Background:

It is very common to see athletes in an outpatient setting.  Many times there is a specific cause for injury, but sometimes the major complaint is decreased performance with athletes.  Therefore, physical therapists have a role in improving performance and restoring athlete’s full capability in relation to their sport.  It is important to realize that this is well within the scope of physical therapy, and therapists need to have the tools to provide the proper training for high level athletes as well.

 

Case Scenario:

The patient is a 22-year-old baseball pitcher at a Division 2 college that presents to physical therapy with unexplained shoulder fatigue and decreased performance.  He reports no pain and denies any traumatic events that may be causing the decreased performance.  He complains that his arm feels “dead”, but upper quarter neuro screen was all normal and special tests for rotator cuff and impingement were all negative, except external rotation weakness.  The patient reports that his throwing velocity decreases dramatically after throwing 20-25 pitches, and also states that his college coach verified the decreased velocity with a radar gun.  His reported prior level of function was that he could maintain a throwing velocity for about 80-90 pitches.  He shows 4/5 weakness in internal rotation, external rotation, scaption, and scapular muscles which is more dramatic (3+ or 4-/5) after 8 min of moderate upper body cycling.  He continues to pitch but is limited to 25 pitch maximum by his coach, and he wants to return to unrestricted pitching and his program to improve throwing velocity for next season.  Increasing throwing velocity and strength to return to prior level is his main goal for therapy.  *Sports subscale on DASH:  14/20 moderate to severe disability related to sports.*

Clinical question:

What are the most effective exercise programs to improve muscle performance in overhead athletes in relation to throwing velocity?

 

Search Strategy:

Applied criteria for results:

• Inclusion Criteria: (1) Competitive athletes (high school or higher); (2) Repetitive throwing athletes; (3) Training programs with structured frequency/duration

 

• Exclusion Criteria: (1) Non-throwing athletes; (2) Adolescents (13 years and younger); (3) One time interventions/warm-ups

 

• Other limits: (1) Randomized control trials; (2) Published within the last 10 years

 

 

Evidence Appraisal and Key Results:

Evidence Summary:

This collection of studies shows different types of exercise programs that can target throwing velocity in a multitude of ways.  The higher level studies (6/10 quality score) show moderate evidence that adding heavy resistance or medicine ball exercises that focus on upper body strength and power to a normal sport specific training regimen increase throwing velocity more than basic strength training without any adverse effects.  There are also studies that show low-medium evidence (5/10 score) that closed kinetic chain activities are more beneficial than open kinetic chain training during off season workout.  Also, there are 3 workouts (Thrower’s ten, Keiser pneumatic, Plyometric) that can help increase throwing velocity in baseball players, although this study had the smallest effect size.  This specific study’s control group did no activity.  Therefore, the study may be suggesting that any type of strength training improves throwing velocity, rather than these 3 programs being the most effective exercise choices.  Finally, there is one low quality study (4/10 score) that shows very low evidence that medicine ball training improves throwing velocity.  This study is considered low evidence because it does not measure throwing velocity directly.  However, the study does show a significant increase in power measurements in the upper body.  Therefore, it is possible that those results would correlate to increase in throwing velocity because the arm speed is faster during throwing.

 

Clinical Bottom Line:

Overall, the studies show that most exercise programs that have a strength, power, and stability focus will improve throwing velocity the most.  There is no recommendation for specific exercises that can be made, but the program should be sport specific with a power, strength, and stability aspect for the upper body.  However, the studies that show the biggest increases also have a lower body and core component.  Therefore, a total body view toward exercises targeting throwing velocity may be the most efficient because the lower body and core may help to improve the other aspects involved the throwing motion.

 

Application to Case:

Limitations/Considerations:

o   A few studies consist of all females.

o   Does not provide clear understanding how males respond

o   Focus on handball players

o   Differences in throwing mechanics, size of ball, etc.

o   No adverse effects reported in an athletic population.

o   Very cheap, and extremely cost effective.

o   Easy to apply because studies were done with normal training activities.

Prescribing Exercise:

Based on the combined results, the best prescription would be a combination of upper body medicine ball, closed chain and scapular stability, and heavy resistance exercises.  Doing this in conjunction with his normal lower body and core routine would be the most beneficial.  The most effective dosage is 3 times a week for 6 weeks with 1-2 throwing sessions/week (25-30 pitches) and maintain baseball activities.  It is important to pick sport specific movements related to baseball to achieve the highest effect possible for the patient.  Combining exercises from the studies gives the best result, and that provides the power, strength, and stability focus to achieve the highest possible muscular performance.

 

References:

1.)    Hermassi S, Chelly MS, Tabka Z, Shephard RJ, Chamari K. Effects of 8-Week in-Season Upper and Lower Limb Heavy Resistance Training on The Peak Power, Throwing Velocity, and Sprint Performance of Elite Male Handball Players. Journal of Strength and Conditioning Research. 2011;25:2424-2433.

2.)    Escamilla RF, Ionno M, deMahy MS, et al. Comparison of Three Baseball-Specific 6-Week Training Programs on Throwing Velocity in High School Baseball Players. Journal of Strength and Conditioning Research. 2012;26:1767-1781.

3.)    Ignjatovic AM, Markovic ZM, Radovanovic DS. Effects of 12-Week Medicine Ball Training on Muscle Strength and Power in Young Female Handball Players. Journal of Strength and Conditioning Research. 2012;2011;26:2166-2173.

4.)    Prokopy MP, Ingersoll CD, Nordenschild E, Katch FI, Gaesser GA, Weltman A. Closed-Kinetic Chain Upper-Body Training Improves Throwing Performance of NCAA Division I Softball Players. Journal of Strength and Conditioning Research. 2008;22:1790-1798.

5.)    Raeder C, Fernandez-Fernandez J, Ferrauti A. Effects of Six Weeks of Medicine Ball Training on Throwing Velocity, Throwing Precision, and Isokinetic Strength of Shoulder Rotators in Female Handball Players. Journal of Strength and Conditioning Research. 2015;29:1904-1914.