The shoulder is the most complex and unstable joint in the human body. With so many multi-dimensional movements, it is very easy to sustain an injury through sport or daily activities. The Glenohumeral joint relies on static stabilizers (ligaments, capsule) and dynamic stabilizers (tendon, muscles) for proper mechanical movements. If these elements are disrupted or weakened, the individual is susceptible to injury. As a physical therapist evaluating a client, it is common to find muscular imbalances of the shoulder complex that contribute to tendonitis, bursitis, instability and impingement syndromes.

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One of the more common weaknesses that contribute to these injuries are deficits in scapula stability and the infraspinatus muscle (external rotators). Tightness in the internal rotators (subscapularis) also plays a key role in this imbalance.

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The scapula stabilizers (serratus anterior, lower and middle trapezius, rhomboids) are the most often overlooked muscle groups in a shoulder injury. It is very important to strengthen these muscles FIRST so the scapula can “sit” properly providing a foundational base of support.

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Once this is accomplished, progression to rotator cuff strengthening, especially the external rotators, is appropriate. It is crucial for the shoulder complex to be biomechanically efficient in order to prevent injury. This will promote return to overhead activities and sports such as throwing and swimming with minimal pain and improved performance. A physical therapist well-versed in the mechanics and function of the Glenohumeral joint can help address these injuries.

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A major concern with younger athletes, ages 12-15 years, is throwing curve balls or breaking pitches. This can cause extreme torque on the adolescent’s shoulder and elbow, especially the growth plates leading to a condition known as “Little League Shoulder.” These guidelines can significantly minimize the risk of injury:

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• Begin the season with light throwing following proper body mechanics

• Warm up and stretch prior to throwing

• Have pitch counts for 12-14 year olds

• Do not exceed 60 pitches per game, separated by 2 to 3 days’ rest.

• Avoid throwing curve balls or breaking pitches until age 16. (When the growth plate begins to close).