By Benjamin Kraft, DC
Guest Writer
Chiropractic Physician
Columbus Chiropractic and Rehabilitation Center

Scapular Stability for Injury Prevention

Shoulder pain and injury is a common complaint among baseball players, especially pitchers.  The shoulder is the most complex joint in the body and considering that, there is a lot that can go wrong.    The majority of biomechanical and overuse injuries can be traced back to stability of the scapula and scapular stabilizing muscles. ^(1,2)  The scapula is referred to as the “shoulder blade” and has 17 different muscles that attach to it.  The scapula moves on the rib cage independent of the glenohumeral joint (the ball and socket that most people think when thinking shoulder).  The motion of the scapula on the ribcage is very important for determining the position of the humerus (arm bone) in the glenoid fossa (socket).  The arm depends on the position and muscular stability of the scapula to be able to generate force or speed with the arm.  That means that the more stable your scapula is, the harder, faster, and safer you can throw.  Studies have linked altered scapular positioning and shoulder injuries. ^(3,4)  Results from these studies tell us the greater the control or stability in the scapula with proper scapular positioning, the chance of shoulder injury decreases.

                                                            

Now that studies have shown a correlation, what does this mean for our baseball players?  Well, we need to stabilize the scapula to prevent injury.  Recent studies have shown that we anchor our stability through the core. ^(5,6)  Having proper function of the diaphragm and core anchors the scapular stabilizing muscles and allows for better force generation without risking injury.  Muscles that help to stabilize the scapula like Serratus Anterior, Lower and Middle Trapezius, Latissimus Dorsi originate on the ribcage, spine, and fascia around the midsection.  Stability is gained with an abdominal brace of the core musculature and breathing with the diaphragm to increase pressure inside the abdomen.  That pressure is where the body’s stability starts.

                                                                     

The next step is taking the information from the research and applying it practically to our baseball players.  The goal is to properly integrate core muscles with the shoulder to improve stability.  Below are pictures of a couple of exercises that help us to achieve that.  The first is a side bridge.  The side bridge allows us to use Serratus Anterior to lock the shoulder in while also forcing our core to stabilize the midsection and breathe (using the diaphragm) into the abdomen.

                                                           
                                                                      Side Bridge 

                                                
                                                              Quardruped Diagonals

Turkish get ups and quadruped diagonals are other examples of great ways to work in core stability while simultaneously training your body to stabilize the scapula and protect the shoulder.  These are not the only exercises that help with shoulder strength or stability, nor is this saying do not do your normal strength training.  What this is saying is that if you want to effectively maximize your throwing potential while minimizing your risk of injury, it is important to work on scapular stability.  If you have had a past shoulder injury, it is even more necessary for you to work on scapular stability.  If you have an instability in your shoulders, like winging scapula, it is necessary that you work on scapular stability.  We need to get our players working on these little issues before they become big issues.  

Any questions or comments? I would love to hear them.

Dr. Benjamin Kraft is a graduate of New York Chiropractic College in upstate New York.  He is full body certified in Active Release Technique (ART) and Kinesio Tape (KTP).  He is also a therapist certified in Selective Functional Movement Assessment (SFMA).  He specializes in functional assessment, manual therapy, strength and conditioning, and rehabilitation as they relate to everyone ranging from the elite athlete to the weekend warrior to the casual jogger.  He takes pride in helping people get out of pain and back to enjoying their lives. His experience has included a sports internship treating NCAA track and field athletes as well as several Chiropractic clinics in upstate New York.

References

1. Moseley JB Jr, Jobe FW, Pink M, Perry J, Tibone JE. EMG analysis of the scapular muscles during a scapular rehabilitation program. Am J Sports Med. 1992;20:128–134.
2. Kuhn JE, Plancher KD, Hawkins RJ. Scapular winging. J Am Acad Orthop Surg. 1995;3:319–325.
3. Struyf et al “Scapular positioning and movement in unimpaired shoulders, shoulder impingement syndrome, and glenohumeral instability” Scand J Med Sci Sports. 2011 Jun;21(3):352-8
4. Laudner et al. “Differences in Scapular Upward Rotation Between Baseball Pitchers and Position Players” Am J Sports Med December 2007 vol. 35 no. 12 2091-2095
5. McGill S. Low Back Disorders: Evidence-Based Prevention and Rehabilitation. Champaign, IL: Human Kinetics; 2002.
6. McGill SM. Low back stability: From formal description to issues for performance and rehabilitation. Exerc Sport Sci Rev.2001;29:26–31. 

Photos

http://www.britannica.com/EBchecked/topic/526634/scapula (Scapula)
http://www.menshealth.com.sg/fitness/build-better-abs-being-your-side (Side Bridge)
http://depts.washington.edu/msatlas/shserant.html (Ribcage with Serratus Anterior)
http://www.functionalmovement.com/articles/Philosophy/2013-12-17_the_importance_of_primitive_patterns (Quadruped Diagonals)