Movement Econ 315: Addressing throwing shoulder pain by getting after the t-spine

There are lots of similarities in the painful or dysfunctional shoulder. In general, most of these young men and women sit among the top of the heap in their overall size, strength and power capabilities. This is a great advantage to have over your competition but in many case, like the one's we see often, these strengths expose many different weaknesses.

The one we're highlighting here is "ipsilateral thoracic spine rotation lack". We just call it 'thrower's spine'. During normal trunk rotation and shoulder horizontal abduction (think cocking the throwing arm) the t-spine and ribs should rotate and angle themselves back toward the direction of the dominant arm. More often than not in our painful or dysfunctional baseball and softball players this lack of dominant side rotation is very apparent.

If you are working with throwing athletes, be sure to check and address this aspect of their movement econ. This lack of mobility will ask the shoulder to produce the remaining mobility needed to complete the throw.

As has been previously discussed, the movement economics of asking the shoulder to do what the t-spine should be doing is obvious. We're taking an activity which by itself is already violent and difficult and therefore very movement costly and adding more ways to waste movement capital. Unless the movement account is VERY BIG, there won't be too many throws before you are overdrawn.

It is very important to know what other mobility or stability issues exist in your athletes. If 'thrower's spine' isn't the most significant movement econ issue, then this mobilization won't deposit the biggest lump sum to the movement account. If it is, then here is a great first line treatment and home exercise that we use with great effectiveness: the side-lying t-spine rotation (documented as: SL T/S rot):

Have the athlete lie on his/her non-dominant side. If they are a right handed thrower, they should be lying on their left. Next they should maximally flex their hips up toward their chest as in the 'fetal' position. This posture ensures that all of the subsequent rotation happens at the t-spine and not with help from the hips or lumbar spine. Lastly, the athlete will place their hand behind their head or will reach straight ahead with their dominant arm as in pushing away from their chest. The set-up is complete.

The mobilization is simple: The athlete will turn their head toward their dominant side as far as it possible. Once the cervical spine is maximally rotated, begin to track the elbow or arm in as big as arc as possible toward the dominant side. Once the barrier to continued rotation is met, the position is held; a long 5 count is fine. At this time, there shouldn't be pain but restriction to further movement or an urge to lift the knees is normal. Keep the knees together and the bottom knee in contact with the ground/plinth. The mobilization should be done x10 and then t-spine rotation reassessed in standing. If there is a major difference between sides, the mobization should be done more toward the deficient side.

Note: There are some pretty high quality videos of this self mobe available if you simply search 'sidelying thoracic spine mobilization'.

This movement econ strategy should add the funds necessary to getting you or your athletes back on the hill.

Be well.

Guest bloger! Liz Davies: Fight Cancer with Exercise

Physical activity can result in a variety of benefits for people with cancer, just as it would for people who are cancer free. A daily exercise routine gives people a way to stay active, maintain a healthy weight and be more muscular. In addition to these rewards, physical activity increases positivity and self-confidence while lowering exhaustion and the threat of cardiovascular disease and diabetes.

It is important for people undergoing cancer treatments to make sure they remain active; starting just about any type of regular exercise can improve healing. This is true no matter what type of cancer someone is dealing with, whether that is colon cancer or mesothelioma! It is also recommended to consult a professional before beginning a daily exercise routine. There are many licensed health and exercise professionals that can be of great assistance and can tailor individual exercise programs in order to deal with the impact that cancer may have on someone.

Patients who have no prior experience exercising can start with low to moderate intensity mobility exercises. Yoga, tai chi, and pilates are just a few different forms of exercises that are wonderful for improving mobility and balance and can be easily altered for any level of physical ability.

For people who are accustomed to more activity, cardiovascular exercise like swimming, running and walking are great ways to achieve significant benefits from working out. These activities burn calories while increasing lung capacity and decreasing risk of stroke, heart attack and diabetes.

Resistance training, like weight lifting, should not be ignored. This type of exercise helps with improving muscle mass which is very important because treatments like chemotherapy and radiation often cause significant muscle loss. Ideally it is important to include both cardiovascular exercise and strength training into a daily exercise routine.

Motivation can be hard to find when you have an obstacle like cancer standing in the way. This may feel overwhelming but adding some simple activities to a daily routine can be a good way to start. Putting away groceries, taking the stairs instead of the escalator, or buying a pedometer to monitor activity is a good step in the right direction. With such a large variety of activities to choose from finding what works best for you may be the most important part of using exercise to improve your outcomes.

Liz Davies is a recent college graduate and aspiring writer especially interested in health and wellness. She is also a friend of SPARK Physiotherapy! She wants to make a difference in people’s lives because she sees how cancer has devastated so many people. Liz also likes running, playing lacrosse, reading and playing with her dog, April.