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Diagnosis,Treatment and Mechanics of the Overhead Athlete

Diagnosis,Treatment and Mechanics of the Overhead Athlete. Tanner Thomas, PT,DPT Community Rehab Physical Therapy. Who Are We Treating????. Baseball Players Position Players vs. Pitchers Softball Players Position Players vs. Pitchers Things to consider

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Diagnosis,Treatment and Mechanics of the Overhead Athlete

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  1. Diagnosis,Treatment and Mechanics of the Overhead Athlete Tanner Thomas, PT,DPT Community Rehab Physical Therapy

  2. Who Are We Treating???? • 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

  3. Initial Evaluation-Subjective • 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?

  4. Initial Evaluation-Objective • 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???

  5. Initial Evaluation-Objective • 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°

  6. Initial Evaluation-Objective(cont.) • 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.

  7. Treatment of the Overhead Athlete • 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

  8. Treatment Phases • Phase 1-Acute Phase • Diminish pain and inflammation • Modalities as appropriate-ice,ionto,etc. • Modification of activities • Limiting throwing and certain exercises • Stretching exercises-limitation of IR • GIRD-Glenohumeral Internal Rotation Deficit • Due to posterior muscle tightness • Diagnosed by more than 20-25° loss of IR when compared to other side • Sleeper stretch w/ lock down of scapula • Manual sleeper stretch • Limitation in horizontal adduction • Supine Horz. Add w/ IR and manual stabilization

  9. Stretching Exercises • Phase 1 • Sleeper stretch • Horizontal Adduction Stretch

  10. Treatment Phases-Cont. • 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

  11. Treatment Phases-Cont. • 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

  12. Scapular Control Drills • Phase 2 • Working on protraction/retraction • Elbow in pronation • Sets of 10-15 as tolerated

  13. Treatment Phases-Cont. • 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

  14. Treatment Phases-Cont. • 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

  15. Treatment Phases-Cont. • 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%!!!!

  16. Throwing Assessment • Phases of Throwing • Sequence of body segment motions • Not going to be “Picture Perfect” for every thrower!

  17. Throwing Assessment-Cont. • 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

  18. Throwing Assessment-Cont. • 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

  19. Throwing Assessment-Cont. • 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

  20. Pitching Mechanics • Stance Phase of windup • Solid Base w/ heels on mound • Relaxed elbows and shoulders • Feet shoulder width apart

  21. Pitching Mechanics-Cont. • Small Step Back • Minimal 4-6” step back • Maintain weight on ball of foot

  22. Pitching Mechanics-Cont. • Balance Position • Controlled raising of the lift leg • Need to control this position • Should be able to hold this position as long as asked

  23. Pitching Mechanics-Cont. • Power position • Ball facing away from pitcher • T-pattern • Drive off of mound w/ back leg

  24. Pitching Mechanics-Cont. • Throw to plate • Stride foot toward plate • Elbow equal to shoulder level • Chest not too “open”

  25. Pitching Mechanics-Cont. • Follow through • Flexed knees • Facing batter • Squared Feet

  26. Thank you! • What’s to come?? • Softball mechanics • Performance drills

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