Sunday, November 6, 2016

The Importance of Upper Body Posterior Chain Strengthening in Overhead Athletes
As discussed last week, the prevalence of upper cross syndrome and its role in creating injury in the overhead athlete is important to account for and work to prevent. The best way to do that, aside from stretching the overactive anterior chain of muscles, is strengthening the posterior chain muscles of the upper body. These muscles are generally not “show” muscles, but are considered more important than the muscles one would generally go to the gym to workout. When these muscles are neglected, pain or injury can occur and results in long rehabilitation.
While pitching, the nature of the high deceleration forces involved require sufficient strength in the posterior chain of the upper body. When lacking said strength, pitchers experience faster fatigue, which leads to compensation in biomechanics to try and prevent a drop in velocity and effectiveness of their pitches. In a study done in high school baseball pitchers, it was found that those with shoulder pain demonstrated significantly less relative supraspinatus (part of the rotator cuff), and middle trapezius strength, compared to healthy athletes measured.2 Thus, the clinician decided to prescribe a rehabilitation intervention plan which focused primarily in strengthening and increasing endurance in the posterior chain of the upper body of these pitchers. Following the end of the study, the pitchers that were put through the intervention program gained strength in their posterior muscle group and did not lose any range of motion in their shoulder.2 This is important, because even though likelihood of re-injury could not be measured, the increased strength without limiting range of motion could determine that there would be a less likely chance of injury occurring due to early fatigue and poor biomechanics.
When selecting the type of intervention you plan on giving your athlete, it is important that it targets key muscles and involves functional strengthening. A comprehensive plan that includes strengthening the rotator cuff muscles, the rhomboids, the serratus anterior, and mid/lower traps such as the Throwers Ten would be ideal. For my baseball athletes, I like incorporating the Throwers Ten combined with plyometric exercise focusing on eccentric strengthening in the posterior chain. As an example, as highlighted in research done by Ellenbecker et al. the reverse catch external rotation plyometric exercise does a great job in eccentrically strengthening the rotator cuff.1 More than anything however, it is important that you remember there are only patients and not protocols. Rehabilitation should be prescribed on a patient by patient basis, as a cookie cutter plan will not work for everyone.

Works Cited:
1Ellenbecker, T. S., Sueyoshi, T., & Bailie, D. S. (2014). Muscular Activation During Plyometric Exercises in 90  of Glenohumeral Joint Abduction. Sports Health: A Multidisciplinary Approach, 7(1), 75-79. doi:10.1177/1941738114553165

2Moore, S. D., Uhl, T. L., & Kibler, W. B. (2013). Improvements in Shoulder Endurance Following a Baseball-Specific Strengthening Program in High School Baseball Players. Sports Health: A Multidisciplinary Approach, 5(3), 233-238. doi:10.1177/1941738113477604

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