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 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 RadialisBrevis (75%) • Acceleration – Lower Trap (76%), Levator (77%),Subscapularis (115%), Latissimus (88%), Tricep (89%), PronatorTeres (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
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
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 • AntecubitalFossa • 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
FORCE GENERATION LEGS TRUNK / BACK SHOULDER ELBOW WRIST 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)
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!” • 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 • Emphasize, control, accuracy, and age appropriate skills • 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