Diagnosis,Treatment and Mechanics of the Overhead Athlete
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Transcript of Diagnosis,Treatment and Mechanics of the Overhead Athlete
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Tanner Thomas, PT,DPTCommunity Rehab Physical Therapy
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Baseball Players◦ Position Players vs. Pitchers
Softball Players◦ Position Players vs. Pitchers
Things to consider◦ Pitching is a combination of ROM, balance and
strength throughout several joints◦ ROM/Strength imbalances will increase risk of
injury◦ Poor mechanics increase risk of injury
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General History Symptoms
◦ Onset of symptoms-trauma or repetitive◦ Pain
When and where???-shoulder,elbow What phase of throwing is painful Multiple joints
◦ How long w/ symptoms What position does player play?
◦ Position vs. Pitcher or both!!◦ Intensity and Duration of throwing
How many games per week?? How much throwing on the side?
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Shoulder/Scapular AROM/PROM◦ Rotational mobility
ER/IR at 90° abduction Norms: ER=137°± 15° IR=40°± 10° Total rotational motion: ER/IR=TRM
177°±16° Wilk et al.2008
Horizontal Adduction◦ Is the scapula moving???
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Elbow ROM Trunk ROM-Thoracic/Lumbar
◦ Rotational movement 45° bilaterally should be minimum
◦ Flexion/Extension Important for follow-through
Hip ROM◦ Rotational Mobility:
IR= 30°± 5° ER=45°± 7°
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Strength◦ Shoulder/Scapular Strength-All planes
Pain or crepitation w/ resisted motion? Assessment at neutral and 90/90 position ER/IR!
IR: 35-40% stronger than ER◦ Elbow/Wrist strength◦ Core strength/Stability
VERY important in mechanics◦ Hip/Knee Strength
Base is EVERYTHING Rotational Hip Strength
Special Tests◦ Hawkins-Kennedy, O’Brien’s, Speed’s, etc.
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Treatment of impairments◦ ROM and Strength deficits in the trunk, hip and
shoulder/scapula
Mechanics-Soon to come!!◦ Minimizing the amount of mechanical changes in
the patients throwing motion is a must◦ “Tweeking” faulty mechanics to decrease overall
risk of injury is acceptable
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Phase 1◦ Sleeper stretch
◦ Horizontal Adduction Stretch
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Phase 1 cont.◦ Posture
Common in overhead athlete to demonstrate poor posture
Tightness in pec minor is common as well as forward head
◦ Strength Deficits Restoring strength to ER’s and scapular stabilizers Core and LE strengthening and proprioception
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Phase 2-Intermediate Phase◦ Continued Strengthening of ER’s and Scapular
stabilizers Begin utilization of the “Thrower’s Ten” exercise
program Full can vs. empty can for supraspinatus
Scapular NMR control drills◦ Maintain soft tissue flexibility◦ Continuation of core and LE strengthening
Participate in running program
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Phase 2◦ Working on
protraction/retraction◦ Elbow in pronation◦ Sets of 10-15 as
tolerated
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Phase 3: Advanced Strengthening Phase◦ Continuation of Throwers Ten w/ manual end
range resistance◦ Dynamic Stabilization Drills
2 lb plyoball throws into trampoline from end range ER
Scapular Horz. Abd. on a physioball Seated ER on physioball w/ single leg support
Increased w/ rhythmic stabilization◦ Shoulder endurance activities
“Wall Dribbling w/ weighted ball UE biking Wall arm circles
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Phase 3-cont.◦ Initiating “mirror” throwing
Working on proper mechanics w/o the use of a ball Only started after pain free ROM and WFL strength
◦ Interval throwing Starting at 45ft, progressing to 60 ft Must be able to throw w/ no pain to 120 ft before
beginning a off the mound program
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Phase 4-Return to Throwing Phase◦ Continuation of strengthening/flexibility exercises
for UE/LE and core◦ Continuation of Phase 1 Interval Throwing
Program◦ Begin initiation of Phase 2 (Off the Mound)
Careful monitoring of thrower’s mechanics and intensity 50% isn’t always 50%!!!!
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Phases of Throwing
◦ Sequence of body segment motions◦ Not going to be “Picture Perfect” for every
thrower!
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Early Cocking/Stride◦ Begins w/ stride towards to the
plate and arms breaking◦ Supraspinatus, Infraspinatus, teres
minor active to initiate ER◦ Ends when front foot hits the
ground
Wind Up◦ Good balance over stance leg◦ Ends w/ knee flexed to maximum
height
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Late Cocking◦ Between foot contact and
maximum ext. rotation◦ Scap retracts, supraspinatus for GH
compression◦ Increased trunk rotation
Acceleration◦ Max ER til release of ball◦ Max elbow extension velocity
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Deceleration◦ Considered the most violent phase
of pitching◦ High eccentric biceps activity to
slow elbow◦ Eccentric loading of posterior cuff
to resist distraction forces
Follow Through◦ Arm motion ends◦ Pitcher is in proper
fielding position
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Stance Phase of windup
Solid Base w/ heels on mound
Relaxed elbows and shoulders
Feet shoulder width apart
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Small Step Back
Minimal 4-6” step back
Maintain weight on ball of foot
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Balance Position
Controlled raising of the lift leg
Need to control this position
Should be able to hold this position as long as asked
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Power position Ball facing away
from pitcher T-pattern Drive off of mound
w/ back leg
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Throw to plate Stride foot
toward plate Elbow equal to
shoulder level Chest not too
“open”
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Follow through Flexed knees Facing batter Squared Feet
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What’s to come??◦ Softball mechanics◦ Performance drills