In part one of this two-part series, I wrote about the flaws I see with the interval throwing program. This next post will go over our system of rehabbing post-operative athletes after surgery.
In an ideal situation, following surgery athletes will go see Jon Herting, Ray Carr, and Nick Perugini over at Precision Performance, our in-house physical therapy practice. They will handle their physical therapy during the first four months and any subsequent treatment needed throughout the rehab process.
Next, after getting cleared for increased activity by the doctor, Rob Rabena, head of Sports Performance, will start the athlete on a workout program to get them back in shape and ready to handle throwing.
The physical therapists, Rob, and I will meet regularly to discuss the athlete’s current state and progress made. Before the athlete starts throwing, I’ll meet with him and outline his entire program—explaining what each phase entails and how the program will progress. We’ll discuss in detail the reasoning behind my programming, and I’ll answer any questions that he has.
Now it’s time to get into the fun stuff: throwing. The rest of this post will be dedicated to explaining our system for throwing rehab: utilization of technology, progression of the throwing motion, and how we increase and monitor training load. Note, the progressions of throwing phases that I’ll outline are similar to Driveline’s system outlined here. Through reviewing their process, evaluating existing literature, and applying some common-sense practices, I’ve developed my own system.
Utilization of Technology
Before the athlete begins throwing, he will be fitted for a Motus sleeve. Motus allows us to track workload, elbow torque, arm speed, arm slot, and shoulder rotation. Having access to this data gives us more information when progressing and making changes to programs. Elbow torque, arm speed, and shoulder rotation should increase as the athlete reacclimates to throwing; if large increases occur from one day to the next, we may make alterations to the program.
In addition to being tracked on Motus, all throws are made in front of a radar gun. In the previous post, I outlined why this method is more effective: using velocity is superior to using distance or RPE to measure intensity. On top of that, athletes don’t apply elbow torque at the same rate that they increase throwing intensity. Simply put, the radar gun provides objective feedback.
Besides providing superior feedback, the radar gun lays the foundation for progressing the throwing program. As a reminder, training load = volume x intensity. In order to gradually increase training load, I’ll either increase volume and hold intensity constant, or hold volume and increase intensity. From a programming perspective, the radar gun gives me a ceiling to set for the athlete. From the athlete’s perspective, he now has daily, achievable goals to strive for every time he throws. The psychological impact of this is substantial – break down the long and arduous rehab process into daily and weekly goals that instill self-efficacy and drive program adherence.
Regressing the Throwing Motion
In the previous post, I discussed how I believe using the crow-hop method from the onset of a throwing program is far too aggressive. Now, I’ll talk about how we initially regress the throwing motion throughout a rehab program. First, let’s cover the principles. In order to regress the throwing motion, we first have to find the most complex form of the move, which could be either pitching off a mound OR running crow-hop (pull down) throwing. Both involve sequencing the legs, hips, torso, and arm at high speeds to deliver force through a baseball. I view each segment as an added layer of complexity to the delivery. So, to regress the delivery, simply remove a segment from the equation.
How does this manifest into exercises for the athlete? By taking away the legs and hips, we can isolate the fastest parts of the sequence: the torso and arm. This allows us to focus on developing the arm action first, then adding complexity as the athlete progresses. As an aside, I currently do not isolate the torso from the arm in this equation, as torso rotation is a necessity to drive proper arm acceleration in the throw. Below is a description of the current system of progressions I use.
Half-kneeling throws: in order to slow down rotational velocities and subsequent forces being delivered to the arm, athletes will start in a half-kneeling stance. The athlete will start with the torso counter rotated and the arm in the high cock position. Then, to initiate the throw, the athlete will retract his non-dominant scapula and rotate his trunk.
Pivot pickoffs: torso counter rotates and glove side scapula retracts to initiate layback in the throwing arm. Torso continues to rotate as the ball is being delivered.
Separation throws: hips open, torso closed, athlete takes a small step and throws.
Roll-ins: hips open, torso closed, athlete walks in to the position he learned in the separation throws.
After roll-ins progression can be dictated by the athlete’s needs. The next progressions add the legs without restriction, so whatever mechanical adaptations needed for lower half should be addressed at this time through the proper exercises. After this, the sole emphasis is to progress throwing intensity and volume methodically.
Throwing Phases
Phase 1: Force acceptance and rotator cuff strengthening
As the athlete transitions out of physical therapy to the throwing floor, we’ll begin by introducing a few exercises that are largely an extension of the physical therapy they’ve been receiving. These exercises will include PlyoCare Rebounders and PlyoCare Reverse Throws, several eccentric rotator cuff exercises, and several elbow and shoulder stability exercises. While there is no forward throwing in this phase, it lays the foundation for two key facets: one, it allows us to build a relationship with the athlete before he starts throwing – where’s he at mentally, how fast does he work, interests outside baseball, etc. Two, we are able to get the athlete onto the throwing floor so he can get out of the rehab environment/mindset and start to envision a return to more intense training.
Phase 2: Overload PlyoCare throwing
In the first throwing phase, athletes will use Driveline’s PlyoCare balls. These are soft-shelled weighted balls that range from 100g (3.5oz) to 2000g (70.5oz). Athletes will start by throwing the blue (450g, 15.9oz) and the red (225g, 7.9oz) PlyoCare balls. The use of overweight balls allows us to stress the arm at lower peak speeds and increased time under tension through the throwing motion. Every throw is monitored via radar gun, and velocities are recorded daily. As the athlete progresses, we will add in the yellow (150g, 5.3oz) PlyoCare ball and more dynamic drills.
Phase 3: Weighted ball implementation
Next, the athlete will begin throwing the 7oz, 6oz, and 5oz baseballs. Throws will continue to be monitored via radar gun. Instead of throwing to a partner, throws will initially be made into a net or wall. The main reason the athlete still isn’t playing catch stems from my view on attentional capacity. For example, on any throw, let’s say an athlete has 100 units of attention to spend on executing the throw. At this point in the program, the athlete spends 60 units on throwing velocity and 40 units on throwing form. However, when we add a partner who serves as a target, now a portion of those 100 attentional units must be diverted to accuracy. Now the athlete spends 45 units on velocity, 25 on form, and 30 on accuracy. After a week or two, depending on the athlete, normal catch play will commence, but higher effort throws will be made into a net.
Phase 4: Max intent throwing
At this point in the rehab process the athlete should be throwing at high intent levels with both the PlyoCare balls and the weighted baseballs. Depending on the athlete, the next progression in the program will be max effort pulldowns or pitching off the mound. ASMI’s research indicates that stress on the mound is similar to stress on a pulldown, so this is why either method can be used in this phase. The amount of time an athlete has before his next competitive season will largely dictate how this phase is attacked.
Wrap-up
Through these last two posts, I hope is is clear that there is a need to change the rehab process. At MSI, we have developed a system to address that need. We are able to better manage workload by using the Motus sensor, monitoring throws by velocity instead of distance, and by regressing the throwing motion in the early stages. By integrating physical therapists, performance coaches, and throwing coaches, we can create one cohesive plan that addresses the athlete’s individual needs.
If you are interested in rehabbing with us, please email me at gzirkel@maplezone.com.
Comments
Post a Comment