Sports Rehab Write-Up: SP Kyle Freeland

Ouch! It’s not too often that we get such a visibly painful injury from a baseball game; but, late in their Sunday, July 9th matchup against the Giants, Rockies SP Kyle Freeland went out with an injury that fits the description.

In the 7th inning, after diving to field a fairly routine bunt, Freeland rolled over onto his back writhing in agony, desperately clutching his right shoulder.

The ground, again, remains undefeated.

As dangerous & debilitating as the injury may seem, according to sources close to the team, Freeland was able to avoid surgery & is expected to return to play later this season.  

In the following days we would get confirmation that Freeland dislocated his non-throwing shoulder during the highlighted play; though, it wouldn’t take a professionally trained eye to discern that from our replay. What’s interesting, however, is that Freeland also suffered a partially torn labrum in this play. Labral tears are fairly common in pitchers, but not in the way that we see in Freeland’s situation.

This provides us a good opportunity to take a look through the literature on labral tears in baseball players, as well as to highlight what makes Freeland’s injury unique.

For one, what is the labrum?

Well in this instance, we’re speaking specifically about the glenoid labrum. Our shoulder is categorized as a ball-and-socket joint; the ball being the head of the humerus, the socket being the glenoid cavity of our shoulder blade. Attached to the perimeter of our glenoid cavity is a fibro-cartilaginous ring – the glenoid labrum. In short, the labrum serves to add stability & congruency to the shoulder joint, increasing the depth of the glenoid cavity by 50% (Howell & Galinat, 1989). The labrum also serves as an attachment point for a number of important soft-tissue structures; most notably the long head of the biceps.

Now, when we look at how the labrum connects to the various structures of the shoulder, it’s not too hard to visualize the various ways that distinct forceful movements can cause damage. Usually when we’re talking about labral injuries in baseball players, we’re thinking of a  SLAP lesion – Superior Labrum Anterior to Posterior. If we take a look back at Snyder’s work from 1990, it highlights a very specific mechanism for SLAP lesions:

The most common mechanism…was a compression force applied to the shoulder. This usually occurred as the result of a fall onto an outstretched arm, with the shoulder positioned in abduction and slight forward flexion at the time of impact.

Snyder’s described the Freeland injury to a T!

Falling in general can be tough, but it’s even worse when all of your weight gets forced through your hand & up your arm; all that force has to go somewhere! When we look at the replay of Freeland’s injury, we can identify the clear posterior force directed through his shoulder capsule, briefly dislocating his shoulder & tearing his labrum.

So that’s one way to do it! But, while that may be the most common mechanism for a labral tear in the general population, it’s not the most common in baseball pitchers. For one, labral tears are typically seen in a pitcher’s throwing shoulder. As highlighted in the 2018 review by Lin, Wong, & Kazam, the most prevalent type of SLAP lesion in overhead athletes is associated with repetitive throwing & the posteriorly directed torsional force at the anchor of the long head of the biceps during the late cocking phase of a throw. So, we’re pretty used to hearing about labral injuries in the throwing shoulders of high-volume, high-intensity pitchers. Kyle Freeland took a much more traumatic, painful route to the injury, but luckily to his non-throwing arm.

So what does the road to recovery look like for Freeland?

In the 2017 study done by Schrøder et. al comparing sham (didn’t really happen) surgical intervention to genuine labral repair, they found that there was no significant clinical benefit of surgical intervention over the sham surgery for patients with Type 2 SLAP lesions. So, going the conservative route seems to have been the right play in this situation!

The typical timeline for return to sport in labral tears is between 4 to 6 months (Michener et. al, 2018); though, with Freeland’s injury being to his non-throwing arm & being described by all accounts as “slight” or “minor”, he might not be out for very long at all!

Over the next couple of weeks, Freeland can expect a rehab protocol consisting of regular posterior capsule stretching, addressing shoulder internal rotation deficits, & maximizing scapular and rotator cuff strength & stability.

In the hands of a good rehab specialist, it won’t be long before Freeland’s back on the mound launching rockets for the Rockies!

If you’re dealing with a similar injury & seeking professional guidance, consult your trusted physical therapist to equip you with the appropriate strength & ROM exercises to get you back in the lineup!

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References & Work Cited

Howell, S. M., & Galinat, B. J. (1989). The glenoid-labral socket. A constrained articular surface. Clinical orthopaedics and related research, (243), 122–125.

Snyder, S. J., Karzel, R. P., Del Pizzo, W., Ferkel, R. D., & Friedman, M. J. (1990). SLAP lesions of the shoulder. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 6(4), 274–279. https://doi.org/10.1016/0749-8063(90)90056-j

Lin, D. J., Wong, T. T., & Kazam, J. K. (2018). Shoulder Injuries in the Overhead-Throwing Athlete: Epidemiology, Mechanisms of Injury, and Imaging Findings. Radiology, 286(2), 370–387. https://doi.org/10.1148/radiol.2017170481

Schrøder, C. P., Skare, Ø., Reikerås, O., Mowinckel, P., & Brox, J. I. (2017). Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-armed randomised clinical trial. British journal of sports medicine, 51(24), 1759–1766. https://doi.org/10.1136/bjsports-2016-097098

Michener, L. A., Abrams, J. S., Bliven, K. C. H., Falsone, S., Laudner, K. G., McFarland, E. G., Tibone, J. E., Thigpen, C. A., & Uhl, T. L. (2018). National Athletic Trainers' Association Position Statement: Evaluation, Management, and Outcomes of and Return-to- Play Criteria for Overhead Athletes With Superior Labral Anterior-Posterior Injuries. Journal of athletic training, 53(3), 209–229. https://doi.org/10.4085/1062-6050-59-16

Steinmetz, R. G., Guth, J. J., Matava, M. J., Brophy, R. H., & Smith, M. V. (2022). Return to play following nonsurgical management of superior labrum anterior-posterior tears: a systematic review. Journal of shoulder and elbow surgery, 31(6), 1323–1333. https://doi.org/10.1016/j.jse.2021.12.022