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1 THROWING PAINS.IS IT MECHANICAL? PHYSICAL? OR BOTH? Disclosure Nothing to Disclose at this time Jeffrey Lahti, PT/Partner Viverant Adam Barta Owner- Blizzard Baseball Academy July 7 th 2017 Objectives Complete history of injury Objective Evaluation of Throwing Athlete (Upper and lower extremity) Mechanical Analysis-initiating corrective techniques Putting the pieces together to restore the throwing efficiency History Pain (gradual or sudden) Any other areas of dysfunction (Lower extremity? Back?) Position(s) How many teams and games a week Growth Spurt? AllinaHealthSystem 1

2 Interesting Statistics 26% of youth players and 58% of high school pitchers in one study experience elbow pain 29% of 9- to 19-year-old boys experience shoulder pain (according to one study) and between 32% and 35% in two other studies 38% of high school pitchers experience shoulder pain. Athletes who pitch with a tired arm are 6 times more likely to suffer from elbow pain and 4 more times more likely to have shoulder pain than those who pitch when their arms aren't tired. Roughly half of youth pitchers reports elbow or shoulder pain at least once during the season. The risk of shoulder pain is 2 and a half times greater for pitchers who throw more than 75 pitches per game. The risk of elbow pain is 3 1/2 times greater for pitchers throwing more than 600 pitches per season Objective Evaluation Visual exam (Atrophy/asymmetry) ROM (Total Arc of motion)(gird) Strength (Scapular, RTC, Forearm) Flexibility (Arm, Chest, Hips, Ankle) Thoracic mobility Palpation (Bone/Tendons) Special tests Throwing Mechanics Mechanics Courtesy of New York Times (July 2, 2010) Arm Pain and Correlated Throwing Phase of Pathology 1) RTC Pain (Late Cocking/Acceleration/Deceleration) Phase) 2) Scapular Pain/Dysfunction (Deceleration) 3) Internal Impingement (Late Cocking) 4) GH Capsular Lesion (Late Cocking/Early Acceleration) 5) Osseous Lesions(more common in older throwers Late Cocking) 6) Biceps Tendon Lesions (Late Cocking/Early Acceleration) 7) Flexor Bundle/Pronator Strain (Deceleration) 8) UCL Pathology (Acceleration) AllinaHealthSystem 2

3 Phase Breakdown New Terminology 1) Inverted W (Disconnection) 2) Flat Arm 3) Elevated Distal Humerus 4) Forearm Flyout 5) Premature Pronation 6) Crossing the Acromial line 7) Early Torso Release Contributors to Potential Injury Structural Damage Physical Movement Patterns Mechanics / Delivery Preparation Related Warm Ups Training Related Strength Workload / Limited Recovery Pitch Count Internal Systems Food / Nutrition Getting Mechanical Pivot Foot - direction Glute / Hip Load (you call it lift or balance point no!) Separation momentum Disconnect with foot and arm(s) 4a - Foot strike and posture 4a - Hip position (belly button facing forward) 4b - Release / late launch 4b - Glove side AllinaHealthSystem 3

4 Disconnection What is it? When a body segment is acting independently from the trunk and spine Adds additional stress Limits energy production Difficulty with command and secondary pitches Key word: EFFICIENT 5 Key Pitching Pointers-- #1 #1 Elevated Distal Humerus 1) step behinds 2) connection balls Big 5-- #2 Big Five-- #3 #2 Forearm fly out #3 Inefficient back leg, hip, and glute 1) connection ball 1) double crow ups / jump backs AllinaHealthSystem 4

5 Big Five-- #4 Big Five-- #5 #4 Weak glove side ( pitching train ) #5 Postural stabilization (level eyes) 1) wall drill 2) footballs 1) fix landing foot Pitch Count Guide ( As outlined by Dr. Andrews and USA Baseball) Pitch Recommendations AllinaHealthSystem 5

6 References Davis, J.T., et. al. The Effect of Pitching Biomechanics on the Upper Extremity in Youth and Adolescent Baseball Pitchers.Am. J. Sports Med. 2009;37(8): Ellenbecker TS, Mattalino AJ. Concentric Isokinetic Shoulder Internal and External Rotation Strength in Professional Baseball Pitchers. Journal of Orthopaedic & Sports Physical Therapy. 1997;25(3): Escamilla RF, Andrews JR. Shoulder muscle recruitment patterns and related biomechanics during upper extremity sports. Sports Medicine. 2009;39(7): (abstract) Fleisig, G., Kingsley, J., Loftice, J., Dinnen, K., Ranganathan, R., Dun, S., Escamiila, R., Andrews, J. (2006). Kinetic Comparison Among Fastball, Curveball, Change Up, and Slider in Collegiate Baseball Pitchers. The American Journal of Sports Medicine, 34 (3) Fleisig, G. S., & Andrews, J. R. (2012). Prevention of Elbow Injuries in Youth Baseball Pitchers. American Journal of Sports Medicine, 4(4), doi: / Fleisig G, Andrews J, Cutter G, Weber A, Loftice J, McMichael C, Hassel N, Lyman S. Risk of Serious Injury for Young Baseball Pitchers: A 10-Year Prospective Study.Am. J. Sports Med. 2010;20(10): 1-5. Fortenbaugh D, Fleiseg G, Andrews J. Baseball Pitching Biomechanics in Relation to Injury Risk and Performance.Sports Health: A Multidisciplinary Approach 2009;1: Kaplan KM, Jobe FW, Morrey BF, Kaufman KR, Hurd WJ. Comparison of Shoulder Range of Motion, Strength, and Playing Time in Uninjured High School Baseball Pitchers Who Reside in Warm- and Cold-Weather Climates.Am.J Sports Med. 2011; 39(2): Krajnik S, Fogarty KJ, Yard EE, Comstock RD. Shoulder Injuries in US High School Baseball and Softball Athletes, Pediatrics. 2010;125: Lyman S, Fleisig GS, Waterbor JW, et al. Longitudinal study of elbow and shoulder pain in youth baseball pitchers.med Sci Sports Exerc.2001;33(11): Lyman S, Fleisig GS, Andrews JR, Osinski ED. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers.am J. Sports Med2002;30(4): References Myers JB, Pasquale MR, Laudner KG, Sell TC, Bradley JP, Lephart SM. On-the-Field Resistance-Tubing Exercises for Throwers: An Electromyographic Analysis. Journal of Athletic Training. 2005;40(1): Olsen SJ 2nd, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers.am. J Sports Med. 2006;34(6): Sabick, M., Torry, M., Kim, Y., Hawkins, R. (2004) Humeral Torque in Professional Baseball Pitchers. The American Journal of Sports Medicine, 32 (4) Shanley, E., & Thigpen, C. (2013). THROWING INJURIES IN THE ADOLESCENT ATHLETE. International Journal of Sports Physical Therapy, 8(5), Retrieved February 14, 2017, from Shouchen, Dun et. al., A Biomechanical Comparison of Youth Baseball Pitches: Is the Curveball Potentially Harmful?Am.J. Sports Med. 2008;36(4): Teyhen, D. Baseball Pitching: Understanding the Mechanics of Throwing a Baseball May Help Protect the Shoulder and Elbow. Journal of Orthopaedic & Sports Physical Therapy. 2011;41(5):304. Urbin, M., Fleisig, G., Abebe, A., Andrews, J. (2013). Associations Between Timing in the Baseball Pitch and Shoulder Kinetics, Elbow Kinetics, and Ball Speed. The American Journal of Sports Medicine, 41 (2) Valovich McLeod TC, Decoster LC, Loud KJ, Micheli LJ, Parker JT, Sandrey MA, White C. National Athletic Trainers' Association Position Statement: Prevention of Pediatric Overuse Injuries. J Ath. Tr. 2011;46(2): W. Ben Kibler, A. D. Sciascia, T. L. Uhl, N. Tambay, and T. Cunningham, Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation, American Journal of Sports Medicine, vol. 36, no. 9, pp , 2008 Contact Info Jeffrey Lahti PT/Partner Viverant Physical Therapy jlahti@viverant.com ext Labore Road, Suite 102 Vadnais Heights, MN Adam Barta- Owner Blizzard Baseball Academy abarta@minnesotabaseballacademy.com AllinaHealthSystem 6