Tanner Thomas, PT,DPT
Community Rehab Physical Therapy
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
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?
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???
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°
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.
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
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
Phase 1
◦ Sleeper stretch
◦ Horizontal
Adduction Stretch
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
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
Phase 2
◦ Working on
protraction/retraction
◦ Elbow in pronation
◦ Sets of 10-15 as
tolerated
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
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
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%!!!!
Phases of Throwing
◦ Sequence of body segment motions
◦ Not going to be “Picture Perfect” for every thrower!
Wind Up
◦ Good balance over stance leg
◦ Ends w/ knee flexed to maximum
height
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
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
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
Stance Phase of
windup
Solid Base w/ heels on
mound
Relaxed elbows and
shoulders
Feet shoulder width apart
Small Step Back
Minimal 4-6” step
back
Maintain weight on
ball of foot
Balance Position
Controlled raising of
the lift leg
Need to control this
position
Should be able to hold
this position as long
as asked
Power position
Ball facing away from
pitcher
T-pattern
Drive off of mound
w/ back leg
Throw to plate
Stride foot
toward plate
Elbow equal to
shoulder level
Chest not too
“open”
Follow through
Flexed knees
Facing batter
Squared Feet
What’s to come??
◦ Softball mechanics
◦ Performance drills
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