ELBOW PAIN IN BASEBALL
Baseball and elbow pain go together like bacon & eggs.
How many pitchers do you know that haven’t had some sort of elbow tendonitis or discomfort before? Probably not a lot.
Pain, no matter what the cause, is multifactorial. It can be argued that there are social, environmental, and psychological aspects to pain. What I am about to describe in no way is the complete picture or solution.
That being said, throwing fast (like pitching) is inherently stressful on the elbow. No getting around it. It just is.
The ribcage, scapula, and subsequently shoulder & elbow go through quite a lot of range of motion in a throw.
Because of this natural asymmetry, the right scapula tends to be biased into a “winged” and “tipped forward” state.
Consequently, this biases the humerus into internal rotation, but it’s not genuine internal rotation. It is a conspiracy theory involving the lats, pecs, and obliques which are concentrically-oriented and pulling the right shoulder forward.
If this is the case, we are probably going to lack shoulder external rotation. The picture above earlier will be quite hard to get into (without compensating).
We all know the joint-by-joint approach. Here it is again, just because it’s so beautiful and simple.
The shoulder needs to be mobile, as the elbow is inherently more of a stable joint. If we lack range of motion at our shoulder, the elbow might become overly stressed and painful during a pitch or throw.
Taking into account the previous explanation of an internally oriented right shoulder, we could also refer to it as “pronation” of the humerus. If the body is seeking stability and range of motion, it is common to see the forearm orient into more of a supinated state, similar to how a knee can do the same thing if the femur is biased in one orientation.
Therefore, we now we have an elbow that is torqued. So we’re placing a large amount of rotational torque forces on it with throwing. Ouch!
HOW I FIX ELBOW DISCOMFORT
If I were addressing this scenario, I would start at the most proximal structure and work my way out. The ribcage, in this example, needs to be able to expand on this side so that the scapula can sit back on it.
For example, here we have a client of mine performing an exercise. He’s a pitcher who had this exact same issue I am describing.
He is executing an exercise designed to facilitate right glute max & left adductor activity along with right trunk rotation to allow for expansion of the right ribcage.
As a result, it’s countering his asymmetries that have been previously unmanaged and had resulted in a compensatory orientation of his elbow.
For step two, I would facilitate scapula-on-ribcage mechanics, likely via a low trap and long head of triceps to help bring the scapula into a more “neutral” state.
After that, maybe we start to see some improvement. I didn’t even touch the elbow. Not saying I wouldn’t but I believe addressing the underlying causes of the issue (lack of proper ribcage/scapula relationship), will help clear up the symptom: elbow discomfort.
This is but one approach, as it is easily gets more complicated than this. There are other factors to consider such are grip strength, prior injury, pelvic mechanics, etc. But hopefully this gives you an idea of how we can respect the driving force of a musculoskeletal problem within the body.