Scapular Position and Orientation in Throwing Athletes

Myers, J.B., Laudner, K.G., Pasquale, M.R., Bradley, J.P., Lephart, S.M. (2005). Scapular Position and Orientation in Throwing Athletes. American Journal of Sports Medicine, 33(2), 263-271.

In a study with 21 throwers and 21 control participants, the authors measured scapular positioning and movement with electromagnetic tracking devices. They focused on scapular upward and downward rotation, internal and external rotation, elevation and depression, protraction and retraction, and anterior and posterior tipping. They found that throwing athletes have significantly more scapular upward rotation, internal rotation, and retraction. 

Upward rotation of the scapula is essential for injury free throwing. It allows the AC joint to clear and prevents impingement. The dominant limb had more upward rotation than the non-dominant arm in this study. However, after fatigue there was less upward rotation, external rotation, and posterior tipping than in the beginning, which made the athletes more at risk for injury.

The scapular movements can be confusing, so to help out I have described upward rotation as the movement when the bottom tip of the scapula gets closer to the spine. I’ve found that a lot of pitchers, especially young pitchers, have a hard time activating the muscles in their upper back to create these movements. Many times they do it when they pitch, but without activation and without strength, the can fatigue fast. This will lead to a lot of injuries. Internal rotation is when the inside ridge, closest to the spine, flattens out. Retraction is when the top-middle corner pushed in toward the ribs. If you look at the scapula, you can see how this happens.

The key to me is injury prevention. Most colleges have now implemented strengthening programs to help strengthen these movement and prevent fatigue. A lot of strength coaches do Y’s, T’s, W’s, and L’s with weights and trainers do a lot of band work for the rotator cuff muscles. My advice is to educate yourself on the different movements and develop a protocol for strengthening the area. There are a million exercises to do this:

• Facepulls (high and low)
• YTWLA’s
• Touchdowns
• Horizontal shoulder extensions
• Scap push-ups, pull-ups, dips, and inverted rows
• Blackburns
• Jobe Shoulder Complex

What you have to avoid is the SICK scapula. A SICK scapula is an asymmetric malposition of the scapula in which the Scapula has Inferior medial border prominence, Coracoid pain and malposition, and dysKinesis of movement. Basically, the scapular muscles get weak, then hurt, and then the scapula doesn’t move, or moves way too much. 

One other thing, in a study called Effects of Muscle Fatigue on and the Relationship of Arm Dominance to Shoulder Proprioception reported by Zach Dechant in his blog post “Training the Rotator Cuff to Failure”, he mentions the effects of rotator cuff fatigue and the throwing motion. Many people, including myself, used to believe that we should work the scapula and rotator cuff muscles BEFORE throwing. With this study as evidence, I feel like these muscles should be worked after the throwing workout. Of course, it is much easier to get an athlete to do their work before their bullpen, as they will be tired and want to be finished, but it makes a lot more sense to make a short workout afterward. This will also lead into a stretching routine and ice. Develop a systematic protocol for post-workout and your athletes will be much healthier!