Got Hungry Bum?

Everyone stand up.

Come on, off your chairs.

By now many of you have been on your butt in front of your computer with a starbucks in hand, scrolling through Twitter, Facebook, other blogs, and the online version of your local newspaper. Some of you may have even visited Perez Hilton’s site but don’t worry, I won’t hate.

For those of you who are still standing, thanks. Those of you who have sat back down, get back off your you-know-what.

Thanks!

Ok, by a show of hands, how many of you work with baseball players. It can be at any capacity…trainer, strength coach, parent, doc, therapist, coach…Those of you who said yes, please stay standing. Those who said no, you are welcome to press your “back” button and go back to Twitter (who knows Ellen may have a new contest and Lance may have posted a new picture of Max).

Great. Now for those of you left behind, how many of you have worked with a pitcher? If so, stay standing, if not, please take your seat. For those who said yes, who has worked with a baseball player that has, at one time or another, complained of shoulder pain?

Excellent.

Now how many have “assessed” that shoulder? What did you all find? Lots of answers out there. Not surprising with the varying professional backgrounds all of you bring to the table.

Ok, with these “assessments”, how many of you have revealed an internal rotation deficit?

What’s that?

Thanks! Someone out there said the word/acronym “G.I.R.D”.

Ok. Ok. Now what is this often combined with? Yup, a perceived increased range of glenohumeral external rotation. And what do you all all do for this? Let’s review…

Teach the sleeper stretch
Perform active release (ART) of the posterior capsule and/or external rotators
Passive mobilizations using The Rotator

Well did you know that the above may actually be COUNTERINTUITIVE in some athletes? Why you ask? Well let me tell you about a little something called…

HUMERAL RETROVERSION

So everyone, please remain standing if you honestly can say that you compared this shoulder with that of the opposite extremity. And for those of you who did, were the TOTAL ranges of motion (combined IR + ER) equal? If this was the case and there was still a perceived increase in external rotation of the affected arm…

That is… if the left GH joint = 110 ER + 60 IR (170 total) and the right GH joint = 90 ER + 80 IR (also 170 total)…then your athlete may have developed the often forgotten entity called “Humeral Retroversion”.

The reason, I’m writing this is because one of the more popular concepts in sports medicine and performance, and especially in baseball, has been to focus on posterior capsule and cuff.

This is fine and dandy but what if the posterior capsule isn’t tight? What if there ISN’T internal impingement? And what if the anterior structures AREN’T lax? Then maybe your athlete has actually experienced a developmental remodeling of the bone that has “twisted” the humeral shaft? And let me tell you, if your athlete has been a pitcher since he’s been in the womb, then maybe his body has developed a way to:

Reach greater ball velocity, and
Protect against shoulder injury (i.e. internal impingement and anterior instability)

Now if this is the case, this may actually be beneficial to the athlete. So as long as you have fully assessed your athlete, have ruled out any significant risk of injury, and have confirmed the presence of humeral retroversion (you may need to do so by CT scan but there are other ways as described above), then you can rest assured that one of the only problems he’ll have in the future is an inability to pick out a wedgie.

I mean, there really is no reason to increase one’s IR if they have sufficient functional ROM!

Ok you can all sit down now!

Ps. Humeral Retroversion has been brought to you by the stress induced remodeling of bone in the proximal epiphysis during adolescence.

PPS. ART and The Rotator are actually great and I would most certainly recommend them both when clinically indicated.

Photo sources: 1, 2, 3

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