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2 Key Subscapularis Arm Care Exercises for Baseball Players

The subscapularis is a muscle that is often neglected when talking about arm care exercises for baseball players.

The subscapularis is a rotator cuff muscle that attaches from the inside of your shoulder blade/scapula and wraps underneath to the front part of your shoulder. It can be placed at a mechanical disadvantage with poor mechanics.

 

It contracts to protect your shoulder from excessive external rotation (layback) late in the throwing motion. There are also larger muscles that contribute to the velocity of the throw that are involved to provide stability (pectoralis major and the latissimus dorsi) in this layback position.

If the shoulder isn’t trained specific to the movement pattern, type of contraction, and position the arm needs to be in to accept these forces, you’re leaving yourself open to injury.

I often see exercises done by throwing athletes with bands or tubing that are nonspecific and do not prepare the shoulder for the forces that are placed on it during maximal external rotation.

Performing any tubing or band exercise does have a potentially positive effect for any throwing athlete, but there are simple things and pivotal positions that athletes should include that can make exercises for the rotator cuff so much better.

The rotator cuff’s primary role is to keep the humerus centered in the socket, resist distraction, and contribute to the ligamentous stability of the glenohumeral joint to prevent excessive anterior and posterior translation of the humeral head.

If the shoulder moves too much in the socket during the throwing motion in either direction that can contribute to instability and injury.

Knowing what a muscle’s role is in the throwing motion and what types of contractions it goes through should be the guiding principle in which exercises are chosen and how they’re performed. There is an extremely delicate balance that must be maintained when training a rotator cuff.

These factors are often overlooked and not included in most arm care routines and training regimens, even in professional baseball. My personal experience in professional baseball with injury, anterior subluxation requiring surgical correction, incomplete recovery, and 17 years of clinical experience working with throwing athletes has forced me to evaluate the effectiveness of rotator cuff exercises.

The posterior rotator cuff is often the prominent focus of in therapy for shoulder athletes, and rightfully so. But the subscapularis is a pivotal muscle for the throwing athlete but it is often neglected in therapy and training situations.

Below are two joint and contraction specific subscapularis exercises that we utilize and often include in our throwers’ corrective exercise programs. These videos give great detail as to the “why” behind certain exercises are chosen.

 

 

If you want to have a long-playing career, or even a healthy throwing season, you should implement these 2 exercises into your arm care routine and be sure to focus on your subscapularis.

Safe Implementation of a Baseball Interval Throwing Program

Whether it be a pitcher or outfielder rehabbing from shoulder or elbow surgery or injury, no greater sense of joy and excitement overwhelms them than the first day they can throw a baseball.

For some, it is the highlight of last three to four months of hard work, dedication and determination to return to the sport they love and have grown up playing. For others, especially rehabilitation specialists such as physical therapists and athletic trainers, it can be the scariest.

The first time our throwers start throwing, we always have that one question in the back of our mind…will they reinjure themselves?

Although, we would never return someone to throwing without physician clearance, a satisfactory clinical exam, a battery of plyometric testing and proper screening of pitching mechanics, the possibility of re-injury exists.

Before you start the throwing program that has been prescribed, it is important to consider some key components for the program to be properly executed.

Lastly, effective education and communication must be approached for a thrower to fully return to a competitive state.

Key Components to Address Before Starting A Throwing Program

Over the last few years with adolescent baseball injuries on the rise, there have been many throwing programs available for free on the internet developed by baseball coaches and rehabilitation specialists on how to return to throwing following an injury or surgery.

This can be concerning since key variables and questions may not be addressed in these programs. It is critical to analyze the who, what, when, where, why, and how.

Common Questions About Interval Throwing Programs

The Who, What, and When

  • Who should I be throwing with?
  • What types of pitches should I throw? Are my mechanics okay?
  • How do I monitor my mechanics changes?
  • How many days a week should I throw?
  • How many days should I rest?

The Where, Why, and How

  • How far should I throw?
  • How hard should I throw?
  • How am I going to monitor my velocity?
  • Should I throw from the mound or flat ground?
  • Can I complete multiple sets in one day?
  • Should I throw on a line, crow hop or arc my throws?
  • If I experience pain, what should I do? Continue or stop?

These key components all need to be addressed because implementing a throwing program without proper supervision and knowledge of that program can be doing more harm than good.

If you do not know the answers to ANY of those questions, you need to ask!  Your doctor and rehabilitation specialist should be able to answer those questions and customized their answer to your unique injury and situation.

For those of us who work in the clinic, we wish we could go outside and throw with our throwers. However, that is not always practical due to limited space, time management with other patients and lastly, insurance.

As rehab specialists, we hope to keep our throwers to the very last day of their rehab. However, insurance does not always allow this due to a limited number of patient visits.

In these cases, what do we do? There have been many times where throwers have been given throwing programs with no direction or insight on how to initiate or complete the program.

Interval throwing programs are an essential part, if not the most important part of the rehabilitation process and should not be overlooked by any means.

It’s what allows us to find out if our throwers are ready for advancement in rehab or if they can return to sport.

Would we allow an ACL patient to initiate running without proper supervision or guidance? How about a soccer player with a sprained ankle? Would we allow them to initiate agility training without first assessing isolated linear and lateral movements?

We know that return to play outcomes are much higher in ACL patient’s when supervised rehabilitation occurs. Why are we not doing the same for our throwers?

These questions must be addressed and the interval throwing program must be supervised at all times.

Players must be monitored so that velocity, volume, mechanics and pain can all be addressed if the thrower has questions, concerns or incidents arise during the program.

Ways to Safely Implement an Interval Throwing Program

The best way to make sure that all of this occurs is through education and communication.

We need to sit down with our throwers and their parents/guardians to educate and direct them on the throwing program itself, how to initiate it and what to do if they have questions or concerns.

The more detail and direction we can provide will ultimately lead to our goal of a safe return and their goal of returning to baseball.

We also need to make sure that there is always an open line of communication between our throwers, their parents/guardians (if the thrower is an adolescent) and the rehab specialist.

Our athletes must know that they can contact us any time if questions or concerns come up so that we can properly guide and educate them through the process. Injuries take a toll on our throwers not only physically, but emotionally and psychologically.

Telling a baseball player that he or she cannot throw can be one of the most disappointing things they could hear.

It is our job to make sure that we provide the highest quality of care to get them back to throwing quickly but most importantly, safely.

The last thing that we would ever want to happen is to have one of our throwers reinjure themselves due to something so simple such as improper guidance, which could have easily been prevented through proper education and communication.

The interval throwing program is something that must never be overlooked or taken lightly. It is such an important part of the rehab process that allows throwers to stress the surgically repaired or injured tissue in a safe and controlled manner.

It also allows our throwers to become more confident as they move throughout the throwing program and their overall rehab.

Most importantly, it gives us the objective information that we have been waiting to find out for the last few months which is, are they ready to return?

Before starting an Interval Throwing Program, it is important to consider the key components of that throwing program by analyzing the who, what, where, when, why, and how. Lastly, effective education and communication can go a long way for the athlete.

Evidence-Based Inseason Arm Care for Baseball Players

Recently the American Sports Medicine Institute published some fantastic research identifying specific changes in pitchers that may increase risk of an arm injury during the baseball season.

The most important changes have been linked to range of motion in the throwing arm.  At our facility, we identify three changes in measurement as red flags while in season: decreased shoulder flexion, decreased shoulder internal rotation and increasing shoulder external rotation.

We have adopted specific mobility and stability exercises as part of an arm care system that draws heavily on this research.  I will outline how we progress through our most common exercises that drives the best results for players.

 

How to Prevent Loss of Shoulder Flexion

Pitchers will acquire a heavy workload on the lats and low back muscles during the year, especially at the start of the baseball season.  Stiffness in these muscles will contribute to loss of shoulder flexion and the ability to fully reach overhead.

We have players start with lat soft tissue mobilization for 1-2 sets of 10, and then follow with lat isometric liftoffs for 1 set of 5 for 5 second holds.

 

How to Prevent Loss of Shoulder Internal Rotation

More people are now familiar with the concept of pitchers losing shoulder internal rotation from throwing.

This can happen for a variety of reasons, including chronic bony changes in mature throwers over time, and acute changes to the rotator cuff and trunk muscles in pitchers during the season.

This article will not detail the total motion concept, and if you are unfamiliar I would urge you to read articles by ASMI that are readily available online.  Mike Reinold has an excellent article about GIRD and loss of internal rotation in baseball players.

We mandate that all players at our facility have a plan for pre- and post-throwing to prevent negative long-term changes in shoulder range of motion.  Here you will see how we target the posterior shoulder to accomplish this.

We have players start with posterior shoulder mobilization for 1-2 sets of 10, and then follow with the cross-body rotation stretch for 1 set of 10.

How to Prevent Excessive Increase of Shoulder External Rotation

Rapid increases in shoulder external rotation have been linked with increased risk of injury in throwers.  This change in external rotation is also correlated with throwing harder, so we should not be surprised by the link between the two.  So how can we encourage our athletes to throw hard while reducing injury risk?

We use data from a recent ASMI weighted ball study that demonstrated an increase of more than 5 degrees of shoulder external rotation during a throwing program is correlated with a risk of arm injury.

Motor control of end-range external rotation and trunk position often decreases with workload and fatigue in our experience.  As a result, we prescribe two of the following exercises to maintain motor control in the layback phase of throwing.

We have players start with half kneeling cuff stabilization for 2-3 sets of 3 for 5 second holds, and then follow with external rotation oscillations for 2-3 sets of 15.

The cuff stabilization drill allows the coach or clinician to progressively load the shoulder based on feel and comfort for each player.

There seems to be a gap in the baseball world between recommendations from research and real-world implementation with players.  I hope this article will provide some ideas for fitness and medical providers to connect the dots and help reduce the epidemic of arm injuries currently plaguing baseball!

Combining Strength Training And Throwing Programs For Baseball Pitchers

The increases in pitching velocity and the distance guys are covering when they go yard tells one thing for sure… Guys are getting in the gym and getting bigger, faster and stronger. Period.

That’s great. As a matter of fact, nothing could make me happier as a strength and conditioning coach. But let it be said, with training comes a responsibility on educating athletes as to how and when is the best way and time to incorporate it.

This gets especially tricky when it needs to be integrated with a throwing program. A great program should incorporate throwing and strength training as ONE program and not viewed as two separate entities. Let me try and briefly explain why one hand washes the other.

When an athlete lifts, he is spending valuable energy that he must pay back via recovery before going at it again the next time. Much like paying back a debt.

As we get closer to the season and throwing is introduced alongside lifting, overall training volume is increased and the amount of debt to payback is doubled. Stack up enough debt, and both an athlete’s recovery and performance will tank.

Any strength training program that’s combined with pitching / throwing needs to be highly coordinated to be effective.

This is the first thing we need to understand when we start putting together a strength and throwing program. As each athlete’s size, strength and other characteristics differ, so must the overall program. We break this down into three parts:

  • Physical Preparation
  • Skill Preparation
  • Periodization

Let’s look at these three separately…

Physical Preparation

This is strength, mobility and power. This is where a lot of guys miss the boat.

These goals will likely create the greatest initial performance improvements as well as lay down a “grass roots” foundation of strength and mobility for the future when training protocols get more advanced. It also goes a long way in helping to reduce the risk of injury.

An example of this would be a 6’2” high school junior weighing 165 lbs. with a less than average strength numbers in the weight room.

For this athlete, playing fall ball and spending that much-needed energy on the weekends pitching becomes not only counterproductive to his physical preparation strength-wise, but adds extra and unnecessary mileage on the arm.

Getting in the weight room earlier (September / October) to work on some hypertrophy prior to starting a strength phase in November / December should be the priority and just what the doctor ordered.

Skill Preparation

Video Analysis and Mechanical Remapping

The use of video analysis helps us break down mechanics, not only from a bio-mechanical standpoint but also from a sequencing and delivery view point. From there, we can better prepare a set of individualized throwing correctives into the throwing program.

Timeline and Throwing Sessions

I am not going to get into the specifics of the timeline too much here, but during a four-month off-season program there should an ample shutdown period which would allow for a heavier lifting schedule. Here is a summary timeline from November – February:

Frankly, I think it’s a must that pitchers throw 2x per week in preparation for the spring. Throwing 1x per week does not allow the connective tissue of the arm to develop the resiliency necessary to resist the demands of a high-level throw.

 

Pitch Design and Development

We have had a Rapsodo baseball camera in-house for a while and it has changed how we evaluate certain aspects of pitching. We are discovering things about pitchers that were unfathomable just a year ago without this technology.

You can use the information from a Rapsodo in a long-term development plan with pitchers in ways unheard of even a few years back, both for improving their existing repertoire and also in new pitch design and development. Here is a typical screenshot from the device:

While strength training should never be out of the equation for this athlete, it should share the spotlight with more sport-specific work such as correcting mechanical issues, addressing his mobility and increasing force production through plyometric training.

Periodization

Let me start by saying this. Both types of athletes need to spend time in the weight room and working on throwing movements and skills throughout the off-season.

However, each athlete simply needs to spend the bigger part of his time on what he needs the most to optimize performance. This is all about individualized programs and customization.

A complete initial physical assessment and throwing evaluation will give us the roadmap and help us make the best use of the time spent with our athletes.

On a final note, please make sure you’re getting a thorough assessment to determine where you fall on the physical / skill preparation profile. Your off-season program should be designed with this in mind and most importantly make sure it’s performed by a highly qualified PT/strength and conditioning coach or AT with a great track record.

See ya’ in the gym…

 

 

Total Motion Release: A New Warm-Up Approach

There is no surprise that baseball is a very one-sided sport. Due to this one-sidedness, baseball athletes present an adaptive muscular tightness and weakness in their throwing shoulder from repetition after repetition.

There is also no surprise that one of the most common techniques to improve joint range of motion and structural alignment is through static stretching. Contrary to popular belief, it may not affect throwing velocity.

Static stretching may be a good tool to pull from the tool box, but it may not have the greatest carry over since throwing a baseball is a dynamic activity.

However, what might surprise you is that there is a new method being used called Total Motion Release (TMR).

The TMR system assesses the body as a unified symphony of joints, like the Functional Movement Screen (FMS), to determine pain or dysfunction in one area that is affected by movements that take place elsewhere in the body.

The TMR system has six different movements to assess dysfunction and asymmetry. In this present study, the researchers only used the Standing Trunk Twist and Standing Arm Raise.

The TMR system was compared to a general dynamic warm up to determine which method was superior in increasing total range of motion in the throwing shoulder.

All 20 subjects performed both the TMR and dynamic warm up. However, in the cross-over design of the study, one group performed the TMR following the dynamic warm up and vice versa.

The results of the study showed that the TMR system significantly improved total range of motion in the throwing shoulder when compared to the general dynamic warm up.

The results also showed that there was also a time effect. Those who performed the TMR following the dynamic warm up significantly improved total joint range of motion when compared to the group who performed the TMR first.

A general dynamic warm up is important for increasing blood flow, tissue extensibility, and neuromuscular communication. To get the biggest bang for your buck, perform your dynamic warm up first, and then follow it up with using controlled movements from the TMR system.

Future research is needed to determine the retention rate of the range of motion improvements following the TMR system.

For example, between innings, 6-hours post pitching, 12-hours post pitching, 24-hours post pitching, as well as its effects on athletic performance such as throwing velocity, total innings pitched, etc.

Comparing the immediate effects of a total motion release warm-up and dynamic warm-up protocol on the dominant shoulder in baseball athletes.

A decrease in total range of motion (ROM) of the dominant shoulder may predispose baseball athletes to increased shoulder injury risk; the most effective technique for improving ROM is unknown. The purpose of this study was to compare the immediate effects of Total Motion Release® (TMR®) to a generic dynamic warm-up program in baseball athletes. Baseball athletes (n=20) were randomly assigned to an intervention group: TMR® group (TMRG; n=10) or traditional warm-up group (TWG; n=10). Shoulder ROM measurements were recorded for internal (IR) and external (ER) rotation, the intervention was applied, and post- measurements were recorded. Each group then received the other intervention and post- measurements were again recorded. The time main effect (p ≤ .001) and the time x group interaction effect were significant (p ≤ .001) for IR and ER. Post hoc analysis revealed TMR® produced significant increases in mean IR (p ≤ .005, d = 1.52) and ER (p ≤ .018, d = 1.22) of the dominant shoulder initially. When groups crossed-over, the TMRG experienced a decrease in mean IR and ER following the dynamic warm-up, while the TWG experienced a significant increase in mean IR (p ≤ .001, d = 3.08) and ER (p ≤ .001, d = 2.56) following TMR® intervention. TMR® increased IR and ER of the dominant shoulder more than a dynamic warm-up. Dynamic warm-up following TMR® also resulted in decreased IR and ER; however, TMR® following dynamic warm-up significantly improved IR and ER. Based on these results, TMR® is more effective than a generic dynamic warm-up for improving dominant shoulder ROM in baseball players.

Push Off Ground Reaction Force and Ball Speed in High School Pitchers

Many pitching coaches teach young players to either stay “tall and fall” or push as hard off the mound as they can when delivering a pitch to home plate. Is one method more optimal than the other?

If you want to throw hard, you must be able to produce force into the ground that will propel you in a forward direction towards home plate. The linear momentum that is created contributes to rotation of the trunk before ball release.

These movement sequences have been studied before in college-aged pitchers, and previous research has shown that college pitchers threw hardest when producing a high amount of force into the mound.

However, these same sequences have not been studied in the high school population.

A recent study looked at the role of push off and ground reaction force during the throwing motion on throwing velocity in high school aged pitchers.

Of the 52 pitchers that were analyzed, the results showed a significant relationship between ball speed and ground reaction force.

During the push off, horizontal ground reaction force reached around half the body weight of the player, which previous research has shown greater metrics in collegiate pitchers. While there was a statistically significant correlation between push off force and ball speed, it was weakly correlated.

These results tell us that high school aged pitchers are not utilizing their lower half when producing a pitch to home plate.

While the weak relationship may be due to poor hip musculature and general strength, poor motor control of the trunk, and lack of movement awareness, it may also indicate that while push off force is important, factors such as height, weight, and physical maturity are more important for high school aged pitchers.

According to the researchers, peak rotation velocity of the pelvis must be achieved prior to peak rotation of the trunk.

As a rule of thumb, if you want to throw hard and be successful on the mound, focus on these key variables:

  1. Get stronger in the weight room, and train to use this strength in a powerful manner
  2. Work on push off force and momentum when throwing your bullpens
  3. Include dynamic exercises that highlight the coordination between the trunk and pelvis

 

 

The relationship between the push off ground reaction force and ball speed in high school aged pitchers.

Baseball pitching is a sequential movement that requires transfer of momentum from the lower extremity to the throwing arm. Therefore, the ground reaction force (GRF) during push off is suggested to play a role in production of ball speed. The purpose of this study was to investigate the correlation between GRF characteristics during push off and ball speed in high school baseball pitchers. A total of 52 pitchers performed fast pitches from an indoor pitching mound. A force plate embedded in an indoor mound was used to capture the push off GRF. The GRF characteristics (peak anterior, vertical, and resultant forces, vertical and resultant forces at the time of peak anterior GRF, and impulse produced by the anterior GRF) from the three fastest strike pitches from each pitcher were used for analyses. Spearman’s rank correlation coefficients were used to describe the relationships between ball speed and the GRF characteristics. Ball speed was only weakly correlated with peak resultant force (r=.32, p=.02), and vertical (r=.45, p<.001) and resultant (r=.42, p=.002) forces at the time of peak anterior force. The ball speed was not correlated with other variables. The correlation between ball speed and push off force in high school pitchers was weak, especially when compared to what was reported for adult pitchers in other studies. Unlike for adult pitchers, higher push off force is only weakly correlated with ball velocity in high school pitchers, which suggests that training to better utilize body momentum may help high school pitchers improve ball speed.