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%!!!!

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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

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Small Step Back

  Minimal 4-6” step back Maintain weight on ball of foot

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Balance Position

   Controlled raising of the lift leg Need to control this position Should be able to hold this position as long as asked

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Power position

   Ball facing away from pitcher T-pattern Drive off of mound w/ back leg

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Throw to plate

   Stride foot toward plate Elbow equal to shoulder level Chest not too “open”

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Follow through

   Flexed knees Facing batter Squared Feet

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What’s to come??

Softball mechanics Performance drills