This is an excerpt from Sport Therapy for the Shoulder With Online Video by Todd S. Ellenbecker & Kevin E. Wilk.
The interval sport return program for baseball and softball (throwing) is designed to gradually return motion and strength to (and confidence in) the throwing arm after injury or surgery by slowly progressing through graduated throwing distances. The program begins upon clearance by the athlete's physician to resume throwing and is performed under the supervision of the rehabilitation team (physician, physical therapist, and athletic trainer). The program is set up to minimize the chance of reinjury and emphasize prethrowing warm-up and stretching. In development of the interval throwing program (ITP), the following factors are considered most important:
- The act of throwing the baseball involves the transfer of energy from the feet through the legs, pelvis, and trunk and out the shoulder through the elbow and hand. Therefore, any return to throwing after injury must include attention to the entire body.
- The chance for reinjury is lessened by a graduated progression of interval throwing.
- Proper warm-up is essential.
- Most injuries occur as the result of fatigue.
- Proper throwing mechanics lessen the incidence of reinjury.
- Baseline requirements for throwing include these:
- Pain-free ROM
- Adequate muscle power
- Adequate muscle resistance to fatigue
Because of individual variability among throwing athletes, there is no set timetable for completion of the program. Most athletes, by nature, are highly competitive individuals and wish to return to competition at the earliest possible moment. While this is a necessary quality in all athletes, the proper channeling of the athlete's energies into a strictly controlled throwing program is essential to lessen the chance of reinjury during the rehabilitation process. The athlete may tend to want to increase the intensity of the throwing program. This will increase the incidence of reinjury and may greatly retard the rehabilitation process. The recommendation is to follow the program exactly, as this is the safest route to return to competition.
During the recovery process the athlete will probably experience soreness and a dull, diffuse aching sensation in the muscles and tendons. If the athlete experiences sharp pain, particularly in the joint, all throwing activity should be stopped until this pain ceases. If the pain continues, he should contact his physician.
The athlete should supplement the ITP with a high-repetition, low-weight exercise program. Strengthening should address a good balance between anterior and posterior musculature so that the shoulder will not be predisposed to injury. Special emphasis must be given to posterior rotator cuff musculature for any strengthening program. Weight training does not increase throwing velocity, but it increases the resistance of the arm to fatigue and injury. The athlete should do weight training on the same day as throwing but after the throwing has been completed; the day in between should be used for flexibility exercises and a recovery period. A weight training pattern or routine should be stressed at this point as a "maintenance program." This pattern can and should accompany the athlete into and throughout the season as a deterrent to further injury. It must be emphasized that weight training is of no benefit unless accompanied by a sound flexibility program.
The ITP is designed so that each level is achieved without pain or complications before the next level is initiated. This sets up a progression in which the athlete achieves a goal before advancing, rather than advancing according to a specific time frame. Because of this design, the ITP may be used for different levels of skills and abilities compared to those characteristic of high school to professional levels. Progression will vary from person to person throughout the ITP. As an example, one athlete may wish to use alternate days throwing with or without using weights in between; another athlete may have to throw every third or fourth day due to pain or swelling. The athlete should be reminded to listen to her body, since pain signifies when it may be necessary to slow down. Again, completion of the steps of the ITP will vary from person to person. There is no set timetable with regard to days to completion.
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