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Preventative Care for the Throwing Athlete . Scott Sheridan, MS PT ATC CSCS Head Athletic Trainer The Phillies. Youth Injuries - Data. 3.5 million kids under age of 14 receive medical treatment for sports injuries each year - PowerPoint PPT Presentation
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Preventative Care for the Throwing Athlete
Scott Sheridan, MS PT ATC CSCSHead Athletic TrainerThe Phillies
Youth Injuries - Data
3.5 million kids under age of 14 receive medical treatment for sports injuries each year
62% of injuries occur in practice, but same precautions are not put in place in practice as they are in games.
By age 13, 70% of kids drop out of youth sports, The top three reasons: adults, coaches, parents
Youth Injuries - Data Among athletes 5 to 14 years of age, 25% of
baseball players were injured while playing there sport
Since 2000 there has been a fivefold increase in the number of serious shoulder and elbow injuries in youth baseball and softball False: Players do not come back stronger and
throwing harder after Tommy John Surgery!!
More than 50% of all sports injuries in children are preventable
Definition of Prevention
Primary – avoids the development of disease
Secondary – early disease detection
Tertiary – reduces impact on already existing condition
Want to detect problems as early as possible
Things We Can Not Prevent
Genetics
Quality of Tissue?
What is Happening Biomechanically with Throwing a Ball
Not a “Normal” Act Calculated stress with throwing exceeds the load to failure of the native ligament.
Flexor Muscle – Intimately attached to UCL, assist w/ stability
Extensors - Increase ESM activation and Decrease FPM activation in injured pitchers during acceleration**
Muscular Fatigue - Biomechanics EMG Activity with Pitching (% of Max Muscle Test)
Early Cocking – Upper Trap (64%), Supraspinatus(60%)
Late Cocking – Serratus Anterior (106%), Subscapulairs (99%), Levator (72%), Infraspinatus (74%), Extensor Carpi Radialis (72%), Extensor Carpi Radialis Brevis (75%)
Acceleration – Lower Trap (76%), Levator (77%),Subscapularis (115%), Latissimus (88%), Tricep (89%), Pronator Teres (85%), Flexor Carpi Radialis (120%), Flex Dig Superficialis (80%), Flexor Carpi Ulnaris (112%)
Deceleration – Lower Trap (78%), Teres Minor (84%), Flexor Carpi Radialis (79%), Flexor Carpi Ulnaris (77%)
Follow Through – All less than 42%
DiGiovine et al.- J Sh and Elbow 1992
“Not the Reaction You Want!”
How Do We Prevent Injuries?
Screenings / Pre Participation Examinations Importance of the Active Warm Up Gradual / Appropriate Progression of Activity /
Conditioning Understand What to Do When an Injury
Occurs!
Screening The purpose of the screening is to create a list of
dysfunctions.
Ultimately the goal is to provide the throwing athlete the best possible anatomical and physiological base to achieve throwing efficiency.
Types of Examinations
Medical History / Questionnaire
Information Gathering
Communication
Types of Examinations
Functional Movement Screen Performed by Athletic Trainer / Physical Therapist Objective is to identify limitations / asymmetry
Restrictions / Imbalances will distort motor learning, movement perception, body awareness, and mechanics
Deep Squat
Hurdle Step
In Line Lunge
Shoulder Mobility
Active Straight Leg Raise
Trunk Stability Pushup
Rotary Stability
Types of Examinations
Orthopedic Shoulder
Range of Motion Strength Special Testing
Posture Scapular Assessment Spinal Assessment Lower Extremity
Hip Range of Motion Changes
Shoulder Examination
Range of Motion
Decreased Internal Rotation (GIRD), increase posterior capsule thickness with throwing
Change in Total ROM (IR + ER)
Humeral Retroversion (maintain what given at birth on dominant / throwing side)
Posture Assessment Areas to Evaluate
Forward Head Forward Shoulder Coracoid Antecubital Fossa TS – Kyphosis, Flat,
Scoliosis LS – Flat, Lordotic Shoulder Position Inferior Ang. Mid-Thorax
Scapular Assessment Shoulder pain is the result of movement
impairment of the scapula, that disrupts relationship of glenoid and the humerus
Scapular Assessment
Spinal Assessment
Spinal Assessment
Lower Extremity
Why Evaluate All These Areas?
Kinetic Chain Progression
Core is active with any movement
Velocity most directly correlated with Lower extremity strength
Exercise in manner that they will be used (functional)
FORCE GENERATION
LEGS
TRUNK / BACK
SHOULDER
ELBOW
WRIST
The Injury “Cause List” Range of Motion Changes
Reinold et al – AJSM 2008; decrease in sh. IR, total motion, and elbow extension immediately after, lasting 24 hours
Scapular Dyskinesis (Kibler) Muscular Fatigue(shoulder, scap, forearm)* Core Stability Spinal Mobility (wind up vs. follow through) Limitations in the Lower Body (opening up?)
Importance of Active Warm Up
Should always be the first thing that is done before practice or game.
Not just a static stretching program.
Developed to address consistent concerns found during screening process.
Should be sweating after completing.
Gradual and Appropriate Progression of Activity / Conditioning
Equipment Weekly Inspections
Hitting Progressions Indoor, Tee, # of Swings
Throwing Programs Long Toss – Distance?
Types of Exercises
What to do if an injury occurs?
Symptoms are present for a reason. Do not let a minor problem progress into a
major problem. Remember types of prevention!
Compensations will occur Seek appropriate medical advice
Orthopedist, Physical Therapist, Athletic Trainer @ School
Red Flag Symptoms Elbow
Medial Elbow Pain Ulnar Nerve Symptoms
Shoulder Deltoid Soreness Posterior Shoulder Pain
Performance Concerns Control and Velocity
Duration of Symptoms Sore During – Sore After – Sore Next Day
“Don’t Bring Me a Problem, Bring Me a Solution!”
① Pre Participation Exam / Screening② Warm Up Appropriately③ Do Not Pitch Through Symptoms④ Do Not Play Year-Round⑤ Communicate to players regarding how they
are feeling⑥ Emphasize, control, accuracy, and age
appropriate skills⑦ Speak to a medical professional if you have
concerns about an injury or to develop a prevention strategy.
Special Thank You - Acknowledgement
Kinetic Rehab Phil Donley, MS PT ATC
Jeff Cooper, MS ATC Gray Cook, PT Gary Gray, PT
Craig Morgan, MD Shirley Sahrmann
Ron Hruska
Questions / Solutions