Softball and Anterior Humeral Glide: The Silent Instigator of Shoulder Pain

 

Fastpitch has received minimal attention throughout sports medicine literature. For decades people have carried the false perception that, compared with baseball pitching the underhand motion  creates less stress on the shoulder and is a “safe” motion. Research by Barrentine et al.(3) found that forces on the shoulder and elbow during fastpitch were around 70-95% of the forces found in baseball overhand pitching.

Flat Thoracic Spine, Shoulder Blades Tipped Forward 

Flat Thoracic Spine, Shoulder Blades Tipped Forward 

Softball players are experiencing anterior shoulder pain more than ever now hovering just below half of all high school and collegiate pitchers (47%). The combination of high weekend tournament demands (6 to 9 games) along with poor overall movement quality may be the cause of both ligamentous injuries and instability in the shoulder.  One common occurrence I am seeing in my assessments is the presence of anterior humeral glide (AHG).

 

What is AHG?

AHG is when the head of the humerus “glides” forward in relation to the shoulder socket. It is common for softball athletes to present with flat thoracic spines, shoulder blades tipped forward, resulting in a forward translation of the humeral head. It is important to note softball pitchers must fight distraction forces in the shoulder to control both internal rotation and elbow extension off the mound.  

Take a look at this slow-mo video and watch as the humerus "glides" forward during the windup.

 

 

 

Why is this a bad thing?

 

When an athlete presents with AHG while just standing in place, the forces if any on the shoulder are minimal. The scary thing is, having a softball pitcher who on average is throwing 86 to 139 innings in a season (Meyers, J Sports Med 01) in this AHG position results in chronic and repetitive overuse to the musculature and connective tissue in the front of shoulder (biceps tendon, deltoid, subsapularis, pec major and anterior capsule).

 

Here are 3 exercises to help athletes learn how to get out of excessive AHG.

1) Split Stance Low Cable Row

Cue: “Separate your clavicles”

What does it do

  •  Teaches the shoulder blade and the humerus to work at a    “team,” not as individuals
  •  Multi-planer stability
  • Strengthens upper back and scapular retractors (remember, most softball players present with shoulder blades tipped forward)

 

2) Half-Kneeling 90/90 External Rotation Hold.

 Cue: “quiet biceps”

What does it do?

  •  Teaches the athlete what they should feel and even what they should not feel when attempting to strengthen the rotator cuff
  • Increase ones ability to recruit the rotator cuff muscles
  • Visual feedback

 

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3) Serratus Slide Variation

 Cue: drive your elbows “up” and“out”

What does it do?

  •  Strengthens the serratus anterior which plays a crucial role in stabilizing the scapula against the rib cage
  • Helps prevent scapular winging
  • Increase scapular stability/control

 

Knowing what AHG looks like and implementing variations of these exercises throughout your training cycles can have a profound impact on not only your performance but your shoulder health as well. 

 

Sources:

Hill, J. L., Humphries, B., Weidnier, T., & Newton, R. U. (2004). FEMALE COLLEGIATE WINDMILL PITCHERS: INFLUENCES TO INJURY INCIDENCE. Journal Of Strength & Conditioning Research (Allen Press Publishing Services Inc.)18(3), 426-431.

Loosli, A. R., Requa, R. K., Garrick, J. G., & Hanley, E. (1992). Injuries to pitchers in women's collegiate fast-pitch softball. The American Journal Of Sports Medicine, (1), 35.

Smith, M. V., Davis, R., Brophy, R. H., Prather, H., Garbutt, J., & Wright, R. W. (2015). Prospective Player-Reported Injuries in Female Youth Fast-Pitch Softball Players. Sports Health: A Multidisciplinary Approach7(6), 497-503.