Shoulder Injuries in Baseball

Abstract

Baseball is a type of sport that entails players throwing the ball in an overhead motion. This motion necessitates muscle activation in the upper part of the body which can lead to injuries as a result of poor throwing mechanics, overuse of the muscles and muscle imbalances.  Most of the players continue to train and play in continuous condition of pains and injuries to meet the demands of the coaches and team. These injuries can significantly affect the future of the player in the game. Recent studies show that more than half the baseball players in the USA do not return to the same or higher level of play they were before a severe injury. The results are even more shocking for the professional baseball players; only 18% of the injured players get back to their original or higher level of play. These injuries have great psychological effects on the players when they go back to the field.

Introduction

Shoulder injuries in baseball players result from long practice hours and competition. Recent research reveal that shoulder injuries in collegiate and professional baseball arises from years of repetition and overuse. In the USA, there are over 19 million baseball players, 25% of whom are pitchers. The repetitive nature of pitching puts the pitchers at a high risk of overuse injuries. This eventually affects the performance of the players.  The purpose of this essay is to explore the causes, diagnosis, prevention and treatment of shoulder injuries in baseball players. In addition, it analyses the psychological effects of the injured players going back to the field to play.

Causes of shoulder injuries

Shoulder injuries are the most common form of injuries among the baseball players. This is because of the force used in a long and rapid throw. Shoulder pain complains are very common among the baseball players of all ages. The most common form of pain in shoulders is the dead arm, where a player experiences pain when throwing leading to incapability to throw with velocity. Shoulder injuries mostly start with a pain when throwing and shortly after the throw. The pain may progress to the point that the player is not bale to throw anymore.

The shoulder injuries maybe categorized into two main categories, one of them is the overuse injuries.  These are the injuries that occur due to stress and pressure on muscles, soft tissues and joints without over a long period of time, without enough time to heal. The injuries begin as small and nagging pains that may develop into devastating injuries if left untreated. The second category is the acute or traumatic injuries, which result from an abrupt force or impact on the shoulders. These injuries can be very traumatic, and include fractures, and damage of muscles, tendons and ligaments and joint dislocations.

To get an understanding of shoulder pain, it is necessary to have an understanding of the throwing mechanism and the shoulder joint anatomy. The throwing mechanism is divided into four phases, namely, wind up, cocking, acceleration, and deceleration.  During the wind up stage, elbow movements and kinematics are very low. At this stage, throws the ball across his body reducing the energy distributes to the lower body, this predisposes the player to injuries in the upper part of the body. In the cocking stage, the arm of the player is at the maximum external rotation, and the lower body, hips and legs are accelerated. At the third stage, the arm is accelerated, but the phase is dynamic and short.  The humerus rotates internally during this phase, and the player releases the ball. During the final stage, the arm is decelerated. The arm reaches the maximum internal rotation. The shoulder anatomy enables a player to produce velocity when throwing. This velocity predisposes the player to shoulder and upper extremity injury.

Shoulder pain can also originate from the bones making up the shoulder joint. These bones are the humerus on the upper arm and the scapula, on the shoulder blade.  The scapula includes the glenoid and is attached to the clavicle.  In youthful players, the growth plates are still developing and remain open, and the cause of pain in such players would be a fracture of the upper part of the humerus. The fracture causes the growth plates to separate due to the excessive pressure during a throw. Among the elder players, the pain is usually caused by other pathological processes like a tumor in the bone.

The other cause of the shoulder pain is irritation or inflammation of rotator cuff tendons of the shoulder after a throw. The exact cause for this irritation is not known, but there are several theories. The first possibility is that the tendons are under too much stress. This usually happens when a player attempts to get into shape too fast with a short period. The other theory is that the shoulder ligaments have been stretched a lot and the shoulder is getting too loose. The ball of the shoulder joint slides a lot putting pressure on the tendons making them to hurt. The theory explaining the cause of the pain is the tearing of labrum. The work of the labrum is to rotate around the socket of the shoulder and stabilizing it. When a player exerts so much pressure and stress on labrum for a long period of time, then it tears off causing the pain.

The shoulder injuries can be prevented by the proper use of the body mechanics to avoid injury. Players should also wok on strengthening exercises, which are important to construct muscular endurance.  The players should also conduct warm ups like stretching the shoulders before and after the plays. They should also ensure that they get enough play in between and after games to ensure that they do not overuse the muscles.

Diagnosis of the shoulder injury

It is a very challenging task to diagnose the cause of the shoulder pain. This begins with the history of the player and the pain. This prompts a number of questions like; how was the start of the pain, was it acute or chronic? Where is the pain positioned? For how long has the athlete played baseball? What position has the player been playing in the game? Which phase of the throwing action causes the pain?

The doctor then carries out a physical examination on the player to determine the type of injury. The diagnosis on the type of injury helps the doctor to determine the type of diagnostic imaging study needed. This could the x-rays or MRI (Magnetic Resonance Imaging) to determine the extent of the injury. X-rays are mostly used to examine the bone structures while MRI is used to examine the soft tissues (Farouk & Elaziz, 2010).

Treatment of the shoulder injuries

The treatment of shoulder injuries is complex, but early identification and prevention of the injuries is the best treatment. Pain is usually the initial indication of injury, and the coaches should question the players constantly on the existence of shoulder pains. Coaches and the players should also be on the lookout for decreased stamina, velocity, and poor throwing methods.

The initial treatments entail the player resting the arm for some time. This avoids the activities causing or increasing the pain.  A rest of an average of 3 months is recommended with a gradual come back to throwing. If the pain results from soft tissues stabilizers, then a physical therapy program is recommended. The focus of this program is to stretch and strengthen muscles and ligaments around the shoulder. Physical therapy is an effective treatment method for the shoulder injuries. Over 90% of the players recover by physical therapy. The 10% of the player who fail to recover from this program tend to older playing at highly competitive levels (Carson & Gasser, 1998).

In some cases, players fail to respond to the physical therapy programs and rest program. When this happens, the surgery may be necessary. Depending on the location of the injury, open surgery or arthroscopic surgery would be carried out. This involves repairing the labral to stitch back the cartilage ring to the socket, posterior capsular release decrease tightness of the capsule, and anterior capsular placation to tighten the shoulder capsules. Most players are able to go back to their initial levels after the surgery, but they may take at least 9 months to go back to the field after the injury.

When undergoing treatment, it is important that the player be taken to a rehabilitation program to prepare him to go back to the field. The aim of the rehab is to get the athletes back to the field in a short time without compromising their safety.  The rehabilitation focuses on strength, endurance, flexibility and pain management. During rehabilitation player is introduced to throwing gradually. This reduces the return time from the injury. Several techniques are undertaken during rehabilitation to stabilize back pain, strengthening the rotator cuff, and improving flexibility of the elbows. During the rehab, the player is to taken through psychological therapy, aimed at helping him to cope with pain and comeback to the field. This is one of the most important treatments for the injured player (Lyman, Fleisig & Osinski, 2002).

Psychological effects of going back to play after injury

The psychological effect of an injury can affect a player for a long time even after the physical healing has completed. This may hinder the ability of the player to get back to the level they were in before the injury. As a result, it is important for coaches and trainers to take part in the rehabilitation process of the athletes. In most cases, Self confidence and performance of the athletes is lower than the pre-injury period. The injuries lead to negative expectations and memories for the athlete. This affects their performance in the games. When this happens, the athlete needs a sports psychologist to work them through the healing process and re-establish their performance.

According to Lyman, when athletes get injuries, they go through very disturbing emotional experiences. These experiences follow a five-stage process, namely denial, anger, bargaining, depression and acceptance and reorganization. During the initial shock stages, an athlete ignores the consequences of the injury, but as the injury gets worse, they turn to anger, which they turn to themselves or to others. This causes distress especially to people whose identity is based on being a player.  After the anger, an athlete starts to bargain or rationalize to get rid of the reality. The athlete may start promising that they will work hard to recover from the losses of the injury. The reality of the injury pushes the athlete into depression. Finally, the athlete accepts the injury and turns to rehabilitation for healing, so that they can return to sports.

One of the effects of the injuries is that they create fears among the injured players. In some cases, the injuries are sustained as a result of physical contact with other players. The players fear getting into contact with the other players when practicing or when playing. This makes the player’s confidence in the field to reduce with the fear that they will be injured again. The lack or inability of practice during rehabilitation may have a very negative impact on the players.

After injuries, players go through psychological shock, which greatly affects the players. When these players go through the rehabilitation process, most medics concentrate on the physical healing while they ignore the psychological rehabilitation of the players. This makes the players prone to more injuries after recovery. The player may also not get to their former state or level in the sport due to the fear of getting injured again. These psychological changes also create anxiety during training and reduce the self confidence of the players. A research conducted on eight players with acute shoulder injuries revealed that the players experienced immense anxiety when training but after psychological rehabilitation, they were able to deal with the fears and the anxiety during training.

Anxiety and worries characterizes most players after recovery from injury. The mere yelling of an embarrassed coach can coach an athlete into anxiety.  When the coach yells, the athlete stops focusing on the game and starts concentrating on the bad things. Unconsciously, the athlete starts undermining the self confidence and the anxiety rises up immensely.  As the athlete becomes more and more anxious, muscles tighten making it hard to execute the play effectively. This affects the performance of the athletes, who may eventually stop playing.

When the player gets back to the field, the mere remembrance of the trauma associated with a previous injury or a fall disrupts any attempts of the player returning to their original form. All traumas cause some body reactions, whether they were intentional or not. When a player becomes stressful or conscious of a previous trauma, the body reacts triggering the muscles to tighten. This affects the performance of the players. Taking an illustration from a baseball player.  Throwing a baseball precisely demands that the player’s hand follow a downward motion, the wrist snaps downward leading to a smooth throw. When a player suffers an injury, the body becomes tense and this makes it hard for the player to throw. The result is a slowed down ball throw accompanied by control and accuracy troubles (Shuer & Diertrich, 1997).

According to Shuern and Diertrich, whenever an athlete suffers from an injury, the experience remains stuck in neurology and physiology in its original experience. When the player consciously or unconsciously remembers the trauma, he re-experiences the trauma. Farouk and Elaziz hold that the occurrence of the trauma is sometimes so intense that the athlete re-experiences the trauma all-over again.  When the present performance of the athlete is constantly affected by the past traumas, the athlete gets into frustrations for his inability to get back to his initial form. This frustration further pushes the athlete into anxiety and once again, may make the athlete to give up his position in the game.

Different athletes react different to sports injury. There are the optimists and the pessimists. The personalities of these two groups of people may affect how an athlete adjusts to an injury. The pessimists have uncontrolled negative thoughts about the injuries. They blame themselves about the injury. They tell themselves that it will never get better and that the injury will affect everything they do. These attitudes affect how the player performs after healing and getting back to the field. They believe that they can never be as good as they were before the injury. This greatly affects how they perform, and mostly, their performance is terrible because they do not believe in themselves (Pod log & Eklund, 2009).

The optimists, on the other hand, have different thoughts about themselves and the injuries. They constantly tell themselves positive messages like there is nothing they would have done about the injury. That the injury will heal and get back to normal and that the injury will not affect anything they do. When these athletes get back to play baseball, they adjust rapidly and perform like they did before the injury. Sometimes, these athletes perform better that they initially did as they would want to prove that the injury did not affect the way they played.

Conclusion

Prevention of shoulder injuries is the most effective ways of treating shoulder injuries. However, injuries are inevitable in baseball games owing the nature of the game. More than half of the baseball players suffer an injury during the period they participate in the game. It is, therefore, the responsibilities of the players, coaches and parents to recognize shoulder pains and injuries early enough. Treatment and diagnosis of shoulder injuries is very effective when discovered early.  Several treatments options are available to rectify the injuries, they include rest, physical therapy and in extreme cases, surgery. Psychological treatment is also very crucial though most doctors ignore it, while concentrating so much on physical treatment. The players go through a very tough psychological trauma after the injury. There is fear of re-injury and nervousness which affects the performance of the player. Social and moral support from the family, coach and other team members comes in handy in helping the player recover from injury and getting back to their initial level of play before the injury.