As spring training is finishing up and the regular season is underway, many of the seasoned players come into issues. This is when injuries start occurring. Many experience symptoms of what we call thoracic outlet syndrome or when the nerves that affect the shoulders, elbows, wrists and hands get choked or pinched.
Thoracic outlet syndrome aka TOS aka pinched nerves, is often confused with carpal tunnel syndrome because their symptoms can be similar. Many don’t know these issues typically arise from the neck first then the nerve cords are caught along the way all the way down to the hands. These pinched nerves can have a huge effect on a baseball player's arm in particular as they give the arm strength, accuracy and precision for throwing, catching and swinging.
The common symptoms of TOS are a noticeable reduction of strength, tourniquet-like feeling choking the arm, throbbing, swelling, pain, as well as numbness and tingling. Sharp bursts of electrical feeling “zingers” are also common and can be especially scary.
Obviously, these things greatly impact throwing mechanics and the ability to hold the ball and have severely limited professional player’s careers. What sad is these problems can mostly be prevented if one starts to protect the neck first.
Having had TOS myself, I'm sharing what I would have done differently to prevent and rehab it all over again.
Causes of Thoracic Outlet Syndrome
TOS often stems from poor shoulders. That instability then rattles the ribs and neck which in turn rattles the nerves. But it can also come from instability in the neck that then rattles the shoulder, ribs and nerves. And if you've read other blogs or you follow the R+ Youtube channel, you know that I'm a stickler about poor habits. So of course, poor habits can have an effect on TOS as well.
1. Unstable neck bones that lead to pinched nerves:
Unstable neck bones can occur when one self-pops their necks (self-adjustments) or receives many chiropractic adjustments. These pops can stretch the ligaments and weaken the muscles that hold your neck bone in place. The neck has to be able to combat the forward-moving bowling ball we call a had. When these ligaments and muscles are unstable, it's like a cave collapsing in on the poor nerves. Combine that with an unstable shoulder (which I'll talk about below) or one that is moving improperly then you're bound to have some nerve damage or injury.
2. Instability in the shoulder joint:
Just like the neck, stability (and more specifically, dynamic stability) is the key component to a healthy moving shoulder. Shoulders that are on-axis and remain on-axis during movement (this is where dynamic stability comes into play) keeps those nerves from being aggravated.
3. Faulty throwing mechanics:
Now, I don't think this takes a genius to figure out. Of course, if there are poor mechanics in a movement, there will be issues. Think of walking only on the side of your foot all day every day. Eventually, you're going to have blisters and tons of foot and back pain. The same goes for any other kind of motion. If some muscles aren't working properly, others will have to compensate for it and they'll get tired out. Then you're moving in a weird way and your poor nerves are getting overstretched and angry. Enter that awful numbness and tingling sensation that is oh so common with TOS.
4. Habits habits habits. Side sleeping, poor posture and more:
In this day and age of computers/electronic devices, we're all set up for rounded shoulders and forward head posture. Sit down in a slumped, rounded shoulders position and try to raise your arm out in front of you. Do this carefully because I guarantee you won't be able to raise it the whole way up without an ouchie. Now, sit in a good posture and try to perform the same action. Much easier now, huh?
Even the slightest degree of poor standing posture will set you up for impingements, inflammation and irritation within the joint.
So if you feel that pinch or pain when you're just slowly raising your arm, imagine what a poor posture does to a pitcher trying to throw a fastball.
So here are my top 5 favorite exercises to protect against and rehabilitate the thoracic outlet and address the 4 above causes.
First Rib Mobilization: Keeping the first rib in place is imperative so that it doesn't bang into nerves. The bad thing is this joint is very unstable and tends to glide up with torquing of the head and trucks as well as during overhead motion. It is important that this rib remains stable with a strong neck and rib intercostal muscles and this exercise helps your body do just that.
Cervical Stabilization: As mentioned above, neck stability is very important so that the ribs and shoulders can do their jobs. Small muscles like up the back of your head/neck and big muscles go from head to shoulders. We have a tendency of employing the big muscles to stabilize the neck instead of the little ones. That can cause the nerves that go to your collarbone to get all tangled up. This exercise targets those small stabilization muscles so the larger muscles don't have to compensate for them.
Shoulder Blade Clocks: A third of your shoulder mechanics stems from your shoulder blade. The safety of the nerves and ribs comes with control of the shoulder blade. Moving it in all directions offers more degrees of freedom and lowers the likelihood of improper movement.
Shoulder Setting: Ok, this is straight up one of the best shoulder exercises of all time. It helps address every single one of the above causes of TOS. This exercise keeps the shoulder bone close to the socket and away from the nerves!
Collarbone Stabilization (Cover Position): This is a progression to the shoulder setting. So it sets not only your clavicle but also the shoulder and shoulder blade. It helps all three bones move in sync and decrease impingements in throwing mechanics.
So keep your nerves happy this baseball season with these simple exercises!
Remember, we can and we will get better together.
Dr. Justin C. Lin