With off-season fundamental work and passing leagues becoming a much more normal part of a quarterback’s development, we have begun to see an increase in overuse injuries. Generally, if the throwing motion is done correctly, the quarterback won’t feel any pain, but so few quarterbacks throw the ball with great mechanics that injuries do occur. Adding to this issue are some issues in training – so many quarterbacks do the same workouts as their teammates, which is potentially a problem for two reasons: who’s to say their teammates have a good workout written by their coach in the first place? And a quarterback needs a different workout because of the extreme specificity of their position.
Quarterbacks overuse a relatively unstable joint with a lot of force, which can lead to many overuse injuries. Quarterbacks are also dissimilar to pitchers in that a football is much heavier than a baseball and forces the arm to externally rotate, putting a lot more stress on the arm. The task of coaching a quarterback to be both effective and healthy is a difficult one, and not one that should be undertaken by an under-qualified coach. So many head coaches want to be the ones to coach their quarterbacks, which makes sense, however, if their knowledge on biomechanics and fundamentals is lacking in any way, they put their quarterback at a much higher risk of overuse and chronic injuries.
Let’s start by taking a look at kinetic sequencing, which is how the body transfers power into the throw. All of our power starts from the ground; as we push and twist into our feet we use the force the ground returns to us to power our throw (as you Isaac Newton followers will remember, for every force, there is an equal and opposite force, so when we push and twist into the ground, the ground returns that same force). From there, we twist our hips out in front of our shoulders, then shoulders out in front of our arm, then eventually the arm catches up, the elbow extends, the arm pronates down and we release the ball. Each segment of the body goes a bit behind the one before it, which creates power and torque. This is the same effect as a whip or a trebuchet (see: ancient but brilliant catapult system). This kinetic chain is extremely effective for creative power, but if one part of this chain doesn’t work right, all the successive parts of the chain are forced to compensate, which can lead to poor throws and injuries, particularly when done for hundreds and thousands of repetitions.
The first thing we must do to prevent throwing injuries is check biomechanical integrity. For those of you who have been with us for a while or regularly read our blogs, you know that biomechanical integrity is essentially the body’s ability to move correctly. A quarterback must have good thoracic spine mobility (which allows the hips to go in front of the shoulders in the chain), good external rotation in the shoulder (which allows the shoulders to lead before the ball), and a stable scapula (to stop the shoulder from leaving the back too soon, helping to support the smaller muscles inside the shoulder complex). While biomechanical is by far the most important part of preventing throwing injuries, it has been discussed in other posts and this entry will focus on some other items. Just keep in mind that all I’m about to write is a moot point without biomechanical integrity.
The common injuries we’re going to examine today are rotator cuff/labrum issues, biceps tendinitis, and UCL strains. These are what I feel are the three most common and easily preventable injuries in quarterbacks. Often times, these are brought on more from bad training habits and throwing mechanic issues.
The rotator cuff and labrum are fairly small items in the shoulder that require the support of the scapula in order really maintain any stability. When a quarterbacks tells me he has pain or injuries in the rotator cuff or labrum (which would really have to be a doctor’s diagnosis), the first thing to look at is the scapula. If the scapula doesn’t stabilize to the back well, it will put extra pressure into the cuff and labrum. This is what some physical therapists refer to as winging – as the hands move up, the scapula comes quickly away from the spine. To fix this, do exercises such as Y, T, W’s, pillow presses, wall sits with scapula mobility, or anything that creates scapula retraction. This should help train the scapula to hold onto the back better, and begin to save the shoulder.
Biceps tendinitis is a very painful injury, and is particularly damaging to a quarterback as the rotator cuff and biceps are two links of the same chain. A quarterback with biceps tendinitis often times causes the injury through his training regimen. By doing straight-bar bench presses and curls, we tighten the complex of muscles and tissue around the connection of the shoulder, chest, and arm. In doing so, we inwardly rotate the shoulders, creating a slightly hunched look, and put extra pressure into the rotator cuff and biceps. Because of this, I highly suggest all quarterbacks remove curls and bench press from their training regimens. Instead of curls and barbell bench press, increase pulling exercises such as chins up and inverted rows, and use dumbbells instead of a barbell (this allows a free movement of the shoulder because dumbbells can rotate, as opposed to being locked into position by a barbell which stops the shoulder from being able to rotate). Chin ups and inverted rows will help the quarterback open up their posture and still strengthen the smaller muscles in the arm without tightening the front of the shoulder, biceps, and chest.
UCL injuries (the ligament that runs along the inside of the elbow and associated with Tommy John surgery) generally arise from throwing mechanic issues (which generally arise from physical limitations or poor coaching). To prevent these elbow injuries, first make sure the shoulder and scapula are functioning properly. As we discussed before, when one part of the kinetic chain doesn’t work, the successive ones are forced to compensate. So, if the shoulder isn’t working right, the elbow compensates. Next, look at the mechanics involved. During the time in which the arm is moving forward into the throw, does the elbow ever move below the level of the shoulder? Or, does the angle between the forearm and upper arm ever go below 90? If either of these things are true, it is probably contributing to the pain in the elbow. To put in a few bench marks, the elbow should have approximately a 90 degree angle when it is cocked back, ready to begin moving forwards. At release, the elbow shoulder be at about ear height, still with a slight bend.
When designing a training program, make sure to include plenty of work on scapula stability and mobility, helping consistently prep the shoulder to be properly functional during activity. Also work on thoracic rotation, as that will help the parts of the chain coming before the shoulder and elbow to work properly. This would include stretches that help separate the hips and shoulders, like a half kneeling twist. Avoid pressing exercises with the exception of push-ups and dumbbell presses (nothing that locks the hand and shoulders, preventing them from rotating), and increase the amount of pulling exercises like chin ups, inverted rows, and dumbbell rows, etc. Also avoid overhead pressing, as this puts the shoulder in a fairly compromising position and generally isn’t done properly (most athletes over-extend their spine to save the shoulder, which ends up just hurting the back).
A couple red flags in the throwing motion that can lead to injuries:
-A low elbow through the release: make sure the elbow is about ear height at the release.
-A straight elbow at release: this tends to lead to AC joint pain in the shoulder. Full extension in the arm shoulder only be reached after the release, not before.
-An elbow that rises above the height of the ball: the elbow should never be higher than the ball at any point in the throwing motion, even while we are just cocking the arm back to throw. This creates wing, which in both quarterbacks and pitchers is a huge red flag. This will lead to both rotator cuff and UCL issues, as well as potentially erratic accuracy.
-A long strider: quarterbacks who over-stride lock their hips into place early, instead of allowing rotation. This decreases hip to shoulder separation, which causes the release point to be further in front of the body, which causes the rotator cuff to be overstressed AND the elbow to drop at release, which sends the ball high (see: Mark Sanchez). The proper stride length is approximately the athlete’s tibial tuberosity X 1.5, or about 26-30 inches in most quarterbacks.
Finally, even if a quarterback does all over the throwing mechanic and training items correctly, they still need to take care of their shoulder. Ice properly, warm-up properly, and tell your coach if your arm is feeling overly fatigued. Repetitions are not a problem; bad repetitions with an uncared-for shoulder are a problem.
If you have any questions, please feel free to write me at adrayson@SportPerformanceU.com.
SPU's Alex Drayson writes the SPU Football Performance Blog.
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