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Return to Throwing after Shoulder or Elbow Injury

Abstract

Purpose of review

Throwing places high demands on the human body, and specific characteristics are developed over time unique to these athletes. When returning to throw after injury, it is important to follow a criterion-based progression that allows the body to be prepared appropriately for the stresses that throwing will require. There is currently a void in the literature for criteria-based progression that helps these athletes return to the highest level of play.

Recent findings

As injury rates continue to rise in baseball, there is increased evidence showing contributions of the core and lower extremity to the baseball pitch. There is also additional data showing pitcher specific characteristics such as range of motion and scapular position in this unique population. The rehab professional should take into account every phase of the pitch starting from balance through ball release when designing a comprehensive return-to-throwing program.

Summary

Returning an athlete back to a throwing sport can be an overwhelming task. The rehabilitation specialist must have a sound understanding of the throwing motion as well as any biomechanical implications on the body, contributions throughout the kinetic chain, range of motion, and strength characteristics specific to the thrower as well as proper tissue loading principles. It is important that these athletes are not progressed too quickly through their programs and that a criteria-based progression is followed. They should have normalized range of motion, strength, and scapular mechanics, followed by a sound plyometric progression. Once this is achieved, they are advanced to an interval throwing program with increasing distance, effort, and volume which should be tracked for workload, making sure they do not throw more than their body is prepared for.

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Correspondence to Terrance A. Sgroi.

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Both authors declare that they have no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Injuries in Overhead Athletes

Appendix

Appendix

Pre-plyometric and plyometric progression example
 • Isometrics mid-range progressing to end ranges as ROM increases
 • Resistance through full ROM, constant speed (slower to maximize recruitment)
 • Increase volume of resistance to develop a good work capacity
  ○ Up to three sets, 12–15 repetitions
  ○ Step wise incremental increase in resistance
  ○ Reinforce end range fatigue tolerance with perturbations (proprioception)
   ▪ Body blade static holds at end range (Max ER @ 0 abd)
   ▪ Manual perturbations at end range
 • Begin slow eccentrics to maximize cross-bridge formation
  ○ 90/90 tubing ER X 10 f/b 5 manually resisted eccentric with tubing
 • End with drop set resistance with increasing velocity (superset)
  ○ One set of 10 D2 flexion (high resistance/Blue) f/b 1 × 10 low resistance/high velocity (yellow)
  ○ Add eccentrics to first set
 • Perturbation exercises emphasizing the stretch-shortening cycle (SSC)
  ○ 90/90 wall dribbles, wall clock taps
 • Transition into plyometric program
  ○ Tubing dynamic hug press—MB wall dribbles—MB plyo chest pass
  ○ Lat pull downs—OH MB wall dribbles—OH soccer pass (rebounder)
  ○ ½ kneel chops (tubing/double arm)—D2 extension tubing—MB chops (rebounder)
  ○ Tubing row into ER with eccentrics—½ kneel ER flips (concentric)
  ○ Single-arm D2 flexion/eccentric extension—eccentric plyo ball catches
  ○ Single-arm D2 extension (tubing)—½ kneel 90/90 plyo ball throw (rebounder)

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Sgroi, T.A., Zajac, J.M. Return to Throwing after Shoulder or Elbow Injury. Curr Rev Musculoskelet Med 11, 12–18 (2018). https://doi.org/10.1007/s12178-018-9454-7

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Keywords

  • Return-to-throw
  • Return-to-play
  • Plyometrics