Prevention of Adolescent  Throwing Problems Michael Levinson PT,CSCS Hospital for Special Surgery February 26,2011
HSS educational activities are carried out in a manner that serves the educational component of our Mission.  As faculty w...
Young Throwing Athletes: Injury Factors <ul><li>Overuse is the key factor </li></ul><ul><li>Repetitive overloading of the ...
Young Throwing Athletes: Injury Factors <ul><li>Lack of warmup </li></ul><ul><li>Inadequate strength and conditioning </li...
Range of Motion Changes <ul><li>GIRD </li></ul><ul><li>Often associated with the older throwing population </li></ul><ul><...
Rotational Motion Changes in the Glenohumeral Joint of the Adolescent/ Little League Baseball Player Meister, et al. AJSM,...
Young Throwing Athlete: Loss of ROM <ul><li>Little League Shoulder; 13.6y/o </li></ul><ul><li>IR loss = increases physes s...
Young Throwing Athlete: ROM Loss <ul><li>IR deficits associated with valgus instability  </li></ul><ul><li>Dines, et al. A...
Postural Changes <ul><li>Often begin in the formative years </li></ul><ul><li>Depressed, rounded shoulder </li></ul><ul><l...
Scapula Deviations <ul><li>Upward rotation </li></ul><ul><li>Lateral slide </li></ul><ul><li>Increased protraction </li></...
Young Throwing Athlete: Role of the Scapula <ul><li>Injury Prevention </li></ul><ul><li>May cue them to improve mechanics ...
Young Throwing Athlete: Training the Scapula <ul><li>Endurance </li></ul><ul><li>Efficiency </li></ul><ul><li>Force Couple...
Don’t’ Forget the Latissimus <ul><li>Prime accelerator </li></ul><ul><li>Core muscle group </li></ul><ul><li>Compressive l...
Muscular Imbalances <ul><li>Well documented in the older population </li></ul><ul><li>IR/ER ratio </li></ul><ul><li>Eviden...
Young Throwing Athlete: Optimal Time to Address the Kinetic Chain <ul><li>Maximal linear wrist velocity correlates with ma...
Core and Lower Extremity Training for the Thrower <ul><li>Closed chain </li></ul><ul><li>Balance is critical </li></ul><ul...
Core and Lower Extremity Strengthening
Core and Lower Extremity Strengthening
Address the Kinetic Chain: Hip and Trunk Flexibility <ul><li>Increased stride length associated with increased velocity </...
Avoiding Reinjury: USA Baseball Medical and Safety Advisory Committee <ul><li>Volume of pitches </li></ul><ul><li>Type of ...
Volume of Pitches <ul><li>Important risk factor </li></ul><ul><li>Increased surgery: </li></ul><ul><li>-Pitches/ game </li...
Risk of Serious Injury for Young Baseball Players:  A 10-Year Prospective Study Fleisig, et al. AJSM 2011 <ul><li>481 Pitc...
Type of Pitches <ul><li>Fastballs: greatest loads on the shoulder and elbow </li></ul><ul><li>Breaking balls ? </li></ul><...
Throwing Velocity <ul><li>Associated with increased injury </li></ul><ul><li>Taller and heavier players </li></ul><ul><li>...
Injury prevention <ul><li>Adhere to suggested age related pitch counts </li></ul><ul><li>At least 3 months per year of “ac...
Develop Good Mechanics <ul><li>Good balance point </li></ul><ul><li>Stride toward home plate </li></ul><ul><li>Avoid “open...
Summary <ul><li>Young throwers do have special needs </li></ul><ul><li>Many of the adaptive changes begin as the athlete m...
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Prevention of Adolescent Throwing Problems

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Michael Levinson PT,CSCS
Hospital for Special Surgery

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Transcript of "Prevention of Adolescent Throwing Problems"

  1. 1. Prevention of Adolescent Throwing Problems Michael Levinson PT,CSCS Hospital for Special Surgery February 26,2011
  2. 2. HSS educational activities are carried out in a manner that serves the educational component of our Mission. As faculty we are committed to providing transparency in any/all external relationships prior to giving an academic presentation. Mickey Levinson HSS Disclosure: DO NOT have a financial relationship with any commercial interest.
  3. 3. Young Throwing Athletes: Injury Factors <ul><li>Overuse is the key factor </li></ul><ul><li>Repetitive overloading of the shoulder and elbow </li></ul><ul><li>Fatigue (practice) </li></ul><ul><li>Poor recovery </li></ul>
  4. 4. Young Throwing Athletes: Injury Factors <ul><li>Lack of warmup </li></ul><ul><li>Inadequate strength and conditioning </li></ul><ul><li>Poor mechanics </li></ul><ul><li>Open physes </li></ul>
  5. 5. Range of Motion Changes <ul><li>GIRD </li></ul><ul><li>Often associated with the older throwing population </li></ul><ul><li>Soft tissue/ osseous adaptions </li></ul><ul><li>Functional impingement/ increased translation </li></ul>
  6. 6. Rotational Motion Changes in the Glenohumeral Joint of the Adolescent/ Little League Baseball Player Meister, et al. AJSM, 2005 <ul><li>Players 8-16 y/o </li></ul><ul><li>Elevation loss of 5 ° </li></ul><ul><li>IR loss of 21° </li></ul><ul><li>Significant changes in IR from 12-13 y/o </li></ul><ul><li>Loss of ROM with maturation </li></ul>
  7. 7. Young Throwing Athlete: Loss of ROM <ul><li>Little League Shoulder; 13.6y/o </li></ul><ul><li>IR loss = increases physes stress </li></ul><ul><li>With age increased ER </li></ul><ul><li>Internal impingement </li></ul>
  8. 8. Young Throwing Athlete: ROM Loss <ul><li>IR deficits associated with valgus instability </li></ul><ul><li>Dines, et al. AJSM, 2009 </li></ul><ul><li>IR: physiologic counter to valgus torque </li></ul><ul><li>Fleisig, et al. AJSM, 1995 </li></ul><ul><li>“ Little League” elbow </li></ul><ul><li>MCL injuries </li></ul>
  9. 9. Postural Changes <ul><li>Often begin in the formative years </li></ul><ul><li>Depressed, rounded shoulder </li></ul><ul><li>Thoracic kyphosis </li></ul><ul><li>Forward head posture </li></ul><ul><li>Scapula asymmetry </li></ul>
  10. 10. Scapula Deviations <ul><li>Upward rotation </li></ul><ul><li>Lateral slide </li></ul><ul><li>Increased protraction </li></ul><ul><li>Anterior tilted </li></ul><ul><li>Weak posterior and inferior musculature </li></ul>
  11. 11. Young Throwing Athlete: Role of the Scapula <ul><li>Injury Prevention </li></ul><ul><li>May cue them to improve mechanics </li></ul><ul><li>Load the scapula in cocking phase </li></ul><ul><li>Control the rate of protraction </li></ul><ul><li>Maximize the role of the rotator cuff </li></ul>
  12. 12. Young Throwing Athlete: Training the Scapula <ul><li>Endurance </li></ul><ul><li>Efficiency </li></ul><ul><li>Force Couples </li></ul><ul><li>Often weak posteriorly and inferiorly </li></ul>
  13. 13. Don’t’ Forget the Latissimus <ul><li>Prime accelerator </li></ul><ul><li>Core muscle group </li></ul><ul><li>Compressive load </li></ul><ul><li>Reduce stress of the glenohumeral joint </li></ul>
  14. 14. Muscular Imbalances <ul><li>Well documented in the older population </li></ul><ul><li>IR/ER ratio </li></ul><ul><li>Evidence in adolescent pitchers </li></ul><ul><li>Trakis, et al. AJSM, 2008 </li></ul><ul><li>Bias toward the posterior cuff </li></ul>
  15. 15. Young Throwing Athlete: Optimal Time to Address the Kinetic Chain <ul><li>Maximal linear wrist velocity correlates with maximal push off the back leg </li></ul><ul><li>MacWilliams, et al. AJSM, 1998 </li></ul><ul><li>Pushoff supplies the initial momentum </li></ul><ul><li>Breaking force of lead leg allows transfer of energy to upper body </li></ul>
  16. 16. Core and Lower Extremity Training for the Thrower <ul><li>Closed chain </li></ul><ul><li>Balance is critical </li></ul><ul><li>Strong rotational component </li></ul><ul><li>Unilateral activity </li></ul><ul><li>Build strength and power without sacrificing flexibility </li></ul>
  17. 17. Core and Lower Extremity Strengthening
  18. 18. Core and Lower Extremity Strengthening
  19. 19. Address the Kinetic Chain: Hip and Trunk Flexibility <ul><li>Increased stride length associated with increased velocity </li></ul><ul><li>Velocity a function of separation between pelvis and upper trunk </li></ul><ul><li>Hip rotation for proper foot contact </li></ul>
  20. 20. Avoiding Reinjury: USA Baseball Medical and Safety Advisory Committee <ul><li>Volume of pitches </li></ul><ul><li>Type of pitches </li></ul><ul><li>Fatigue/ inadequate recovery </li></ul><ul><li>Velocity </li></ul><ul><li>Mechanics </li></ul>
  21. 21. Volume of Pitches <ul><li>Important risk factor </li></ul><ul><li>Increased surgery: </li></ul><ul><li>-Pitches/ game </li></ul><ul><li>-Innings/ game </li></ul><ul><li>-Months/ year </li></ul><ul><li>-Fatigue </li></ul><ul><li>Olsen, et al. AJSM, 2006 </li></ul><ul><li>Pitch to fatigue not through it </li></ul>
  22. 22. Risk of Serious Injury for Young Baseball Players: A 10-Year Prospective Study Fleisig, et al. AJSM 2011 <ul><li>481 Pitchers ( 9-14 years old ) </li></ul><ul><li>10 year follow up </li></ul><ul><li>More than 100 innings/ year: 3.5 X more injuries </li></ul><ul><li>Also playing catcher </li></ul><ul><li>Curveballs before 13 years old: not significant </li></ul>
  23. 23. Type of Pitches <ul><li>Fastballs: greatest loads on the shoulder and elbow </li></ul><ul><li>Breaking balls ? </li></ul><ul><li>Learned correctly ? </li></ul><ul><li>Repetition of learning a new skill </li></ul><ul><li>Avoid until physically mature </li></ul><ul><li>Learn a changeup </li></ul>
  24. 24. Throwing Velocity <ul><li>Associated with increased injury </li></ul><ul><li>Taller and heavier players </li></ul><ul><li>More highly recruited and overused </li></ul>
  25. 25. Injury prevention <ul><li>Adhere to suggested age related pitch counts </li></ul><ul><li>At least 3 months per year of “active rest” </li></ul><ul><li>Avoid pitching in multiple leagues </li></ul><ul><li>Caution with “showcases” </li></ul><ul><li>Develop good mechanics at an early age </li></ul><ul><li>Hard throwers need to be watched more closely </li></ul>
  26. 26. Develop Good Mechanics <ul><li>Good balance point </li></ul><ul><li>Stride toward home plate </li></ul><ul><li>Avoid “opening up” too soon </li></ul><ul><li>Correct arm angle </li></ul><ul><li>Long arm path in follow through </li></ul>
  27. 27. Summary <ul><li>Young throwers do have special needs </li></ul><ul><li>Many of the adaptive changes begin as the athlete matures </li></ul><ul><li>Never too early to begin strength and conditioning </li></ul><ul><li>Address the entire kinetic chain </li></ul><ul><li>Patient education and modification is critical </li></ul>
  28. 28. Thank You

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