Tanner Thomas, PT,DPTCommunity Rehab Physical Therapy

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?

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???

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°± 5° ER=45°± 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.

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◦ Sleeper stretch

◦ Horizontal Adduction Stretch

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

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

Phase 2◦ Working on

protraction/retraction◦ Elbow in pronation◦ Sets of 10-15 as

tolerated

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

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

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%!!!!

Phases of Throwing

◦ Sequence of body segment motions◦ Not going to be “Picture Perfect” for every

thrower!

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

Wind Up◦ Good balance over stance leg◦ Ends w/ knee flexed to maximum

height

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

Small Step Back

Minimal 4-6” step back

Maintain weight on ball of foot

Balance Position

Controlled raising of the lift leg

Need to control this position

Should be able to hold this position as long as asked

Power position Ball facing away

from pitcher T-pattern Drive off of mound

w/ back leg

Throw to plate Stride foot

toward plate Elbow equal to

shoulder level Chest not too

“open”

Follow through Flexed knees Facing batter Squared Feet

What’s to come??◦ Softball mechanics◦ Performance drills