Training the Shoulder Complex in Baseball pitchers

Training the Shoulder Complex in BaseballPitchers: A Sport-Specific ApproachJeffrey J. Jeran, MS, CSCSNational Institute of Occupational Safety and Health Wellness Center, Morgantown,West Virginia

Robert D. Chetlin, PhD, CSCS, HFIWest Virginia University School of Medicine, Morgantown,West Virginia

© National Strength and Conditioning AssociationVolume 27, Number 4, pages 14–31

Keywords: exercise; training; shoulder; pitchers; baseball

Introduction

The upper extremity is exposedto inordinate stress during abaseball pitch. Specifically, the

overhand throw places considerable

and varied load upon the shouldercomplex. The rapid transition be-tween eccentric (i.e., cocking phase)and concentric (i.e., accelerationphase) muscle actions during a base-ball pitch produces extreme forcesaround the glenohumeral joint andgreatly contributes to soft tissue mi-crotrauma of the shoulder complex.The kinematics of a baseball pitchnecessitates extreme range of motion(ROM) in the shoulder complex.Though the shoulder is well suited toaccommodate great ROM, the sacri-fice of strength and stability that isinherent in shoulder design producesa tenuous balance between elite per-formance and debilitating shoulderinjury. This may be better under-stood when anatomically comparingthe inverse relationship betweenstrength/stability and ROM in ball-and-socket joints (i.e., shoulder andhip). That is, while the shoulder canproduce great ROM, its architectureis inherently unstable (with referenceto the humeral head in the shallowglenoid fossa). Conversely, the hip isquite strong and stable, yet lackslarge ROM (with reference to thefemoral head in the deep acetabu-lum). Thus, in order to performpitching movements, the shoulder is

exposed to an inordinate amount ofstress it was not necessarily intendedto handle. This anatomical paradoxillustrates the thin line between ac-complished performance and trau-matic injury in both novice and expe-rienced throwers.

A variety of shoulder injuries may re-sult from exposure to the high forcesassociated with the baseball pitch(e.g., subacromial impingement,bicipital tendonitis, rotator cuff ten-donitis, partial tear or rupture of thesupraspinatus, labral tear, and tears ofthe superior labrum from anterior toposterior [SLAP]). Therefore, thepurpose of this paper will be three-fold: first, to describe the trauma as-sociated with the rapid and forcefultransition between the end of thecocking phase and the start of accel-eration phase, when injury suscepti-bility is high; second, to account forthe functional anatomy responsiblefor throwing competence; and third,to introduce some specific trainingmodes designed to enhance kinemat-ics (i.e., the description of the pitch-ing motion without regard to theforces that produce the motion) ofthe baseball pitch. With regard to thislatter purpose, we will also provide a

s u m m a r y

The purpose of this paper is to identify

exercise performance-related factors

which may contribute to shoulder

pain and dysfunction and to describe

appropriate training strategies for

promoting shoulder stability and en-

hanced function. The intent is not to

help the reader diagnose and treat in-

juries or to prescribe therapeutic in-

terventions. Strength and condition-

ing professionals should encourage

injured clients to consult a physician,

physical therapist, or other appropri-

ate health care professional before

starting a conditioning program.

14 August 2005 • Strength and Conditioning Journal

thorough training regimen for allportions of the shoulder complex thatcontribute to throwing dynamics.

Eccentric Loading: The CockingPhaseThe cocking phase is defined as the peri-od of time between the beginning of thewindup and the point at which theshoulder is in maximum external rota-tion. The cocking phase sets the body inposition so all involved segments maycontribute to the forward motion of theball (24).

When the contralateral foot plants toinitiate delivery the trunk rotates for-ward, and the shoulder reaches a posi-tion of approximately 90° abduction,30° horizontal extension, and 90–120°of external rotation. The elbow is nor-mally flexed to about 90°, and thewrist is in a slightly extended position.From the point of closed-chain con-tralateral foot plant to the subsequentthrowing action, the time until releaseis typically quite similar for all pitchers(6, 28).

The cocking phase concludes when theshoulder and elbow are brought to a po-sition of horizontal extension and theshoulder is externally rotated to approx-imately 160°. Shoulder complex rota-tion during windup is not limitedstrictly to glenohumeral rotation butrather includes a composite motionconsisting of glenohumeral rotation,scapulothoracic rhythm, and trunk ex-tension. Various authors have deter-mined that maximum shoulder externalrotation during this phase ranges from160–185° among professional pitchers(5, 6, 20, 28). There is no forwardmovement of the ball in the cockingphase, except when the contralateralfoot plants and forward trunk rotationbegins (i.e., transition).

Explosive Concentric Contrac-tion: The Acceleration PhaseThe acceleration phase begins with thethrowing shoulder in the position of

maximum external rotation (i.e., at theend of the cocking phase) and termi-nates with rapid release and accelerationof the ball toward the plate. The inter-nal rotation of the shoulder in the accel-eration phase can be described as one ofthe most explosive human movementsin sport (5). The transfer of energy fromthe lower extremity to the rotation ofthe core, combined with the upper ex-tremity, results in the extreme velocityseen in the acceleration phase (21).

There are 4 components, occurringtransitionally from external to internalrotation, that lead to ball release.Specifically, these forces lead to maxi-mum velocity. First, the shoulder is ex-plosively internally rotated. Ball releaseoccurs between 40 and 60° of externalrotation. Second, as the shoulder is in-ternally rotated, the elbow flexes from90° to approximately 120°. The elbowrapidly extends to a position of 25° offlexion 30 to 40 milliseconds beforeball release. Third, 20 milliseconds be-fore ball release, wrist flexion beginsfrom a position of extension and endsin a neutral position (i.e., ball release).The wrist does not flex beyond neutraluntil the ball is actually released. Final-ly, radioulnar pronation begins 10 mil-liseconds before ball release, with theforearm pronated to approximately 90°at release (i.e., for a fastball) (3, 24).Pronation is a normal mechanism formost pitchers throwing various types ofpitches (3, 5, 8, 24, 28).

ConsequencesPrecise coordination of the upper ex-tremity muscles is necessary to generatesufficient force and assure sound tech-nique to avoid injury. The chronic stressof pitching can lead to a variety of in-juries to the shoulder. Some of the mal-adies associated with the cocking and ac-celeration phase include subacromialimpingement, bicipital tendonitis, andanterior instability (12).

If the abducted arm is not properlypositioned by the serratus anterior

and the upper and middle trapezius,internal impingement and anteriorinstability can occur within the gle-noid (12). The great ROM needed tothrow a baseball can lead to laxity ofthe static stabilizers (capsular liga-ments and labrum). The dynamic sta-bilizers (supraspinatus, infraspinatus,subscapularis, teres minor, and thelong head of the biceps) must besomewhat flexible in order to maxi-mize ROM. There is a thin line be-tween necessary flexibility for perfor-mance and pathologic laxity, whichcan lead to increased local stress andinjury (21).

In the late cocking phase, the anteriorshoulder muscles can sustain limited mi-crotrauma from maximal external rota-tion and horizontal extension. Anteriortranslation (i.e., partial loss of joint in-tegrity) of the humeral head in the gle-noid may result from repetitive micro-trauma to the static stabilizers. With therepetitive trauma of throwing, stressesfrom extremes of eccentric muscle con-traction can lead to microtears at myo-tendinous attachments. Anterior instabil-ity may result from failing support of thedynamic as well as static stabilizers (16).

When the static stabilizers become fa-tigued, recruitment of the rotator cuffmuscles increases, which may lead toanterior translation and impingement(12). In the late cocking phase, whenthe arm is abducted and maximally ro-tated externally, an anterior subluxa-tion may cause direct contact betweenthe humeral head and the posterosupe-rior glenoid rim. When this happens,the posterosuperior rotator cuff ten-dons and labrum become pinched be-tween these 2 structures, thus leadingto internal impingement syndrome(12, 14, 17, 27). Impingement syn-drome may be classified as primary(i.e., mechanical compromise of thesubacromial space, including spurring)or secondary (i.e., functional impair-ment associated with glenohumeral orscapulothoracic instability). Though

15August 2005 • Strength and Conditioning Journal

pitchers may experience either variety,internal impingement—in this case,posterior superior impingement—ismost often associated with overhandthrowers (15).

Internal impingement can coexist withvarious forms of shoulder injury, such asfraying of the biceps tendon, which maybe a result of anterior subluxation. Inthe unstable shoulder, the action of thelong head of the biceps is increased due

to elbow eccentric deceleration or as anadjunct to shoulder stabilization (10).Itoi and colleagues (10) speculated that“the long head of the biceps is more im-portant than the rotator cuff muscles asstability from the capsulolabral complexdecreases.” Damage and inflammationto the long-head bicipital tendon fromrepetitive trauma may lead to bicipitaltendonitis. Affected pitchers may, there-fore, complain of pain over the anterioraspect of the shoulder. This may lead

athletic trainers to speculate that bicipi-tal tendonitis is the culprit (11).

Spurring of the inferior surface of theacromion from overuse leads to a nar-rowing of the subacromial space andimpingement syndrome, particularly inolder throwers (12). In the accelerationphase, mechanical compression of thesupraspinatus insertion is caused fromthis narrowing of the subacromial space(12). The narrowing may contribute totearing or rupture of the supraspinatustendon, possibly leading to early termi-nation of the athlete’s career (12). Inter-nal impingement may also affect theposterior insertion of the infraspinatuson the greater tuberosity of thehumerus and origin of the long head ofthe biceps on the supraglenoid tubercle.Internal impingement is worsened bythe thickening and fibrosis of the sub-acromial bursa, which may be caused byrepetitive throwing, inflammation, andoveruse (18, 29).

Functional Anatomy Several muscle groups contribute to thecoordinated action of the baseball pitch.From proximal to distal these includethe shoulder fixators, shoulder exten-sors/flexors, shoulder rotators (inter-nal/external), and elbow extensors/flex-ors. The rotator cuff muscles greatlycontribute to dynamic stabilization aswell as acceleration and deceleration ofthe glenohumeral joint during throwing(5, 13, 14). Figure 1a shows the musclesof the rotator cuff, and Figure 1b illus-trates the associated movement of theshoulder complex.

In the early cocking phase (or windup),the serratus anterior and trapezius arerecruited. Impingement can occur ifthe serratus and trapezius do not posi-tion the glenoid appropriately. Thescapula is rotated upward and protract-ed to keep the glenoid in position. Thisposition allows the middle deltoid andsupraspinatus to efficiently abduct thearm. The supraspinatus provides fineadjustments to the humeral head, but


Figure 1. (a) Superior view of the shoulder complex and arrangement of the rotatorcuff (22). (b) Shoulder complex muscles “fix” scapula, permitting normaloverhead activities (26).

a

b

the middle deltoid provides most of theforce for abduction (9, 16). Thesupraspinatus protects the glenoid bystabilizing the humeral head from ex-cessive translation (i.e., anterior sub-luxation) (4). The static stabilizers ofthe shoulder and inferior glenohumer-al ligament limit anterior and posteriortranslation of the humeral head whenthe humerus is abducted to 90° ormore (1).

The opposing influence of the scapularprotractor (serratus anterior) and retrac-tors (trapezius, rhomboids, and levatorscapulae) permit smooth external rota-tion of the humerus in the late cockingphase (4, 16). Actions of the pectoralismajor and minor, latissimus dorsi, bi-ceps brachii and subscapularis also addanterior and posterior stability to theglenohumeral joint and shoulder girdle(10, 19, 23). Action of the deltoid di-minishes as the rotator cuff muscles in-crease activity during the late cockingphase. The infraspinatus and teresminor are responsible for the major ex-ternal rotation observed during thisphase. The supraspinatus is the least ac-tive of all the rotator cuff muscles duringthe late cocking phase (7, 9).

In the acceleration phase, the glenoidfossa of the scapula acts as the fulcrumfor the explosive torque that accompa-nies this phase. The major muscles thatcontribute to the observed forces of theacceleration phase are the powerful ad-ductors/internal rotators of the shoul-der, namely the pectoralis major andlatissimus dorsi (16, 17). The subscapu-laris guides the humeral head in the gle-noid, much like the supraspinatus in thecocking phase, and prevents the sublux-ation of the humeral head during explo-sive internal rotation. The teres minorlimits the humeral head from posteriortranslation by allowing movement in thecapsule when the shoulder is at maxi-mum external rotation and extension,which can occur when the shoulder iscocked (15). As the humerus is internal-ly rotated, the posterior deltoid is posi-

tioned to horizontally extend the armduring the early part of the accelerationphase (15, 18, 25).

Injury Prevention and Perfor-mance Enhancement: The Casefor Activity-Specific ExercisesThe act of pitching conforms to spe-cific laws and principles that governmovement. Newton’s second law, thelaw of acceleration, states that

“the rate of change of momentum ofa body is proportional to the ap-plied force and takes place in the di-rection in which the force acts” (2).

In other words, the acceleration of anobject depends on its mass and onthe amount of applied force, and,therefore, objects with less mass areeasier to move and will move beforeheavier objects they may be attachedto. Normal arm abduction is possiblebecause the mass of the scapular fixa-tors is greater than the deltoid, thuscausing the arm to move in the ex-pected direction. If the scapular fixa-tors were paralyzed by a denervationinjury, for example, then attemptedabduction of the shoulder would re-sult in an awkward rotation of thescapula (which would move first be-cause it is less massive) and notshoulder abduction. Scapular kine-matics is, therefore, an importantconsideration for competent pitch-ing motion, according to the law ofacceleration, because weak scapularfixators may adversely affect armstrength (via insufficient scapularstabilization) and accuracy (via un-wanted scapular movement).

Inappropriate scapular kinematicsmay be further illustrated by the bio-mechanical principle of levers.Throwing a baseball involves third-class lever action, where the gleno-humeral joint acts as the fulcrum, thebaseball acts as resistance oppositethe axis, and the muscles responsiblefor delivery are located between thefulcrum and the resistance. Imagine

that your arm, shoulder, and scapulaform a type of catapult (a classicthird-class lever), where the scapulaforms the base (i.e., the fulcrum oraxis), the shoulder, upper arm, andforearm provide the desired muscleaction (i.e., the effort), and the bas-ket (i.e., the hand) holds the ball(i.e., the resistance). If the scapula orbase is weak, or not tightly fixed, andyou have the strongest arm in theworld, the law of acceleration assuresthat your unstable base (i.e., scapula)will be difficult to control, resultingin improper mechanics, inaccuratethrowing, poor velocity, and in-creased susceptibility to injury.Therefore, we believe that a strongbase (i.e., the scapular fixators) isvital to both skilled performance andinjury prevention. The scapular fixa-tors, therefore, should be trained asdiligently as those muscles that aredirectly involved in accelerating theball.

In our experience, many training pro-grams for pitchers overemphasizestrengthening the rotator cuff mus-cles, overlooking the fixators of thescapula. The exercises presented at theend of this paper are specifically di-rected at not only improving perfor-mance, but also protecting the shoul-der complex from repetitive ortraumatic injury. We will also discussthe training variables of mode, inten-sity, frequency, and duration for bothrotator cuff and scapular fixation exer-cises.

There are 2 fundamental appliedtraining principles that must be un-derstood before prescribing shoulderexercises. First, the principle of sportspecificity necessitates that exercisetraining should approximate, asclosely as possible, the movementsassociated with the sport in question.Unfortunately, some exercise profes-sionals may fail to do an activityanalysis on the sport, which leads tothe same exercises prescribed for the


general population being directed to-ward the thrower (2). For example,traditional internal and external ro-tation of the glenohumeral joint,with elbow held tightly to side andmotion in a transverse plane about avertical axis (Figures 2 and 3), hasfew, if any, sport-specific implica-tions for throwing a baseball. How-ever, this exercise certainly has clini-cal benefit as a means to strengthenthe internal and external rotators ofthe glenohumeral joint.

Second, the specific adaptation toimposed demand (SAID) principleimplies that the body will adapt tothe demands of the training stimulusbut will not adapt beyond the scopeof that stimulus. For example, en-durance training programs will notproduce gains in strength (2). Thecomplexity of the shoulder joint dic-tates a multifaceted training ap-proach, which includes (a) trainingtargeted to agonist, antagonist, andfixator muscles, (b) training that em-phasizes strength and power, (c) resis-tance exercise performed in theplanes and about the axes of motion

associated with the intended activity(consider that many conventionalshoulder exercises are not always per-formed in activity-specific planes,and that the rotator cuff should betrained in affiliated planes of mo-tion), and (d) an emphasis on im-provement in concentric, eccentricand isometric strength. The literatureindicates that excessive eccentricloading (especially of the supraspina-tus tendon) is strongly correlated torotator cuff injury (18, 27). We em-phasize that shoulder training modal-ities should utilize combinations ofconcentric, eccentric, and isometricmuscle actions.

Medicine Ball Shoulder Train-ing Exercises (Table 1)

Applied Simulated Throw (Figure 4)This exercise is performed in transi-tion ROM (i.e., transition from eccen-tric loading to concentric muscle ac-tion). While holding a baseball-sizedmedicine ball or a specialized medi-cine ball, assume throwing position atend of cocking phase (i.e., shoulderextended and abducted, elbow flexed,


a b

Figure 2. Traditional (a) external rotation and (b) internal rotation exercises. Note: Based upon our professional experience and un-published observations that poor posture (e.g., forward head and shoulders) is a factor in the creation of shoulder prob-lems, we advise paying particular attention to head and neck posture with each exercise to develop improved posture.Head and shoulders should be slightly extended, back held in a slightly extended position, knees comfortably flexed, andlegs shoulder-width apart with a slightly staggered stance, whenever possible. See Figure 3 for correct standing position.

Figure 3. Suggested posture for stand-ing exercises. Head, shoul-ders and back are held inslightly extended position,with knees comfortablyflexed, feet approximatelyshoulder-width apart, andstance moderately staggered.


Table 1Medicine Ball Training

Exercise Targeted muscles Safety considerations

Applied simulated throw (Figure 4)

Internal and external rotators Simulated throwing motion should be performed in avery deliberate and controlled fashion; it is advisedthat the abbreviated motion transitioning from ec-centric (i.e., late cocking phase) to concentric (i.e.,early acceleration phase) muscle actions be per-formed with a 2- or 3-s count.

Medicine ball snatch (Figure 5)

Upper trapezius, anterior deltoid, rhom-boids, levator scapulae, supraspinatus

Exercise should be performed with strict control, es-pecially during eccentric phase; hold ending positionby isometrically contracting the scapular retractorsfor 1–2 s.

“Pop” drill (Figure 6) Anterior deltoid, coracobrachialis, andlong head of biceps

Maintain upper arm position parallel to the ground ina parasagittal plane throughout movement; maintainelbow flexion of 120–130 during drill, with palm inelevated and pronated position.Wrist should be heldin approximately 30 of extension.

“Power pops” (Figure 7) Anterior deltoid, coracobrachialis, longhead of biceps, and finger flexors

Utilize the safety considerations of the “pop” drill.

Self pass (Figure 8) Supraspinatus, infraspinatus, and teresminor

Elbows should be flexed to 90 and held tight to thetorso; fingers should be slightly flexed to maintaincontrol of the ball. Perform the external rotation por-tion of the movement in a very controlled fashion.

“Around-the-world”(Figure 9)

Internal and external rotators Exercise must be performed in very deliberate andcontrolled fashion (i.e., 3–4 seconds to complete 1revolution). Utilize a solid base of support with kneesslightly flexed, feet approximately shoulder widthapart with a concurrently staggered stance; head,neck, and back should be maintained in slightly ex-tended position.

a b

Figure 4. Applied simulated throw: (a) eccentric loading to (b) concentric action.

and wrist slightly extended). Move theresistance through a small (approxi-mately 6 inch) ROM, alternating be-tween eccentric and concentric phasesof throwing motion.

Medicine Ball Snatch (Figure 5)This exercise is similar to a conventionalsnatch; however, ball elevation shouldbe controlled. Flex shoulders to elevateball until movement past head puts

shoulders into extended lock-out posi-tion. At this point, utilize an isometricmuscle action to retract the scapulae.Return the ball to the starting positionwith a very deliberate eccentric action,and repeat.

“Pop” Drill (Figure 6)With a small medicine ball in the palm,flex the shoulder with the upper armparallel to floor. Flex the elbow untilthe supinated palm is directly superiorto the shoulder. Next, flex the shoulderto facilitate a slight release (i.e., a fewinches of movement) from the palm.Catch the ball and repeat while holdingthe upper extremity in static position.The pop drill is intended to target theshoulder flexors. The exercise should beperformed in a rapid, yet controlled,fashion in a parasagittal plane.

“Power Pops” (Figure 7)Assume the same position as describedfor the pop drill, but instead of usingshoulder flexion to facilitate ball release,use both shoulder and finger flexion topop the ball out of the hand, then catchand repeat.

Self Pass (Figure 8)Flex both elbows to about 90° (Figure8a) and pronate the palms until theyface the midline. Holding this position,toss a small medicine ball back and forthbetween each hand (Figure 8b). To in-corporate an external rotation compo-nent, allow the shoulders to rotate later-ally after catching the ball. Repeat.

“Around-the-World” (Figure 9)With medicine ball extension handlesheld in a vertical position in front of theface, rotate the ball in a transverse planeabout a vertical axis in alternate clockwiseand counterclockwise fashion. Handsshould alternate between superior and in-ferior positions with each rotation.

Manipulation of the Training Variables• Frequency. 2–3 days on, 1day off.• Intensity (Time per Set). 15 seconds,


Figure 5. Medicine ball snatch: (a) starting position; (b) initial pull; (c) ball elevation;(d) ending position.

a b

dc


a b

Figure 6. “Pop” drill: (a)starting position; (b) ball release.

a b

Figure 7. “Power pops”: (a) starting position; (b) explosive “pop.”

a b

Figure 8. Self pass: (a) starting position; (b) tossing motion.

30 seconds, 45–60 seconds. The useof time (seconds) instead of repeti-tions allows for continuous repeatedeffort each time as opposed to a tradi-tional volume (sets ¥ repetitions).

• Progression (Volume and Frequency).Begin with one 15-second set of eachexercise, 1 day on, 1 day off; progressto three 45- to 60-second sets, 2–3days-on-1-day-off.

Table Top and Wall Exercises(Table 2)

Scapular Protraction/Retraction(Table Top; Figure 10)To Strengthen the Scapular Protractorsand Retractors. While seated beside thetable, place a hand on the table with theelbow straight. Slide the hand and armforward by moving your scapula intoprotraction. Next, slide the hand andarm backward by moving your scapulainto retraction. Keep your shoulderlevel; do not allow it to rise closer toyour ear. Maintain upright head andneck posture throughout the exercise.

Scapular Elevation/Depression(Table Top; Figure 11)To Strengthen Scapular Elevators and De-pressors. While seated beside the table,with the shoulder abducted and elbow infull extension, slide hand backward intoelevation and foreword to depression.One must concentrate on depressing thescapula during this exercise.

Scapular Protraction/Retraction,(Wall; Figure 12)To Strengthen the Scapular Protractors andRetractors. Stand with your finger tips onthe wall in front of you at a comfortableheight, but no higher than shoulder level.Keep your elbows straight and move bothof your shoulders so your scapulae moveinto protraction, and then move themback into retraction. Hold the retractionposition for 6 seconds. Maintain goodupright head and neck posture through-out the exercise.

Scapular Elevation/Depression,1 (Wall; Figure 13)To Strengthen Scapular Elevators and De-pressors. Stand with your fingertips on thewall in front of you at a comfortableheight, but no higher than shoulder level.Keep your elbows straight and move bothof your shoulders so your scapulae moveinto retraction. Keep them in retractionand then move them into elevation andthen into depression. Hold the depres-sion position for 6 seconds.


Figure 9. “Around-the-world”: (a) starting position; (b) clockwise rotation; (c) contin-ued rotation; (d) ending position.

a b

dc


Table 2Table Top and Wall Exercises


Scapular protraction/retraction:table top (Figure 10)

Serratus anterior, rhomboids, and upper,mid, and lower trapezius

Maintain upright head and neck posture through-out the exercise. Opposite hand should be placedbehind head.

Scapular elevation/depression:table top (Figure 11)

Upper trapezius, rhomboids, levatorscapula, lower trapezius, pectoralisminor, and lower serratus anterior

Maintain upright head and neck posture through-out the exercise. Opposite hand should be placedbehind head.

Scapular protraction/retraction:wall (Figure 12)

Serratus anterior, rhomboids, and upper-mid-lower trapezius

Maintain good upright head and neck posturethroughout the exercise. Head and shouldersshould be slightly extended, back held in a slight-ly extended position, knees comfortably flexed,and legs shoulder width apart.

Scapular elevation/depression:wall, 1 (Figure 13)



Scapular elevation/depression:wall, 2 (Figure 14)



“Thumbtack” exercise:Wall (Fig-ure 15)



“No money” exercise (Figure 16) Restore scapular flexibility Maintain good upright head and neck posturethroughout the exercise. Head and shouldersshould be slightly extended, back held in a slight-ly extended position, knees comfortably flexed,and legs shoulder width apart.

Figure 10. Scapular protraction/retraction: (a) starting position; (b) protraction; (c) retraction.

a b c


a b

Figure 11. Scapular elevation/depression: (a) scapular elevation; (b) scapular depression.

a b

Figure 12. Wall exercise for scapular protraction/retraction: (a) scapular protraction; (b) scapular retraction.

a b

Figure 13. Wall exercise for scapular elevation/depression: (a) scapular elevation; (b) scapular depression.

Scapular Elevation/Depression,2 (Wall; Figure 14)To Strengthen Scapular Elevators and De-pressors. Stand with the fingertips of onehand on the wall beside you at a comfort-able height, but no higher than shoulderlevel. Place the opposite hand behind yourhead with the elbow in line with your headand the scapula in retraction. Move thescapula of the hand on the wall into eleva-tion and then down into depression. Holdthe depression position for 6 seconds.

“Thumbtack” Exercise (Wall;Figure 15)To Restore Scapular Flexibility and to

Strengthen Scapular Elevators and De-pressors. This is a wall exercise for scapu-lar elevation/depression and shoulderinternal/external rotation. Place yourthumbs on the wall in front of you in acomfortable position, but no higherthan shoulder level. Keep your elbowsstraight and rotate your arms using yourthumbs as pivot points (as if you werescrewing a thumbtack into the wall). Besure to rotate the arms fully in each di-rection to the extreme so that the shoul-ders rise (scapular elevation) and lower(scapular depression) with the extremepositions of rotation. Keep your headand neck in good postural alignment.

“No Money” Exercise (Figure 16)To Restore Scapular Flexibility. Lieon the floor or on a table, or standwith your back against the wall.Bend your elbows and raise yourhands to elbow level, keeping yourelbows against your side. Move intoscapular retraction and move yourhands toward the floor or wall by ro-tating the shoulders. Keep your headin a good postural position. Holdthe final position for 10 seconds andthen relax and return to the startingposition. Maintain good uprightneck and head posture during theexercise.


a b

Figure 14. Wall exercise for scapular elevation/depression: (a) scapular elevation; (b) scapular depression.

a b

Figure 15. Wall “thumbtack” exercise: (a) internal rotation and elevation; (b) external rotation and depression.

Manipulation of the Training Variables• Frequency. 2–3 days on, 1day off.

(The exercises should be performedbefore practice or game warm-up.)

• Intensity (Repetitions per Set). 10–12repetitions, 1–2 sets.

• Progression (Volume and Frequency).Begin with one 10-repetition set ofeach exercise, 1 day on, 1 day off;progress to three 12 repetition sets,2–3 days on, 1 day off.

Standing Multi-Muscle Move-ment Exercises (Table 3)

Lateral Lunge (Figure 17)To Strengthen Scapular Depression/Down-ward Rotation and Elevation/Upward Ro-tation With the Large Arc Shoulder Motion.Begin by standing with your hands onyour chest. Take a stride to the right, mov-ing the right hand in a low sweeping mo-tion that continues up and above thehead, ending overhead. This movementcauses the scapula to move down and then

up, resulting in elevation and upward ro-tation. Return to the resting position byfollowing the same path of the hand backto the chest. This movement results inscapular depression and downward rota-tion. Repeat the same motion with the lefthand and return to the starting position.Keep the head and neck in good posturalalignment throughout the exercise.

Forward Lunge (Figure 18)To Strengthen Scapular Protraction Withthe Forward Stride and Retraction With


a b

Figure 16. “No money” exercise: (a) starting position; (b) retraction/external rotation.

Table 3Standing Compound Movements


Lateral lunge (Figure 17) Upper and lower trapezius, pectoralisminor, serratus anterior, rhomboids, andlevator scapula

Safety considerations are the same for all 4 exer-cises. Maintain good upright head and neck pos-ture throughout the exercise. Head and shouldersshould be slightly extended, back held in a slight-ly extended position, knees comfortably flexed,and legs shoulder width apart.

Forward lunge (Figure 18) Serratus anterior, rhomboids, and upper,mid, and lower trapezius

“Lawn mower” pull (Figure 19) Rhomboids, upper, mid, and lower trapez-ius, serratus anterior, levator scapula, andpectoralis minor

“4-Count” exercise (Figure 20) Upper, mid, and lower trapezius, rhom-boids, levator scapula, lower trapezius,pectoralis minor, and serratus anterior

the Backward Stride. Begin by standingwith your hands on your chest. First,stride forward with the right leg andreach forward with the left hand, keep-ing the left elbow at shoulder level.Next, stride back with the right leg so itlands well behind the left leg and movethe left arm back so the elbow finishesbehind the left shoulder at shoulderlevel. Repeat these movements for theprescribed number of repetitions, andthen repeat the movements for the leftarm, stepping with the right leg. Keepyour head and neck in good posturalalignment.

“Lawn Mower” Pull (Figure 19)To Strengthen Scapular Depression/Pro-traction/Downward Rotation on theDownward Movement and Scapular Ele-vation/Retraction/Upward Rotation Withthe Upward Movement. Begin by stand-ing with your hands on your chest.Squat at the knees and hips, keeping theback straight, and touch the outside ofthe right knee with the left hand. Standup and move the left elbow above andbehind the left shoulder, keeping thechest facing forward. Repeat with theright hand touching the left knee.

4-Count Exercise (Figure 20)To Strengthen Scapular Depression, Ele-vation, Protraction, and Retraction.Begin by standing with your hands onyour chest. First, squat at the knees andhips to move the left hand down totouch the outside of the left knee, keep-ing the back straight and the chest fac-ing forward. Next, stand up and movethe left elbow behind the left shoulder.Move the left elbow and hand across thechest just below the chin, and then movethe left elbow back to position 2. Repeatthe 4 movements for the assigned num-ber of repetitions. Repeat the process forthe right shoulder.

Manipulation of the Training Vari-ables• Frequency. The exercises should be

performed after bullpen work andafter pitching in a game.

• Intensity (Repetitions per Set). 10–12repetitions, 1–2 sets.

• Progression (Volume and Frequency).Begin with one 10-repetition set of

each exercise, and progress to two12-repetition sets. Use cuff weights,starting with 2 lbs and progressingfrom there.


a b

Figure 18. Forward lunge: (a) protraction; (b) retraction.

a b

Figure 17. Lateral lunge: (a) starting position; (b) retraction/upward rotation.

“Six Pack” Exercises (Table 4)

Position 1 (Figure 21a)To Strengthen Scapular Retractors andPosterior Rotator Cuff Muscles. Lying onyour stomach, move your arms so theyare directly to the side of the shoulders(approximately 90° abduction) with the

elbows straight and the hands pointingto the floor. Move the scapulae into re-traction and the shoulder into horizon-tal abduction. Hold for 6 seconds.

Position 2 (Figure 21b)To Strengthen Scapular Retractors andPosterior Rotator Cuff Muscles. Lying on

your stomach with your arms in thesame position as position 1, turn yourthumbs up to point to the ceiling. Per-form the same movement as in position1, and hold for 6 seconds.

Position 3 (Figure 21c)To Strengthen Scapular Retractors/Eleva-tors and Posterior Rotator Cuff Muscles.Lying on your stomach as in position 1,move your hands and shoulders so thehands are in line with your eyes (approx-imately 110° of abduction) with the el-bows straight and the hands pointing tothe floor. Move the scapulae into retrac-tion and slight elevation and the shoul-der into horizontal abduction, and holdfor 6 seconds.

Position 4 (Figure 21d)To Strengthen Scapular Retractors/Eleva-tors and Posterior Rotator Cuff Muscles.Starting in position 3, turn your handsso the thumbs point to the ceiling, andhold for 6 seconds.

Position 5 (Figure 21e)To Strengthen Scapular Retractors/De-pressors and Posterior Rotator CuffMuscles. Lying on your stomach, bendyour elbows to 90°, turn your palmsso your thumbs point up, and move


a b

Figure 19. “Lawn mower” pull: (a) protraction/depression; (b) retraction/elevation.

Figure 20. “4-Count” exercise: (a) position 1; (b) position 2; (c) position 3; (d) position 4.

a b c d

your arms to the same level as theshoulder (approximately 90°). Re-tract your scapulae and raise yourthumbs to the ceiling (externally ro-tating your shoulders). Hold for 6seconds.

Position 6 (Figure 21f)To Strengthen Scapular Retractors/Depres-sors, Posterior Rotator Cuff, and Latis-simus Dorsi and Teres Major Muscles.Lying on your stomach, place palms onthe table beside your hips, keeping yourelbows straight. Raise your hands ashigh as you can and retract your scapu-lae. Hold for 6 seconds.

Manipulation of the Training Variables• Frequency. 1–2 days per week (the

exercises should be done before prac-tice on nonpitching days).

• Intensity (Repetitions per Set). Performall 6 positions in succession, 1–2 sets.

• Progression (Volume and Frequency).Begin with 1 set of each exercise,and progress to 2 sets, 2 days aweek.

Conclusion/Discussion The overhand throw places consider-able and varied load upon the shouldercomplex. The rapid transition betweeneccentric (i.e., cocking phase) and con-centric (i.e., acceleration phase) muscleactions during the baseball pitch pro-duces tremendous forces on andaround the glenohumeral joint, con-tributing greatly to soft tissue micro-trauma of the shoulder complex. Theintention of this article was to informthe reader of the various stresses in-volved in the baseball pitch, as well assome of the injuries associated withsuch activity. Additionally, we provideda systematic and comprehensive shoul-der training routine focusing on the en-tire shoulder complex, something that,

in our opinion, has been missing fromthe repertoire of general strength train-ing programs intended for pitchers.Based upon our experience, exercisetraining for baseball has not been as in-dividualized or position-specific asneeded; some training programs forpitchers overemphasize strengtheningthe rotator cuff muscles, neglecting thefixators of the scapula. Additionally, ifactivity analysis is not utilized, thoseprofessionals responsible for imple-menting strength and conditioningprograms may simply prescribe exercis-es intended for the general population(2). Training the baseball pitcher isunique, and exercise prescription forthis type of athlete should accommo-date specific pitching kinematics. It isour belief that facilitating a sport-spe-cific training program for the baseballpitcher may improve performance andreduce the incidence of injury to theshoulder complex. ♦


Table 4“Six-Pack” Exercises

Exercise Targeted Muscles Safety Considerations

Position 1 (Figure 21a) Rhomboids, upper-, and mid trapezius,supraspinatus, and teres minor

Safety considerations are the same for all 6 posi-tions. Exercises should be performed on an athlet-ic training table if possible.The amount of move-ment will be based on shoulder and upper backflexibility. If movement is painful, omit exercise.

Position 2 (Figure 21b) Rhomboids, upper-, and mid trapezius,supraspinatus, and teres minor

Position 3 (Figure 21c) Rhomboids, upper- and mid trapezius,levator scapula, supraspinatus, and teresminor

Position 4 (Figure 21d) Rhomboids, upper- and mid trapezius,levator scapula, supraspinatus, and teresminor

Position 5 (Figure 21e) Rhomboids, upper-, mid- and lower trapezius, pectoralis minor, lower serratusanterior, supraspinatus, and teres minor

Position 6 (Figure 21f ) Rhomboids, upper-, mid- and lower trapezius, pectoralis minor, lower serratusanterior, supraspinatus, and teres minor

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Jeffrey Jeran is Wellness Program Direc-tor for the Morgantown Branch of the Na-tional Institute of Occupational Safetyand Health and Centers for Disease Con-trol and Prevention.

Robert Chetlin is an Assistant Professorin the Division of Occupational Therapy atthe West Virginia University School ofMedicine.


Jeran

Chetlin

80 April 2007 • Strength and Conditioning Journal

C o r r e c t i o n

The authors of this article, Strength andConditioning Journal, 27(4):14-31, 2005,wish to correct inadvertent omissionsfrom their manuscript, including thefollowing references:

1. BLACKBURN, T.A., W. D. MCLEOD, B.WHITE, AND L. WOFFORD. EMGanalysis of posterior rotator cuff exer-cise. Athl. Train. J. Natl. Athl. Train.Assoc.25:40-45. 1990.

2. BURKHART, S.S., C.D. MORGAN, AND

W.B. KIBLER. The disabled throwingshoulder: Spectrum of pathology partI: Pathoanatomy and biomechanics.Arthroscopy. 19:404-420. 2003.

3. BURKHART, S.S., C.D. MORGAN, AND

W.B. KIBLER. The disabled throwingshoulder: Spectrum of pathology partII: Evaluation and treatment of SLAPlesions in throwers. Arthroscopy.19:531-539. 2003.

4. BURKHART, S.S., C.D. MORGAN, W.B.KIBLER. The disabled throwing shoul-

der: Spectrum of pathology part III:The SICK scapula, scapular dyskinesis,the kinetic chain, and rehabilitation.Arthroscopy. 19:641-661. 2003.

Figures 12, 13, 15, 17, 18, and 19 werebased on the exercises in reference #4.Figure 21 is based upon the exercises inreferences #1 and #4. The written de-scriptions of figures 10-21 should becredited to P. B. Donley of the Philadel-phia Phillies organization. ♦

Correction for Training the Shoulder Complex in Baseball Pitchers:A Sport-Specific Approach

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Training the Shoulder Complex in Baseball pitchers