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February 26, 2019
Blue Jay's pitcher Marcus Stroman may want to forget much of 2018. Stroman started the season with right shoulder inflammation in spring training requiring him to be shut down, limiting his build up of pitches in the lead up to the season. Then he was placed on the disabled list on May 11, 2018 (retroactive to May 9, 2018) for shoulder fatigue. Stroman himself stated that there was more to it than just the shoulder fatigue. After returning from the disabled list, he struggled and wound up on the disabled list again in August 18th for a blister. Stroman had previously told MLB.com on Aug. 8: "It's something that I've been dealing with all year, to be honest with you, I just haven't said anything"
This spring we find out from Stroman that he was suffering from shoulder issues all of last year. While to some this admission would be a surprise, however, if we look at how he performed it shouldn't surprise anyone. Stroman had career worsts in ERA, WHIP, walk rate, strikeouts per walk, and Win-Loss record. He clearly struggled with control and was pitching up in the zone more often than in the past. Considering he is most effective when pitching at or below the knees, this was not optimal and suggested that something was off.
In 2017, Stroman pitched much better but also complained about the ball as he has having issues with "hot" spots which are precursors to blisters. He was able to pitch the whole year, making 33 starts and accumulating 201 innings on his way to a career best ERA at 3.08. This was the first year that Stroman ever had issues with the ball. Only the Blue Jays and Stroman would know for sure whether he was already having some tightness in the shoulder or through his hips and pelvis that were subtly affecting him. Obviously, it was not enough to prevent him from pitching very effectively.
#1 - Stroman has to be able to pitch down in the zone. This will mean that he is able to get on top of the ball and be able to extend through the shoulder without any restriction.
#2 - Stroman will have more control particularly with his fastball. This will make it easier for his off-speed pitches to be used to have batters chase them out of the zone reducing his walk rate to a more acceptable level
#3 - As he builds his pitch count, Stroman will continue to pitch down in the zone and not show any signs of fatigue
#4 - Stroman will not be looking at or examining his right hand for "hot" spots or blisters as these were caused by the change in arm angle from his shoulder issues. In 2018, he tried to compensate for the shoulder with increased pressure through his fingers leading to the blisters.
If I were responsible for the health of Marcus Stroman, I would do the following:
Knowing that Stroman had an left ACL repair in the past, would lead me to first check his left quadriceps (and lower extremity) for any weakness. If there is weakness, then he or any other right handed pitcher would likely compensate for this weakness by over using the tensor fascia lata and iliotibial band. These structures are on the outside of the thigh start at the hip and attach to the knee cap as well as the tibia below the knee. Overuse causes tightness that would spread to the left hip and abdominal region and through the connective tissue fascial chains up to the right shoulder. So any weakness and tightness in the left thigh would gradually become more of an issue over time for any right handed pitcher.
Along the same lines, normal alignment and mobility of the pelvis would be essential. Any restriction at the pelvis would gradually cause tightness into the shoulders. For example, a rotation and restriction at the right pelvis causes weakness of the gluteus medius which is one of the muscles that is used to push off from the rubber. The push and rotation during the stride phase is responsible for about 50% of the velocity of a pitch. To maintain the same velocity on the fastball, a pitcher would then have to compensate for this in other areas which may lead to impingement and pain in the shoulder or increased strain at the elbow. Looking at it from a tissue perspective, a rotated pelvis can cause tightness in the hip flexors and lower abdomen which have attachments to the upper back pulling it into more flexion. Increased flexion or bend in the upper back reduces the rotation through the body and compromises how well the shoulder blade stabilizers work. If the shoulder blade is not controlled as well, the rotator cuff and long head of biceps muscles have to work harder causing increased strain and possibly inflammation of the tendons from rubbing in the shoulder joint. Both of these cause restrictions and pain in the shoulder.
If you follow the logic, the next place to check is the mobility of the lower back and upper back then neck before even looking at the shoulder. Treating the symptoms is easy mindless therapy. Good therapy is not mindless or easy. It requires thought, observation and good feedback. Treatment of the symptoms directly may help initially but the symptoms will return. Good treatment tracks down the cause so the symptoms don't come back, ever! It may take a little longer but the results are so much better.
Toyoshima S, Hoshikawa T, Miyashita M, et al. Contribution of the body parts to throwing performance. Biomechanics IV. Baltimore, University Park Press, 1974;169–174