Care and Maintenance of Baseball Players Arms

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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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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

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Baseball Throw

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

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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

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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

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Scapula (Shoulder Blade) is Foundation for
Shoulder Health

• Injured shoulder presents similar to poor
  posture
• Shoulder Blade is tilted, protracted and rotated
  upward (cant throw correctly) Upper
  Traps-culprit
• Analogy Mansion on a bad foundation

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2nd Consideration Range of Motion

• Isolated glenohumeral elevation (IGHE) between
  105-115 degrees (how the shoulder blade moves on
  the arm)
• Clinically 120-140 degrees External Rotation (ER)

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Range of Motion Continued

• Clinically 60-70 degrees of Internal Rotation
  (IR)
• Theory If you dont have this, brain knows it
  needs to get to the target and the next best
  place is Tommy John region (overpronation)

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Conventional Wisdom

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

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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 doesnt need stretched
  leads to instability (cuff/labral tears)

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How To Achieve-Breathing

• 90/90 hip lift with balloon (carries over to
  throwinge.g. inhale (diaphragm) when cocking and
  exhale (obliques) when accelerating)
• Manual release of subclavius muscle

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

• Deceleration
• Acceleration

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Deceleration

• Most violent phase
• Distraction force at the shoulder is 11 with
  body weight
• Labral injuries secondary to eccentric load of
  biceps
• Loose bodies of the elbow

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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

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Core Strength for Arms of a ThrowerDecelerators/
Stabilizers

• Train eccentrically/negatively (as the muscle
  lengthens)
• Rotator Cuff supraspinatus (2 and 10 oclock
  position)
• Infraspinatus/Teres Minor

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Scapular Stabilizers (Cools et al 2007)

• Horizontal Abduction- Ts (target middle traps)
• Prone Extension-Arrows (target rhomboids)

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Decelerators/Stabilizers Continued

• Seated row (target middle traps)
• Prone scapular plane elevation- Ys (need to be
  careful with this one) target lower traps

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Often Overlooked Stabilizer

• Lateral head of the triceps (has attachment to
  the shoulder blade)

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Protection for UCL/Tommy John

• Biceps curls-slows elbow in deceleration
• Forearm pronation/supination
• Wrist curls

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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

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Accelerators Training the Frontside

• Anterior Deltoid
• Pectoralis Major
• Latissimus Dorsi
• Teres Major
• Long head of the Triceps
• Anconeus
• Wrist flexors

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Accelerators

• Lat pull downs
• Triceps extension

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Accelerators Continued

• Anterior deltoid-Front Raises (careful not to add
  too much weight-overloads the cuff and the
  biceps)
• Modified (Neutral/Towel) Bench Press

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Upper Extremity Plyometrics

• Baseball throwers rely on stretch shortening
  cycle for arm speed and power.
• Enhance neuromuscular coordination and muscle
  recruitment.

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Plyos For Rotator Cuff

• One handed throws can reach velocity levels of up
  to 1,200 to 1,500 deg/s

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Plyometrics For Larger Muscles

• Good exercise for trunk accelerators (abdominal,
  hips) Can perform either kneeling or standing

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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)

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Isokinetics Continued

• Biceps/Triceps

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Dynamic Stabilizing Gizmos

• Body Blade for rotator cuff stability
• BOING elbow stabilizer

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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

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No-Nos/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

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No-Nos (Stretches Anterior Capsule)

• Lat Pulls (behind the neck) Can injure the
  neck but also stretches anterior capsule
• Dips Stretches anterior capsule

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Last but not least

• Regular bench press puts too much pressure on
  the anterior capsule
• Shoulder Shrugs Target-Upper Traps

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

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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
• ?Shoulder anterior force
• Leading with the elbow

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Drills for Throwers

• Using mirror for visual feedback

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Wall drill

• Protects thrower from getting too much horizontal
  abduction in cocking phase

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Frontside Drill

• Teaches direction

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Power Position

• Teaches loading the backside. 65 of body weight
  should be on stance leg at the end of stride

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Position at Foot Contact (FC)
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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

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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 throwers
  sometime have flawed ability to estimate effort
  (Fleisig et al 1996)

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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.

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Do not forget!!

• Abdominals
• LE exercises
• Back extensor strength
• Agility Drills
• Run, run, run

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Pain Management

• Medications per MD
• Iontophoresis
• InterX
• Ice/heat
• Joint mobilizations
• No pain, no gainno good!!!
• Cant chase pain

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Team Effort

• Between MDs, PT, ATC, patient, coach, and family

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Thank you