Pain is medial (inside) and intermitten.

This is a different problem than “tennis elbow” or LL elbow that occur on the Lateral outside of the elbow injury. Your Dr’s have this wrong.

This is actually a good sign in that it is telling us he uses his pronators to perform some of his pitches, probably his fastball that may have towards the ball arm side movement.
The problem is his pronators are insufficiently fit and need to be incredibly fit to pronate the forearms.

quote:

”The forearm exercises ordered by the PT include band work and wrist "up and downs"”

Band work will passively exercise non sport specifically his shoulders but unfortunately he also needs forearm Flexor work.
The best exercises for this involve supination to pronation of the forearms that most general trainers skip over and it does not get done!
One good one is forearm twirls performed with Kettle bells or a home made device using 5 gallon buckets and a PVC handle with rope, here is one of D1 my clients performing bucket twirls in HS. http://www.youtube.com/watch?v=q8hSiV3Su0Y

Another is to attain a 6 LB. Ladies shot put and flip the ball with pressure between his middle finger and thumb by pronating it aggressively from his belly up releasing the ball and catching it with the other hand.

By far the best exercise is to get the shot put and throw it with varying degrees of Ulnar flexion (fingers up and towards the outside) and Radial flexion (fingers up and towards the inside) to pronate the drive and release voluntarily and Sport specifically.
Unfortunately this is a logistical problem that has to be overcome and why more people do not do this. Here is a 13 YO performing some of the drills.
http://www.youtube.com/watch?v=MHRgU9u4kmI

No supination or low arm angles allowed for this drill!!!!

The best pitching tenet is to pronate all your pitches and the best way to learn this is free at DrMikeMarshall.com

Good practices in the future.

Yardbird - Thanks for all the great information. We are going this week for a 2nd opinion based on conversations with our son's baseball coach/instructor. Will let you know if the 2 opinions match....Thanks again

Yardbird do you realize that you never told VHS how to check his biological age?

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Yardbird do you realize that you never told VHS how to check his biological age?

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coach2709 - Thanks for saying that, I thought I had overlooked it or was too stupid to figure it out from the description....and after so much advice, didnt want to ask for more....LOL

coach2709

quote:

“Yardbird do you realize that you never told VHS how to check his biological age?”

It was a moot point at this time because he said that his son was chronologically 17 y and 3 mo. giving him more than enough leeway to proceed with adult training.I just gave him the basics and a heads up. Had his son been chronologically 14 or 15 there would have been a chance that his elbow problems could have involved his growth plates making the mechanical diagnosis more difficult and mentionable? In hind site I guess I could have told him to check Dr.Marshall’s very detailed information of the how’s and why’s. Thanxs for that and I will in the future.

Vhs_02_2012,

quote:

“I thought I had overlooked it or was too stupid to figure it out from the description”

Giving you details at that point would have been way over the top, even though everybody complains about the limited information I pass on anyway. Since when explaining injurious situations by parents here and elsewhere not one has started with biological age and shows that this information is seemingly unimportant to all including coaches when asking youth pitchers to perform training routines or competitions.
It is actually of the most importance! And should be the first consideration when anybody talks about these subjects, especially medical doctor's, did yours?

I appreaciate what you shared and helped us do more research into the subject...Also good to know I survived another day without being identified as an idiot....LOL

As a follow up, we saw a different Sports Medicine Dr yesterday (not ortho, but GP in sports medicine)recommended from summer team coach.

He says the elbow is fine because in "functional" position and manipulation, there is no pain. More complicated answer from DR, but that's the readers digest version.

He says shoulder is less flexible than desired and the inability to backwards extend (due to inflexibiity) is putting more torque on elbow to produce velocity resulting in intermitten pain. The reduced flexibility is compouned by a really tight front shoulder capsule due to strength training on the front and not enough attention to back muscles.

Again all more detailed in the discussion and in the orders for PT (which I can barely read). This seems like the right answer and we dont have any reservations like we did after the first opinion.

Thanks for the input in this thread.

vhs_02_2012,

Thanks for sharing your OP and follow up. I hope this is the right diagnosis, and everything get better soon.

Get him in a yoga class VHS!

You will be amazed at the results. I have been amazed with the increased in the flexibility my son has picked up now that he has been doing yoga regularly for the past two months.