Overhead Athletes and Salvaging Total Arc of Motion
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Physical therapists (PTs) are movement specialists who optimize movement to benefit the individual.
According to APTA, PTs have a role in the prevention, wellness, fitness, and management of disease and disability. In addition, the US Department of Health and Human Services stresses the importance of physical activity for Americans to counteract a sedentary lifestyle.
Proper physical activity can aid in the prevention of diseases and allow Americans to remain functional members of society. If this is the case, why aren't there more preventive measures taken to evaluate and identify improper movements of individuals in society, particularly in overhead athletes?
I have played softball since I was 6 years old and was a university level Division 1 catcher for 4 years.
When I was in the 8th grade I was asked to play on the high school varsity team, something I had dreamed about.
A couple of weeks into the season I had developed a bicipital tendinopathy in my throwing shoulder. Thankfully, it had healed and I was able to play the remainder of my season.
Fast-forward to college. All throughout my collegiate career, my shoulder would ache here and there, and it just never felt "right," but not knowing then what I know now I continued to play as if nothing was wrong.
Now, I have minimal shoulder internal rotation and have limitations when it comes to reaching overhead, which interfere with daily activities. Knowing more now about preventive care and the risk factors for shoulder injuries among overhead throwers, my problems could have been avoided if there was at least 1 person who advocated for preventive care.
Skeletally immature children begin to play Little League around the age of 4 years. During this period of time, the immature shoulder girdle is put through a tremendous amount of stress and undergoes remodeling in line with the tensile stresses produced with overhead throwing. These biomechanical changes may predispose the individual to injury.
With the help of a physical therapist, a thrower's shoulder range of motion could be evaluated and assessed for adequate shoulder total arc of motion (TAM) as well as a pathological glenohumeral rotation deficit.
Compared to the nonthrowing arm, shoulder injuries among overhead athletes are associated with a reduced throwing shoulder TAM of greater than 5° and a glenohumeral internal rotation deficits (GIRD) of more than 20. The physical therapist can prescribe exercises tailored to the thrower's needs to minimize risk of injury.
There are numerous studies that have been conducted on baseball pitchers and position players in regard to pitch count and the effects on the shoulder, but there is a scarcity of research on softball position players, in particular catchers. A catcher's throwing motion is similar to a pitcher's throwing motion in that they achieve excessive amounts of external rotation during the cocking phase. This similar motion may also predispose them to injury.
If one of the roles of a physical therapist is prevention, these young athletes should be monitored throughout their athletic careers to prevent possible shoulder impairments that could occur from repetitive throwing.
Physical therapists could have wellness visits to prescribe exercises to minimize risk factors associated with injury, and minimize functional impairments following the athletic career due to repetitive throwing.
Although there is a need for enhancement of preventive care with overhead athletes, it is imperative that insurance companies recognize the importance in wellness prevention. The need for prevention is widely recognized when it comes to an individual's oral health, but not necessarily musculoskeletal health and well-being. If the same importance was acknowledged by insurance companies, American society could enhance their musculoskeletal well-being, allowing them to achieve longer active participation in society.
Danielle Warnken, SPT, is a first year student at Sacred Heart University. Danielle can be reached via email. Danielle would like to acknowledge the editorial contribution of James Koo, PT, DPT, FAAOMPT, James.Koo@nyulangone.org, and Emmanuel "Manny" Yung, PT, DPT, FAAOMPT, firstname.lastname@example.org.