Transcript Care & Maintenance of Baseball Throwers presentation

Care and Maintenance of
Baseball Players Arms
David S. Roskin, PT
Duke University Sports Medicine
Durham, NC 27710
Baseball Throwing: The most violent
activity you can do with the arm in sports


Throwing is similar among various sports, including
football, javelin, water polo, tennis serve, and volleyball
serve/spike and freestyle swimming stroke but nothing
equals the demands of baseball throwing
In order to care for baseball players and minimize
injury potential, a thorough understanding of: the
necessary range of motion, strength and biomechanics
required to throw safely, is needed
Baseball Throw

The most challenging shoulder and elbow
activity in all of sport secondary to the angular
velocities generated
 (Fleisig et.al., 1989)
Velocity Demands at the Shoulder
and Elbow




Shoulder internal rotation:
7500 deg/sec +/-1000 deg
Stephen Strasburg: 8000
deg/sec vs. Tom Brady: 2300
deg/sec
2300 deg/sec is velocity at
elbow in baseball
Torque of elbow in maximal
external rotation (MER) of
shoulder is higher than the
load the ulnar collateral
ligament can withstand
First (Consideration) Things First:
Posture



Stretch weakness defined
by middle/lower
trapezius positioned in
elongation at rest
(Kendall) weak backside;
tight frontside
Cues: Sit as you stand
Feedback: “SIT UP”!!!
on screensaver
Scapula (Shoulder Blade) is
Foundation for Shoulder Health

Injured shoulder
presents similar to poor
posture

Shoulder Blade is tilted,
protracted and rotated
upward (can’t throw
correctly) Upper Trapsculprit
Analogy: Mansion on a
bad foundation

2nd Consideration: Range of Motion

Isolated glenohumeral
elevation (IGHE)
between 105-115 degrees
(how the shoulder blade
moves on the arm)

Clinically 120-140
degrees External
Rotation (ER)
Range of Motion Continued


Clinically 60-70 degrees
of Internal Rotation (IR)
*Theory: If you don’t
have this, brain knows it
needs to get to the target
and the next best place is
Tommy John region
(overpronation)
Conventional Wisdom

Cross Body Adduction

Tight posterior capsule that
needs stretched out (McClure
et al 2007)

Standing Vertebral Stretch
Not A Fan



“Sleeper Stretch”-impinges
on the rotator cuff and is for
the most part really
uncomfortable
Stretching at 90/90 should
be avoided unless really tight:
Will get this motion in
cocking position with
throwing ( medical term:
acquired laxity)
Stretching a shoulder that
doesn’t need stretched leads
to instability (cuff/labral
tears)
How To Achieve-Breathing

90/90 hip lift with
balloon (carries over to
throwing…e.g. inhale
(diaphragm) when
cocking and exhale
(obliques) when
accelerating)

Manual release of
subclavius muscle
3rd Consideration-How to Strength
Train According to Phases of Throw

Deceleration

Acceleration
Deceleration




Most violent phase
Distraction force at the shoulder is 1:1 with body
weight
Labral injuries: secondary to eccentric load of
biceps
Loose bodies of the elbow
Decelerators: Training the “Backside”
(Muscles that Slow Down and Stabilize)






Supraspinatus
Infraspinatus and teres minor
Posterior deltoid
Rhomboids, middle and lower trapezius
Biceps
Wrist extensors
Core Strength for Arms of a Thrower:
Decelerators/Stabilizers
Train eccentrically/negatively
(as the muscle lengthens)
 Rotator Cuff: supraspinatus
(2 and 10 o’clock position)
 Infraspinatus/Teres Minor
Scapular Stabilizers (Cools et al 2007)

Horizontal Abduction“Ts” (target middle
traps)

Prone Extension“Arrows” (target
rhomboids)
Decelerators/Stabilizers Continued

Seated row (target
middle traps)

Prone scapular plane
elevation- “Ys” (need to
be careful with this one)
{target lower traps}
Often Overlooked Stabilizer

Lateral head of the
triceps (has attachment
to the shoulder blade)
Protection for UCL/Tommy John



Biceps curls-slows elbow in
deceleration
Forearm
pronation/supination
Wrist curls
Acceleration




Ball moves forwardstarts with IR of the
humerus. Up to 8,000
deg/s.
Impingement
Rotator cuff tears
Medial epicondylitis:
gripping ball to tight
Accelerators: Training the
“Frontside”







Anterior Deltoid
Pectoralis Major
Latissimus Dorsi
Teres Major
Long head of the Triceps
Anconeus
Wrist flexors
Accelerators

“Lat” pull downs

Triceps extension
Accelerator’s Continued

Anterior deltoid-Front
Raises (careful not to add
too much weightoverloads the cuff and
the biceps)

“Modified”
(Neutral/Towel) Bench
Press
Upper Extremity Plyometrics


Baseball throwers rely on stretch shortening
cycle for arm speed and power.
Enhance neuromuscular coordination and
muscle recruitment.
Plyos For Rotator Cuff

One handed throws can
reach velocity levels of
up to 1,200 to 1,500
deg/s
Plyometrics For Larger Muscles

Good exercise for trunk
accelerators (abdominal,
hips); Can perform
either kneeling or
standing
Isokinetics (Accomodating
Resistance)


Accommodates to resistance
delivered by the player and
gives the same amount of
force back throughout the
entire ROM (rotator cuff)
Nice adjunct to training
 Instant feedback to both
therapist/thrower
 Works at different
speeds/provides
specificity to baseball (500
deg/s)
Isokinetics Continued

Biceps/Triceps
Dynamic Stabilizing “Gizmos”

Body Blade for rotator
cuff stability

BOING: elbow stabilizer
Exercises to AVOID!!


Lateral Raise: The main
culprit (lever arm is too
long, usually use too
much weight, impinges
on the cuff
Upright Row: Impinges
on the cuff, not
functional unless your
job is taking groceries
out of a car trunk or
shopping cart
No-No’s/Impingers Continued

“Empty Can”: Not
functional, impinges on
the rotator cuff

Overhead Press:
Impinges on
cuff/biceps-a baseball
weighs between 5 and
5.25 ounces
No-No’s (Stretches Anterior
Capsule)

“Lat” Pulls (behind the
neck): Can injure the
neck but also stretches
anterior capsule

Dips: Stretches anterior
capsule
Last but not least…


Regular bench press:
puts too much
pressure on the
anterior capsule
Shoulder Shrugs:
Target-Upper Traps
Final Consideration: Throwing
Mechanics
Improper Mechanics
Increased Stress
(Joint forces and torques)
Increased Risk of Injury
Biomechanical Analysis

Phases
Events


Wind up
Stride
Balance
Foot contact

Arm cocking
Maximum external rotation

Arm Acceleration
Maximum internal rotation ease

Arm Deceleration
Ball Release

Follow Through
Biomechanical Analysis
• Improper Mechanics
• Early/Late Arm rotation
–
–
–
–
 Shoulder anterior force
 Shoulder proximal force
 Elbow medial force
 Elbow varus torque
• Foot placement
– Shoulder anterior force
• Shoulder rotation
– Shoulder anterior force
• Leading with the elbow
Drills for Throwers

Using mirror for visual
feedback
Wall drill

Protects thrower from
getting too much
horizontal abduction in
cocking phase
Frontside Drill

Teaches direction
Power Position

Teaches loading the
backside. 65% of body
weight should be on
stance leg at the end of
stride
Position at Foot Contact (FC)
Baseball Pitch
Bat Toss
ASMI, 1994
Shea Stadium, 2000
Interval Throwing Programs (ITP)


LONG TOSS:
Throwing from short
to longer distances
MOUND:
Throwing off mound
with progression from
fastballs/change-ups to
breaking balls
ITP Continued



Goal of ITP: The thrower will be prepared for
the workload encountered during competion
without risk for injury.
Long toss with pitchers up to 120 feet, then
mound; infielders 150 feet; outfielders 180 feet
ITP usually start at 50% intensity but thrower’s
sometime have flawed ability to estimate effort
(Fleisig et al 1996)
ITP Continued

Rehab/care cannot
reproduce the speed or
the joint forces generated
during throwing. The
only way to mimic the
forces of a baseball
throw is to actually
throw a baseball.
Do not forget!!





Abdominals
LE exercises
Back extensor strength
Agility Drills
Run, run, run
Pain Management







Medications per MD
Iontophoresis
InterX
Ice/heat
Joint mobilizations
“No pain, no
gain…………no good!!!
Can’t chase pain
Team Effort
Between MDs, PT, ATC, patient,
coach, and family
Thank you