Scott Sheridan - Kinetic PT Pitching Survival Guide 2011

Preventative Care for the
Throwing Athlete
Scott Sheridan, MS PT ATC CSCS
Head Athletic Trainer
The 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
 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
Definition of Prevention
 Primary – avoids the development of disease
 Secondary – early disease detection
 Tertiary – reduces impact on already existing
Want to detect problems as early as possible
Things We Can Not Prevent
 Genetics
 Quality of Tissue?
What is Happening
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/
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 /
 Understand What to Do When an Injury Occurs!
 The purpose of the screening is to create a list of
 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 /
 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
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
 Velocity most directly
correlated with Lower
extremity strength
 Exercise in manner that
they will be used
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
 Should always be the first
thing that is done before
practice or game.
 Not just a static stretching
 Developed to address
consistent concerns
found during screening
 Should be sweating after
Gradual and Appropriate
Progression of Activity /
 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
 Remember types of prevention!
 Compensations will occur
 Seek appropriate medical advice
 Orthopedist, Physical Therapist, Athletic Trainer @
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!”
Pre Participation Exam / Screening
Warm Up Appropriately
Do Not Pitch Through Symptoms
Do Not Play Year-Round
Communicate to players regarding how they
are feeling
⑥ Emphasize, control, accuracy, and age
appropriate skills
⑦ 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

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