Abstract
Purpose of review
Throwing places high demands on the human body, and specific characteristics are developed over time unique to these athletes. When returning to throw after injury, it is important to follow a criterion-based progression that allows the body to be prepared appropriately for the stresses that throwing will require. There is currently a void in the literature for criteria-based progression that helps these athletes return to the highest level of play.
Recent findings
As injury rates continue to rise in baseball, there is increased evidence showing contributions of the core and lower extremity to the baseball pitch. There is also additional data showing pitcher specific characteristics such as range of motion and scapular position in this unique population. The rehab professional should take into account every phase of the pitch starting from balance through ball release when designing a comprehensive return-to-throwing program.
Summary
Returning an athlete back to a throwing sport can be an overwhelming task. The rehabilitation specialist must have a sound understanding of the throwing motion as well as any biomechanical implications on the body, contributions throughout the kinetic chain, range of motion, and strength characteristics specific to the thrower as well as proper tissue loading principles. It is important that these athletes are not progressed too quickly through their programs and that a criteria-based progression is followed. They should have normalized range of motion, strength, and scapular mechanics, followed by a sound plyometric progression. Once this is achieved, they are advanced to an interval throwing program with increasing distance, effort, and volume which should be tracked for workload, making sure they do not throw more than their body is prepared for.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Conte S, Requa RK, Garrick JG, Anonymous. Disability Days in Major League Baseball. Am J Sports Med. 2001;29(4):431–6. https://doi.org/10.1177/03635465010290040801.
Keller RA, Steffes MJ, Zhuo D, Bey MJ, Moutzouros V. The effects of medial ulnar collateral ligament reconstruction on major league pitching performance. J Shoulder Elb Surg. 2014;23(11):1591–8. https://doi.org/10.1016/j.jse.2014.06.033.
Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Return-to-play outcomes in comparison of operative versus nonoperative treatment. Am J Sports Med. 2016;44(3):723–7. https://doi.org/10.1177/0363546515621756.
Erickson BJ, Chalmers PN, Bush-Joseph CA, Verma NN, Romeo AA. Ulnar collateral ligament reconstruction of the elbow a systematic review of the literature. J Orthop Sports Phys Ther. 2015 1–7.
Klouche S, Lefevre N, Herman S, Gerometta A, Bohu Y. Return to sport after rotator cuff tear repair. Am J Sports Med. 2016;44(7):1877–87. https://doi.org/10.1177/0363546515598995.
Fedoriw WW, Ramkumar P, Mcculloch PC, Lintner DM. Return to play after treatment of superior labral tears in. Am J Sports Med. 2014;42(5):1156–9.
Wright RW, Steger-may K, Wasserlauf BL, Neal MEO, Weinberg BW, Paletta GA. Elbow range of motion in professional baseball pitchers. Am J Sports Med. 1988;34(2):190–3.
• Camp CL, Zajac JM, Pearson DB, Sinatro AM, Spiker AM, Werner BC, et al. Decreased shoulder external rotation and flexion are greater predictors of injury than internal rotation deficits: analysis of 132 pitcher-seasons in professional baseball. Arthrosc J Arthrosc Relat Surg. 2017;33(9):1629–36. https://doi.org/10.1016/j.arthro.2017.03.025. This paper is a nice reivew of normal range of motion in elite pitchers. This data revealed that preseason shoulder ER and flexion deficits are risk factors for development of elbow injuries. This can help others treating this population identify and address these potential risk factors.
Wilk KE, MacRina LC, Arrigo C. Passive range of motion characteristics in the overhead baseball pitcher and their implications for rehabilitation. Clin Orthop Relat Res. 2012;470(6):1586–94. https://doi.org/10.1007/s11999-012-2265-z.
Wilk KE, Macrina LC, Fleisig GS, Aune KT, Porterfield RA, Harker P, et al. Deficits in glenohumeral passive range of motion increase risk of shoulder injury in professional baseball pitchers. Am J Sports Med. 2015;43(10):2379–85. https://doi.org/10.1177/0363546515594380.
Burkhart SS, Morgan CD, Ben Kibler W. The disabled throwing shoulder: Spectrum of pathology part III: the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthrosc J Arthrosc Relat Surg. 2003;19(6):641–61. https://doi.org/10.1016/S0749-8063(03)00389-X.
Kibler W. The role of the scapula in athletic shoulder function. Am J Sports Med. 1998;26(2):325–37. https://doi.org/10.1177/03635465980260022801.
Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM. Scapular position and orientation in throwing athletes. Am J Sports Med. 2005;33(2):263–71. https://doi.org/10.1177/0363546504268138.
Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther. 2000;80(3):276–91.
Oliver G, Weimar W, Plummer H. Gluteus Medius and scapula muscle activations in youth baseball pitchers. J Strength Cond Res. 2015;29(6):1494–9. https://doi.org/10.1519/JSC.0000000000000797.
Campbell BM, Stodden DF, Nixon MK. Lower extremity muscle activation during baseball pitching. J Strength Cond Res. 2010;24(4):964–71. https://doi.org/10.1519/JSC.0b013e3181cb241b.
Wilk KE, Voight ML, Keirns MA, Gambetta V, Andrews JR, Dillman CJ. Stretch-shortening drills for the upper extremities: theory and clinical application. J Orthop Sports Phys Ther. 1993;17(5):225–39. https://doi.org/10.2519/jospt.1993.17.5.225.
• Davies G, Riemann BL, Manske R. Current concepts of plyometric exercise. Int J Sports Phys Ther. 2015;10(6):760–86. This paper is a comprehensive look at plyometric exercise and its application in rehabilitation programs. It provides a nice overview of plyometrics, phases, neurophysilogical basis of plyometrics and clinical guidelines for implementation.
Brumitt J, Cuddeford T. Current concepts of muscle and tendon adaptation to strength and conditioning. Int J Sports Phys Ther. 2015;10(6):748–59.
Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sport Phys Ther. 2010;40(2):67–81. https://doi.org/10.2519/jospt.2010.3047.
• Lorenz D, Morrison S. Current concepts in periodization of strength and conditioning for the sports. Int J Sports Phys Ther. 2015;10(6):66213. This paper reviews what is currently known about periodization and gives a comprehensive way of applying it within a sports medicine practice.It may be of benefit to apply these models in long term rehabilitation programs for sports related injuries.
Haff GG, Nimphius S. Training principles for power. Strength Cond J. 2012;34(6):2–12. https://doi.org/10.1519/SSC.0b013e31826db467.
Cormie P, McGuigan M, Newton R. Developing maximal neuromuscular power. Sport Med. 2011;41(1):17–38. https://doi.org/10.2165/11537690-000000000-00000.
Pezzullo DJ, Karas S, Irrgang JJ. Functional plyometric exercises for the throwing athlete. J Athl Train. 1995;30(1):22–6.
Reinold MM, Wilk KE, Reed J, Crenshaw K, Andrews JR. Interval sport programs: guidelines for baseball, tennis, and golf. J Orthop Sports Phys Ther. 2002;32(6):293–8. https://doi.org/10.2519/jospt.2002.32.6.293.
McCarthy J, Wood D, Bolding M, Roy J, Hunter G. Potentiation of concentric force and acceleration only occurs early during the stretch-shortening cycle. J Strength Cond Res. 2012;26(9):2345–55. https://doi.org/10.1519/JSC.0b013e3182606cc5.
Mangine G, Ratamess N, Hoffman JR, Faigenbaum A, Kang J, Chilakos A. The effects of combined ballistic and heavy resistance training on maximal lower and upper body strength in recreationally trained men. J Strength Cond Res. 2008;22(1):132–9. https://doi.org/10.1519/JSC.0b013e31815f5729.
Keller RA, Mehran N, Khalil LS, Ahmad CS, ElAttrache N. Relative individual workload changes may be a risk factor for rerupture of ulnar collateral ligament reconstruction. J Shoulder Elb Surg. 2017;26(3):369–75. https://doi.org/10.1016/j.jse.2016.11.045.
Hulin BT, Gabbett TJ, Blanch P, Chapman P, Bailey D, Orchard JW. Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers. Br J Sports Med. 2014;48(8):708–12. https://doi.org/10.1136/bjsports-2013-092524.
• Murray NB, Gabbett TJ, Townshend AD, Blanch P. Calculating acute:chronic workload ratios using exponentially weighted moving averages provides a more sensitive indicator of injury likelihood than rolling averages. Br J Sports Med. 2017;51(9):749–54. https://doi.org/10.1136/bjsports-2016-097152. Data examining acute and chronic workload ratio in relation to injury risk. This study sets parameters for moderate, high and very high workload thresholds.
Gabbett T. Infographic: the training–injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2017;50:273–80.
Fleisig GS, Bolt B, Fortenbaugh D, Wilk KE, Andrews JR. Biomechanical comparison of baseball pitching and long-toss: implications for training and rehabilitation. J Orthop Sports Phys Ther. 2011;41(5):296–303. https://doi.org/10.2519/jospt.2011.3568.
Anz AW, Bushnell BD, Griffin LP, Noonan TJ, Torry MR, Hawkins RJ. Correlation of torque and elbow injury in professional baseball pitchers. Am J Sports Med. 2010;38(7):1368–74. https://doi.org/10.1177/0363546510363402.
Fortenbaugh D, Fleisig GS, Andrews JR. Baseball pitching biomechanics in relation to injury risk and performance. Sports Health. 2009;1(4):314–20. https://doi.org/10.1177/1941738109338546.
Fleisig GS, Diffendaffer AZ, Ivey B, Aune KT. Do baseball pitchers improve mechanics after biomechanical evaluations? Sport Biomech. 2017 1–8. https://doi.org/10.1080/14763141.2017.1340508.
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This article is part of the Topical Collection on Injuries in Overhead Athletes
Appendix
Appendix
Pre-plyometric and plyometric progression example |
• Isometrics mid-range progressing to end ranges as ROM increases |
• Resistance through full ROM, constant speed (slower to maximize recruitment) |
• Increase volume of resistance to develop a good work capacity |
○ Up to three sets, 12–15 repetitions |
○ Step wise incremental increase in resistance |
○ Reinforce end range fatigue tolerance with perturbations (proprioception) |
▪ Body blade static holds at end range (Max ER @ 0 abd) |
▪ Manual perturbations at end range |
• Begin slow eccentrics to maximize cross-bridge formation |
○ 90/90 tubing ER X 10 f/b 5 manually resisted eccentric with tubing |
• End with drop set resistance with increasing velocity (superset) |
○ One set of 10 D2 flexion (high resistance/Blue) f/b 1 × 10 low resistance/high velocity (yellow) |
○ Add eccentrics to first set |
• Perturbation exercises emphasizing the stretch-shortening cycle (SSC) |
○ 90/90 wall dribbles, wall clock taps |
• Transition into plyometric program |
○ Tubing dynamic hug press—MB wall dribbles—MB plyo chest pass |
○ Lat pull downs—OH MB wall dribbles—OH soccer pass (rebounder) |
○ ½ kneel chops (tubing/double arm)—D2 extension tubing—MB chops (rebounder) |
○ Tubing row into ER with eccentrics—½ kneel ER flips (concentric) |
○ Single-arm D2 flexion/eccentric extension—eccentric plyo ball catches |
○ Single-arm D2 extension (tubing)—½ kneel 90/90 plyo ball throw (rebounder) |
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Sgroi, T.A., Zajac, J.M. Return to Throwing after Shoulder or Elbow Injury. Curr Rev Musculoskelet Med 11, 12–18 (2018). https://doi.org/10.1007/s12178-018-9454-7
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DOI: https://doi.org/10.1007/s12178-018-9454-7