Overhead Throwers- A Structured Season

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Jobe Institute Board Certified in Family Medicine & Sports Medicine Director of Primary Care Sports Medicine at KJOC Lead Primary Care Sports Medicine Physician- LA Rams

1 Overhead Throwers- A Structured Season Casey G. Batten, MD Christos D. Photopoulos, MD Cody Jones, PT, DPT, OCS Eric S. Honbo, PT, DPT, OCS, Cert DN Mike Scioscia ADVANCED PHYSICAL THERAPY AND SPORTS MEDICINE and the CEDARS-SINAI KERLAN JOBE INSTITUTE Casey Batten, MD Cedars-Sinai Kerlan Jobe Institute Board Certified in Family Medicine & Sports Medicine Director of Primary Care Sports Medicine at KJOC Lead Primary Care Sports Medicine Physician- LA Rams Former Head Team Physician for University of California Berkeley Athletics Academic Interest: Sport concussions, Athlete Cardiac Screening Procedures: Dx US, US guided injections, Biologic Stem Cell Injections, Tenex Procedure 1

2 Christos Photopoulos, MD Cedars-Sinai Kerlan Jobe Institute Kerlan Jobe Orthopedic Physician Team Physician Los Angeles Rams Los Angeles Dodgers Los Angeles Kings Sports Medicine Consultant Los Angeles Lakers PGA Tour USC Football Clinical Interest: arthroscopic surgery, joint preservation, knee replacement surgery, fracture care Specialties: Sports Medicine, Elbow, Shoulder, Knee Cody Jones, PT, DPT, OCS Advanced Physical Therapy & Sports Medicine Owner Advanced Physical Therapy & Sports Medicine Board Certified Clinical Specialist Team PT for multiple WBA and WBO World Title Holders in Boxing. Background/Special Interests: sports medicine, post concussion management, vestibular/balance dysfunctions, running mechanics & injuries 2

3 Eric S. Honbo, PT, DPT, OCS, Cert DN Advanced Physical Therapy & Sports Medicine Owner Advanced Physical Therapy & Sports Medicine Board Certified Clinical Specialist Consultant Chinese National Olympic Team & Committee Background Special Interests: Sports Medicine, Overhead Throwing Injuries, Shoulder & Elbow Dysfunction, Rehab & Clinical Applications for PRP/Biologic Injection & Rehabilitation World Outdoor Track & Field Championships, WTA, NBA Summer Camp USC Orthopaedic Physical Therapy Residency and Spine Rehabilitation Fellowship programs in Beijing, China Manager-Los Angeles Angels (longest tenured manager MLB) 2000-present Mike Scioscia Manager, Los Angeles Angels Former MLB Catcher Los Angeles Dodgers (all time leader games caught) 2 time MLB Allstar & 2 Time World Series Champion (1988 & 2002) American League Manager of the year 2002 &

According to the U.S. Centers for Disease Control (CDC) Since 2000 there has been a fivefold increase in the number of serious shoulder and elbow injuries among youth baseball and softball players.

4 According to the U.S. Centers for Disease Control (CDC) Since 2000 there has been a fivefold increase in the number of serious shoulder and elbow injuries among youth baseball and softball players. Overuse injuries are responsible for nearly half of all sports injuries to middle and high school students 20% of children ages 8 to 12 and 45% of those ages 13 to 14 will have arm pain during a single youth baseball season. More than 1/2 of the 2 million sports injuries in children are preventable By age 13, 70% of kids drop out of youth sports. The top three reasons: adults, coaches and parents Lost Concept of Periodization Periodization is the systematic planning of athletic or physical training Goal: Is to reach peak performance at the most important competition(s) of the year. Typically: break year into Off-Season, Pre-Season, In-Season Each phase of training allows you to work towards different goals. Cycles of training: MICRO - 7 days, MESO- 2 wks to 2 mos, MACRO- 1 year 4

5 Hans Selye s General Adaptation Syndrome Model Macro Cycle of Training 5

OFF-SEASON REST No overhead throwing of any kind for at least 2-3 months per year (4 months is preferred). No competitive baseball pitching for at least 4 months per year.

6 OFF-SEASON REST No overhead throwing of any kind for at least 2-3 months per year (4 months is preferred). No competitive baseball pitching for at least 4 months per year. ASMI Position Statement for Adolescent Pitchers Why? When? Fall Ball versus Summer Ball leagues. My preference for high school and college: July- September. MLB October-November. Can I Still Train? Absolutely, check out our Off-season training regimen 6

Training Focus for Each Season 1. Prehab Early Pre-season- Foundational Strength : Posterior Chain, Core and Stabilizers (Scapular and Shoulder). LONG TOSS PROGRAM 2.

7 Training Focus for Each Season 1. Prehab Early Pre-season- Foundational Strength : Posterior Chain, Core and Stabilizers (Scapular and Shoulder). LONG TOSS PROGRAM 2. Prehab Late Pre-season- Max Strength, Max Power : Increase strength then convert to power. 3. In-Season- Maintain, Maintain. Taper prior to competition and at end of season to avoid injury 4. Off-Season- Heal, Balance body, Increase Flexibility and Stabilize. Cardio Base Training Program By Phase 7

IN-SEASON REST- PITCH COUNTS MLB and USA Baseball Developed PitchSmart Pitch Count Guidelines A series of practical, age appropriate guidelines to help players, parents and coaches avoid overuse

8 IN-SEASON REST- PITCH COUNTS MLB and USA Baseball Developed PitchSmart Pitch Count Guidelines A series of practical, age appropriate guidelines to help players, parents and coaches avoid overuse injuries. Risk factors for injury: League w/ No Pitch counts (45%), Consecutive days (43.5%), Multiple Teams/ overlapping seasons (30.4%), Multiple games/same day (19%), Pitched for more than 8 months in a year (13.2%) 8

9 Macro Cycle for 12 year old, 7 Grader Goal: Cooperstown, NY Tournament in July 1. Travel Ball schedule 2. School Team schedule 3. Additional Agility Training 1-2 x per week Forced Off-Season due to injury ASMI Position Statement For Injury and Pitchers (2016) Regardless of mound height, the real solution is for young pitchers to do less full-effort pitching and more sub-maximal throwing (practice throws, playing other positions, playing other sports). To become a successful adult pitcher, the youth should not strive to be a youth pitcher but instead should be a young athlete that is a good pitcher. sitionstatement 9

10 Thank You The Tommy John surgery doesn t automatically make the player better, as much as the rehab does. If you don t have a good rehab to make the tissue come back with good blood supply, then you re not as well of as before surgery. -Casey the Peacock, MD 10

.. Prehab Concept Ground Reaction Force Exercise Examples Strengthening, Stretching

- Prehab ) What is it? What should I stretch? Which direction? What should I strengthen?

Depends, based on individual needs >15 years old ( growth plates closing),*hips/legs,

11 .. Prehab Concept Ground Reaction Force Exercise Examples Strengthening, Stretching Distance Based Throwing Programs Eric Honbo, PT, DPT, OCS, CERT, DN Rehab (or better yet - Prehab ) What is it? What should I stretch? Which direction? What should I strengthen? Is there a better arm slot to throw or angle my shoulder should be in during my throw? Depends, based on individual needs >15 years old ( growth plates closing),*hips/legs, Core, Rotator Cuff, Periscapular muscle groups Injury risk increases when <90 deg in relation to trunk 11

12 Rehab (or better yet - Prehab ) What is it? Should my son/daughter be strengthening if only 8-14 year old? Focus on single leg balance, agility/foot work, coordination, cardiovascular, light 0-1 lb. focusing on form How many sets/reps should I be doing? 3-5 sets x15/20 reps (Endurance emphasis) but depends... Prehab - How Can I Prevent Injury? 8-12 weeks off throwing- allow shoulder girdle to rest/recover (Periodization) Enhance physical/mental game via playing other sports (USA Soccer, UCLA examples) Start Prehab 6-8 weeks prior to competition (now?) Need much bigger warm up- Sweating before picking up ball LKC, Core, Shoulder Girdle Strength program Distance Based Interval Throwing Program to Enhance Tissue Adaptation & be ready for Competition (4-6 wks+) 12

13 What Do I Need to Stretch? Yes No NO NO 1 IR Limited Motion vs... Hypermobility 13

14 Slide 26 1 Which needs stretching/mfr/capsule mob and which needs strengthening/stab/nmr? Eric Honbo, 11/26/2017

15 . Total Arm Motion - TAM. Internal Rotation Stretching 14

Ground Reaction Force (GRF) Major Key to transferring Energy to Hips-> Trunk-> Arm-> Release Point-> Velo

reaction ) on the athlete...& up the Kinetic Chain to release point.

on brakes, GRF then generates equal/opposite force vector to maximize Rotational ( Uncoiling ) Kinetic

16 Ground Reaction Force (GRF) Major Key to transferring Energy to Hips-> Trunk-> Arm-> Release Point-> Velo If an athlete exerts force onto the ground ( action ), the ground will exert an equal and opposite force ( reaction ) on the athlete...& up the Kinetic Chain to release point. 2 Main Forces to generate GRF: Push off Rear Leg initiates forward kinetic energy & Landing Front Leg puts on brakes, GRF then generates equal/opposite force vector to maximize Rotational ( Uncoiling ) Kinetic Chain Energy to increase point ( Velo ) GRF - Landing Leg Strong Correlation Peak Force Production and Ball Velocity (both Push off and Landing Leg) 15

17 GRF - Push Leg & Rubber Set Up Foot against side of rubber Foot- Everted off the rubber GRF & Leg Importance:. / A 20% decreased kinetic energy delivered from HIP/TRUNK requires 34% increase in rotational velocity of the SHOULDER to impart the same amount of force to the hand (release point) If >60% majority of throw generated from LE & core, then what should strengthening programs emphasize?? 16

18 Rotational Core Strengthening Examples APTSM Rotational Core. 2 Ground Reaction Force & Velocity- Take Away Message Rotational momentum ( UNCOILING ) is driven through legs & trunk-> shoulder, elbow, hand to release point. It is created by results of ground reaction force at thrower s feet SIMPLY PUT 2 things: 1) Back Leg: get a big PUSH OFF THE RUBBER to increase your linear speed towards target with big stride & foot to GROUND (fast) to generate maximal reactive GRF 2) Front Leg: needs strength & stability to be able to QUICKLY STOP YOUR FORWARD MOMENTUM to then generate maximal uncoiling energy to ball release 17

19 Slide 34 2 generate and sequentially transfer potential energy to the upper extremity for conversion to kinetic energy to propel the baseball toward home plate. Inefficiency or failure of the kinetic chain can increase the kinetic requirements of the shoulder to maintain top velocity and performance. Eric Honbo, 11/26/2017

20 ARM SLOT- Is One Better?. Arm Angle & Trunk Angle Want to see Arm Angle ~90 deg or more in relation to trunk 18

21 Strengthening- What About My Shoulder? Single planar good for foundation but Focus on Complex Multi-planar Recruit Legs, Trunk, Balance, Weight Transfer to front leg Rollers, discs/bosu, ½ or Tall Kneel progressions Simulate Sport Specific Shoulder Girdle Examples APTSM THROWERS STRENGTH PROGRAM. 19

Focus on Multi-planar Stretching and Where Needed Most (hip, trunk and shoulder IR if they do most commonly) Arm Slot (does it

22 Scapular Strength Examples: APTSM SCAPULAR STABILITY PROGRAM (2).crdownload. Take Aways: Prehab starts 6-8 weeks before season (now) Focus on Strengthening the Entire Kinetic Chain Key Ingredient= Legs/Core Focus on Multi-planar Stretching and Where Needed Most (hip, trunk and shoulder IR if they do most commonly) Arm Slot (does it matter? Want 90 deg angle in relation to trunk, look for arm dropping but in relation to trunk) Interval Throwing Program 6-8 weeks progressing short to long toss Distance (how far is enough?) 20

23 Can You Access These Materials? Yes Advanced Physical Therapy & Sports Medicine home page Facebook page - Advanced Physical Therapy & Sports Medicine Facebook page Youtube Channel cedptsportsmed/videos Powerpoint Presentation PDF s Videos Thrower s Lower 10 LE Strength Program Throwing Program Sample Pitchsmart/USA Baseball- Pitch Count & Rest Recommendations RDRBI Baseball Talk & Data (Fun) Rotational Core Shoulder Girdle Throwers Strength Program Scapular Stability Program Thrower s Lower 10 Strength Program Warm Up 21

Useful Web Sites Kerlan Jobe www.kerlanjobe.com Pitch Smart http://m.mlb.com/pitchsmart (USA Baseball & MLB) ASMI www.asmi.org USA Baseball www.usabaseball.com Driveline Baseball www.

org/ (American Orthopaedic Society for Sports Medicine) PubMed (for scientific articles on throwing) Are players coming back with more velocity & better location after surgery?

24 Useful Web Sites Kerlan Jobe Pitch Smart (USA Baseball & MLB) ASMI USA Baseball Driveline Baseball Stop Sports Injuries (American Orthopaedic Society for Sports Medicine) PubMed (for scientific articles on throwing) Are players coming back with more velocity & better location after surgery? The difference is players are doing the things they should have been doing before getting injured- rotator cuff & periscapular strengthening, emphasis on leg/hip & core strength, balance training, cardiovascular training, graduated interval throwing programs...strengthening & stretching the right things, and using appropriate rest intervals. -Frank Jobe, MD 22

25 Thank You On Deck: Mike Scioscia 23

Prevent injuries before getting on the field

Prevent injuries before getting on the field from stopsportsinjuries.org QUICK FACTS - Twenty percent of children ages 8 to 12 and 45 percent of those ages 13 to 14 will have arm pain during a single youth