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 1 11/29/2017 ● Kerlan Jobe Orthopedic Physician ● Team Physician ○ Los Angeles Rams ○ Los Angeles Dodgers Christos ○ Los Angeles Kings ● Sports Medicine Consultant Photopoulos, MD ○ Los Angeles Lakers ○ 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 2 11/29/2017 ● 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-Los Angeles Angels (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 3 11/29/2017 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 11/29/2017 Hans Selye’s “General Adaptation Syndrome” Model Macro Cycle of Training 5 11/29/2017 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 11/29/2017 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 11/29/2017 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 11/29/2017 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&section=TJpo sitionstatement 9 11/29/2017 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 11/29/2017 ● ‘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 11 11/29/2017 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+) 12 11/29/2017 What Do I Need to Stretch? Yes No NO NO 1 IR Limited Motion vs. Hypermobility . 13 Slide 26 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 . Internal Rotation Stretching 14 11/29/2017 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) 15 11/29/2017 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 11/29/2017 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 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 11/29/2017 ARM SLOT- Is One Better? . Arm Angle & Trunk Angle Want to see Arm Angle ~90 deg or more in relation