11/29/2017

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

● 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 Casey Batten, MD California Berkeley Athletics ● Academic Interest: Sport concussions, Cedars-Sinai Kerlan Jobe Athlete Cardiac Screening Institute

● Procedures: Dx US, US guided injections, Biologic Stem Cell Injections, Tenex Procedure

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● Kerlan Jobe Orthopedic Physician ● Team Physician ○ Los Angeles Rams ○ Christos ○ ● Sports Medicine Consultant Photopoulos, MD ○ ○ PGA Tour Cedars-Sinai Kerlan Jobe ○ USC Football Institute ● Clinical Interest: arthroscopic surgery, joint preservation, knee replacement surgery, fracture care ● Specialties: Sports Medicine, Elbow, Shoulder, Knee

● Owner Advanced Physical Therapy & Sports Medicine Cody Jones, PT, DPT, ● Board Certified Clinical Specialist OCS ● Team PT for multiple WBA and WBO World Title Holders in Boxing. Advanced Physical Therapy & ● Background/Special Interests: sports Sports Medicine medicine, post concussion management, vestibular/balance dysfunctions, running mechanics & injuries

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● Owner Advanced Physical Therapy & Sports Medicine ● Board Certified Clinical Specialist ● Consultant Chinese National Olympic Team & Eric S. Honbo, PT, Committee DPT, OCS, Cert DN ● Background Special Interests: Sports Medicine, Overhead Throwing Injuries, Shoulder & Elbow Advanced Physical Therapy & Dysfunction, Rehab & Clinical Applications for Sports Medicine 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- (longest tenured manager MLB) 2000-present

Former MLB Catcher Los Angeles Dodgers (all time leader games caught) Mike Scioscia

Manager, Los Angeles Angels 2 time MLB Allstar & 2 Time World Series Champion (1988 & 2002)

American League Manager of the year 2002 & 2009

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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 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

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Hans Selye’s “General Adaptation Syndrome” Model

Macro Cycle of Training

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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

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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

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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%)

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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. http://www.asmi.org/research.php?page=research§ion=TJpo sitionstatement

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Thank You

“The 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

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● ‘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 Depends, based on individual direction? needs

What should I strengthen? >15 years old ( growth plates closing),*Hips/legs, Core, Rotator Cuff, Periscapular Is there a better arm slot to muscle groups throw or angle my shoulder Injury risk increases when <90 should be in during my throw? deg in relation to trunk

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Rehab (or better yet - ‘Prehab’) What is it?

Should my son/daughter be Focus on single leg balance, strengthening if only 8-14 year agility/foot work, old? coordination, cardiovascular, light 0-1 lb. focusing on form

How many sets/reps should I be 3-5 sets x15/20 reps doing? (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+)

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What Do I Need to Stretch? Yes No

NO

NO

1

IR Limited Motion vs. Hypermobility . .

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1 Which needs stretching/MFR/capsule mob and which needs strengthening/stab/NMR? Eric Honbo, 11/26/2017 11/29/2017

. Total Arm Motion - TAM

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Internal Rotation Stretching

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If an athlete exerts force onto the ground (‘action’) , the ground will exert an equal and opposite force (‘reaction’) on the Ground Reaction athlete...& up the Kinetic Chain to release Force (GRF) point. 2 Main Forces to generate GRF: Major “Key” to transferring Energy to Hips-> Trunk-> Arm-> “Push off Rear Leg initiates forward Release Point-> ‘Velo’ 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)

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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??

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Rotational Core Strengthening Examples

APTSM Rotational Core

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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

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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 11/29/2017

ARM SLOT- Is One Better?

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Arm Angle & Trunk Angle Want to see Arm Angle ~90 deg or more in relation to trunk

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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

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Scapular Strength Examples:

APTSM SCAPULAR STABILITY PROGRAM (2).crdownload

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Take Aways:

● Prehab starts 6-8 weeks before ● Arm Slot season (now) ○ (does it matter? Want 90 deg angle in relation to trunk, ● Focus on Strengthening the Entire look for arm dropping but in relation to trunk) “Kinetic Chain”

● Key Ingredient= Legs/Core ● Interval Throwing Program ● Focus on Multi-planar ● 6-8 weeks progressing short to long toss ● Stretching and Where Needed Most ● Distance (how far is enough?) (hip, trunk and shoulder IR if they do most commonly)

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Can You Access These Materials?

Yes ● Powerpoint Presentation ● PDF’s Advanced Physical Therapy & Sports ○ Thrower’s Lower 10 LE Strength Program Medicine home page ○ Throwing Program Sample ○ Pitchsmart/USA Baseball- Pitch Count & www.APTSM.com Rest Recommendations ○ RDRBI Baseball Talk & Data (Fun) Facebook page - Advanced Physical ● Videos Therapy & Sports Medicine Facebook ○ Rotational Core page ○ Shoulder Girdle Throwers Strength Program ○ Scapular Stability Program ○ Thrower’s Lower 10 Strength Program Youtube Channel ○ Warm Up https://www.youtube.com/user/Advan cedPTSportsMed/videos

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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.drivelinebaseball.com/

Stop Sports Injuries www.stopsportsinjuries.org/ (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

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Thank You On Deck: Mike Scioscia

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