Scott Sheridan - Kinetic PT Pitching Survival Guide 2011
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Transcript Scott Sheridan - Kinetic PT Pitching Survival Guide 2011
Preventative Care for the
Throwing Athlete
Scott Sheridan, MS PT ATC CSCS
Head Athletic Trainer
The Phillies
Youth Injuries - Data
3.5 million kids under age of 14 receive medical
treatment for sports injuries each year
62% of injuries occur in practice, but same
precautions are not put in place in practice as
they are in games.
By age 13, 70% of kids drop out of youth sports,
The top three reasons: adults, coaches, parents
Youth Injuries - Data
Among athletes 5 to 14 years of age, 25% of
baseball players were injured while playing there
sport
Since 2000 there has been a fivefold increase in
the number of serious shoulder and elbow injuries
in youth baseball and softball
False: Players do not come back stronger and
throwing harder after Tommy John Surgery!!
More than 50% of all sports injuries in children are
preventable
Definition of Prevention
Primary – avoids the development of disease
Secondary – early disease detection
Tertiary – reduces impact on already existing
condition
Want to detect problems as early as possible
Things We Can Not Prevent
Genetics
Quality of Tissue?
What is Happening
Biomechanically
with Throwing a Ball
Not a “Normal” Act
Calculated stress with
throwing exceeds the load to
failure of the native ligament.
Flexor Muscle – Intimately
attached to UCL, assist w/
stability
Extensors - Increase ESM
activation and Decrease FPM
activation in injured pitchers
during acceleration**
Muscular Fatigue - Biomechanics
EMG Activity with Pitching (% of Max Muscle Test)
Early Cocking – Upper Trap (64%), Supraspinatus(60%)
Late Cocking – Serratus Anterior (106%), Subscapulairs (99%),
Levator (72%), Infraspinatus (74%), Extensor Carpi Radialis
(72%), Extensor Carpi Radialis Brevis (75%)
Acceleration – Lower Trap (76%), Levator (77%),Subscapularis
(115%), Latissimus (88%), Tricep (89%), Pronator Teres (85%),
Flexor Carpi Radialis (120%), Flex Dig Superficialis (80%), Flexor
Carpi Ulnaris (112%)
Deceleration – Lower Trap (78%), Teres Minor (84%), Flexor
Carpi Radialis (79%), Flexor Carpi Ulnaris (77%)
Follow Through – All less than 42%
DiGiovine et al.- J Sh and Elbow 1992
“Not the Reaction You Want!”
How Do We Prevent Injuries?
Screenings / Pre Participation Examinations
Importance of the Active Warm Up
Gradual / Appropriate Progression of Activity /
Conditioning
Understand What to Do When an Injury Occurs!
Screening
The purpose of the screening is to create a list of
dysfunctions.
Ultimately the goal is to provide the throwing athlete the
best possible anatomical and physiological base to
achieve throwing efficiency.
Types of Examinations
Medical History /
Questionnaire
Information Gathering
Communication
Types of Examinations
Functional Movement Screen
Performed by Athletic Trainer / Physical Therapist
Objective is to identify limitations / asymmetry
Restrictions / Imbalances will distort motor
learning, movement perception, body
awareness, and mechanics
Deep Squat
Hurdle Step
In Line Lunge
Shoulder Mobility
Active Straight Leg Raise
Trunk Stability Pushup
Rotary Stability
Types of Examinations
Orthopedic
Shoulder
Range of Motion
Strength
Special Testing
Posture
Scapular Assessment
Spinal Assessment
Lower Extremity
Hip Range of Motion
Changes
Shoulder Examination
Range of Motion
Decreased Internal
Rotation (GIRD), increase
posterior capsule thickness
with throwing
Change in Total ROM
(IR + ER)
Humeral Retroversion
(maintain what given at
birth on dominant /
throwing side)
Posture Assessment
Areas to Evaluate
Forward Head
Forward Shoulder
Coracoid
Antecubital Fossa
TS – Kyphosis, Flat, Scoliosis
LS – Flat, Lordotic
Shoulder Position
Inferior Ang. Mid-Thorax
Scapular Assessment
Shoulder pain is the result of movement
impairment of the scapula, that disrupts
relationship of glenoid and the humerus
Scapular Assessment
Spinal Assessment
Spinal Assessment
Lower Extremity
Why Evaluate All These Areas?
FORCE GENERATION
Kinetic Chain Progression
Core is active with any
movement
Velocity most directly
correlated with Lower
extremity strength
Exercise in manner that
they will be used
(functional)
LEGS
TRUNK / BACK
SHOULDER
ELBOW
WRIST
The Injury “Cause List”
Range of Motion Changes
Reinold et al – AJSM 2008; decrease in sh. IR, total motion, and elbow
extension immediately after, lasting 24 hours
Scapular Dyskinesis (Kibler)
Muscular Fatigue(shoulder, scap, forearm)*
Core Stability
Spinal Mobility (wind up vs. follow through)
Limitations in the Lower Body (opening up?)
Importance of Active Warm
Up
Should always be the first
thing that is done before
practice or game.
Not just a static stretching
program.
Developed to address
consistent concerns
found during screening
process.
Should be sweating after
completing.
Gradual and Appropriate
Progression of Activity /
Conditioning
Equipment
Weekly Inspections
Hitting Progressions
Indoor, Tee, # of Swings
Throwing Programs
Long Toss – Distance?
Types of Exercises
What to do if an injury occurs?
Symptoms are present for a reason.
Do not let a minor problem progress into a major
problem.
Remember types of prevention!
Compensations will occur
Seek appropriate medical advice
Orthopedist, Physical Therapist, Athletic Trainer @
School
Red Flag Symptoms
Elbow
Medial Elbow Pain
Ulnar Nerve Symptoms
Shoulder
Deltoid Soreness
Posterior Shoulder Pain
Performance Concerns
Control and Velocity
Duration of Symptoms
Sore During – Sore After – Sore Next Day
“Don’t Bring Me a Problem,
Bring Me a Solution!”
Pre Participation Exam / Screening
Warm Up Appropriately
Do Not Pitch Through Symptoms
Do Not Play Year-Round
Communicate to players regarding how they
are feeling
⑥ Emphasize, control, accuracy, and age
appropriate skills
⑦ Speak to a medical professional if you have
concerns about an injury or to develop a
prevention strategy.
①
②
③
④
⑤
Special Thank You Acknowledgement
Kinetic Rehab
Phil Donley, MS PT ATC
Jeff Cooper, MS ATC
Gray Cook, PT
Gary Gray, PT
Craig Morgan, MD
Shirley Sahrmann
Ron Hruska
Questions / Solutions