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Special Topics > Rehab of the overhead throwing athlete > Flashcards

Rehab of the overhead throwing athlete Flashcards

1
Q

Common pathologies in shoulder

A
  • instability
  • Labral
  • Impingement
  • -subacromial; bieps; RC
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2
Q

Common Pathologies Elbow

A
  • UCL
  • Flexor/pronator tendonitis
  • Ulnar nerve
  • Valgus extension overload
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3
Q

Little league Shoulder

A
  • stress reaction or widening of proximal humerus epiphysis
  • MC in 11-13 year olds, high performers
  • no change with rest
  • Decreased ER and abd strength
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4
Q

RX for little league shoulder

A
  • minimum 6 weeks no throwing
  • gentle post shoulder stretching, and core strnegth
  • after pain free ROM, begin RC strengthening, scapular strength and control
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5
Q

Little league elbow

A
  • Repetitive stressors to elbow
    • Medial epi apophysitis or avulsion fx
  • -UCL injury; OCD of capitellum
  • Posterior valgus extension overload
  • 8-14 year olds
  • Pain with palpation to medial epicondyle, painful resisted wrist flexion and pronation ; painful with full ext of elbow
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6
Q

RX of little league elbow

A
  • rest 6-8 weeks; RC and scapular strengthening, dynamic shoulder stabilization,
  • return to throwing program at 6 weeks if pain -free ROM and MMT testing
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7
Q

what are the 5 phases of throwing

A
  • wind-up
  • cocking: Early and Late; stride length
  • acceleration
  • deceleration
  • follow-through
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8
Q

what phase leads to most amount of stress on: passive structures

A

cocking

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9
Q

what phase leads to most amount of stress on: shoulders

A

deceleration

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10
Q

what phase leads to most amount of stress on: elbow

A
  • acceleration
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11
Q

Wind up

A
  • initiation of pitching motion
  • minimal UE forces
  • winding up LE to generate forces
  • need: SLS on trail leg; Hip flexion on lead leg
  • ends when hands separate
  • places the body in a position where all body segments can contribute to the kinetic chain of throwing
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12
Q

Early cocking

A
  • high shoulder muscle activity in deltoid
  • stride length
  • lead leg hip ER ROM and strength
  • stance leg hip IR ROM and strength
  • ends when foot contacts ground
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13
Q

Late cocking

A
  • Extreme shoulder ER ROM
  • elbow valgus stress greatest
  • Peak RC activation
  • stance leg- Max hip ER strength
  • lead leg- max hip IR strength
  • hip ER mobility of stance leg
  • ends at max shoulder ER
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14
Q

Stride length in cocking phase

A
  • foot contact measurements
  • stride length 87% height
  • lead foot position/angle
  • lumbopelvic rotation ROM / timing
  • Upper trunk angle
  • Shoulder ER
  • legs and trunk= main force generators during the act of pitching
  • –reduces teh need for excessive contributions by the shoulder
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15
Q

shoulder stresses
shoulder ER:
- at foot contact
- if ER late

A
  • at foot contact: 65 deg = 380 N

- if ER late: 0 deg at FC = 670N

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16
Q

acceleration phhase

A
  • when arm starts moving forward to ball release
  • high concentric shoulder muscle activity
  • -serratus anterior, subscap
  • 0-95 mph in 50 millisec
  • IR from 170 deg ER to ball release at 90 deg ER
  • max shoudler IR angular velocity: fastest joint motion in sport 6260-8540 deg/sec
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17
Q

deceleration phase

A
  • from ball release to max shoulder IR
  • high eccentric muscle shoulder activity: teres minor , infraspinatus
  • recognized as most harmful phase (hawkins-kennedy)
18
Q

follow through phase

A
  • body slows down motion of arm, body comes to rest
  • should be under ocntrol: controlled fall
  • lead leg- Max hip IR mobility
19
Q

common movement faults in throwing

9 faults

A
  • Hip mobility deficits
  • decr balance control/ stability
  • decr core strength/endurance
  • gluteal strength/coordination deficits
  • thoracic mobility deficits
  • shoulder mobility deficits
  • exxcessive humeral anterior glide
  • scapular strength/ coordination deficits
  • fatigue/overthrowing/ poor pitching mechanics
20
Q

hip mobility deficits

A
  1. hip IR lead leg, needed for follow through
    - – 5 deg loss = incr risk
    - - stride leg IR at 90 deg
  2. hip extension trail leg
    - - leads to incr shoulder ER
  3. hip flexion on lead leg (windup and follow)
    - 10 deg diff incr risk for elbow
  4. decr HIP ER ( cocking phase into acceleration)
    - -> incr shoulder horizontal adduction ROM
    - “throwing across body”
    - increaed shoulder ER torque
21
Q

Decreased balance/stability

A
  • single limb stance
  • 10 sec in those with shoulder pain vs 17 sec control
  • <7 deg saggital pelvic motion
  • Y balance test SEBT
22
Q

functional screen for balance and stability

A
  • SLS in windup
  • SEBT
  • Single limb cross over reach (10 of 12reps)
  • Rotate leg in 75 deg arc (3x)
23
Q

trunk control/ COre stability

A
  • Lead leg- internal obl
  • stance leg external obl
  • most active during late cocking thru acceleration
  • Peak Pelvic rotation occurs prior to peak upper torso rotation velocity: momentum transferred up the chain
24
Q

Early trunk rotation

A
  • early trunk rotation was associated with significantly elevated risk of injury requiring surgery
  • throwing velocity strongly correlated with peak trunk rotational velocity
  • – throwing medicine ball
  • – faster the rotation: faster the pitch
  • – farther the toss: faster the pitch
25
Q

trunk control/ core stability

-testing endurance/strength Norms

A
  • Prone plank
  • Side plank
  • Sorsensen’s
  • DL Bridge
  • SL Bridge reps
  • CKCUEST
  • Rotation Med ball throw
26
Q
  1. gluteal strength/coordination exercises
A
  • side plank hip abduction
  • side plank with resistance bands
  • swiss ball plank rotation
  • single leg medicine ball throw
  • Plyometric lunge ground hop
  • Lateral ground hop
  • Medicine ball lateral swing hop
27
Q

GLuteal activity

A
  • Glute max stance leg >100% during late cocking to acceleration
  • GLut med: stride leg >100% from foot contact to ball release
28
Q

Thoracic mobility deficits

A
  • need thoracic extension: greater the extension, greater the scapular post tilt and improved GH ER at late cocking
  • pitchers need more trunk rotation to the non-throwing arm side
    • more rotation, means more time to wind up and more time to decelerate in follow through
29
Q

thoracic mobility interventions

A
  • Extension MWM
  • Kneeling OP stretch
  • HVLA thrusts
  • Sidelying windmill/ openbook
  • kneeling thoracic rotation stretch
30
Q

shoulder mobility deficits

A
  • Max PROM shoulder ER at 90 vs max trhowing ER
  • controls 121 supine vs 159 throwing
  • Pain: 114 supine vs 175 throwing
31
Q

GIRD : Glenohumeral internal rotation deficit

A

-GIRD is a loss of 18 deg or greater of IR in the throwing shoulder compared to non-throwing shoulder

32
Q

excessive humeral anterior glide

A
  • combination of posterior shoulder tightness and anterior capsule laxity
  • resulting in imprecise humeral rotation and excessive anterior glide
  • encourage centration of teh joint during retraining
33
Q

scapular stabilizing activity During Late cocking

A
  • Serratus anterior the highest
  • levator scapulae
  • mid trap
  • rhomboid
  • lowe trap
  • uppe rtrap
34
Q

Rotator Cuff activity During Late cocking

A
  • subscapularis highest
  • teres minor
  • infraspinatus
  • supraspinatus
35
Q

activity of scapular stabilizers and RC in deceleration

A
  • Teres minor highest

- lower trap highest

36
Q

serratus anterior during cocking

A
  • eccentrically and isometrically contract to resist retraction
  • concentrically to cause protraction and upward rotation
37
Q

middle and lower trapezius activity

A
  • fire concentrically to resist protraction
  • create stable surface for RC to work
  • > 20% difference in protractor/ retractor ratio incr risk of shoulder pain
38
Q

fatigue and overthrowing

risk factors

A
  • pitches per game
  • innings pitched per season
  • months pitched per year
  • lack of rest, pitching fatigued
39
Q

key guidelines

A
  • dont’ pitch with elbow or shoulder pain
  • don’t pitch on consecutive days
  • don’t play year-round
  • REST is BEST
  • develop skills that are age appropriate
  • emphasize control, acuracy, and good mechanics
  • master the fastball first and the change- up second, before considering breaking pitches
40
Q

Plyometric prerequisites

A
  • full pain free AROM
  • 80% strength VS OPP side
  • good quality movement
  • no swelling
41
Q

Plyomertic parameters

A
  • Freq: 2x week ; 6-8 weeks
  • recovery time 48-72 hours
  • volume: 5-10 reps/set 1-3 sets per motion; 6 different motions
  • 60 throws low ; 120 high
  • intensity 80-100% MVC
  • 2 arms to one arm
  • 5-10% progression each week
42
Q

long toss vs pitching

A
  • shorter stride length
  • less ER at foot contact
  • ## Helps to learn deceleration with earlier ball release

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