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Prevention of Adolescent Throwing Problems


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Michael Levinson PT,CSCS
Hospital for Special Surgery

Published in: Health & Medicine
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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