Rehab of the overhead throwing athlete Flashcards
1
Q
Common pathologies in shoulder
A
- instability
- Labral
- Impingement
- -subacromial; bieps; RC
2
Q
Common Pathologies Elbow
A
- UCL
- Flexor/pronator tendonitis
- Ulnar nerve
- Valgus extension overload
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
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
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
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
7
Q
what are the 5 phases of throwing
A
- wind-up
- cocking: Early and Late; stride length
- acceleration
- deceleration
- follow-through
8
Q
what phase leads to most amount of stress on: passive structures
A
cocking
9
Q
what phase leads to most amount of stress on: shoulders
A
deceleration
10
Q
what phase leads to most amount of stress on: elbow
A
- acceleration
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
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
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
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
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
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
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
- hip IR lead leg, needed for follow through
- – 5 deg loss = incr risk
- - stride leg IR at 90 deg - hip extension trail leg
- - leads to incr shoulder ER - hip flexion on lead leg (windup and follow)
- 10 deg diff incr risk for elbow - 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
trunk control/ core stability
| -testing endurance/strength Norms
- Prone plank
- Side plank
- Sorsensen's
- DL Bridge
- SL Bridge reps
- CKCUEST
- Rotation Med ball throw
26
4. gluteal strength/coordination exercises
- 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
GLuteal activity
- Glute max stance leg >100% during late cocking to acceleration
- GLut med: stride leg >100% from foot contact to ball release
28
Thoracic mobility deficits
- 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
thoracic mobility interventions
- Extension MWM
- Kneeling OP stretch
- HVLA thrusts
- Sidelying windmill/ openbook
- kneeling thoracic rotation stretch
30
shoulder mobility deficits
- Max PROM shoulder ER at 90 vs max trhowing ER
- controls 121 supine vs 159 throwing
- Pain: 114 supine vs 175 throwing
31
GIRD : Glenohumeral internal rotation deficit
-GIRD is a loss of 18 deg or greater of IR in the throwing shoulder compared to non-throwing shoulder
32
excessive humeral anterior glide
- 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
scapular stabilizing activity During Late cocking
- Serratus anterior the highest
- levator scapulae
- mid trap
- rhomboid
- lowe trap
- uppe rtrap
34
Rotator Cuff activity During Late cocking
- subscapularis highest
- teres minor
- infraspinatus
- supraspinatus
35
activity of scapular stabilizers and RC in deceleration
- Teres minor highest
| - lower trap highest
36
serratus anterior during cocking
- eccentrically and isometrically contract to resist retraction
- concentrically to cause protraction and upward rotation
37
middle and lower trapezius activity
- fire concentrically to resist protraction
- create stable surface for RC to work
- >20% difference in protractor/ retractor ratio incr risk of shoulder pain
38
fatigue and overthrowing
| risk factors
- pitches per game
- innings pitched per season
- months pitched per year
- lack of rest, pitching fatigued
39
key guidelines
- 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
Plyometric prerequisites
- full pain free AROM
- 80% strength VS OPP side
- good quality movement
- no swelling
41
Plyomertic parameters
- 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
long toss vs pitching
- shorter stride length
- less ER at foot contact
- Helps to learn deceleration with earlier ball release
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