Training for Injury Prevention of the Shoulder Paul Pursley PT CSCS University of Iowa Hospitals and Clinics

Non-trainable Variables Appropriate Gear Good Genes Good Sportsmanship Bad Luck

Trainable Variables Sport Specific Skills Flexibility Strength Balance Biomechanics

What Kind of Throw are We Training For?

Phases of the Overhead Throw Wind-up Phase Cocking Phase  Early cocking phase  Late cocking phase Acceleration Phase Deceleration Phase Follow Through

Wind-up Phase Single limb stance Core musculature

Cocking Phase Early Cocking Phase  Minimal muscle activation at global shoulder Late Cocking Phase ( Front foot planted)  Moderate Pectoralis activity  Cocking completed by Pec/Lat

Acceleration Phase Pectoralis Major Subscapularis Latissimus Dorsi Teres Major Serratus Anterior Trunk/LE MM

Deceleration Phase Posterior Deltoid Infraspinatus Teres Minor UT/MT Rhomboids

Standards for IR/ER Ratio ER approx. 66% of IR strength during isokinetic testing. Reminder of importance of rotator cuff and scapular stabilizers

Strength Training…

Thrower’s “Ten” Thrower’s 12  Shoulder Extension, Shoulder Flexion, IR/ER at 0° abduction, IR/ER at 90° abduction, High/Middle/Low Rows, Scapular Punches (Dynamic Hug), Throwing Acceleration, Throwing Deceleration. On the Field Resistance Tubing Exercise for Throwers: an EMG Analysis. Journal of Athletic Training Jan-Mar, 40(1) 15-22

Shoulder Extension

Shoulder Flexion

IR/ER at 0° Abduction

ER/IR at 90° Abduction

High/Middle/Low Rows

Scapular Punches ”Dynamic Hug”

Stabilization High speed resisted target reach Pertubation training Body weight resisted  UE walking  UE weight bearing on unstable surfaces

Multiple Joint Lifts Push Press Clean and Snatch High Pull Bench Press

Multi-Planar Lifts PNF Pattern DI/DII  Dumbbells, Kettle Bells, Resistance Tubing, Cable Column Resisted Overhead Throw

Plyometrics Med Balls  Anterior-Chest pass  Posterior-posterior throw Body weight  Box push-up

Periodization Off Season  Hypertrophy/Endurance Phase 6wks, 60-70% 1RM, repetitions Low intensity-High volume  Strength Phase Increase to >80% 1RM, 5-8 repetitions Initiate plyometric training

Periodization Preseason  Power Phase 6-8 weeks prior to competition phase Lower volume-Increased intensity 90% 1RM Allow full recovery between sets

Periodization Competition Phase  Low volume-High intensity Sport Specific Considerations  Length of season  Aerobic vs. Anaerobic  Impact vs. Non-impact

Principles for Implementation Incorporate into existing practice Exercise selection  Thrower’s “10”  Stabilization Exercise  Medicine balls for anterior and posterior shoulder plyometrics  Body weight resisted Pull-ups Dips Rope climb Peg board

Thank You!