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Care and Maintenance of Baseball Players Arms David S. Roskin, PT Duke University Sports Medicine Durham, NC 27710.

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Presentation on theme: "Care and Maintenance of Baseball Players Arms David S. Roskin, PT Duke University Sports Medicine Durham, NC 27710."— Presentation transcript:

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2 Care and Maintenance of Baseball Players Arms David S. Roskin, PT Duke University Sports Medicine Durham, NC 27710

3 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 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 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

4 Baseball Throw The most challenging shoulder and elbow activity in all of sport secondary to the angular velocities generated The most challenging shoulder and elbow activity in all of sport secondary to the angular velocities generated (Fleisig et.al., 1989) (Fleisig et.al., 1989)

5 Velocity Demands at the Shoulder and Elbow Shoulder internal rotation: 7500 deg/sec +/-1000 deg Shoulder internal rotation: 7500 deg/sec +/-1000 deg Stephen Strasburg: 8000 deg/sec vs. Tom Brady: 2300 deg/sec Stephen Strasburg: 8000 deg/sec vs. Tom Brady: 2300 deg/sec 2300 deg/sec is velocity at elbow in baseball 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 Torque of elbow in maximal external rotation (MER) of shoulder is higher than the load the ulnar collateral ligament can withstand

6 First (Consideration) Things First: Posture Stretch weakness defined by middle/lower trapezius positioned in elongation at rest (Kendall) weak backside; tight frontside Stretch weakness defined by middle/lower trapezius positioned in elongation at rest (Kendall) weak backside; tight frontside Cues: Sit as you stand Cues: Sit as you stand Feedback: “SIT UP”!!! Feedback: “SIT UP”!!! on screensaver on screensaver

7 Scapula (Shoulder Blade) is Foundation for Shoulder Health Injured shoulder presents similar to poor posture Injured shoulder presents similar to poor posture Shoulder Blade is tilted, protracted and rotated upward (can’t throw correctly) Upper Traps- culprit Shoulder Blade is tilted, protracted and rotated upward (can’t throw correctly) Upper Traps- culprit Analogy: Mansion on a bad foundation Analogy: Mansion on a bad foundation

8 2 nd Consideration: Range of Motion Isolated glenohumeral elevation (IGHE) between degrees (how the shoulder blade moves on the arm) Isolated glenohumeral elevation (IGHE) between degrees (how the shoulder blade moves on the arm) Clinically degrees External Rotation (ER) Clinically degrees External Rotation (ER)

9 Range of Motion Continued Clinically degrees of Internal Rotation (IR) Clinically 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) *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)

10 Conventional Wisdom Cross Body Adduction Cross Body Adduction Tight posterior capsule that needs stretched out (McClure et al 2007) Tight posterior capsule that needs stretched out (McClure et al 2007) Standing Vertebral Stretch Standing Vertebral Stretch

11 Not A Fan “Sleeper Stretch”-impinges on the rotator cuff and is for the most part really uncomfortable “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 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) Stretching a shoulder that doesn’t need stretched leads to instability (cuff/labral tears)

12 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) 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 Manual release of subclavius muscle

13 3 rd Consideration-How to Strength Train According to Phases of Throw Deceleration Deceleration Acceleration Acceleration

14 Deceleration Most violent phase Most violent phase Distraction force at the shoulder is 1:1 with body weight Distraction force at the shoulder is 1:1 with body weight Labral injuries: secondary to eccentric load of biceps Labral injuries: secondary to eccentric load of biceps Loose bodies of the elbow Loose bodies of the elbow

15 Decelerators: Training the “Backside” (Muscles that Slow Down and Stabilize) Supraspinatus Supraspinatus Infraspinatus and teres minor Infraspinatus and teres minor Posterior deltoid Posterior deltoid Rhomboids, middle and lower trapezius Rhomboids, middle and lower trapezius Biceps Biceps Wrist extensors Wrist extensors

16 Core Strength for Arms of a Thrower: Decelerators/Stabilizers Train eccentrically/negatively (as the muscle lengthens) Train eccentrically/negatively (as the muscle lengthens) Rotator Cuff: supraspinatus (2 and 10 o’clock position) Rotator Cuff: supraspinatus (2 and 10 o’clock position) Infraspinatus/Teres Minor Infraspinatus/Teres Minor

17 Scapular Stabilizers (Cools et al 2007) Horizontal Abduction- “Ts” (target middle traps) Horizontal Abduction- “Ts” (target middle traps) Prone Extension- “Arrows” (target rhomboids) Prone Extension- “Arrows” (target rhomboids)

18 Decelerators/Stabilizers Continued Seated row (target middle traps) Seated row (target middle traps) Prone scapular plane elevation- “Ys” (need to be careful with this one) {target lower traps} Prone scapular plane elevation- “Ys” (need to be careful with this one) {target lower traps}

19 Often Overlooked Stabilizer Lateral head of the triceps (has attachment to the shoulder blade) Lateral head of the triceps (has attachment to the shoulder blade)

20 Protection for UCL/Tommy John Biceps curls-slows elbow in deceleration Biceps curls-slows elbow in deceleration Forearm pronation/supination Forearm pronation/supination Wrist curls Wrist curls

21 Acceleration Ball moves forward- starts with IR of the humerus. Up to 8,000 deg/s. Ball moves forward- starts with IR of the humerus. Up to 8,000 deg/s. Impingement Impingement Rotator cuff tears Rotator cuff tears Medial epicondylitis: gripping ball to tight Medial epicondylitis: gripping ball to tight

22 Accelerators: Training the “Frontside” Anterior Deltoid Anterior Deltoid Pectoralis Major Pectoralis Major Latissimus Dorsi Latissimus Dorsi Teres Major Teres Major Long head of the Triceps Long head of the Triceps Anconeus Anconeus Wrist flexors Wrist flexors

23 Accelerators “Lat” pull downs “Lat” pull downs Triceps extension Triceps extension

24 Accelerator’s Continued Anterior deltoid-Front Raises (careful not to add too much weight- overloads the cuff and the biceps) Anterior deltoid-Front Raises (careful not to add too much weight- overloads the cuff and the biceps) “Modified” (Neutral/Towel) Bench Press “Modified” (Neutral/Towel) Bench Press

25 Upper Extremity Plyometrics Baseball throwers rely on stretch shortening cycle for arm speed and power. Baseball throwers rely on stretch shortening cycle for arm speed and power. Enhance neuromuscular coordination and muscle recruitment. Enhance neuromuscular coordination and muscle recruitment.

26 Plyos For Rotator Cuff One handed throws can reach velocity levels of up to 1,200 to 1,500 deg/s One handed throws can reach velocity levels of up to 1,200 to 1,500 deg/s

27 Plyometrics For Larger Muscles Good exercise for trunk accelerators (abdominal, hips); Can perform either kneeling or standing Good exercise for trunk accelerators (abdominal, hips); Can perform either kneeling or standing

28 Isokinetics (Accomodating Resistance) Accommodates to resistance delivered by the player and gives the same amount of force back throughout the entire ROM (rotator cuff) 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 Nice adjunct to training Instant feedback to both therapist/thrower Instant feedback to both therapist/thrower Works at different speeds/provides specificity to baseball (500 deg/s) Works at different speeds/provides specificity to baseball (500 deg/s)

29 Isokinetics Continued Biceps/Triceps Biceps/Triceps

30 Dynamic Stabilizing “Gizmos” Body Blade for rotator cuff stability Body Blade for rotator cuff stability BOING: elbow stabilizer BOING: elbow stabilizer

31 Exercises to AVOID!! Lateral Raise: The main culprit (lever arm is too long, usually use too much weight, impinges on the cuff 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 Upright Row: Impinges on the cuff, not functional unless your job is taking groceries out of a car trunk or shopping cart

32 No-No’s/Impingers Continued “Empty Can”: Not functional, impinges on the rotator cuff “Empty Can”: Not functional, impinges on the rotator cuff Overhead Press: Impinges on cuff/biceps-a baseball weighs between 5 and 5.25 ounces Overhead Press: Impinges on cuff/biceps-a baseball weighs between 5 and 5.25 ounces

33 No-No’s (Stretches Anterior Capsule) “Lat” Pulls (behind the neck): Can injure the neck but also stretches anterior capsule “Lat” Pulls (behind the neck): Can injure the neck but also stretches anterior capsule Dips: Stretches anterior capsule Dips: Stretches anterior capsule

34 Last but not least… Regular bench press: puts too much pressure on the anterior capsule Regular bench press: puts too much pressure on the anterior capsule Shoulder Shrugs: Target-Upper Traps Shoulder Shrugs: Target-Upper Traps

35 Final Consideration: Throwing Mechanics Improper Mechanics Increased Risk of Injury Increased Stress (Joint forces and torques)

36 Biomechanical Analysis Phases Events Wind up Balance StrideFoot contact Arm cockingMaximum external rotation Arm AccelerationMaximum internal rotation ease Arm DecelerationBall Release Follow Through

37 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 Biomechanical Analysis

38 Drills for Throwers Using mirror for visual feedback Using mirror for visual feedback

39 Wall drill Protects thrower from getting too much horizontal abduction in cocking phase Protects thrower from getting too much horizontal abduction in cocking phase

40 Frontside Drill Teaches direction Teaches direction

41 Power Position Teaches loading the backside. 65% of body weight should be on stance leg at the end of stride Teaches loading the backside. 65% of body weight should be on stance leg at the end of stride

42 Bat Toss Shea Stadium, 2000 Position at Foot Contact (FC) Baseball Pitch ASMI, 1994

43 Interval Throwing Programs (ITP) LONG TOSS: Throwing from short to longer distances LONG TOSS: Throwing from short to longer distances MOUND: MOUND: Throwing off mound with progression from fastballs/change-ups to breaking balls

44 ITP Continued Goal of ITP: The thrower will be prepared for the workload encountered during competion without risk for injury. 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 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 usually start at 50% intensity but thrower’s sometime have flawed ability to estimate effort (Fleisig et al 1996)

45 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. 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.

46 Do not forget!! Abdominals LE exercises Back extensor strength Agility Drills Run, run, run

47 Pain Management Medications per MD Medications per MD Iontophoresis Iontophoresis InterX InterX Ice/heat Ice/heat Joint mobilizations Joint mobilizations “No pain, no gain…………no good!!! “No pain, no gain…………no good!!! Can’t chase pain Can’t chase pain

48 Team Effort Between MDs, PT, ATC, patient, coach, and family

49 Thank you


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