How to Deal with Batter’s Shoulder
What is Batter’s Shoulder?
Batter’s Shoulder is an injury to the posterior (backside) shoulder during a swing. During the swing the head of the humerus of the lead shoulder subluxates or dislocates through the back. This causes damage to the backside labrum in the form of a tear. Now, injuries to the labrum do not heal over time, so this will make is easier to sublux or dislocate in the future in not only batting, but throwing as well. This is called Posterior Shoulder Instability.
This injury accounts for 2-12% of shoulder injuries in batters. While not too common, the rarity makes research hard to find. Last summer I had a ball player sign on with me for this injury, and I did a deep research dive into how to treat it. This blog will go over treatment options and discuss potential timelines for the injury. Let's get started!
Treatment
When the labrum sustains damage the stability of the shoulder is compromised. If the tear is small enough to avoid surgery that is great. Treatment then has to focus on increasing strength and stability of the muscles. These muscles will have to make up the ground lost in terms of stability.
Being that the injury is along the backside, the backside muscles are most important. Notably, the Infraspinatus and Teres Minor. These muscles run directly behind the shoulder joint and can increase stability there. A common strengthening exercise could be any variation of Shoulder External Rotation as this is one of these muscles’ primary jobs. EMG Studies found that a Side Lying External Rotation has the highest activation of these muscles, so that is a great place to start.
Other than that, Rhythmic Stabilization drills will be important. These are performed by providing external forces to the shoulder as it moves. Examples include providing small perturbations in over head positions, wall taps, or even external rotation exercises. The external force will increase demand on the muscles to keep the shoulder in the correct direction.
Lastly, work the Rotator Cuff as a whole. The primary job of the Rotator Cuff as a whole is to provide stability to the shoulder. Exercises that can trigger that response include anything that pulls the shoulder away from the body. Think Farmer’s Carries, KettleBell Swings, and Pull-ups (the down portion).
Now remember, the labrum will not heal itself, so variations of these exercises will have to remain a staple in the athletes arm program as long as they are playing.
Once the ball player achieves full shoulder mobility and strength they can begin a return to hitting program. For my player this took about 4 weeks, but it could take longer depending on how severe the tear is. The key with the Hitting Program is that the batter must be careful to not swing too hard too fast, especially just through the air. Batter’s Shoulder is actually more common when a batter whiffs at a pitch. This is because when contact is made a counterforce is produced from the ball hitting the bat. This counterforce reduces bat speed and reduces shear force to the backside of the shoulder.
Now if the tear is too big, or conservative management does not work, surgery is required. While this is a damper, you should keep your head up because the long term outcomes are great. One study showed that all 5 baseball players who underwent surgery for Batter’s Shoulder were able to return to full play in 6 months. This is longer than the 2 months it took my non-surgical patient to get back, but you at least will get back. Another important note is that all players made it back in full capacity.
Throwing Considerations
The primary goal of rehabbing a player with Batter’s Shoulder is to return them to the plate. Also, since the lead shoulder is the one sustaining the injury it will almost always be the non-throwing shoulder. In the rare case that a switch hitter sustains the injury to his throwing shoulder, throwing will have to be considered as well.
During the throwing motion the back of the shoulder is most stressed during follow through. To help players return to full throwing you want to utilize all the exercises listed above along with Deceleration Exercises. Deceleration Exercises will help the shoulder slow down in a controlled manner. Great exercise options here include Negative Pull-ups, Deceleration Catches, and Eccentric External Rotation. Once the athlete gets full mobility and strength they can begin an Internal Throw Program.
Batter’s Shoulder is one of the few batter specific shoulder injuries. The rarity of the injury can make treatment direction difficult to find in the research. If you are a position player with shoulder pain while batting it is worth getting it checked out.
References
OKeefe, K. J., Haupt, E., Thomas, W. C., King, J., Moser, M., Farmer, K. W., & Schoch, B. (2020). Batter’s shoulder: Clinical outcomes and return to sport. Cureus. https://doi.org/10.7759/cureus.7681
Cricchio, M., & Frazer, C. (2011). Scapulothoracic and scapulohumeral exercises: A narrative review of electromyographic studies. Journal of Hand Therapy, 24(4), 322–334. https://doi.org/10.1016/j.jht.2011.06.001
