Transcript Diagnosis and Treatment of the Overhead Athlete
Tanner Thomas, PT,DPT Community Rehab Physical Therapy
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Baseball Players
Position Players vs. Pitchers
Softball Players
Position Players vs. Pitchers ◦ ◦ ◦
Things to consider
Pitching is a combination of ROM, balance and strength throughout several joints ROM/Strength imbalances will increase risk of injury Poor mechanics increase risk of injury
◦ ◦ General History Symptoms Onset of symptoms-trauma or repetitive Pain When and where???-shoulder,elbow What phase of throwing is painful ◦ ◦ ◦ Multiple joints How long w/ symptoms What position does player play?
Position vs. Pitcher or both!!
Intensity and Duration of throwing How many games per week??
How much throwing on the side?
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Shoulder/Scapular AROM/PROM
Rotational mobility ER/IR at 90 ° abduction Norms: ER=137 °± 15 ° IR=40 °± 10 ° Total rotational motion: ER/IR=TRM 177 °± 16 ° Wilk et al.2008
Horizontal Adduction Is the scapula moving???
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Elbow ROM Trunk ROM-Thoracic/Lumbar
Rotational movement ◦ ◦ 45 ° bilaterally should be minimum Flexion/Extension Important for follow-through
Hip ROM
Rotational Mobility: IR= 30 °± ER=45 °± 5 ° 7 °
◦ ◦ ◦ ◦ Strength Shoulder/Scapular Strength-All planes Pain or crepitation w/ resisted motion?
Assessment at neutral and 90/90 position ER/IR!
IR: 35-40% stronger than ER Elbow/Wrist strength Core strength/Stability VERY important in mechanics Hip/Knee Strength ◦ Base is EVERYTHING Rotational Hip Strength Special Tests Hawkins-Kennedy, O’Brien’s, Speed’s, etc.
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Treatment of impairments
ROM and Strength deficits in the trunk, hip and shoulder/scapula ◦ ◦
Mechanics-Soon to come!!
Minimizing the amount of mechanical changes in the patients throwing motion is a must “Tweeking” faulty mechanics to decrease overall risk of injury is acceptable
◦ Phase 1-Acute Phase Diminish pain and inflammation Modalities as appropriate-ice,ionto,etc.
Modification of activities Limiting throwing and certain exercises Stretching exercises-limitation of IR GIRD-Glenohumeral Internal Rotation Deficit Due to posterior muscle tightness Diagnosed by more than 20-25 ° other side loss of IR when compared to Sleeper stretch w/ lock down of scapula Manual sleeper stretch Limitation in horizontal adduction Supine Horz. Add w/ IR and manual stabilization
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Phase 1
Sleeper stretch ◦ Horizontal Adduction Stretch
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Phase 1 cont.
Posture Common in overhead athlete to demonstrate poor posture Tightness in pec minor is common as well as forward head Strength Deficits Restoring strength to ER’s and scapular stabilizers Core and LE strengthening and proprioception
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Phase 2-Intermediate Phase
Continued Strengthening of ER’s and Scapular stabilizers Begin utilization of the “Thrower’s Ten” exercise program Full can vs. empty can for supraspinatus Scapular NMR control drills Maintain soft tissue flexibility Continuation of core and LE strengthening Participate in running program
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Phase 2
Working on protraction/retraction Elbow in pronation Sets of 10-15 as tolerated
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Phase 3: Advanced Strengthening Phase
Continuation of Throwers Ten w/ manual end range resistance Dynamic Stabilization Drills 2 lb plyoball throws into trampoline from end range ER Scapular Horz. Abd. on a physioball Seated ER on physioball w/ single leg support Increased w/ rhythmic stabilization Shoulder endurance activities “Wall Dribbling w/ weighted ball UE biking Wall arm circles
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Phase 3-cont.
Initiating “mirror” throwing Working on proper mechanics w/o the use of a ball Only started after pain free ROM and WFL strength Interval throwing Starting at 45ft, progressing to 60 ft Must be able to throw w/ no pain to 120 ft before beginning a off the mound program
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Phase 4-Return to Throwing Phase
Continuation of strengthening/flexibility exercises for UE/LE and core Continuation of Phase 1 Interval Throwing Program Begin initiation of Phase 2 (Off the Mound) Careful monitoring of thrower’s mechanics and intensity 50% isn’t always 50%!!!!
Phases of Throwing
◦ ◦ Sequence of body segment motions Not going to be “Picture Perfect” for every thrower!
◦ ◦ Wind Up Good balance over stance leg Ends w/ knee flexed to maximum height ◦ ◦ ◦ Early Cocking/Stride Begins w/ stride towards to the plate and arms breaking Supraspinatus, Infraspinatus, teres minor active to initiate ER Ends when front foot hits the ground
◦ ◦ ◦ Late Cocking Between foot contact and maximum ext. rotation Scap retracts, supraspinatus for GH compression Increased trunk rotation ◦ ◦ Acceleration Max ER til release of ball Max elbow extension velocity
◦ ◦ ◦ Deceleration Considered the most violent phase of pitching High eccentric biceps activity to slow elbow Eccentric loading of posterior cuff to resist distraction forces Follow Through ◦ Arm motion ends ◦ Pitcher is in proper fielding position
Stance Phase of windup Solid Base w/ heels on mound Relaxed elbows and shoulders Feet shoulder width apart
Small Step Back
Minimal 4-6” step back Maintain weight on ball of foot
Balance Position
Controlled raising of the lift leg Need to control this position Should be able to hold this position as long as asked
Power position
Ball facing away from pitcher T-pattern Drive off of mound w/ back leg
Throw to plate
Stride foot toward plate Elbow equal to shoulder level Chest not too “open”
Follow through
Flexed knees Facing batter Squared Feet
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What’s to come??
Softball mechanics Performance drills