Post-Surgical Rehabilitation Protocols
- Balance and Proprioceptive Training
- Frozen Shoulder Non Op
- Interval Throwing Program
- Jump and Plyometric Training
- little league throwing program
- Off mound
- Paddle program
- Return to Running
- Shoulder 12
- Shoulder Strength Training
- Shoulder Stretches
- Shoulder Ten's
- Shoulder with Plyo
- Sports Conditioning for The Throwers
- Swimming Program
Balance and Proprioceptive Training
Balance and Proprioceptive Training Progression Frequency:
Two to Three times a week
Precautions:
Balance and proprioceptive training can place heavy loads on the kneecap, patellar tendon and knee joint surfaces. Pain at these areas during these exercises should be reported to your physical therapist. Avoid twisting the knee or pivoting at the knee over a fixed foot.
Beginning Phase 1:
1. Weight shifts as tolerated
Beginning Phase 2:
2. Single-leg (SL) standing for balance, timed 30 seconds, eyes open/closed
Beginning Phase 3:
3. Double-leg (DL) standing on unstable surface: wobble board front-back and side- side or standing on foam surface
4. Star-drill on SL, front-back and side reaches
5. Step-and load, front-back, side-side
Beginning Phase 4:
6. SL standing on unstable surface: wobble board front-back and side-side or standing on foam surface
7. DL squats on wobble board, foam, BOSU
8. SL star drill, multi-directional reaches
Beginning Phase 5:
9. SL tasks with perturbations, ball toss
10. Star drill with increasing speed, add weight or resistance, add unstable surface
Frozen Shoulder Non Op
Frozen Shoulder (Adhesive Capsulitis)
Adhesive capsulitis is commonly known as a frozen shoulder. Adhesive capsulitis has a gradual onset of decreased range of motion. Many people notice they have difficulty reaching overhead or behind their back.
Who’s at risk?
• The most common risk factor is diabetes mellitus, especially type I. Adhesive capsulitis affects approximately 10% to 20% of all diabetics.
• Affects more women than men.
• Usual onset begins between ages 30 and 65.
• Other predisposing factors include:
o A period of enforced immobility, resulting from trauma, overuse injuries or surgery
o Hyperthyroidism
o Cervical disk herniation
o Cardiovascular disease
o Clinical Depression
o Parkinson’s disease
o Breast or chest surgery
Causes of frozen shoulder
Most cases of adhesive capsulitis do not have a predisposing risk factor involved and are called idiopathic. The cause of this type of frozen shoulder is unknown, but probably involves an underlying inflammatory process. The capsule surrounding the shoulder joint thickens and contracts. This leaves less space for the upper arm bone (humerus) to move around. Frozen shoulder can also develop after prolonged immobilization because of trauma or surgery to the joint. Usually only one shoulder is affected, although in about 1/3 of cases, motion may be limited in both arms.
If a risk factor or predisposing factor is present and treatable, the underlying stiffness and pain in the shoulder will resolve with physical therapy and treatment for the underlying condition.
Stages of (idiopathic) development:
Frozen shoulder develops slowly, and in three stages.
• Stage One:“Freezing”- Pain increases with movement and is often worse at night. There is a progressive loss of motion with increasing pain. This stage lasts approximately 2-9 months.
• Stage Two: “Frozen”- Pain begins to diminish, and moving the arm is more comfortable. However, the range of motion is now much more limited, as much as 50 percent less than in the other arm. This stage may last 4-12 months.
• Stage Three: “Thawing”- The condition begins to resolve. Most patients experience a gradual restoration of motion over the next 12-42 months; surgery may be required to restore motion for approximately 5% of patients.
Treatment
Non-operative treatment includes:
• Medications to reduce the inflammation and relieve the pain
• A program of physical therapy, often combined with home exercises and other therapies to actively stretch
and help restore motion and function
• Heating or icing the shoulder
• Corticosteroid injections
Surgery is an option, but only if the pain has improved and the stiffness remains after many months of guided physical therapy. Arthroscopic surgery can successfully release and repair the shoulder, but an exercise program to maintain motion and restore function must be initiated immediately after surgery.
Shoulder Stretches
Hold each stretch for a count of 10 and repeat 10-15 times. Once a day
1. Pendulum- Lean forward and place one hand on a counter or table for support. Let your other arm hang freely at your side.Act as if a clock is on the ground Gently swing your arm forward and back (12-6 o’clock). Repeat the exercise moving your arm side-to-side (3-9 o’clock), and repeat again in a circular motion (around the clock). Perform each direction 20 times.
2. External rotation- Grasp a broom stick, golf club or cane with the unaffected arm and cup the other end of the stick with the affected arm. Keep the elbow of the shoulder you are stretching against the side of your body and push the stick horizontally as shown to the point of feeling a pull without pain. Hold for 10 count and then relax for 30 second repeating 10-15 times.
3. Sleeper Stretch- (Internal rotation)- Lie on your side on a firm, flat surface with the affected shoulder under you and your arm bent, as shown. You can place your head on a pillow for comfort, if needed. Use your unaffected arm to push your other arm down. Stop pressing down when you feel a stretch in the back of your affected shoulder. Hold this position for 10 count, then relax your arm for 30 seconds repeating 10-15 times.
4. Again with a broom stick, golf club or cane, held with and overhand grip, shoulder width apart. elevate the unaffected arm while allowing the affected arm to passively elevate until you feel a stretch in your armpit of the affected shoulder. Hold for a count of 10, then relax your arm for 30 seconds and repeat 10-15 times.
Interval Throwing Program
Interval throwing Program 1
The ‘Interval throwing Program’ is a safe program to follow if you have had a shoulder injury or a long layoff from throwing competitively.
Throwers who are returning to throwing after injury to the shoulder should follow the interval-throwing program, exactly, on an every-other-day basis.
The criteria to progress from step to step are that the throwing session was pain free and there is no residual soreness the next day.
For throwers who are free of injury, but returning to throwing after a lay-off period, follow the interval-throwing program, on an every-other-day basis, without the rest periods.
You should use the ‘crow-hop’ method for each throw when performing the interval throwing session. The ‘crow-hop’ method consists of first a hop, then a skip, followed by the throw. This method helps simulate the throwing act, allowing emphasis on total body mechanics involved in the act of throwing. The path of the ball should be an arcing trajectory, not on a flat line trajectory. You should avoid throwing flat-footed to avoid placing excess stress on the throwing shoulder in your training program.
Interval Throwing Program
Phase I: Long Toss Program
45-foot Stage
Step 1: a. Warm-up throwing
b. 45 ft. (25 throws)
c. Rest 15 minutes
d. Warm-up throwing
e. 45 ft. (25 throws)
Step 2: a. Warm-up throwing
b. 45 ft. (25 throws)
c. Rest 10 minutes
d. 45 ft. (25 throws)
e. Rest 10 minutes
f. 45 ft. (25 throws)
60-foot Stage
Step 3: a. Warm-up throwing
b. 60 ft. (25 throws)
c. Rest 10 minutes
d. Warm-up throwing
e. 60 ft. (25 throws)
Step 4: a. Warm-up throwing
b. 60 ft. (25 throws)
c. Rest 10 minutes
d. Warm-up throwing
e. 60 ft. (25 throws)
f. Rest 10 minutes
g. Warm-up throwing
h. 60 ft. (25 throws)
90-foot Stage
Step 5: a. Warm-up throwing
b. 90 ft. (25 throws)
c. Rest 15 minutes
d. Warm-up throwing
e. 90 ft. (25 throws)
Step 6: a. Warm-up throwing
b. 90 ft. (25 throws)
c. Rest 10 minutes
d. Warm-up throwing
e. 90 ft. (25 throws)
f. Rest 10 minutes
g. Warm-up throwing
h. 90 ft. (25 throws)
120-foot stage
Step 7: a. Warm up throwing
b. 120 ft. (25 throws)
c. Rest 15 minutes
d. Warm-up throwing
e. 120 ft. (25 throws)
Step 8: a. Warm-up throwing
b. 120 ft. (25 throws)
c. Rest 10 minutes
d. Warm-up throwing
e. 120 ft (25 throws)
f. Rest 10 minutes
g. Warm-up throwing
h. 120 ft. (25 throws )
150 ft. Stage
Step 9: a. Warm-up throwing
b. 150 ft. (25 throws)
c. Rest 15 minutes
d. Warm-up throwing
e. 150 ft. (25 throws)
f. Rest 10 minutes
g. Warm-up throwing
h. 150 ft. (25 throws)
Step 10: a. Warm-up throwing
b. 150 ft. (25 throws)
c. Rest 10 minutes
d. Warm-up throwing
e. 150 ft (25 throws)
f. Rest 10 minutes
g. Warm-up throwing
h. 150 ft. (25 throws)
180 ft. stage
Step 11: a. Warm-up throwing
b. 180 ft (25 throws)
c. Rest 15 minutes
d. Warm-up throwing
e. 180 ft. (25 throws)
Step 12 :a. Warm-up throwing
b. 180 ft. (25 throws)
c. Rest 10 minutes
d. Warm-up throwing
e. 180 ft. (25 throws)
f. Rest 10 minutes
g. Warm-up throwing
h. 180 ft. (25 throws)Step 13: a. Warm-up throwing
b. 180 ft. (25 throws)
c. Rest 10 minutes
d. Warm-up throwing
e. 180 ft. (25 throws)
f. Rest 10 minutes
g. Warm-up throwing
h. 180 ft. (25 throws)
Step 14: Begin throwing off the pitcher’s mound (see Interval Throwing Program, Phase II ) or return to practice at your position.
Off-season Throwing Program
Following an off-season throwing program is recommended instead of total rest during the off-season. Continuing to throw at a sub-maximum level will help you avoid the total de-conditioning of your throwing mechanics, muscle timing, and coordination.
Continue to throw at a frequency of two times a week, following the following outline:
a. Warm-up throwing
f. 45 ft. (25 throws)
g. 60 ft. (20 throws)
h. 90 ft. (15 throws)
i. 120 ft. (10 throws)
Jump and Plyometric Training
Jump and Plyometric Training Progression
Goals
1. Safely condition the knee and lower limb for the demands of jumping and landing during sports activity
2. Provide a logical sequence of progressive drills for pre-sports conditioning
3. Provide objective criteria for safe progression from training to sports participation
Phases of Training
Double-leg training Double-leg complex training Single-leg training
Recommended Frequency
2 times per week
Sequencing
Begin each training session with a warm-up routine. Perform the jumping drills listed in the appropriate phase of your rehab. Be sure to limit your total contacts (or jumps) to the suggested amount listed for each training session to prevent injury. Progress within the phase as you master each exercise, performing each jump with proper technique and without pain.
Warm-up and Stretch
Generally, you should cycle, jog or use an elliptical trainer, rower or other device for 15 to 20 minutes so that you break a sweat before starting the program. After completing the jumping drills, cool down by stretching for 15 to 20 minutes.
Criteria to Progress
Do not progress to the next step in the phase until the present step is pain free, and you can perform with proper technique and without difficulty (muscle soreness or fatigue).
Technical Essentials
Each hop or jump should be performed with concentration on good technique. Perform each jump with a ‘stick’ landing, i.e. you should land and hold your balance momentarily before proceeding to the next jump. Keep the feet apart and do not let the knees rotate inward when taking off or landing. Soften the impact by landing on the balls of the feet and land with some bend in the knees and hips.
Precautions
Do not begin jump/plyometric training without clearance from your doctor and physical therapist. Jump training places heavy loads on the kneecap, patellar tendon and knee joint surfaces. Pain at these areas during jumping exercises should be reported to your physical therapist.
Phase 1 60 foot contacts/session
Double Limb (DL) hops on mini-trampoline
DL hops on soft surface (carpeted floor, gym floor)
DL Jump rope
Suggested Final Workout:
DL hops on mini-trampoline x 30 repetitions
DL hops on soft surface x 10 reps
DL hops with jump rope x 20 reps
Phase 2 90 foot contacts/session
DL forward hop, 6-12” distance
DL side-to-side hops, 6-12” distance
DL broad jumps, 12-18” distance
DL broad jump-to-vertical jump
Jump rope, alternating single limb (SL) hops
Suggested Final Workout:
Warm-up with DL jumps on mini-tramp or jump rope x 30 reps
DL forward hop x 5 reps
DL side-to-side hops x 5 reps each side
DL broad jumps x 5 reps
DL broad jump-to-vertical x 5 reps
Jump rope, alternate SL hops x 30 reps
Phase 3 120 foot contacts/session
90° DL Jump
180° DL Jump
DL broad jump-to-vertical with 90°-180° turn
Single limb (SL) hops in place on mini-trampoline
Jump rope, double/triple SL hops, alternating feet
SL forward hop, 6-12” distance
SL side-to-side hops, 6-12” distance
Suggested Final Workout:
Warm-up with mini-tramp or jump rope with DL!SL hops x 30-60 reps
DL forward hops (x 5 reps) and side-to-side hops (x 5 reps each direction)
90° to 180° DL Jumps x 5 reps each
DL broad jump-to-vertical with 90° to 180° turn x 5 reps each
SL forward hops (x 5 reps) and side-to-side hops (x 5 reps each direction)
During this phase, drills can be advanced with exercises jumping over cones/hurdles and use of an agility ladder.
little league throwing program
Interval Throwing Program for Little League
Throwers who are returning to throwing after injury to the shoulder should follow the interval-throwing program, exactly, on an every-other-day basis.
Always warm-up and stretch before throwing. Stretch and cool down after finishing throwing. The criteria to progress from step to step are that the throwing session was pain free and there is no residual soreness the next day.
For throwers who are free of injury, but returning to throwing after a lay-off period, follow the interval-throwing program, on an every-other-day basis, without the rest periods.
You should use the ‘crow-hop’ method for each throw when performing the interval throwing session. The ‘crow-hop’ method consists of first a hop, then a skip, followed by the throw. This method helps simulate the throwing act, allowing emphasis on total body mechanics involved in the act of throwing. The path of the ball should be an arcing trajectory, not on a flat line trajectory. You should avoid throwing flat-footed to avoid placing excess stress on the throwing shoulder in your training program.
30-foot Stage
Step 1: a. Warm-up throwing
b. 30 ft. (25 throws)
c. Rest 15 minutes
d. Warm-up throwing
e. 30 ft. (25 throws)
Step 2: a.Warm-up throwing
b. 30 ft. (25 throws)
c. Rest 10 minutes
d. Warm-up throwing
e. 30 ft. (25 throws)
f. Rest 10 minutes
g. Warm-up throwing
h. 30 ft. (25 throws)
45-foot Stage
Step 1: a. Warm-up throwing
b. 45 ft. (25 throws)
c. Rest 15 minutes
d. Warm-up throwing
e. 45 ft. (25 throws)
Step 2: a. Warm-up throwing
b. 45 ft. (25 throws)
c. Rest 10 minutes
d. Warm-up throwing
e. 45 ft. (25 throws)
f. Rest 10 minutes
g. Warm-up throwing
h. 45 ft. (25 throws)
60-foot Stage
Step 3: a. Warm-up throwing
b. 60 ft. (25 throws)
c. Rest 10 minutes
d. Warm-up throwing
e. 60 ft. (25 throws))
f. Rest 10 minutes
g. Warm-up throwing
h. 60 ft. (25 throws)
Step 4: a.Warm-up throwing
b. 60 ft. (25 throws)
c. Rest 10 minutes
d. Warm-up throwing
e. 60 ft. (25 throws))
f. Rest 10 minutes
g. Warm-up throwing
h. 60 ft. (25 throws)
90-foot Stage
Step 5: a. Warm-up throwing
b. 90 ft. (25 throws)
c. Rest 15 minutes
d. Warm-up throwing
e. 90 ft. (25 throws)
Step 6: a. Warm-up throwing
b. 90 ft. (25 throws)
c. Rest 10 minutes
d. 90 ft. (25 throws)
e. Warm-up throwing
f. Rest 10 minutes
g. Warm-up throwing
h. 90 ft. (25 throws)
Off mound
Returning to Throw Off the Pitchers Mound
If you are a thrower who has been injured, or if you have had a long layoff from throwing, you should first complete the interval-throwing program before returning to the higher stress of pitching off the pitchers mound. If you have followed the off-season throwing program, or if you have successfully completed the interval-throwing program, you can now safely begin the ‘Interval Throwing Program Off the Pitchers Mound’ (Wilk and Associates, 1991).
For position players, you can usually safely return to position practice at this time. Warm up throwing before each workout should consist of 25 tosses at 45, 60, 90, and 120 feet (after general warm-up and stretch).
Interval Throwing Program: Phase II
Starting Throwing Off the Pitcher’s Mound Stage 1: Fastball Only
Step1: a. Interval throwing
b. 15 throws off mound 50%
Step 2: a. Interval throwing
b. 30 throws off mound 50%
Step 3: a. Interval throwing
b. 45 throws off mound 50%
Step 4: a. Interval throwing
b. 60 throws off mound 50%
Step 5: a. Interval throwing
b. 30 throws off mound 75%
Step 6: a. 30 throws off mound 75%
b. 45 throws off mound 50%
Step 7: a. 45 throws off mound 75%
b. 15 throws off mound 50%
Step 8: a. 60 throws off mound 75%
Stage 2: Fastball Only
Step 9: a. 45 throws off mound 75 %
b. 15 throws in Batting Practice
Step 10: a. 45 throws off mound 75%
b. 30 throws in Batting Practice
Step 11: a. 45 throw off mound 75%
b. 45 throws in Batting Practice
Stage 3:
Step 12: a. 30 throws off mound 75% warm-up
b. 15 throws off mound breaking balls
c. 45-60 throws in batting practice fastball only
Step 13: a. 30 throws off mound 75%
b. 30 breaking balls 75%
c. 30 throws in Batting Practice
Step 14: a. 30 throws off mound 75%
b. 60-90 throws in Batting Practice 25% breaking balls.
Step 15: Simulated Game progressing by 15 throws per workout. Use interval to 120 ft. phase as warm-up. All throwing off the mound should be done in the presence of the pitching coach to stress proper throwing mechanics.
Always do a full body warm up and stretch all muscle groups before throwing. Do 10 throws at each distance of 45, 60, 90 and 120 as the Interval throwing component in steps 1-5 and to warm-up before steps 6-15. Cool-down by stretching all muscle groups when finished throwing.
Paddle program
Interval Tennis Program
Tennis players who are returning to tennis after injury to the shoulder should follow the interval-tennis program, exactly, on an every-other-day basis.
The criteria to progress from step to step are that the practice session was pain free and there is no residual soreness the next day.
Warm-up and stretching exercises should be done before hitting. Stretch again after hitting and apply ice for 20 minutes.
Monday Wednesday Friday
1st week
12 FH 15 FH 15 FH
8 BH 8 BH 10 BH
rest 10 mins Rest 10 mins Rest 10 mins
13 FH 15 FH 15 FH
7 BH 7 BH 7 BH
2nd Week
25 FH 30 FH 30 FH
15 BH 20 BH 25 BH
Rest 10 mins Rest 10 mins Rest 10 mins
25 FH 30 FH 30 FH
15 BH 20 BH 15 BH
10 OH
3rd week
30 FH 30 FH 30 FH
25 BH 25 BH 30 BH
10 OH 10 OH 15 OH
Rest 10 mins Rest 10 mins Rest 10 mins
30 FH 30 FH 30 FH
25 BH 25 BH 15 OH
10 OH 10 OH Rest 10 mins
30 FH
30 BH
15 OH
FH= Forehand
BH= Backhand
OH= Overhead
4th week
30 FH 30 FH 30 FH
30 BH 30 BH 30 BH
Rest 10 mins Rest 10 mins Rest 10 mins
Play 3 Games Play 1 set Play 1.5 sets
10 FH 10 FH 10 FH
10 BH 10 BH 10 BH
5 OH 5 OH 5 OH
Return to Running
Return to Running Program
General Instructions
1. It is safe to begin the return to running program once you are able to walk 1 mile comfortably without any pain or swelling.
2. Jogging should be done no more than every other day.
3. Use other modes of exercise (bike, elliptical, swimming) for aerobic conditioning while increasing your running distance.
4. The program should be performed step by step. Do not advance your program until you can successfully complete the initial step. Let pain and swelling be your guide. If the activity creates pain, swelling, or causes you to limp, go back to the previous step.
5. Before starting the program and after completion of the program, allow 15 minutes to perform stretching exercises.
6. It is preferable to start on flat terrain, such as a treadmill or soft track, before moving to hard or uneven surfaces.
7. Ice the injured area for 20 minutes after exercise and cool-down.
Running Progression
Phase 1
Day #1 Jog 1⁄4 mile, Walk 3⁄4 mile, comfortable pace
Day #2 Jog 1⁄2 mile, Walk 1⁄2 mile, comfortable pace
Day #3 Jog 3⁄4 mile, Walk 1⁄4 mile, comfortable pace
Phase 2
Day #1 Jog 3⁄4 mile, Walk 1⁄4 mile, comfortable pace
Day #2 Jog 1 mile
Day #3 Jog 1 mile
You can continue to increase distance by 1⁄4 mile per session until you reach your desired distance. When you have reached your training distance without causing any pain or swelling, and have a normal running form, you can gradually start to increase your running speed.
Running should be limited to 3 to 4 times per week with rest days in between run days. You should follow “periodized’ training approach which utilizes the Heavy- Light- Medium format. For example, if your usual long run is 8 miles, then your “Heavy” run is 8 miles. If you are running three times per week, then your run distances would be:
Day 1: Heavy: 8 miles
Day 2: Light: 4 miles
Day 3: Medium: 6 miles
This approach will help prevent over-training and subsequent injury.
Shoe wear
Running shoes should be changed every 3 to 4 months due to the loss of the shoe’s shock absorbing capacity. Proper fit and support is important in minimizing leg injury. Talk to your physical therapist if you have questions regarding your shoe wear.
Shoulder 12
Shoulder Rotator Cuff and Scapular Strengthening Program 12’s
During the season, repeat each exercise 10-15 times, three to four times per week; however it is not recommended that pitcher perform these movement immediately before start or outing
External Rotation
Attach the theraband at waist level to a doorknob or post. While standing sideways to the door and facing straight ahead, grasp one end of the band and pull the band all the way through until it is taut. Feet are shoulder width apart and the knees are slightly flexed. The elbow is placed next to the side with the hand as close to your chest as possible (think of this elbow as being a hinge on a gate). Taking the cord in the hand ‘set’ the shoulder blade and move the hand away from the body as far as it feels comfortable. Return to the start position.
Internal Rotation
Attach the Theraband at waist level in a doorknob or post. While standing sideways to the door and looking straight ahead, grasp one end of the handle and pull the cord all the way through until it is taut. Feet are shoulder width apart and the knees are slightly flexed. The elbow is placed next to the side and is flexed at 90 degrees (think of this elbow as being a hinge on a gate). Taking the cord in the hand, ‘set’ the shoulder blade and move the hand toward the belly as far as it feels comfortable, or to where the endpoint of pain limits you. Return to the start position.
Lateral Raises
Stand with the arm at your side with the elbow straight and the hands rotated so that the thumbs face forward. Raise the arm straight out to the side, palm down, until the hands reach shoulder level. Do not raise the hands higher than the shoulder. Pause and slowly lower the arm.
Standing forward flexion (‘full-can’) exercise
Stand facing a mirror with the hands rotated so that the thumbs face forward. While keeping the shoulder blade ‘set’ and keeping the elbows straight, raise the arms forward and upward to shoulder level with a slight outward angle (30°). Pause for one second and slowly lower and repeat.
Sidelying external rotation
Lying on the non-operated side, bend your elbow to a 90-degree angle and keep the operated arm firmly against your side with your hand resting on your abdomen. By rotation at the shoulder, raise your hand upward, toward the ceiling through a comfortable range of motion. Hold this position for 1 to 2 seconds, and then slowly lower the hand.
Prone extension
The starting position for this exercise is to bend over at the waist so that the affected arm is hanging freely straight down. Alternatively, lie face down on your bed with the operated arm hanging freely off of the side. While keeping the shoulder blade ‘set’ and keeping the elbow straight, raise the arm backward toward your hip with the thumb pointing outward. Do not lift your hand past the level of your hip.
Prone rowing exercise
The starting position for this exercise is to bend over at the waist so that the affected arm is hanging freely straight down. Alternatively, lie face down on your bed with the operated arm hanging freely off of the side. While keeping the shoulder blade ‘set’, raise the arm up toward the ceiling while bending at the elbow. The elbow should be drawn along the side of the body until the hands touch the lower ribs. Always return slowly to the start position.
Prone horizontal abduction (‘T’s)
The starting position for this exercise is to bend over at the waist so that the affected arm is hanging freely straight down. Alternatively, lie face down on your bed with the operated arm hanging freely off of the side. Rotate your hand so that the thumb faces forward. While keeping the shoulder blade ‘set’ and keeping the elbows straight, slowly raise your arm away from your body to shoulder height, through a pain-free range of motion (so that your hand now has the thumb facing forward, and aligned with your cheek .) Hold that position for 1 to 2 seconds and slowly lower. Limit the height that you raise the arm to 90 degrees, or in other words, horizontal to the floor.
Prone scaption (‘Y’s)
The starting position for this exercise is to bend over at the waist so that the affected arm is hanging freely straight down. Alternatively, lie face down on your bed with the operated arm hanging freely off of the side. Keep the shoulder blade ‘set’ and keep the elbows straight. Slowly raise the arm away from your body and slightly forward through a pain-free range of motion (so that your hand now has the thumb facing up, and is aligned with your forehead). Hold that position for 1 to 2 seconds and slowly lower. Limit the height that you raise the arm to 90 degrees, or in other words, horizontal to the floor.
Prone external rotation at 90 abduction (‘U’s)
Lie face down on a table with your arm hanging over the side of the table. Raise the arm to shoulder height at a 90o angle to the body. While holding the arm in this position, rotate the hand upward, until the hand is even with the elbow. Hold one second and slowly let the hand rotate to the starting position and repeat.
Prone Scapular Retraction
Prone position. Support your forehead with the forearm of the opposite arm. Position your arm at 90 degrees elevation with 90 degrees elbow flexion Thumb faces up. Lift hand and elbow together, at the same level. Hold 1-2 seconds and slowly lower the arm.
Prone Elevation
Prone position. Support your forehead with the forearm of the opposite arm. Position the arm at 180 degrees elevation with elbow extended Thumb faces up. Lift hand and elbow together, keeping the elbow straight. Hold 1-2 seconds and slowly lower the arm
Shoulder Strength Training
Strength Training for the Shoulder
This handout is a guide to help you safely build strength and establish an effective weight-training program for the shoulder.
Starting Your Weight Training Program
• Start with three sets of 15-20 repetitions
• Training with high repetition sets ensures that the weights that you are using are not too heavy.
• To avoid injury, performing any weight training exercise to the point of muscle failure is not recommended.
• “Muscle failure” occurs when, in performing a weight training exercise, the muscle is no longer able to provide the energy necessary to contract and move the joint(s) involved in the particular exercise.
• Joint, muscle and tendon injuries are more likely to occur when muscle failure occurs.
• Build up resistance and repetitions gradually
• Perform exercises slowly, avoiding quick direction change
• Exercise frequency should be 2 to 3 times per week for strength building
• Be consistent and regular with the exercise schedule
Prevention of Injuries in Weight Training
• As a warm-up using light weights, you can do the rotator cuff and scapular strengthening program (see next page)
• Follow a pre-exercise stretching routine (see next page)
• Do warm-up sets for each weight exercise
• Avoid overload and maximum lifts
• Do not ‘work-through’ pain in the shoulder joint
• Stretch as cool-down at end of exercise
• Avoid excessive frequency and get adequate rest and recovery between sessions.
• Caution: Do not do exercises with the barbell or dumbbell behind the head and neck. For shoulder safety when working with weights, you must always be able to see your hands if you are looking straight ahead.
Return to Weight Training After Shoulder Surgery
Your doctor or therapist should test your motion and strength and give you clearance before you start weight training.
Criteria:
• Full, pain-free range of shoulder motion
• Normal strength in the rotator cuff and scapular muscles
Exercises and rehabilitation
Your surgeon or your physical therapist will instruct the appropriate stretching and strengthening exercises. It is recommended that you do not begin shoulder exercises without proper instruction and exercise selection based upon your particular set of shoulder circumstances.
Shoulder Stretching Program
The stretching exercises are intended to improve or maintain normal flexibility and range of motion of the shoulder. 1 or 2 of each stretch should be done before weight training (after warming up) and 3 to 5 of each stretch should be done after finishing your workout. Each stretch should be held for 10 to 15 seconds in a static fashion without bouncing or oscillation. Stretching should be done gently, without pain. Shoulder stretching exercises can be found on our website under rehab protocols.
Shoulder Strengthening Program
• Theraband Strengthening for the shoulder
These resistance exercises should be done very slowly in both directions. The goal is to achieve a maximum amount of strengthening while listening to your end-point of pain. Work within a pain free range of motion at all times and do the exercises very slowly. The slower the motion, the better the muscle contraction is throughout the range of movement.
—Shoulder theraband exercises can be found online on our website.
• Rotator Cuff and Scapular Strengthening Program
The rotator cuff and scapular exercises are intended to isolate the essential muscles of the shoulder that provide strength to the rotator cuff and control the scapula (shoulder blade). Each exercise should be done for one set of 15 repetitions prior to a weight training workout or 2-3 times a week for good shoulder strength and muscle balance. Weights used with these exercises can be built up gradually in increments of no more than 1 pound per week, with a safe limit of 5 lb.
—Rotator cuff and scapular exercises can be found online on our website.
Weight Training Program
The following upper body and shoulder strength program is usually safe and provides a good basic foundation of upper body and shoulder strength when combined with the basic shoulder strength and stretch program outlined earlier. The strength program can be followed 2 to 3 times a week. 3 sets of 10 to 15 repetitions can be done for each exercise. You can follow the principles of PRE and RM as outlined in the next section to know when to increase weights in programs where the goal is to increase strength.
Exercise Machines with Free Weight Counterpart Exercises
1. Biceps curl machine or free weight biceps curl
2. Triceps machine or free weight triceps exercise
3. Chest press machine or bench press
4. Seated row machine or bent over dumbbell rows
5. Cable pull down in front of chest or pull ups
6. Shoulder press machine with forward grip or military press
Weight Training Exercises to Avoid
• Pull downs behind-the-neck (wide-grip)
• Behind-the-neck shoulder press
• Wide-grip bench press
• Standing lateral deltoid raises
• Triceps press overhead
• Chest fly exercises
Precautions for Specific Exercises
Pull downs
• Perform exercise in front of the head, to the chest, with a medium width (not wide) grip. Palm-up grip is the safest.
Bench Press
• Your grip should be no wider than the wider than the width of your shoulders. This is usually 17 to 18 inches.
• Grip is made measuring between the knuckles of the index fingers.
• Grip with the palm facing you is the safest.
Military Press (Press Overhead)
• Overhead exercises are very stressful to the rotator cuff and shoulder ligaments, especially when done with the weight behind the neck or head.
• Start and finish overhead presses in front of the shoulder.
Lateral Deltoid Raises
• Should be avoided due to the impinging and wearing effect on the rotator cuff.
• Lateral raises from the prone or bent over position can be done as a substitute for standing lateral deltoid raises.
Forward Raises
• Perform exercise in the “thumb-up” position. It is usually safer and can be done with reasonable weights. Do not use a palm down grip.
Incline Bench Press
• There is a danger of shoulder dislocation if the lifter loses control of the weight behind the head.
Shoulder Stretches
Shoulder Stretches
1. Pendulum- Lean forward and place one hand on a counter or table for support. Let your other arm hang freely at your side.Act as if a clock is on the ground Gently swing your arm forward and back (12-6 o’clock). Repeat the exercise moving your arm side-to-side (3-9 o’clock), and repeat again in a circular motion (around the clock). Perform each direction 20 times.
2. External rotation- Grasp a broom stick, golf club or cane with the unaffected arm and cup the other end of the stick with the affected arm. Keep the elbow of the shoulder you are stretching against the side of your body and push the stick horizontally as shown to the point of feeling a pull without pain. Hold for 10 count and then relax for 30 second repeating 10-15 times.
3. Sleeper Stretch- (Internal rotation)- Lie on your side on a firm, flat surface with the affected shoulder under you and your arm bent, as shown. You can place your head on a pillow for comfort, if needed. Use your unaffected arm to push your other arm down. Stop pressing down when you feel a stretch in the back of your affected shoulder. Hold this position for 10 count, then relax your arm for 30 seconds repeating 10-15 times.
4. Forward elevation - Again with a broom stick, golf club or cane, held with and overhand grip, shoulder width apart. elevate the unaffected arm while allowing the affected arm to passively elevate until you feel a stretch in your armpit of the affected shoulder. Hold for a count of 10, then relax your arm for 30 seconds and repeat 10-15 times.
5. Internal Rotation Behind-the-back stretch- Place the hand of the affected arm behind your back at the waistline. Use your opposite hand or stick or towel as depicted to help lift the other hand toward the shoulder blade of the opposite shoulder- hold this position for 10 count and repeat 10-15
6. External rotation in corner/doorway- Standing facing a corner or in a doorway, position the arms as illustrated with the elbows at shoulder level. Lean your body gently forward toward the corner until a stretch is felt. Hold for a 10 count and release the rotation and then repeat 10-15 times.
7. Cross Arm- Horizontal Adduction- Reach across the chest as if to bring the elbow toward the opposite shoulder. Grasp the elbow an pull gently in that direction. Hold this position for 10 count and repeat 10-15 times
8. Overhead stretches- Stretch the arms overhead as shown in the illustration. Hold this position for 10 count and repeat 10-15 times.
9. Lateral Shoulder and Triceps Stretch- Place the forearm behind the head. With the opposite hand, grasp the elbow and pull the arm back behind the ear. Hold this position for 10 count and repeat 10-15 times.
10. Chest Stretch in Doorway - Stand near a doorway. With the palm facing outward, grasp the edge of the doorway with one arm. Keeping the elbows straight, lean gently forward and rotate your body away from the arm. Hold this position for 10 count and repeat 10-15 times
11. Lateral Neck and Upper Trapezius Stretch - Grasp the right arm with the left hand and pull down and to the left. While maintaining arm position, tilt head to the left and hold 10-15 seconds. Also stretch the head to the left while letting the chin drop toward the chest. Alternate sides.
Shoulder Ten's
Shoulder Rotator Cuff and Scapular Strengthening Program 10’s
During the season, repeat each exercise 10-15 times, three to four times per week; however it is not recommended that pitcher perform these movement immediately before start or outing
External Rotation
Attach the theraband at waist level to a doorknob or post. While standing sideways to the door and facing straight ahead, grasp one end of the band and pull the band all the way through until it is taut. Feet are shoulder width apart and the knees are slightly flexed. The elbow is placed next to the side with the hand as close to your chest as possible (think of this elbow as being a hinge on a gate). Taking the cord in the hand ‘set’ the shoulder blade and move the hand away from the body as far as it feels comfortable. Return to the start position.
Internal Rotation
Attach the Theraband at waist level in a doorknob or post. While standing sideways to the door and looking straight ahead, grasp one end of the handle and pull the cord all the way through until it is taut. Feet are shoulder width apart and the knees are slightly flexed. The elbow is placed next to the side and is flexed at 90 degrees (think of this elbow as being a hinge on a gate). Taking the cord in the hand, ‘set’ the shoulder blade and move the hand toward the belly as far as it feels comfortable, or to where the endpoint of pain limits you. Return to the start position.
Lateral Raises
Stand with the arm at your side with the elbow straight and the hands rotated so that the thumbs face forward. Raise the arm straight out to the side, palm down, until the hands reach shoulder level. Do not raise the hands higher than the shoulder. Pause and slowly lower the arm.
Standing forward flexion (‘full-can’) exercise
Stand facing a mirror with the hands rotated so that the thumbs face forward. While keeping the shoulder blade ‘set’ and keeping the elbows straight, raise the arms forward and upward to shoulder level with a slight outward angle (30°). Pause for one second and slowly lower and repeat.
Sidelying external rotation
Lying on the non-operated side, bend your elbow to a 90-degree angle and keep the operated arm firmly against your side with your hand resting on your abdomen. By rotation at the shoulder, raise your hand upward, toward the ceiling through a comfortable range of motion. Hold this position for 1 to 2 seconds, and then slowly lower the hand.
Prone extension
The starting position for this exercise is to bend over at the waist so that the affected arm is hanging freely straight down. Alternatively, lie face down on your bed with the operated arm hanging freely off of the side. While keeping the shoulder blade ‘set’ and keeping the elbow straight, raise the arm backward toward your hip with the thumb pointing outward. Do not lift your hand past the level of your hip.
Prone rowing exercise
The starting position for this exercise is to bend over at the waist so that the affected arm is hanging freely straight down. Alternatively, lie face down on your bed with the operated arm hanging freely off of the side. While keeping the shoulder blade ‘set’, raise the arm up toward the ceiling while bending at the elbow. The elbow should be drawn along the side of the body until the hands touch the lower ribs. Always return slowly to the start position.
Prone horizontal abduction (‘T’s)
The starting position for this exercise is to bend over at the waist so that the affected arm is hanging freely straight down. Alternatively, lie face down on your bed with the operated arm hanging freely off of the side. Rotate your hand so that the thumb faces forward. While keeping the shoulder blade ‘set’ and keeping the elbows straight, slowly raise your arm away from your body to shoulder height, through a pain-free range of motion (so that your hand now has the thumb facing forward, and aligned with your cheek .) Hold that position for 1 to 2 seconds and slowly lower. Limit the height that you raise the arm to 90 degrees, or in other words, horizontal to the floor.
Prone scaption (‘Y’s)
The starting position for this exercise is to bend over at the waist so that the affected arm is hanging freely straight down. Alternatively, lie face down on your bed with the operated arm hanging freely off of the side. Keep the shoulder blade ‘set’ and keep the elbows straight. Slowly raise the arm away from your body and slightly forward through a pain-free range of motion (so that your hand now has the thumb facing up, and is aligned with your forehead). Hold that position for 1 to 2 seconds and slowly lower. Limit the height that you raise the arm to 90 degrees, or in other words, horizontal to the floor.
Prone external rotation at 90 abduction (‘U’s)
Lie face down on a table with your arm hanging over the side of the table. Raise the arm to shoulder height at a 90o angle to the body. While holding the arm in this position, rotate the hand upward, until the hand is even with the elbow. Hold one second and slowly let the hand rotate to the starting position and repeat.
Shoulder with Plyo
Shoulder Rotator Cuff and Scapular Strengthening Program with plyometrics
During the season, repeat each exercise 10-15 times, three to four times per week; however it is not recommended that pitcher perform these movement immediately before start or outing
External Rotation
Attach the theraband at waist level to a doorknob or post. While standing sideways to the door and facing straight ahead, grasp one end of the band and pull the band all the way through until it is taut. Feet are shoulder width apart and the knees are slightly flexed. The elbow is placed next to the side with the hand as close to your chest as possible (think of this elbow as being a hinge on a gate). Taking the cord in the hand ‘set’ the shoulder blade and move the hand away from the body as far as it feels comfortable. Return to the start position.
Internal Rotation
Attach the Theraband at waist level in a doorknob or post. While standing sideways to the door and looking straight ahead, grasp one end of the handle and pull the cord all the way through until it is taut. Feet are shoulder width apart and the knees are slightly flexed. The elbow is placed next to the side and is flexed at 90 degrees (think of this elbow as being a hinge on a gate). Taking the cord in the hand, ‘set’ the shoulder blade and move the hand toward the belly as far as it feels comfortable, or to where the endpoint of pain limits you. Return to the start position.
Lateral Raises
Stand with the arm at your side with the elbow straight and the hands rotated so that the thumbs face forward. Raise the arm straight out to the side, palm down, until the hands reach shoulder level. Do not raise the hands higher than the shoulder. Pause and slowly lower the arm.
Standing forward flexion (‘full-can’) exercise
Stand facing a mirror with the hands rotated so that the thumbs face forward. While keeping the shoulder blade ‘set’ and keeping the elbows straight, raise the arms forward and upward to shoulder level with a slight outward angle (30°). Pause for one second and slowly lower and repeat.
Sidelying external rotation
Lying on the non-operated side, bend your elbow to a 90-degree angle and keep the operated arm firmly against your side with your hand resting on your abdomen. By rotation at the shoulder, raise your hand upward, toward the ceiling through a comfortable range of motion. Hold this position for 1 to 2 seconds, and then slowly lower the hand.
Prone extension
The starting position for this exercise is to bend over at the waist so that the affected arm is hanging freely straight down. Alternatively, lie face down on your bed with the operated arm hanging freely off of the side. While keeping the shoulder blade ‘set’ and keeping the elbow straight, raise the arm backward toward your hip with the thumb pointing outward. Do not lift your hand past the level of your hip.
Prone rowing exercise
The starting position for this exercise is to bend over at the waist so that the affected arm is hanging freely straight down. Alternatively, lie face down on your bed with the operated arm hanging freely off of the side. While keeping the shoulder blade ‘set’, raise the arm up toward the ceiling while bending at the elbow. The elbow should be drawn along the side of the body until the hands touch the lower ribs. Always return slowly to the start position.
Prone horizontal abduction (‘T’s)
The starting position for this exercise is to bend over at the waist so that the affected arm is hanging freely straight down. Alternatively, lie face down on your bed with the operated arm hanging freely off of the side. Rotate your hand so that the thumb faces forward. While keeping the shoulder blade ‘set’ and keeping the elbows straight, slowly raise your arm away from your body to shoulder height, through a pain-free range of motion (so that your hand now has the thumb facing forward, and aligned with your cheek .) Hold that position for 1 to 2 seconds and slowly lower. Limit the height that you raise the arm to 90 degrees, or in other words, horizontal to the floor.
Prone scaption (‘Y’s)
The starting position for this exercise is to bend over at the waist so that the affected arm is hanging freely straight down. Alternatively, lie face down on your bed with the operated arm hanging freely off of the side. Keep the shoulder blade ‘set’ and keep the elbows straight. Slowly raise the arm away from your body and slightly forward through a pain-free range of motion (so that your hand now has the thumb facing up, and is aligned with your forehead). Hold that position for 1 to 2 seconds and slowly lower. Limit the height that you raise the arm to 90 degrees, or in other words, horizontal to the floor.
Prone external rotation at 90 abduction (‘U’s)
Lie face down on a table with your arm hanging over the side of the table. Raise the arm to shoulder height at a 90o angle to the body. While holding the arm in this position, rotate the hand upward, until the hand is even with the elbow. Hold one second and slowly let the hand rotate to the starting position and repeat.
Theraband diagonal-up
Stand with the theraband attached on your left side for your right hand. Start with your right hand on the left hip with the thumb facing the hip. Start by pulling the band so that your hand travels up and behind your head. Finish so that your thumb is pointing backwards.
Theraband diagonal-down
Stand with the theraband attached behind you at shoulder level. Start with your arm in throwing position. Pull the band down and across your body so that your thumb faces the opposite hip.
Theraband external rotation at 90.
Stand with good posture with the theraband attached in front of you. Keeping the arm elevated to 90 degrees and the elbow at a 90-degree angle, ‘set’ the shoulder blade and then rotate the hand and arm slowly backward and then return slowly to the start position.
Theraband internal rotation at 90.
Stand with good posture with the theraband attached behind of you. Keeping the arm elevated to 90 degrees and the elbow at a 90-degree angle, ‘set’ the shoulder blade and rotate the hand and arm slowly forward and then return slowly to the start position.
Theraband standing ‘T’s.
Stand with the theraband attached in front of you. Stand with the arm flexed forward at shoulder height with the elbow straight. While keeping the elbow straight, pull the arm toward the rear until the arm is by your side.
Dynamic Hug
With the tubing attach behind you at shoulder height, grip both ends of the tubing in your hands with the tubing on the outside of your shoulders. Pull the band forward and slightly downward in a ‘hugging’ motion, or as if you were wrapping both arm around a small tree. Pause and return slowly to the starting position
W’s
With the tubing attached in front of you, stand with the tubing in both hands with the elbows bent at 90o and fixed at your side. Pull the band outward, keeping the elbow at your side. The arms rotate outward making the shape of a ‘W’
Throw with arm at side
For the right arm, stand sideways so that your left side is facing a ‘rebounder’ or wall. Keep the right elbow tucked against your right side with the elbow at a right angle. Throw a 1 to 2 pound ball across the body, keeping the elbow tucked to the side, to the rebounder. Catch the rebounded ball in the same arm position, allowing the arm to comfortably stretch back, and then quickly throw the ball again. Do not pause or stop the ball movement after catching it.
Wall dribbles overhead
Stand facing a wall with your arm held comfortably overhead, above the shoulder joint. Quickly dribble a 1 to 2 pound ball against the wall using your fingertips.
Rebounder throwing
Stand facing a rebounder, with the arm raised in the throwing position. Throw a 1 to 2 pound ball and then catch the rebounded ball in the same throwing position. On the catch, allow the arm to comfortably rotate backward and the quickly throw the ball again. Do not pause or stop the ball movement after catching it.
Decelerations
Kneel on the floor on the knee on the same side of your throwing arm. Flip a 1 or 2 pound ball backwards over your throwing shoulder. Catch the ball in the throwing position and then decelerate your arm forward through your throwing motion. Quickly flip the ball backward again and repeat.
Wall dribble 90’s
Stand facing the wall. Raise the arm into your throwing position. Keeping the elbow close to the wall, quickly bounce a 1 to 2 pound ball against the wall in this position. As you catch the ball, allow the arm to comfortably stretch back into external rotation. Quickly bounce the wall on the wall again. Do not pause or stop the ball movement after catching it.
Wall dribble circles
Stand facing the wall. Raise the arm into an overhead position. Keeping the elbow close to the wall, quickly bounce a 1 to 2 pound ball against the wall using your fingertips. Dribble the ball as you move your arm in an arc from above your head down to shoulder level and back.
Sports Conditioning for The Throwers
Sports Conditioning for the Throwers Shoulder
This program has been developed to provide a comprehensive guide to the conditioning of the shoulder for throwing sports. Following a specific program of exercises for the shoulder, on a year round basis, will help to reduce the risk of injury to the shoulder joint in throwing sports.
An effective shoulder and throwing conditioning program should be focused on providing exercises and drills to develop coordination, strength, speed, power and control in the shoulder joint muscles. In addition to the development of strength in the shoulder muscles, drills to enhance and train the high speed and force necessary for high performance throwing are critical for consistent performance and injury prevention
Five components of the shoulder training program:
1. Warm-up
2. Flexibility and stretching
3. Shoulder and elbow strengthening
4. Plyometric training
5. Position specific throwing
Keys to success in training:
1. Focused effort and concentration when training
2. Always use proper form and technique
3. Quality workouts on a consistent basis
4. Avoid over-training
Stretching Program
• Stretching should always be preceded by a period of warm-up where you increase your body temperature until you are sweating.
• You should slowly assume the stretching position until a comfortable feeling of stretch is felt in the muscle and then held, without further movement, 10 to 15 seconds.
• 3 to 5 repetitions of each stretching exercise should be done, statically holding the stretch for 10 to 15 seconds. There should be NO BOUNCING or oscillations of the body during stretching exercises.
• Stretching should NOT BE PAINFUL or cause soreness after being done. Stretching should be done before and after each workout. Most importantly, always allow time to stretch during the cool-down period after finishing the exercise program.
• Flexibility exercises done in a maintenance program or general fitness program should be done 3 to 4 times per week for 1 to 3 repetitions each.
Shoulder and Elbow Strengthening Program
The following exercises are intended to isolate the essential muscles of the shoulder that provide strength and muscular balance to the rotator cuff muscles and the muscles that control the scapula (shoulder blade). Each exercise should be done for one set of 15 repetitions, 3 times a week during both the off-season and in-season periods. Weights used with these exercises should be built up gradually in increments of no more than 1 pound per week.
Rotator Cuff and Scapular Strengthening Program
The rotator cuff and scapular exercises are intended to isolate the essential muscles of the shoulder that provide strength to the rotator cuff and control the scapula (shoulder blade). Each exercise should be done for one set of 15 repetitions prior to a weight training workout or 2-3 times a week for good shoulder strength and muscle balance. Weights used with these exercises should be built up gradually in increments of no more than 1 pound per week.
Plyometric program (see website for plyometric program)
Position Specific Throwing
The ‘Interval throwing Program’ (Wilk and associates) is a safe program to follow if you have had a shoulder injury or a long layoff from throwing competitively. Always follow the instructions for warm-up and stretching in the previous section. Throwers who are returning to throwing after injury to the shoulder should follow the interval-throwing program, exactly, on an every-other-day basis. The criteria to progress from step to step are that the throwing session was pain free and there is no residual soreness the next day. For throwers who are free of injury, but returning to throwing after a lay-off period, follow the interval-throwing program, on an every-other-day basis, without the rest periods. You should use the ‘crow-hop’ method for each throw when performing the interval throwing session. The ‘crow-hop’ method consists of first a hop, then a skip, followed by the throw. This method helps simulate the throwing act, allowing emphasis on total body mechanics involved in the act of throwing. You should avoid throwing flat-footed to avoid placing excess stress on the throwing shoulder in your training program.
Off-Season Throwing Program
Following an off-season throwing program is recommended instead of total rest during the off-season. Continuing to throw at a sub-maximum level will help you avoid the total de-conditioning of your throwing mechanics, muscle timing, and coordination.
Continue to throw at a frequency of two times a week, following the following outline:
a. Warm-up throwing
b. 45 ft. (25 throws)
c. 60 ft. (20 throws)
d. 90 ft. (15 throws)
e. 120 ft. (10 throws)
Returning to Throw Off the Pitchers Mound
If you are a thrower who has been injured, or if you have had a long layoff from throwing, you should first complete the interval-throwing program before returning to the higher stress of pitching off the pitchers mound. If you have followed the off-season throwing program, or if you have successfully completed the interval-throwing program, you can now safely begin the ‘Interval Throwing Program off the Pitchers Mound’ (Wilk and Associates, 1991) which is outlined on the website.
For position players, you can usually safely return to position practice at this time. Warm up throwing before each workout should consist of 25 tosses at 45, 60, 90, and 120 feet (after general warm-up and stretch).
Return to Batting
If you have had no injury to your shoulder, you may return to normal batting practice. If you are returning from a shoulder injury, follow the Return to Batting Guide.
Return to Batting Guide after Shoulder Injury
• Start batting after progressing through the 90-foot stage of the interval-throwing program
• Do three pain-free workouts at each step before progressing to the next step.
• Start with 10 swings and add 10 swings each workout (30 swings total).
• When progressing to the next step(s), perform 20 swings from the previous step as a warm-up.
Step 1: Swinging a light bat
Step 2: Hitting off tee
Step 3: Soft-toss hitting
Step 4: Batting practice
Off-Season Batting Conditioning
Following an off-season batting program will help keep the shoulder muscles as well as all the ‘batting muscles’ in shape during the off-season time period.
The following program, if followed two times a week, will help keep the shoulder in ‘batting shape’.
1. Swing a light bat 30 swings
2. Hitting off a tee 30 swings
3. Soft toss hitting 30 swings
4. Batting practice 30 swings
Swimming Program
Interval Swimming Program
Prior to returning to swimming you must have full range of motion and full strength in the rotator cuff and scapular muscles. Your range of motion must be pain-free when performing the swimming stroke(s). It is usually best to start with the breaststroke and progress to the crawl stroke second, followed by the backstroke and finally the butterfly stroke. You should first establish a slow steady cadence concentrating on perfect swimming technique building to a reasonable distance (1000 yards). After this, you can start to increase your swimming speed as long as you are pain-free. At the same time, you can then add a second stoke and build up according to the interval program. Additional strokes can be added, as needed according to your program needs. Remember that as total swimming distance increases, the risk of overuse injury becomes greater. The recommended swimming frequency is three times per week with a days rest between sessions. Do not progress to the next part of a step if there is pain while you are swimming. Do not progress to the next step if there is pain that persists into the next day. You should warm-up well and stretch before swimming and cool-down by stretching after finishing. Swimmers that have lax or “loose” joints should warm-up but not stretch
100 to 300 Yard Stage
Step 1: a. Swim 100 yards
b. Rest 5 minutes
c. Swim 100 yards
Step 2: a. Swim 100 yards
b. Rest 5 minutes
c. Swim 100 yards
d. Rest 10 minutes
e. Swim 100 yards
Step 3: a. Swim 150 yards
b. Rest 10 minutes
c. Swim 150 yards
300 to 600 Yard Stage
Step 1: a. Swim 300 yards
Step 2: a. Swim 300 yards
b. Rest 10 minutes
c. Swim 100 yards
Step 3: a. Swim 300 yards Rest 5 minutes
b. Swim 100 yards Rest 5 minutes
c. Swim 100 yards
Step 4: a. Swim 300 yards
b. Rest 5 minutes
c. Swim 100 yards
d. Rest 5 minutes
e. Swim 100 yards
f. Rest 5 minutes
g. Swim 100 yards
600 to 1000 Yard Stage
Step 1: a. Swim 600 yards
Step 2: a. Swim 600 yards
b. Rest 10 minutes
c. Swim 100 yards
Step 3: a. Swim 600 yards Rest 5 minutes
b. Swim 100 yards Rest 5 minutes
c. Swim 100 yards
Step 4: a. Swim 600 yards Rest 5 minutes
b. Swim 100 yards Rest 5 minutes
c. Swim 100 yards Rest 5 minutes
d. Swim 100 yards
Step 5: a. Swim 600 yards Rest 5 minutes
b. Swim 100 yards Rest 5 minutes
c. Swim 100 yards Rest 5 minutes
d. Swim 100 yards Rest 5 minutes
e. Swim 100 yards
Step 6: a. Swim 1000 yards
Step 7: a. Increase swimming speed gradually, continue at 1000 yards if adding a second stroke.
b. Add second stroke, if desired, start at 100-to-300 yard stage, step 1.
c. If swimming competitively, return to team practice when all needed strokes can be done for 1000 yards with increasing speed.
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