The rotator cuff is the most important part of functional anatomy for high school athletes throwing a softball or baseball.

The prevailing theory for softball pitchers is that the windmill pitching motion puts less stress on the shoulder than the overhead throwing motion of baseball pitchers.

Yet recent research tells us that shoulder injuries are not only the most common injury to a high school baseball or softball player, but that these injuries may be on the rise in both baseball and softball. What gives?

The rotator cuff is a functional set of four small muscles (see diagrams). These muscles surround the shoulder joint. They function as a finely tuned mechanism to control position of the ball (humeral head bone) on the socket (glenoid portion of the shoulder blade) during throwing.

The myth in sports, especially softball and baseball, is that the rotator cuff needs to be “strong.” Research has clearly debunked that myth.

In actuality, it’s the timing/coordination of the four muscles, along with their ability to resist fatigue, that are the keys to their function.

Any reader can see on the diagrams that the rotator cuff muscles are small and thin, thus they are unable to provide power to the throwing motion.

However, make no mistake about it, if the rotator cuff becomes dysfunctional due to overuse, it can lead a throwing athlete down a path that starts with pain and tendinitis, to a loss of playing time, and possibly serious injury or surgery.

The good news is there are sports medicine interventions and training advice for both softball and baseball throwing athletes to decrease the risk of serious injury to the rotator cuff:

1. Stay in good all-around athletic shape. Research from major league baseball shows that players with better all-around athletic skills spend less time on the disabled list.

2. All players should have their throwing mechanics videotaped and reviewed by their coaches and a qualified sports medicine professional. This includes position players. Taking poor throwing mechanics out of the equation will decrease the risk of serious rotator cuff injury.

3. Report any, yes ANY shoulder soreness to your athletic trainer. This will start the wheels in motion for a specific evaluation, early treatment, and prevention of a more serious injury. Ignore the pain, and you might be spending more time getting splinters than playing ball.

4. Pay attention to pitch counts. It is recommended that high school baseball pitchers not exceed 100-120 pitches in a 3-4 day period between starts during the season. However, high school softball pitchers may throw anywhere over 1,200 pitches in a tournament situation. This paradox of what is thought to be “acceptable” has many researchers and coaches pointing the finger to “overuse/overload” as the key element contributing to the increase in rotator cuff injuries to high school softball and baseball athletes.

5. Train your core! Leg, trunk, and abdominal stability/strength are the key insurance policy to keep down the risk of rotator cuff injury and add power to your throws.

6. Train yourself to practice good posture. Grandma was right, if you carry yourself in good posture (yeah, even when sitting on the pine) you will decrease your risk of rotator cuff injury. Slouching, rounded out shoulder posture pitches the shoulder blades down and forward, adding stress to the rotator cuff.

7. Stay flexible. Inflexibility will predispose the rotator cuff to extra stress, and research has shown that MLB pitchers lose a measurable amount of motion in external rotation (turning outward with their arm at their side) for about 2-3 days after pitching at least seven innings.

8. Always, ALWAYS warm up to throwing! Perform some low stress activity for your shoulders before light stretching and then ease into your throwing routine, no matter what position you play.

9. Train your rotator cuff to resist fatigue. Your sports medicine specialist can show you proper light load and high volume endurance exercises to keep your rotator cuff balanced.

10. Rotator cuff muscle strains or tendinitis, left untreated, will lead to an eventual partial or even full tear, and add stress to the cartilage rim of the socket (labrum) putting a throwing careers at risk. Get to a sports medicine professional if your sore shoulder does not get better.

Old habits die hard, and there may be resistance from parents (especially if former players), coaches, or teammates, who are not open to the new concepts (supported by research listed above). Winning in baseball and softball, while protecting a young athlete’s throwing shoulder, can go hand in hand.

(About the Author: John Tomberlin has worked with high school athletes in the Cedar Rapids Metro area since 1995. He was a four-sport athlete in high school and a high school coach for two years in Illinois. John has more than 25 years of experience working with athletes as a physical therapist and a certified strength and conditioning specialist. He has worked with professional athletes in the NFL, MLB, and on the PGA and LPGA tours. John also has worked with elite amateur athletes in alpine skiing, figure skating, and track and field.)