The Throwing Athlete

Authors

Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Baseball pitching

Youth Throwing athlete

• The Youth Throwers Ten Exercise Program: A variation of an exercise series for enhanced dynamic shoulder control in the youth overhead throwing athlete¹
  • I have heard negative things about the “thrower’s ten” and how it is too general and basic from Nick Perkins²
• Physical examination of the thrower’s elbow³

Injuries

Most injuries occur at max IR position (from MSK2)

Considerations

Kinetic chain contributions

• Ground leg, hips, trunk are force generators
  • 50-54% of force and kinetic energy
• Shoulder is a funnel and force regulator
• Arm is a force delivery mechanism
• 20% dec in kinetic energy delivered from the hip and trunk necessitates a 34% inc in rotational velocity at the shoulder to deliver the same amt of resultant force to the hand

Stable base/regional interdependence

• Scap base and biomechanics
  • Example: protraction → negatiev effects
• RTC lose length tension relationship
• Lose force generation capacity and stability aspect
• Mid trap, rhomboids, low trap, serratus– altered length tension relationship too in protraction

What is normal AROM

• “Normal” might be >180°
• Someone like a gymnast may require 190° to perform their sport. By not helping them reach this ROM, you may be putting them at risk

Other breakdowns in the kinetic chain?

• Core weakness/control deficits?
  • Greater shoulder dysfunction is correlated with greater stability deficiency (hazar et al 2014)
• LE deficits
  • Limitations to hip flexion and Ir at 90 of hip flexion were risk factors for elbow injury
  • Altered hip Rotational rom has effect on amount of ER torqueue and horiz add ROM

Important Assessments

Mobility

• Even 5° GIRD = increased risk for injury and subsequent shoulder surgery
  • GIRD Criteria: total of 180° of shoulder ROM (ER + IR = 180°)
  • ER : IR ratio we would love to see 2:3 (he said even a 3:4 would be good)
  • ER will never match the IR strength, but needed to help w deceleration load

Strength, power and endurance

• Normative data (athlete) - ER/IR ratio 72-76%, ER torque to body weight ratio of 19-23% , IR torque to body weight ratio of 26=32% , bilateral comparison of ER 95-100% and bilateral comparison of IR 100-115%
• Scap dyskinesia and dysfunction = reduced shoulder strength

LE, core and stability assessments

• Patient with UCL tears demonstrated dec’d performance for stance and lead lower extremities during the Y balance test

Predictors of Throwing ability

• Best predictor: Modified pullup (Inverse row)^{negreteCanUpperExtremity2011?}
• 2nd best predictor: Pushups in 15 sec^{negreteCanUpperExtremity2011?}

Performance Training

• Medicine ball plyometric training increased throwing velocity (McEvoy & Newton 1993)
• Improvements of isolated shoulder power of internal rotators measured with isokinetics and improvement in throwing performance tests (Fortun et al 1990)

References

1.

Wilk KE, Lupowitz LG, Arrigo CA. The Youth Throwers Ten Exercise Program: A variation of an exercise series for enhanced dynamic shoulder control in the youth overhead throwing athlete. International Journal of Sports Physical Therapy. 2021;16(6):1387-1395. doi:10.26603/001c.29923

2.

Perkins N. Stretch Affect Clinical Internship. Published online 10-14-24.

3.

Andrews JR, Wilk KE, Satterwhite YE, Tedder JL. Physical examination of the thrower’s elbow. The Journal of Orthopaedic and Sports Physical Therapy. 1993;17(6):296-304. doi:10.2519/jospt.1993.17.6.296