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
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
(Fleisig et.al., 1989)

5. 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

6. 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

7. 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 Traps-culprit
Analogy: Mansion on a bad foundation

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

9. Range of Motion Continued
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)

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

11. 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)

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)
Manual release of subclavius muscle

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

14. 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

15. 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

16. 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

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

18. Decelerators/Stabilizers Continued
Seated row (target middle 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)

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

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

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

23. Accelerators
“Lat” pull downs
Triceps extension

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

25. Upper Extremity Plyometrics
Baseball throwers rely on stretch shortening cycle for arm speed and power.
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

27. Plyometrics For Larger Muscles
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)
Nice adjunct to training
Instant feedback to both therapist/thrower
Works at different speeds/provides specificity to baseball (500 deg/s)

29. Isokinetics Continued
Biceps/Triceps

30. Dynamic Stabilizing “Gizmos”
Body Blade for rotator cuff stability
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
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
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
Dips: Stretches anterior capsule

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

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

36. Biomechanical Analysis
Phases Events
Wind up Balance
Stride Foot contact
Arm cocking Maximum external rotation
Arm Acceleration Maximum internal rotation ease
Arm Deceleration Ball Release
Follow Through

37. 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
Leading with the elbow

38. Drills for Throwers
Using mirror for visual feedback

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

40. Frontside Drill
Teaches direction

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

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

43. 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

44. 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)

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.

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

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

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

49. Thank you