Tanner Thomas, PT,DPT
Community Rehab Physical Therapy
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Baseball Players
◦ Position Players vs. Pitchers
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Softball Players
◦ Position Players vs. Pitchers
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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
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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
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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
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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
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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-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
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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

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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Wind Up
◦ Good balance over stance leg
◦ Ends w/ knee flexed to maximum
height
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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
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Late Cocking
◦ Between foot contact and maximum
ext. rotation
◦ Scap retracts, supraspinatus for GH
compression
◦ Increased trunk rotation
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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
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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

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