Month: May 2019

Shoulder Health In The Overhead Athlete

This blog will focus on shoulder health in the overhead athlete, specifically baseball players. We will review all pertinent shoulder anatomy that contributes to the throwing motion in this first post.  Nick Motsinger, DPT, CSCS, will be demonstrating some very effective strengthening exercises and total body drills for these muscle groups. These exercises and drills can be incorporated into any warm-up routine or maintenance program to help reduce the risk of shoulder injuries and improve your performance this season.

The overhead throwing motion is an extremely skillful and complicated movement. When throwing a baseball, the overhead athlete places enormous demands on the shoulder complex due to the considerable forces that are generated with such a movement. In this first part of the video, all pertinent shoulder anatomy that contributes to the throwing motion will be reviewed. It is imperative that the majority of the muscles highlighted in this post be strong in order to decrease arm fatigue, and thus the risk of injury, in the overhead athlete.

The Thrower’s Ten

The Thrower’s Ten Program was developed by Kevin Wilk, DPT, and Dr. James Andrews in conjunction with a group of experts with over 100 years of combined baseball sports medicine experience. The Program highlights the best rehabilitation exercises and movements to isolate and strengthen the muscle groups that contribute to the throwing motion. The Thrower’s Ten Program has been shown to address the three most significant causes of shoulder and elbow problems in throwing:
1) decreased arm strength, 2) increased fatigue, and 3) lack of flexibility.

The Thrower’s Ten Program consists of 21 exercises in total. I will demonstrate 8 of these exercises in the first portion of the video and 9 more in the second section (I will not be demonstrating the four wrist strengthening exercises included in the Program). The Program has been designed so that it does not require a lot of equipment or even dumbbells to successfully complete. It can even be properly performed using just resistance tubing or bands. Start with 1 set of 10 reps for each exercise and go from there!
-Diagonal pattern D2 extension & Diagonal pattern D2 flexion
-External rotation at 0 deg. abduction & Internal rotation at 0 deg. abduction
-External rotation at 90 deg. abduction & Internal rotation 90 deg. abduction
-Shoulder abduction to 90 deg. & Scaption, external rotation

This second part of the video is a continuation of the first portion of the video which highlighted the first 8 exercises of the Thrower’s Ten Program. Exercises 9-17 will be demonstrated in this portion (again, I will not be demonstrating the four wrist strengthening exercises included in the Program). Like I mentioned before, start with 1 set of 10 reps for each exercise and go from there! The Thrower’s Ten Program is a safe, simple, and effective way to help reduce the risk of shoulder injuries and improve your performance this season.
1. Sidelying external rotation
2. Prone horizontal abduction (neutral) & Prone horizontal abduction (full external rotation, 100 deg. abduction)
3. Prone rowing & Prone rowing into external rotation
4. Press-ups & Push-ups
5. Elbow flexion & Elbow extension (abduction)

This last portion in our Shoulder Health in the Overhead Athlete series will address mobility and stability concerns of the lower half and core that may prevent a consistent release point. This portion is for all you baseball pitchers out there!

Mike Reinold, DPT does a great job of highlighting some of these issues in his article, “5 Mobility Issues That May Prevent a Consistent Release Point.” If you have mobility or stability concerns in your lower half and core, your body is going to make necessary adjustments with your arm in an effort to throw a strike. This can lead to shoulder and elbow injuries that would otherwise be avoidable. In this portion, I will be demonstrating 8 exercises designed to combat five common mobility and stability faults found in the overhead athlete, specifically pitchers. These common faults are:
1. Inconsistent lead knee and trunk flexion
2. Restricted lead hip mobility
3. Restricted rear hip mobility
4. Poor rear leg stability
5. Poor core control

As with the previous exercises highlighted in this series, start with 1 set of 10 reps for each exercise and increase as tolerated.
1. Lunge onto an unstable surface (BOSU) & Trunk core control drill
2. Get into your hip drill & Posterior hip mobilization
3. Adductor foam rolling & Adductor mobilization
4. Wind-up stability at a balance point
5. Anti-extension core control drill

For questions or for more information please feel free to contact Nick Motsinger at nickm@apexpt.com

Strength and Mobility For a Pain Free Golf Season

It’s that time of year again golfers!

The snow is finally melting in town and we’re all thinking about shaking the winter rust off of our game. Several local driving ranges have opened and soon the courses will too. I’d like to offer some food for thought as we get this season going (albeit a little later than we all had hoped). Most of us here in Spokane spend five months or more without touching a club. That’s an awfully long time for our flexibility and conditioning of golf specific muscles to suffer. A recent study suggests that up to 41% of amateur golfers will experience some type of golf related injury annually. More than 1/3rd of these injuries are to the lower back, with the remainder involving primarily the upper extremity. The overwhelming majority of these injuries can be blamed on overuse, lack of flexibility and swing faults. These statistics should be a little frightening to all of us that love the game, but there is good news! Studies report that a simple warm-up done consistently can reduce injury rates by 50% or more. I’ll address 3 topics that I believe can really help reduce injuries amongst amateur golfers. We’ll discuss the importance of hip strength and mobility, thoracic spine mobility and proper warm up.

Hip Strength and Mobility:

Our hips play a critical role in the golf swing. Not only are they a huge source of our power, but dysfunction in the hips during the golf swing really increases the potential for injury to the low back. A quick overview of the hips during the golf swing: At the top of the backswing the right hip is maximally internally rotated and the left hip is externally rotated (for the right-handed player). This process reverses on the downswing where the left hip is maximally internally rotated while the right hip externally rotates. Deficits in hip mobility while shortening our turn, decrease power, increase the likelihood of swing faults and increase the potential for injury to the low back. Here’s a simple test to find out how your hip rotation measures up!

www.mytpi.com/art…/screening/the_lower_quarter_rotation_test

If you’ve tested yourself and are concerned with the results, here are some good stretches to help address both internal and external rotation of the hip:

https://www.golfchannel.com/…/dr-greg-rose-90-90-hip-stretc…

Strength in our hip stabilizers and gluts are critical. A recent study shows that low handicap players have more than 10% greater gluteal strength relative to bodyweight compared with high handicap counterparts. If your hip muscles have been neglected this offseason, here are some ideas to get you going:

Forward T/single leg RDL
Goblet squat
Bridge
Monster walk
Side plank

Thoracic Spine Mobility:

Another stubborn spot – the thoracic spine (our mid back). This area of the spine is capable of tremendous mobility and can contribute to a nice full turn in the golf swing. However, it’ also tends to become very stiff and can then be a source of limitation in our swing, creating a lot of extra stress of the low back and even the shoulders. Through a proper mobility program for the thoracic spine, we can improve our turn and decrease injury risk. Here’s a quick test you can do at home to check your thoracic rotation:

www.mytpi.com/arti…/screening/the_seated_trunk_rotation_test

Here are some simple exercises to help with motion in the thoracic spine:
Thoracic Rotation Quadruped
Foam Roller
Open Books

Proper Warm-Up:

In the last two sections, we’ve talked about the importance of the hips and thoracic spine in the golf swing. The final topic for the month of April will involve how to execute a proper warm up. Unfortunately, too many of us arrive at the course in a rush with just a few minutes before we head to the first tee. Often this leaves only enough time to hurry through a few shoddy swings and a minute or two on the practice green. Its been shown that an adequate warm-up has several benefits. First, we can decrease our injury potential by half! Second, we have the ability to create additional distance – and who doesn’t want that? A recent study shows a 2 mph bump in clubhead speed and 6-yard boost in distance off the tee just by warming up properly! Here are some ideas for a good warm up.

Try to arrive 45 minutes (at least) before your tee time. This allows you 10-15 minutes to warm up properly before hitting range balls or putting

5-minute brisk walk to increase cardiovascular output and warm up important lower body muscles. Often this could be accomplished walking from parking lot to the driving range

New data suggests dynamic stretching is more applicable for golfers so we can move away from those traditional static stretches held for 30 seconds each

Example of a dynamic warm-up:

Trunk rotations from set up position – start slow and gradually increase speed continuing for 30 seconds

Counterbalance squat – 12 reps

Side lunge – 12 reps each side

Shoulder blade retractions – pull the band apart for 30 seconds

Lunge and rotate – 6 reps each

Now would be the time to hit a few balls. Start with a dozen or so soft wedge shots progressing through short, mid and long irons finishing with just a few balls with hybrids, fairway woods, and the driver.

Most importantly – go enjoy your round!