Rehabbing a thrower is not easy. Having a great understanding of the human body is a lot different than having knowledge of what is happening during the throwing motion. The throwing motion is very complex, but in this day and age there is an ample amount of info on it. There seems to be a large gap in some of the baseball medical community and their knowledge of the throwing motion. We need to be better as a whole to create better return to throw protocols and provide better value for our players.
We first need to realize that we do not train text books, we train over hand throwers. Every time we rehab an athlete, we need to realize that this is a case by case scenario. No two athletes are the same. There is a huge need of coaches that have the understanding of the demands of throwing and the understanding of the human body. We need to have the ability to prescribe lifts to athletes that are general pre-requisites to returning to throw. The pre-requisites are in no way absolutes but knowing which lifts are needed and what muscles are recruited during the lift and what their actions are in throwing motion. On the other hand, we need to have the knowledge to regress and progress lifts during rehab. There will always be set backs through the process. If we do not have the understanding of athlete’s deficiencies and why they were injured in the first place, we will never have the ability to truly rehab a thrower. Most importantly we need to realize every athlete is different and has their own deficiencies.
General pre-requisites to returning to throw for HS and Up
5 BW chin ups (increases eccentric control at lay-back)
10 proper push-ups (demonstrates core stability, upper body strength and scapular control)
Clean Body weight squat (demonstrates core and ankle stability)
Reverse Lunge body weight (Gets you in positions needed to transfer force in the throwing pattern)
Efficient throwing patterns for the athlete
I have seen very well-respected doctors and PT’s create a generic throwing program and hand it over to an athlete. There is a difference in a UCL tear and a rotator cuff injury. There is a difference between a labrum issue and an impingement. Not all throwers mechanics are the same and neither are their injuries. So, why rehab them like they are? Some PTs and surgeons are still advising throwers not to lift until they begin throwing. This is completely backwards. For example, not knowing the importance of the athlete needing to have the ability to perform multiple chin-ups before returning to throw is inexcusable in my opinion. If you claim to call yourself a baseball rehab specialist, you need to know all of the “whys, how’s and what’s” in the rehab process.
Some “whys, how’s and what’s” in the rehab (There are obviously more)
Why are we programming this exercise?
What does the scapulohumeral rhythm look like?
Why did the athlete get injured?
How is the scap working along the thorax?
Why is the athlete moving the way he is?
What are the athlete’s overhead capabilities?
Why is there a correlation between certain lifts and throwing?
What is the athletes end-range stability like?
How do we fix these issues?
Why should we fix these issues?
What are the demands of the throwing motion?
What does the athlete need? Stability? Mobility?
Why is each athlete different?
How can we get the athlete pain free?
Bridging the gap between throwing, performance and rehab is vital to get the most of out of the athlete and allow for a proper return to the field. We as a whole need to be batter at understanding what the athlete needs and the demands of the unique sport of baseball. Collectively, we can all play a big role in the direction of baseball rehab and performance.