Shoulder pain in adolescent baseball players: causes and treatment

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You're listening to the restoring human movement podcast where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now your host, Dr. Sebastian Gonzales. Hey, everyone. This is your host, Sebastian with the restoring human movement podcast. Thanks for joining the movement movement. This is your first time, Michelle. Welcome. We have many episodes in the archives that you've missed out on. We're going to be covering shoulder pain today in baseball players, mainly youth, adolescents, really not going in too much into professionals or college level at this point in time, but that will be a future podcast to come. So you need to make sure to subscribe.

We have other podcasts on shoulders and shoulders and abdominal strains and abdominal strains and low backs and all that stuff way back in the archives, but there's always, always more to come. This should be about a 30-minute episode today where we cover some great diagnosis associated with shoulder pain with throwing athletes like baseball players, as well as some possible causes and possible treatments that could be done. At any point in time, you feel like, hey, I want to work with you guys. You certainly can. Just reach out to us. All of our contact information is below. We're in Costa Mesa, California.

So looking through Dr. Google with, if you just type up shoulder pain in youth baseball, I'm specifically going to cover baseball today because I played baseball for years and it's just a passion of mine. I still play and I'm 40. If you look things up on Google, it says youth baseball players have a higher risk for a variety of shoulder and elbow problems, which by the way, elbow, we may cover in another podcast to come, including rotator cuff injuries, fractures, tendonitises. If your youth player complains about persistent pain in the shoulder or elbow and he can't perform full shoulder range of motion, you should seek medical advice. I do agree with that.

As we go through this, obviously, this is not medical advice today. You should have someone one-on-one look at your kid or look at you if you're the actual, if you're the teenage listener. It's really hard to solve things on your own. I don't think anybody's meant to solve any problem on their own. You guys weren't meant to figure out how to pitch on your own. You have pitching coaches. You weren't learned. You didn't learn how to hit on your own. You had hitting coaches. The same thing happens with overcoming an injury. It's a problem we're trying to solve together with a coach and somebody who's more experienced or seen it more frequently or has a big history of it like a medical professional would.

Not all medical professionals are obviously created equal, so make sure you find one who specializes in athletic youth, especially with throwers. So we're going to cover the diagnosis today. I'll talk a little bit about each of them. Bear, keep in mind that we're talking about more adolescence. I will jump back and forth between little leaguers, adolescents, and a little bit into, it's hard to say true, like high school or like college, because it really just comes down to, um, your unique, uh, uh, growth spurts, your actual age versus your, uh, plain age or your anatomical age. So there's differences of, uh, as you see, like, uh, someone who comes into high school or college, they're all different sizes and shapes.

And it looks like, oh my gosh, this, this kid who came into high school still looks like he should be in middle school or, oh my gosh, this kid should, is this kid in college? Oh no, he's a freshman in high school. Everybody's a little bit different. And this means that their bony structure is different. It means their, uh, anatomy is a little bit different. Their body is maturing in different time, uh, timeframes, and that's okay. And that's completely normal. With that being said, uh, some of these conditions may be a little bit more towards, uh, those people who have not skeletal matured yet.

And other ones, uh, more towards people who are already on pretty much men. So the most common things that we see, at least at performance place for conditions like shoulder pain in throwing athletes, like youth baseball is going to be rotator cuff tears, which is various different types. I'll cover that in a moment. We also have spinal referred shoulder pain, which is super common, more common than you actually think. Labral tears, uh, the labrum is a gasket of the shoulder or a cartilage of the shoulder. We'll cover those a little bit as well. Um, muscle spasms, trigger points, and we should probably mention the, the dreaded little league, uh, little league shoulder.

Uh, little league shoulder is one that's going to be a little bit of an anomaly with this because a lot of these ones, these other ones don't necessarily require the, you, you or your kid to actually reduce, uh, full throwing. You don't have to go completely out of the sport. Um, little leaguer shoulder, which I'll, I'll cover it right now. Little leaguer, uh, little leaguer shoulder is one where you kind of have to, uh, take quite a bit of time off. Uh, I don't like to take kids out of sports, um, because I think it affects their, uh, their mental status. I think it affects their, um, like their habits, uh, developing good habits anyways, and just being good, uh, well-developed, responsible humans.

Uh, by the way, I think sports are, should be used mainly for that. If you're developing a human, you're not developing necessarily an athlete. That's probably a whole side conversation, but little league shoulder is one where the growth plate of the shoulders actually affected. Now, this wouldn't really happen on somebody who's already skilled to mature, like someone in the college should, most of them should already have, uh, their growth spurt complete. Um, people in high school, it's kind of, uh, you know, here and there. Um, but this usually happens around the ages from 11 to 16. So again, 16 could be in high school as well.

This is where the shoulder actually has a growth plate, which is where the bone is still maturing. Um, it actually starts to widen or to kind of separate. Um, normally this is just pain with throwing. Um, but sometimes in more severe cases, it can happen at rest or with general daily activity. Um, normally when I, uh, when we work with people at performance place, we're talking about, um, performance or activity in activities, daily living or things that we do throughout the day. It's always nice to see when an athlete has shoulder pain or back pain or something like that, that really only comes on with an activity or a certain type of activity within their sport.

Example, somebody with shoulder pain while playing baseball or pitching may only have problem, uh, shoulder pain with pitching, but no shoulder pain while throwing, uh, on flat ground or not on a mound. This actually does happen. And like the, the effect of the mound bothers their shoulder, uh, they may be able to hit, they may be a little field. They may be able to play second base. They can flip double plays if they, their secondary position is second base or shortstop and all that's good. But pitching off a mound is not. And so this is probably the best case scenario because it doesn't, hasn't bled into their normal daily life.

It doesn't affect their sleep. It doesn't affect how they, you know, reach overhead to get something. It just affects their sport, which obviously is not ideal, but it it's better than the other things. If your kid or if you, the listener right now are dealing with shoulder pain on a daily basis, when you're not playing sports, I'm not saying your shoulder pain can't be reduced. It can certainly in most cases get better, but this is a little bit more advanced. Uh, I would suggest at this point that you have something, uh, have a medical exam performed pretty soon because like I said earlier, it's starting to reap into your, your day-to-day life.

That doesn't need to be. Uh, I know I have wrist pain right now when just trying to get off the floor, like doing a pushup day-to-day wrist pain. No, not at all. I can drive, I can bat, I can throw, and those are all fine, but getting up off the floor or after diving that bothers my wrist. It's a single type of, um, activity, a very unique activity. I wouldn't go into burpees. I wouldn't do pushups at this point. I would probably modify my life, but I don't have to modify all parts of life. Now, a little leaguer shoulder is one that tends to increase with, uh, frequency of throwing. They say it happens mainly as the diamond increases size.

So when you're going from one league to another, and all of a sudden you have to throw a little bit further. I don't know if that's exactly the case. Um, but I think that there's probably, uh, I think one of the major issues with, with, uh, and this happens to athletes of all ages is, um, throwing through fatigue. We're going to end up covering this a little bit later, but if you're fatigued, maybe pull back on your throwing volume or intensity. They say it's also, uh, has a correlation with, uh, increased velocity, um, and so on. So it's, it's hard to really know exactly, but the other way you can really diagnose this is to see somebody.

Uh, and they'll probably x-ray your, your child if, uh, if you aren't listening right now. Now, some of the other really fun diagnosis are going to be ones that are, you can do a little bit more with, um, rotator cuff tears. This is an important one to realize because, um, rotator cuff tears are all coming, all shapes and sizes. And I know rotator cuff tears sound really terrible. They're really not. Um, if you look at probably any thrower that's beyond college age and up, they're going to have a rotator cuff tear of some type. They're probably going to have minor labral tears too. Uh, I'd have to pull the research on the labrums, but I know with hockey and hip labrums, because there's a labrum in the hip as well.

There was an estimation that about 60% of, uh, professional NHL players have labral tears that are non-symptom generators. They're not painful, but they're still painted a plane at a high level. Uh, they actually took these players and did MRIs, uh, or sorry, I think they did arthrograms. They did, they did imaging and they investigated the labrum and they said, yep, you have a labral tear. And the hockey players like, look, I don't want to know about it. Don't, don't, don't say anything because I'm a commodity, right? I get paid to play. Nobody, I don't want them to know that I have this, this, uh, thing, even though it's not affecting my performance.

So just to note that you're allowed to have these tears without any hat, without having any decrease in performance and without having any decrease, uh, or any increase in symptoms. Typically, it's just found when people start looking, when you have shoulder pain and then people start looking, they say, oh, you got this tear. That tear might've been there for a long time. Now, probably to give you an example of what rotator care, rotator cuff tears may look like and why you shouldn't really worry too much about them. Um, because the wording is very scary when you get an image back, um, is if you get actually a piece of paper, and I do encourage you guys to do this.

If you, at some point, get a piece of paper and then tape it to a desk. And, um, once it's taped to the desk, pull it taut. That way, if you pulled the paper and it pulled the tape and it pulled, it would pull the desk. It would kind of make the desk move. Essentially, it has the ability to transfer load. Now, if you get a pen or even a pin and stick a pin directly through the paper, all the way through, so you can see it on the other side. This is called a complete rotator cuff tear. Yeah, what, what, what? Yeah, a complete tear means through and through. It doesn't mean detached. Because a lot of times people get the impression that there's a detachment.

There's not a detachment. There can be a complete and retracted, detached, but that's a different story. Now, if you take that same paper and you tear it, uh, from one side and it's still attached and it can still transfer load, you can see that it's still part of the tendon is functional. Part of the muscle, muscle tendon junction is functional. And then there's partial tears and so on. So the most common one is the supraspinatus and then the infraspinatus. You see some subscapularis ones, but really not too many. If it was fully torn and pulled off the bone, detached and retracted, if you will, you probably wouldn't be able to raise your arm over your head.

Like you'd lose dramatic strength. Like the muscle is no longer physically attached anymore. Like it doesn't have the ability to do any job, any movement, any task. And so that's in theory. And I'll tell you why it's in theory. Um, I, and I actually met a gentleman one time too. This was not necessarily a rotator cuff tear, but there was certainly a problem with his rotator cuff. Um, I looked at the back of his body and I see right around the shoulder blade, just below that, like the, the line in the shoulder blade that goes kind of horizontal or parallel to the floor. There was a divot. And I said, what's it, what is this?

And it was on his hitting arm. He was a volleyball player. And he said, well, uh, that's been there a long time. I just don't really have any muscle there. And so, uh, that's a whole different problem, but he had no muscular activity there. It appeared like the, the muscle, if it was there at all, it had withered away. He was a, he was more than college level. He was an Olympic level volleyball player, no really reduction of, of, uh, performance, but he did have some pain and the pain was in a completely different area than that. That muscle was kind of withered away. My point is sometimes you can function really well at a high level without really having full function or like a, a functional aspect of the rotator cuff.

Now, the other example I have of this is, um, there's a lady that I know that she, um, she did not have any shoulder pain whatsoever to note. The reason why I'm bringing up the story is, is because, um, it's interesting to see still how people can not have any pain, not have any noticeable lack of function, or at least on a day-to-day level with still having shoulder pathology, like true shoulder pathology, like a completely retracted rotator cuff tear. And, uh, so this lady, uh, she had recently, I think about six months prior, she had fallen walking her dog. She's not generally, she's physically active, like weight training, but she's not like a thrower.

And so she fell on the shoulder and she had a confirmed partial rotator cuff tear. So, uh, me at the time, me and a buddy, we were learning diagnostic ultrasound, which is, um, for rotator cuffs, it's, it's just as good as MRI, especially, um, with the ones that are like super spinaease, infraspinaease, like the ones that most people are concerned about. And so I said, Hey, come on in here. Let me just take a look at your shoulder. I want to see what a true partial rotator cuff tear looks like. She came in, we imaged the shoulder. I couldn't believe what I saw. The whole super spinaease muscle was completely torn off the bone and retracted, no longer attached anymore.

You can see debris where it was actually previously attached on the ultrasound. And so me and me and my buddy looked at each other, we're like, are you, can you put your arm over your head? And she did. Yeah. She was actually wondering like, why, why are we asking this? And, uh, we said, okay, um, can you put your arm behind your back? Yeah. Did it. Zero problems whatsoever. Finally, once we isolated down a physical test where we, where we isolated more of the super spinaease muscle, then she had actually pretty dramatic loss of, of strength. Um, she opted to have rotator cuff surgery to get it reattached, but also she, uh, it kind of begs the question, uh, at least for her scenario, she's not throwing.

She's not an overhead athlete. She's not a pitcher. Uh, do you need it repaired? Uh, and so she'd eventually had it repaired because she was worried about the repercussions of not having it repaired. My point is that, um, you will probably be fine if you have a rotator cuff tear, especially a partial or a complete through and through not attached. You just have to make sure you reduce the pain and normal, normalize some of your body function. All right. People pitch all the time about rotator cuff tears and labral tears. They are not in pain and are high level athletes. Okay. Um, now I should probably mention too, that if you're looking at a rotator cuff tear and you think you have one, um, that usually an image can see that.

An x-ray cannot see that at all, at all. You would need something like an MRI, uh, performed or a diagnostic ultrasound. Uh, those would be the things that would visualize it. But quite honestly, usually a physical exam by someone who knows what they're doing for shoulder examination could figure out beyond reasonable doubt. If there's a cuff tear, um, you just have to give them about 20 minutes. They'll figure it out for you. Now, the next thing, which I already mentioned labrum. So I might as well go into labral tears. Labral tears are kind of the dreaded one, uh, amongst the group. Um, I don't know too many kids, uh, kid athletes, little leaguers that have rotator cuff tears.

I don't think I've ever met one, uh, or at least I've, um, I'm not saying they're not around, but, uh, they, they're not super common if so, or at least they don't present with any pain. Uh, I have met high schoolers with suspected labral tears, uh, and even some that are, uh, confirmed ones, but they're really low grade. They're like grade ones. It's probably important to note there's a lot of different types of rotator cuff tears, or sorry, uh, labral tears. They're different locations. There's different severities, um, anything beyond a grade two is, or two and beyond is said to be more of a surgical case.

A grade one is really not that big of a deal. A grade two, in my opinion, and this might go against the grain of what some people say, but grade two, if you're not planning on pitching again, you can probably rehabilitate that thing perfectly fine. Um, you're not throwing anymore. You choose not to throw anymore. If you desire to throw more than, yeah, you might have to have repaired and then rehab the process around it. Um, it kind of begs the question of, of, of labeled of these tears, rotator cuff tears, what creates these things? If they're, um, if it was just pitching, like it's, it's just pitching over and over and over again or throwing, um, rotator cuff tears can happen a little bit more of an overuse type of style, like repetitive load over time, poor mechanics, um, or even contact on the bony parts of the shoulder.

Labral tears, I mean, in theory they can too, but most people, when they develop large ones, they fall on their shoulder. Um, it's, it's trauma. And so you can have a labral tear obviously with, uh, as a, as a thrower, that's a little bit less of a, um, it's not necessarily an abrupt, uh, trauma, but usually it's not super large. It's just a low grade one or like a two. All right. Labral tears are usually more classified as clicking, popping the shoulder, uh, clunking even, uh, sometimes chronic dislocators have them. Uh, we should probably do another podcast in the future about shoulder dislocations and the different types.

And we won't cover it in this one, but just know there are different types and there's different types that may or may not require surgery. Some just require, require, require rehabilitation. Um, but the labrum is the tough one. Uh, the reason is because the cartilage itself doesn't really have a lot of blood flow and it's harder to heal. Uh, the rotator cuff, the muscular aspect, uh, muscles, very vascular and can heal really well. Bone can too, which is why a lot of the ligular shoulders just get better on their own over time, kind of like a fracture. Um, but the tendon, if it was a tendinopathy, uh, tendonitis, um, or even a tear into the tendon aspect of the rotator cuff muscle, like they're a little bit harder.

Um, sometimes they need a little bit of help. Whenever there's a tendonitis, uh, or a tendinopathy or a partial cuff tear. Typically rehabilitation and loading the shoulder to some degree to strengthen it is required. It really is. Um, it may not happen right now. It should not really be too painful to do. It should just be hard. Um, and usually people need a little bit of help of designing a program like that versus just trying random stuff they see on YouTube, which I don't suggest that you try. Exercises like internally rotating the shoulder, externally rotating it, lat raises, front raises, things like that.

Uh, J bands are not necessarily the best for all types of, uh, uh, shoulder pathology. So I think it's probably important to note like J bands, I'm down with them, but usually J bands is more of a preventative. It's not a therapy. Uh, it's not specific. And plus I've seen the way people do J bands and it's, uh, I think they could do probably a little bit better. If you're interested in working with performance place, perhaps pick our brains about your unique situation, you can for a limited time. We're offering a $29 special 30 minute discussion where we can help answer any questions or concerns you may have before you start your recovery.

We call this a discovery session. You'll learn if you want to actually work with us and we get to learn if we should actually be working with your specific case. We don't take on cases. We don't think we can help and we don't want to waste your time and money. Call us or email us 7 1 4 5 0 2 4 2 4 3 or email info at P2 sports care.com. Now back to the show. Mentioning heavy balls too. This is just tangent conversation. Um, if I recall, I don't think there's a lot of evidence to support that heavy balls actually help out with throwing velocity. I know you feel like you throw harder afterwards, but heavy balls, not necessarily, uh, it decreases the arm speed.

Uh, just a whole tangent note with performance. Maybe we'll come back to it, that to another day, uh, back onto some other types of, uh, diagnosis, probably the most common, which we're going to cover a little bit later in regards to some of the causes and how to treat it is a spinal referred shoulder pain. Um, after the stay at home order, uh, shelter in place, we had a lot of, uh, young athletes coming in with really odd presentations of things like clavicle pain with no, no trauma, no thrones. They weren't throwing, uh, they weren't doing anything too much at all. They just started back maybe, uh, uh, uh, uh, physical activity cause they weren't doing much.

Um, we've had people with shoulder pain, pseudo rotator cuff strains, deltoid, bicep, tricep, forearm, elbow, uh, shoulder blade. Uh, all these areas can be spinal referred, neck referred, and oftentimes they are, uh, shoulders actually, even though it feels like a rotator cuff or like a labrum, but it doesn't click and pop and clunk, uh, any different than the other shoulder. Uh, a lot of times I'd say, uh, the, one of the studies showed that it was about 70% was still neck referred. We have a general saying, like if you're, if you've screened out the neck and you're working with somebody and trying to help them develop a plan for their shoulder, screen the neck.

And then if it doesn't bear any fruit, go to the shoulder, try the shoulder for a couple of days. If it doesn't bear any fruit, go back to the neck, check the next three times before you actually commit to the shoulder. Cause the neck has different ways that you can, um, rehabilitate that, treat that. So the shoulder gets better on its own. Uh, I remember I had a gentleman, he was older. He was trying to play football with his son. Uh, he had a, uh, quote unquote, lateral tear that was not getting better. He couldn't put his arm over his head. Uh, he even thought it was a frozen shoulder. Uh, we just treated his neck over the course of two, three weeks and he was arm overhead again.

He had no problem. He still had problems throwing the football to his son over hand. He could do underhand though, but normal day-to-day stuff got better. As I mentioned before, it should generally get better day-to-day pretty quickly. Spinal referred, uh, shoulder pain usually comes more from the nerves that are coming from the neck or it can be as a type of referred pain. There's a shoulder blade aspect that a lot of people may be experiencing with their shoulder and you might call it the rhomboid or the trap or, you know, it's kind of deep to the shoulder blade. This is called cloward sign.

You can look it up if you want to. It's a C L O W A R D cloward sign of the shoulder blade. And basically years ago, I think it was in the fifties or sixties. Uh, there was a bunch of MDs that were treating shoulder blade pain. And they're like, well, we, we can't tell what structure this is coming from. We know what's coming from the neck somehow, but we're not really sure where. And so they injected the joints and then around the nerves and they went to the disc and the neck. And lo and behold, the neck disc referred it to the shoulder blade. It was Dr. Cloward. So he said, you know, Cloward sign is born.

And so this is a big, big, big sign that the neck is part of the problem. Um, I can't tell you how many people try to put a baseball or lacrosse ball in between the shoulder blades and try to rub this thing out, which is not the right thing to do. It'll have a little bit of benefit for a look for like a day or two, but it's not going to stick. You have to stop the central cause. So spinal referred shoulder pain is probably one of the most common, although it's not the most treated. And, um, it's sad to say, I think this is why a lot of people have unsuccessful shoulder rehabilitation for three months.

And they've done their homework. It's, I'm sure it's frustrating to be like, well, I did my homework. I don't know why it's not getting better. You're either your diagnosis wrong was wrong or your treatment's wrong. If they diagnose it as a shoulder problem, like a labrum or a rotator cuff, and they treated it appropriately as such, it should have gotten better. And if it's wrong, if, if it was more spinal referred aspect, then it probably won't get better. It doesn't mean it can't get better. It just means that you did the wrong program is all. Now we just have to shift you to the appropriate program.

Now let's get onto some causes, uh, of shoulder pain with youth and adolescents. I'm sure you guys have heard a lot of these, but you probably haven't heard all of them. There's pitch counts and rest days. If you don't know about this already and your kids just getting into baseball, uh, perhaps you should go look at little league.com. I think they have these numbers all over there. There's been pitch count and rest day, uh, intervention for a very long time. Now, um, I know a lot of people coaching our new coaches, uh, this is something you should be aware of too. They might've made you aware of it when you signed up to coach the team, but there's a chance that you haven't, uh, heard of it.

And I do suggest you try it because this is pretty important. And this is the standard at this point in time, they change it every once in a while. But at this point in time, if you're six to eight years old, you shouldn't be throwing any more than five, uh, 50 pitches a day. Uh, if you're nine to 10, 75 pitches a day, 11 to 12, 85, 13 to 16, 95 pitches a day. Little league says under the age of 14 years old, then they should not be through the, if they throw over 66 pitches, they should have four days of rest. Four days of rest. So if you're pitching this kid and he's going like, um, he's getting deep into the count of a lot of people.

And he's probably about, you know, three, four innings in, he's probably going to hit that 66 pitch mark pretty quickly. Um, and he needs four days rest, 15 to 16. And, uh, then we are looking at 76 pitches and five days rest. And that scale is based upon how many pitches they've thrown. So you need to make sure you're familiar with this. I'm not a baseball coach, so I don't really need, need to have it in my back pocket, but I know where to find it. The other thing, um, that is actually pretty common is poor posture and rounded shoulders. Don't really help out the situation with, uh, youth throwers, baseball players, uh, even, even some of the fielders will still have problems because of poor shoulder or sorry, poor posture and rounded shoulders.

Now this doesn't make them bad people. It just makes them kids. And I think what, if you look around right now, if you're out in public, look around and see how many people have a really terrible posture. And how many people are looking down at their phone, you might be one of them. And if you're looking down at your phone, it's going to drag your whole upper body into that position, which is really not helpful for shoulder conditions, or at least to even theoretically prevent them. Now I'm not, I'm not a big proponent of saying you need to have perfect posture all the time and you don't need to have your shoulders back.

Like you're in the military. It's not going to fix any problems, but the more the person is in a rounded position and the more the shoulders are slouching forward. And the more time throughout the day that they're like that, they essentially need a break from it. Consider it almost like a pitch count. If you're like that for like four hours a day, because you're always looking at your phone, perhaps you need a couple of days rest from it. Or the next day, do something different. Do not that. Sitting elicits this posture, looking down, playing with dogs, looking at the floor, even having bad inner, inner, like communication skills, inner, interpersonal communication skills.

Like not looking at people in the face, they look down all the time at people's feet. This is, this is something that is a really big problem. I'm sure decades ago it was the same thing, but now I see all the time. Kids are literally looking down all the time. This does not necessarily insinuate they will have shoulder pain now, but the problem is a lot of people will bring their, their day-to-day problems to the field and then blame the sport. Well, I threw too many pitches today. I was 40 pitches. I'm six years old. I know I was under the 50, but it had to be the pitches. No, it's because you look down all the time.

Get up, walk around, be a kid. It's more that people bring their problems to the field. Like hamstring strains don't really happen on the field for high school as they happen in the classroom. Back pain does not happen on the field. It happens in the classroom aside from trauma. Like if you hit another fielder and you fall or something like that or someone hits you in the back of the baseball bat or you get hit by a ball. These are all different stories, but generally people bring their problems to the field and they have no idea that they need to treat their body better throughout the day. And I just want to bring it to everyone's attention.

Now, I don't know Tom Brady personally, and everybody knows Tom Brady's like, how does he do it? How does he do it? He's 40 and he's going like he still plays like he's, you know, 25. And yeah, but, you know, Tom Brady, as well as a bunch of other players, baseball players, different players of all types, they actually treat their body as if they want to play every day and it needs to perform. While us, you know, high schoolers, it's like we're required to sit and read and look at screens all the time. That's just it's it's not helpful. I know I suffer from this on a day to day because I do work for a living.

I don't play for a living, but I do like to play. And so I consider that my part of my week is exposing my body to not rounded posture, not rounded over, not poor posture, not sitting too much and doing a little bit of physical activity. Like weight training and running throughout the week so I can get my body moving so I can then succeed the one day week that I play or two days week that I play. So poor posture, rounded, rounded shoulders is a big problem. If you take a look at your kid right now and they're slouched over like that, rather than tell them to sit up straight, just get the take their phone away.

I know it's going to be hard to do, but that'll probably solve the problem in itself. Just get them outside and give them a different activity. I think too much of one sport is a problem as well, mainly because they don't expose all their limbs to a bunch of different movements. This is a we call early specialization in sport. I don't even think that like I think just pre high school, they should still be playing a bunch of different sports. You want to build an athlete. Athletes are good at sports. You don't want to build just a baseball player because then they're going to probably have the problems that baseball players will.

Other things to consider is past ankle, hip, low back or limb hamstring problems, making the arm essentially do the work. Now, this is going to get pretty deep into stuff and I won't spend too much time because I wrote a whole article on our website. If you go to ptsportscare.com on this and just search shoulder pain. The throwing mechanics are generally about 18 to 20% come from the shoulder or upper limb and it goes out to the ball. The remainder of it comes from the torso down. And so some people who have had past ankle injuries or knee ones, like their limb is not conditioned the same. I know their limb doesn't hurt, but they're not using their limb appropriately in throwing mechanics.

I remember I had this catcher one time. He had shoulder pain. He was in high school. And so generally what I like to do when we look at throwers who have shoulder or elbow pain, we need to look at the whole person. We can't just look at the shoulder and the elbow. We need to look at the whole person. How do they move and how are they able to transfer energy from the ground to the limb, to the shoulder, to the ball and outward. And so I had him squat. I said, can you show me your catching position? And so we squatted down and he shifted over to a side of his body. And I said, are you, you know, you're out in the center, right?

And they're like, oh, I just kind of, this is how I squat. And I said, okay, do you remember when you started doing that? They said, no. And I said, okay, so go ahead and stand up. Let me just take a look at you. I look at his limb. The one that he shifted his weight off of, he had a big old gash in his knee. And it was an old gash. It was like scarred over and everything. I said, what was this? He's like, oh yeah, I got, someone's, uh, someone slid into me. I got cleated. I said, how long ago was this? And he's like, uh, it was, it was about two years ago. It's fully healed now. I said, when'd you start having your shoulder problems?

He said, uh, about six months after that, after that, you know? And, um, now obviously linking up the shoulder to the shoulder, to the, to the lower limb is not the logical step that everybody would take. But, uh, I dare you guys to try to throw across the diamond when you jump, you can't, it's hard. It's hard. You got to use the rest of your, like your, your body, your, your torso, your core to do so. If you plant your feet and throw, you have the power, you have the velocity. So not allowing your lower body to do its job will push it to the upper body. It will push to other areas because you'll still get the job done.

You'll still throw the ball. So assessing the lower body is important. And if you're looking for someone to do that, we can do it at performance place. In fact, we can do it on video. Pretty simple to do. Now, how do you treat these areas? Um, the, probably the simplest way to think about it is you got to cool it down and build it up. If you have something like little leaguer shoulder, the cool down time is very different and very, um, probably very much longer than something like a partial rotator cuff tear or like a neck referred shoulder pain. There are different timelines. Um, the cool down process is mainly for the triggering activity.

And if the triggering activity is throwing off the mound, we can still have them throw from the, uh, from the grass and do long toss. That's all probably going to be fine. But if everything hurts the shoulder, including sleeping on it, then we need to scale that back a little bit. We need to cool it down to build it up. I prefer also to, uh, keep them playing in some form. I never pull the person completely out of the sport unless absolutely required. The reason being is because I'm sure that little league high school, um, you guys are probably thinking about like, are you going to lose your position?

You got people waiting in the wings. You got people who are going to try to steal the position from you. And rightfully so. You do the same thing. If you took two months, three months, four months off, you're going to lose your position. It's just the reality of it. So I like to keep them playing in some form. They may have to imagine you're, uh, uh, uh, a pitcher who has problems with only curve balls. If you're, if you're throwing a bullpen, work on other pitches and just tell your coach, you got to communicate with them. Say, look, I'm dealing with a problem with my, with my curve ball. Uh, I was told I can't do that for the next two weeks.

Can we just do these other things too? That way you're showing that you actually want to, um, you want to play. Uh, I think every coach will, will respect your decisiveness, um, your communication, and it makes them respect you more. You know, it's, it's communication is key. Just tell them what's going on. And if they have a question or if you allow them to speak to your medical provider or your team, who's helping you, um, they can communicate that as well. I knew we do that. We do it at a performance place. We just call the coach if the, if the parent allows and we say, look, we're going to keep him out of this and this type of activity, but he can still bunt.

You can still steal. He can still throw. He can be long toss. He can warm up the team. But if he has any hint of pain at all, I want you to scale him back and then make sure he stops that activity. We'll, we'll plug it back in in a couple of weeks if we can. And that way the person knows that they're not going to lose their spot, but also to the coach knows that they're not just being lazy. The last thing is, is you should work with a professional. You really should. Um, there's a lot of psychological and physical changes that happen through, uh, injuries that take too long. Um, I've had a back pain that took weight, uh, back injury that took way too long.

Uh, I've worked with kids who have had pain for, you know, six months. I've worked with adults who have had, uh, pain for 10 years, you know, and the longer you have it, not only the harder it mentally is on you to recover, but also the harder it is to reverse engineer. Some of the things that have happened to your body, uh, your body will adapt to what you throw at it. And if you let it go for six months to a year to two years, and it'll eventually adapt, uh, to the status that you have it in. If you can't throw overhead for six months and you start throwing sidearm, like your body's going to start adapting to that.

And it's going to become a little bit harder to actually reintegrate back in overhead throwing mechanics. Um, it's patterning, software patterns to habits, if you will. Um, but also the muscles, tendons, ligaments change, things change. The last thing to consider too, is that, um, as much as everybody wants to believe that their shoulders can be quote unquote fixed, it's not going to get fixed. There is no fix. Now, I don't say that because I want to scare anybody or make anyone feel bad. Um, I say this to empower you guys, because I know, as I'm, as I mentioned earlier, that people who throw at college and, uh, major league level have rotator cuff tears.

Did they do anything to quote unquote fix it? Did they go sew it up? Did they, you know, throw a bunch of PRP and stem cell and all these other things at it to heal the area? Maybe, but probably not. If you image them right now, it's still, it's still there. And that's not a problem. It's just the reality of it. They can still function because they've trained their body to adapt to the situation favorably. And that's what injury rehabilitation is really no different than that. It's not rehab, rehabbing the area. It's rehabbing the human and rehabbing the body around it. Your body is learning how to adapt and you need someone to help you figure that out.

That's why a pitching coach will be helpful. That's why a medical professional will be helpful or a physical therapist or a personal trainer or a strength coach or a sports chiropractor. Like all of them can be helpful. Like all of them can be helpful, but you need to, you need to make sure that you ask them and make sure that you realize that you're not just going to fix, fix the problem. I'll stop after this special note, but actually tendonitis or tendinopathies, tendinopathies specifically, they're kind of an interesting thing over the years. If you look at a tendon under a like sliced area, like you call it cross-sectional area, the tendon itself has islands of dead zone.

It's islands of degenerative tissue, they call it. It does not get better. No matter how much stuff you put into it, there's very limited evidence to show that you will actually get that area to come back alive again. But the good thing is the tendon will adapt if you allow it. If you challenge the tendon in a good way in a recovery program, then the tendon itself grows and the area of healthy tendon actually exceeds that of a tendon that you would have on the other side, which is quote unquote not bad. You still have a ton of healthy tendon, which can do all the job that you want it to do. So the area that's quote unquote dead, the islands does not matter.

But if you only do things to quote unquote fix those islands, you're not going to get anywhere. Or at least I don't think you will. I'm sure that I'm, I'm sure I can be wrong in some regards, but I'm fairly certain that if that's all you do, you're missing a large chunk of recovery. And it's, it's, it's unfortunate. And I would feel very bad not telling you that. So just know it will not quote unquote fix itself. It will not get better, but it does not mean that you can't feel better and you can't perform. If you guys are looking for help, reach out to us at performance place. Call us at 714-502-4243.

Again, 714-502-4243 or email us info at p2sportscare.com. We have all the links in the description below of the, of your podcast player. And we have tons of free information on our website intended to help you guys find the right thing for you. We realize we're not going to be the right place for everybody. We don't see people with a little eager shoulder, but we need to make sure that we send you the right place. Because if you're just hanging on and assuming it's going to get better on its own, or just keep throwing, like this is the wrong thing for you to do. You need to make sure you find the right thing to do.

And hopefully we can help guide you there. We'll see you guys soon. Subscribe to the show.