Interval Rehabilitation Programs




Interval throwing program for baseball players—phase I


The interval throwing program (ITP) is designed to gradually return motion, strength, and confidence in the throwing arm after injury or surgery by slowly progressing through graduated throwing distances. The ITP is initiated after clearance by the athlete’s physician to resume throwing and performed under the supervision of the rehabilitation team (physician, physical therapist, and athletic trainer).


The program is set up to minimize the chance of reinjury and emphasize prethrowing warm-up and stretching. In development of the ITP, the following factors are considered most important.




  • The act of throwing the baseball involves transfer of energy from the feet through the legs, pelvis, and trunk and out the shoulder through the elbow and hand. Therefore, any return to throwing after injury must include attention to the entire body.



  • The chance for reinjury is lessened by a graduated progression of interval throwing.



  • Proper warm-up is essential.



  • Most injuries occur as a result of fatigue.



  • Proper throwing mechanics lessens the incidence of reinjury.



  • Baseline requirements for throwing include the following:




    • Pain-free range of motion



    • Adequate muscle power



    • Adequate resistance of muscle to fatigue




Because of individual variability in all throwing athletes, no timetable can be set for completion of the program. Most athletes, by nature, are highly competitive individuals and want to return to competition at the earliest possible moment. Although this is a necessary quality of all athletes, proper channeling of the athlete’s energies into a rigidly controlled throwing program is essential to lessen the chance of reinjury during the rehabilitation period. The athlete may have a tendency to want to increase the intensity of the throwing program. This will increase the incidence of reinjury and may greatly retard the rehabilitation process. It is recommended that the program be followed rigidly because this will be the safest route to return to competition.


During the recovery process the athlete will probably experience soreness and a dull, diffuse aching sensation in the muscles and tendons. If the athlete experiences sharp pain, particularly in the joint, all throwing activity should stop until the pain ceases. If the pain continues, the physician should be contacted.


Weight Training


The ITP should be supplemented with a high-repetition, low-weight exercise program. Strengthening should address a good balance between the anterior and posterior musculature so that the shoulder will not be predisposed to injury. Special emphasis must be given to the posterior rotator cuff musculature for any strengthening program. Weight training will not increase throwing velocity, but it will increase the resistance of the arm to fatigue and injury. Weight training should be done the same day as the athlete throws; however, it should be done after throwing is completed, with the day in between used for flexibility exercises and a recovery period. A weight training pattern or routine should be stressed at this point as a “maintenance program.” This pattern can and should accompany the athlete into and throughout the season as a deterrent to further injury. It must be stressed that weight training is of no benefit unless accompanied by a sound flexibility program.


Individual Variability


The ITP is designed so that each level is achieved without pain or complications before the next level is started. This sets up a progression that a goal is achieved before advancement instead of advancing in a specific timeframe. Because of this design, the ITP may be used for different levels of skills and abilities from those in high school to professional levels.


The reasons for being in the ITP will vary from person to person. For example, one athlete may want to use alternate days throwing with or without using weights in between; another athlete may have to throw every third or fourth day because of pain or swelling. A good rule for follow is “Listen to your body—it will tell you when to slow down.” Again, completion of the steps of the ITP will vary from person to person. There is no set timetable in terms of days to completion.


Warm-up


Jogging increases blood flow to the muscles and joints and thus increases their flexibility and decreases the chance of reinjury. Because the amount of warm-up will vary from person to person, the athlete should jog until a light sweat develops and then progress to the stretching phase.


Stretching


Because throwing involves all muscles in the body, all muscle groups should be stretched before throwing. This should be done in a systematic fashion beginning with the legs and including the trunk, back, neck, and arms. Continue with capsular stretches and L-bar range-of-motion exercises.


Throwing Mechanics


A critical aspect of the ITP is maintenance of proper throwing mechanics throughout the advancement. Use of the crow-hop method simulates the throwing act and allows emphasis on proper body mechanics. This throwing method should be adopted from the onset of the ITP. Throwing flat-footed encourages improper body mechanics, places increased stress on the throwing arm, and therefore predisposes the arm to reinjury. The pitching coach and sports biomechanics specialist (if available) may be valuable allies to the rehabilitation team with their knowledge of throwing mechanics.


Components of the crow-hop method are first a hop, then a skip, followed by the throw. The velocity of the throw is determined by the distance, and the ball should have enough momentum to travel only each designed distance. Again, emphasis should be placed on proper throwing mechanics when the athlete beings phase II, “throwing off the mound” or throwing from the athlete’s respective position, to decrease the chance of reinjury.


Throwing


Using the crow-hop method, the athlete should begin warm-up throws at a comfortable distance (approximately 30 to 45 feet) and then progress to the distance indicated for that phase ( Fig. B-1 ). The program consists of throwing at each step two to three times without pain or symptoms before progressing to the next step. The object of each phase is for the athlete to be able to throw the ball without pain the specified number of feet (45, 60, 90, 120, 150, and 180 feet) 75 times at each distance. After throwing at the prescribed distance without pain, the athlete will be ready for throwing from flat ground at a distance of 60 feet, 6 inches with the normal pitching mechanics or return to the respective position (step 14). At this point, full strength and confidence should be restored in the athlete’s arm. It is important to stress the crow-hop method and proper mechanics with each throw. Just as advancement to this point has been gradual and progressive, return to unrestricted throwing must follow the same principles. A pitcher should first throw only fast balls at 50% and then progress to 75% and 100%. At this time, the pitcher may start more stressful pitches such as breaking balls. A position player should simulate a game situation, again progressing at 50% to 75% to 100%. Again, if an athlete has increased pain, particularly at the joint, the throwing program should be backed off and readvanced as tolerated, under the direction of the rehabilitation team.




Figure B-1


Interval throwing program progression.





  • 45-Foot Phase




    • Step 1:



    • (A)Warm-up throwing



    • (B)45 feet (25 throws)



    • (C)Rest 5–10 minutes



    • (D)Warm-up throwing



    • (E)45 feet (25 throws)



    • Step 2:



    • (A)Warm-up throwing



    • (B)45 feet (25 throws)



    • (C)Rest 5–10 minutes



    • (D)Warm-up throwing



    • (E)45 feet (25 throws)



    • (F)Rest 5–10 minutes



    • (G)Warm-up throwing



    • (H)45 feet (25 throws)




  • 60-Foot Phase




    • Step 3:



    • (A)Warm-up throwing



    • (B)60 feet (25 throws)



    • (C)Rest 5–10 minutes



    • (D)Warm-up throwing



    • (E)60 feet (25 throws)



    • Step 4:



    • (A)Warm-up throwing



    • (B)60 feet (25 throws)



    • (C)Rest 5–10 minutes



    • (D)Warm-up throwing



    • (E)60 feet (25 throws)



    • (F)Rest 5–10 minutes



    • (G)Warm-up throwing



    • (H)60 feet (25 throws)




  • 90-Foot Phase




    • Step 5:



    • (A)Warm-up throwing



    • (B)90 feet (25 throws)



    • (C)Rest 5–10 minutes



    • (D)Warm-up throwing



    • (E)90 feet (25 throws)



    • Step 6:



    • (A)Warm-up throwing



    • (B)90 feet (25 throws)



    • (C)Rest 5–10 minutes



    • (D)Warm-up throwing



    • (E)90 feet (25 throws)



    • (F)Rest 5–10 minutes



    • (G)Warm-up throwing



    • (H)90 feet (25 throws)




  • 120-Foot Phase




    • Step 7:



    • (A)Warm-up throwing



    • (B)120 feet (25 throws)



    • (C)Rest 5–10 minutes



    • (D)Warm-up throwing



    • (E)120 feet (25 throws)



    • Step 8:



    • (A)Warm-up throwing



    • (B)120 feet (25 throws)



    • (C)Rest 5–10 minutes



    • (D)Warm-up throwing



    • (E)120 feet (25 throws)



    • (F)Rest 5–10 minutes



    • (G)Warm-up throwing



    • (H)120 feet (25 throws)




  • 150-Foot Phase




    • Step 9:



    • (A)Warm-up throwing



    • (B)150 feet (25 throws)



    • (C)Rest 5–10 minutes



    • (D)Warm-up throwing



    • (E)150 feet (25 throws)



    • Step 10:



    • (A)Warm-up throwing



    • (B)150 feet (25 throws)



    • (C)Rest 5–10 minutes



    • (D)Warm-up throwing



    • (E)150 feet (25 throws)



    • (F)Rest 5–10 minutes



    • (G)Warm-up throwing



    • (H)150 feet (25 throws)




  • 180-Foot Phase




    • Step 11:



    • (A)Warm-up throwing



    • (B)180 feet (25 throws)



    • (C)Rest 5–10 minutes



    • (D)Warm-up throwing



    • (E)180 feet (25 throws)



    • Step 12:



    • (A)Warm-up throwing



    • (B)180 feet (25 throws)



    • (C)Rest 5–10 minutes



    • (D)Warm-up throwing



    • (E)180 feet (25 throws)



    • (F)Rest 5–10 minutes



    • (G)Warm-up throwing



    • (H)180 feet (25 throws)



    • Step 13:



    • (A)Warm-up throwing



    • (B)180 feet (25 throws)



    • (C)Rest 5–10 minutes



    • (D)Warm-up throwing



    • (E)180 feet (25 throws)



    • Step 14:



    • Begin throwing off the mound or return to the respective position




  • Flat Ground Throwing




    • (A)Warm-up throwing



    • (B)Throw 60 feet (10–15 throws)



    • (C)Throw 90 feet (10 throws)



    • (D)Throw 120 feet (10 throws)



    • (E)Throw 60 feet (flat ground) using pitching mechanics (20–30 throws)




  • Flat Throwing




    • (A)Warm-up throwing



    • (B)Throw 60 feet (10–15 throws)



    • (C)Throw 90 feet (10 throws)



    • (D)Throw 120 feet (10 throws)



    • (E)Throw 60 feet (flat ground) using pitching mechanics (23–30 throws)



    • (F)Throw 60–90 feet (10–15 throws)



    • (G)Throw 60 feet (flat ground) using pitching mechanics (20 throws)




Batting


Depending on the type of injury that the athlete has, the time to return to batting should be determined by the physician. It should be noted that the stress placed on the arm and shoulder in the batting motion is very different from the stress placed on them in the throwing motion. Return to unrestricted use of the bat should also follow the same progression guidelines as seen in the training program. Begin with dry swings and progress to hitting off a tee, then soft toss, and finally live pitching.


Summary


By using the ITP in conjunction with a structured rehabilitation program, the athlete should be able to return to full competition status with the chance of reinjury minimized. The program and its progression should be modified to meet the specific needs of each individual athlete. A comprehensive program consisting of a maintenance strength and flexibility program, appropriate warm-up and cool-down procedures, proper pitching mechanics, and progressive throwing and batting will assist the baseball player in returning safely to competition.

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Apr 13, 2019 | Posted by in PHYSICAL MEDICINE & REHABILITATION | Comments Off on Interval Rehabilitation Programs
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