Shoulder and Elbow Injury Prevention in Baseball March, 3rd 2016 Jeff Kraayeveld ATC, AT/L Kristin Tognetti, DPT, MTC Helen McDevitt, MSPT, OCS Dr. Gregory Gramstad, MD Dr. Anthony Wei, MD

Purpose Baseball injuries treated at Rebound Injury mechanisms Shoulder/elbow injury prevention Rebound Performance Throwing Program

Common Baseball Injuries Elbow Ulnar Collateral Ligament sprain or tear Surgical (Tommy John Surgery) Non-Surgical (Rehab) Tendonitis Posterior Impingement Shoulder Rotator Cuff Injuries Labral Injuries Multi-Directional Laxity

Injury Perspective of the Athlete Subjective Data Pain during or after throwing Feeling a “POP” Loss of control Loss of velocity Numbness or tingling

Causes of Shoulder and Elbow Injury in Baseball Overuse > 8 months of baseball participation Playing with multiple teams, showcase's Catcher/ pitcher position combination Muscle Weakness Increases stress on shoulder and elbow Fatigue = Poor Mechanics = Injury Flexibility vs. Stability Tight posterior capsule vs. weak posterior muscles

Arm Soreness Muscle soreness is normal in throwing athletes Avoid maximum effort when sore Difference between muscle soreness and joint pain Joint Pain = Red Flag Bullpen use for mechanics and location, NOT VELOCITY

Research on Pitching Loss of Motion Loss of 8.5 degrees of IR Loss of 9.5 degrees of total motion Loss of 2.4 degrees of elbow extension Loss of motion is still present even 24 hours after throwing. Relief pitcher vs. starting pitcher

Signs of Fatigue Increased time between pitches Loss of control More upright at ball release Elbow drop

Risk Factors for Pitchers Fatigued pitching and increased injury risk 36 times more likely to develop injury Pitching >100 innings per year Too many pitches without adequate rest Pitching on consecutive days Playing with multiple teams concurrently Radar gun usage 70-90% more likely to be injured when specializing early Most collegiate players are multisport athletes

Pitch Count Considerations Age Daily Max (Pitches in Game) Required Rest (Pitches)   0 Days 1 Days 2 Days 3 Days 4 Days 15-16 95 1-30 31-45 46-60 61-75 76+ 17-18 105

Guidelines 4 months off from competitive pitching every year, at least 2 months off from overhead throwing Proper warm up Consistent pitch counts and rest periods Avoid playing with multiple teams concurrently Avoid pitcher / catcher combination Avoid pitching in multiple games on same day Monitor signs of fatigue Follow safe practices at showcases

Prevention Off-season rest Flexibility vs. stability (strength) Proper weight lifting (technique and lifts) Proper stretches Proper throwing mechanics

Stretches

Upper Extremity Dynamic Warm Up Paddles 90/90 IR/ER 90/90 Butterfly's Goal Posts Genies Interlock Push Circle F/B Swim F/B Push side/side Interlock Pull Pull Side/Side 90/90 Box Thumb Up Push Down Palm Down Push Down Thumb Down Push Down Thumb Up Push Up Palm Down Push Up Thumb Down Push Up Palm Press Prayer Push Palm Together Thumb Up Press Thumb Down Press Rotate Forward Rotate Backward Press R to L Finger Press 5, 4, 3, 2, 1 Spider 5, 4, 3, 2, 1 Spider Forward Spider Backward Spider Side/Side Palm Forearm Press Press Thumb Out Press Thumb In Press Elbow Rib Squeeze Wipers Overhead Prayer Rear Presses Palms Out Palms In Hands Together

Mechanical Flaws Inverted W Elbow Drop / Shoulder Height Upright Trunk / Trunk Tilt

Inverted W

ESPN - The Magazine (2012)

Elbow Drop / Shoulder Height

Upright Trunk / Trunk Tilt

Resources Websites Apps www.pitchsmart.org www.playball.org Throw Like A Pro Hudl Technique

Offered at Rebound Doctors Dr. Gramstad Dr. Wei Sports Clinic Dr. DaSilva - Tuesday 3-5pm during high school season Rebound Performance Throwing Program 12 visit over 6 weeks In-season Off-season Group setting

Throwing Program Baseball related band and plyometric exercises Pre-throwing warm up education Proper form for exercises and drills Shoulder blade/ rotator cuff strengthening Video analysis - Hudl Take home pictures and videos with voiceover Research based throwing mechanics

Contact Jeff Kraayeveld ATC, AT/L. Rebound Physical Therapy at Pacific Crest 601 SE 117th Ave. Suite 210 Vancouver, WA 98683 360-449-8700 jkraayeveld@reboundmd.com