Preventative Care for the Throwing Athlete

Scott Sheridan, MS PT ATC CSCSHead Athletic TrainerThe Phillies

Youth Injuries - Data

3.5 million kids under age of 14 receive medical treatment for sports injuries each year

62% of injuries occur in practice, but same precautions are not put in place in practice as they are in games.

By age 13, 70% of kids drop out of youth sports, The top three reasons: adults, coaches, parents

Youth Injuries - Data Among athletes 5 to 14 years of age, 25% of

baseball players were injured while playing there sport

Since 2000 there has been a fivefold increase in the number of serious shoulder and elbow injuries in youth baseball and softball False: Players do not come back stronger and

throwing harder after Tommy John Surgery!!

More than 50% of all sports injuries in children are preventable

Definition of Prevention

Primary – avoids the development of disease

Secondary – early disease detection

Tertiary – reduces impact on already existing condition

Want to detect problems as early as possible

Things We Can Not Prevent

Genetics

Quality of Tissue?

What is Happening Biomechanically with Throwing a Ball

Not a “Normal” Act Calculated stress with throwing exceeds the load to failure of the native ligament.

Flexor Muscle – Intimately attached to UCL, assist w/ stability

Extensors - Increase ESM activation and Decrease FPM activation in injured pitchers during acceleration**

Muscular Fatigue - Biomechanics EMG Activity with Pitching (% of Max Muscle Test)

Early Cocking – Upper Trap (64%), Supraspinatus(60%)

Late Cocking – Serratus Anterior (106%), Subscapulairs (99%), Levator (72%), Infraspinatus (74%), Extensor Carpi Radialis (72%), Extensor Carpi Radialis Brevis (75%)

Acceleration – Lower Trap (76%), Levator (77%),Subscapularis (115%), Latissimus (88%), Tricep (89%), Pronator Teres (85%), Flexor Carpi Radialis (120%), Flex Dig Superficialis (80%), Flexor Carpi Ulnaris (112%)

Deceleration – Lower Trap (78%), Teres Minor (84%), Flexor Carpi Radialis (79%), Flexor Carpi Ulnaris (77%)

Follow Through – All less than 42%

DiGiovine et al.- J Sh and Elbow 1992

“Not the Reaction You Want!”

How Do We Prevent Injuries?

Screenings / Pre Participation Examinations Importance of the Active Warm Up Gradual / Appropriate Progression of Activity /

Conditioning Understand What to Do When an Injury

Occurs!

Screening The purpose of the screening is to create a list of

dysfunctions.

Ultimately the goal is to provide the throwing athlete the best possible anatomical and physiological base to achieve throwing efficiency.

Types of Examinations

Medical History / Questionnaire

Information Gathering

Communication

Types of Examinations

Functional Movement Screen Performed by Athletic Trainer / Physical Therapist Objective is to identify limitations / asymmetry

Restrictions / Imbalances will distort motor learning, movement perception, body awareness, and mechanics

Deep Squat

Hurdle Step

In Line Lunge

Shoulder Mobility

Active Straight Leg Raise

Trunk Stability Pushup

Rotary Stability

Types of Examinations

Orthopedic Shoulder

Range of Motion Strength Special Testing

Posture Scapular Assessment Spinal Assessment Lower Extremity

Hip Range of Motion Changes

Shoulder Examination

Range of Motion

Decreased Internal Rotation (GIRD), increase posterior capsule thickness with throwing

Change in Total ROM (IR + ER)

Humeral Retroversion (maintain what given at birth on dominant / throwing side)

Posture Assessment Areas to Evaluate

Forward Head Forward Shoulder Coracoid Antecubital Fossa TS – Kyphosis, Flat,

Scoliosis LS – Flat, Lordotic Shoulder Position Inferior Ang. Mid-Thorax

Scapular Assessment Shoulder pain is the result of movement

impairment of the scapula, that disrupts relationship of glenoid and the humerus

Scapular Assessment

Spinal Assessment

Spinal Assessment

Lower Extremity

Why Evaluate All These Areas?

Kinetic Chain Progression

Core is active with any movement

Velocity most directly correlated with Lower extremity strength

Exercise in manner that they will be used (functional)

FORCE GENERATION

LEGS

TRUNK / BACK

SHOULDER

ELBOW

WRIST

The Injury “Cause List” Range of Motion Changes

Reinold et al – AJSM 2008; decrease in sh. IR, total motion, and elbow extension immediately after, lasting 24 hours

Scapular Dyskinesis (Kibler) Muscular Fatigue(shoulder, scap, forearm)* Core Stability Spinal Mobility (wind up vs. follow through) Limitations in the Lower Body (opening up?)

Importance of Active Warm Up

Should always be the first thing that is done before practice or game.

Not just a static stretching program.

Developed to address consistent concerns found during screening process.

Should be sweating after completing.

Gradual and Appropriate Progression of Activity / Conditioning

Equipment Weekly Inspections

Hitting Progressions Indoor, Tee, # of Swings

Throwing Programs Long Toss – Distance?

Types of Exercises

What to do if an injury occurs?

Symptoms are present for a reason. Do not let a minor problem progress into a

major problem. Remember types of prevention!

Compensations will occur Seek appropriate medical advice

Orthopedist, Physical Therapist, Athletic Trainer @ School

Red Flag Symptoms Elbow

Medial Elbow Pain Ulnar Nerve Symptoms

Shoulder Deltoid Soreness Posterior Shoulder Pain

Performance Concerns Control and Velocity

Duration of Symptoms Sore During – Sore After – Sore Next Day

“Don’t Bring Me a Problem, Bring Me a Solution!”

① Pre Participation Exam / Screening② Warm Up Appropriately③ Do Not Pitch Through Symptoms④ Do Not Play Year-Round⑤ Communicate to players regarding how they

are feeling⑥ Emphasize, control, accuracy, and age

appropriate skills⑦ Speak to a medical professional if you have

concerns about an injury or to develop a prevention strategy.

Special Thank You - Acknowledgement

Kinetic Rehab Phil Donley, MS PT ATC

Jeff Cooper, MS ATC Gray Cook, PT Gary Gray, PT

Craig Morgan, MD Shirley Sahrmann

Ron Hruska

Questions / Solutions