Does anybody have a conservative return to pitch progression . Pt is a 16 y/o who came to me with instability/and posterior capusular tightness. Rehab has been going well. He is no longer in pain during normal shoulder motions. We have been doing lots of funcitonal t-band and proprioception, but we have yet to reuturn to throwing. Outside of throwing without pain what is a good outline?
The purpose of this program is to gradually increase the intensity of throwing while minimizing the chance for re-injury. Proper throwing mechanics must be maintained through the program with a regulation baseball. It is important to warm-up (15-20 throws at 30-45 feet) and stretch prior to each throwing session. Each rest is followed by a warm-up prior to harder throwing. Every throwing session should be followed by a 10-minute rest. If pain or soreness presents the stage should be stopped and then restarted the following session. Each stage should be completed without pain or soreness before continuing.
Odd Step W.U. 25 throws at X feet Rest W.U. 25 throws at X feet
Even Step W.U. 25 throws at X feet Rest W.U. 25 throws at X feet W.U. 25 throws at X feet
1 and 2. 45 feet 3 and 4. 60 feet 5 and 6. 90 feet
There are a lot of throwing progressions out there. They all basically have the same idea in mind. Mechanics are the key. Once he is good at 90 feet without pain or soreness on flat ground then he can return to the mound. Obviously there is so much more to it than just this, but it is a good basis. I have worked on more aggressive programs, but this is conservative.
before return to throwing, I often ensure they can accomplish a drop and catch program (to simulate the eccentric nature of the release portion of the throw). I start them with 2 lbs with the arm in full ext rot at 90deg abd, drop the weight forward (they are leaning forward) and then catch it, by dropping the arm into internal rotation (follow thru). Obviously the farther they drop the weight the larger the strain on the shoulder. Make sure the posterior capsule tightness is resolved before this progression.