Case Study: 16 Year Old Softball Pitcher

This week I’d like to share a story about a 16 year old softball player. This girl had been experiencing increasing back pain for a few months, but notes her back had always been stiff and irritated on her right side near her shoulder blade since middle school. She states her back pain worsens with continued activity and sometimes has difficulty sleeping at night due to right sided back pain. She also notes pain when sitting in school, but it’s not as bad. She has stopped pitching in softball due to increasing pain. She had gone to a chiropractor for the past year, but noticed little change.

Now that we know the history of her problem, let’s discuss why previous treatment for her back didn’t fix her symptoms. First, she noted pain was most specifically on her right side. Second, a throwing athlete will likely involve the shoulder. Third, worsens with continued activity is a sign of muscle strain and fatigue. Fourth, pain on the right side when sleeping. All of the above symptoms point to dysfunction of the shoulder, but will create pain in the back.

Here’s why the shoulder is the source of her one sided back pain. When the shoulder becomes stiff and rigid due to scar tissue, misuse, disuse, etc. the body compensates for that restriction. It does this by utilizing the next joint over the shoulder blade(scapula) or scapulothoracic joint. The scapula does not have a true joint though, it’s held in place by only muscle. If the shoulder isn’t moving properly, the body adjusts and utilizes the scapula instead. When this occurs the muscles controlling the motion and positions of the scapula get fatigued for having to work so hard it creates one sided back pain around the scapula. This happens specifically as the body’s way to create the same level of motion in the shoulder girdle complex, but is using the joints and muscles incorrectly. This can lead to significant pain and also degeneration of the spine over time.

After performing my assessment on this patient I determined through basic screening of the back and shoulder that the shoulder was far more limited than the back. I treated her for 5 weeks and only worked on her shoulder. It eliminated her one sided back pain and she returned to pitching in softball.

This problem occurred in a 16 year old athlete, but is common in almost all generations and lifestyles. I have seen this similar problem in grocery store clerks as well as office workers and desk jockeys. Many people get distracted by the amount of pain in the back that they start looking for answers to the pain in the back, but if we could only look at the bigger picture we would understand that pain is only a symptom, and the problem is hiding somewhere else.

Get assessed by your friendly neighborhood Doctor of Physical Therapy(DPT) today!

Stay healthy movers!