When an athlete comes to physical therapy looking for help returning to throwing we take them through a few steps. First, my team of physical therapists will ask about their history with throwing and their sport, any injuries they are experiencing now or have experienced due to throwing or sport in the past and what their goals are for getting back into their sport. We will gather any injury- or surgery-related protocols from their doctors to guide their rehab and return to throwing. We will then perform a physical examination to assess the injured area and also to assess other components of the body that are important for throwing and return to their sport like core stability, hip and spine mobility and forearm strength.

With all of this information we will create a plan to address any injuries while also building the necessary strength, motor control, endurance and mobility needed throughout the body to return successfully to throwing. Once cleared to begin a return to throwing program they will be taken through a progressive series of activities aimed to prepare the tissues of the arm for repetitive and powerful throwing. As they go we will be assessing their response to throwing, looking out for any symptom exacerbation or new issues and helping them make modifications and decisions along the way.

HOW LONG DOES A RETURN TO THROWING PROGRAM TAKE?

• How much rehab do you need to recover from your injury or surgery so that the tissues are ready to withstand the forces of throwing?
• When does your physician, surgeon or therapist clear you to begin some of the precursors of a return to throwing protocol like rotator cuff and core strengthening, stretching, neuromuscular control exercises and upper extremity plyometrics?
• Are there other impairments that have developed due to a period of inactivity that also need to be addressed before you can return to full play?
• How well does the injury tolerate the increase in throwing volume and intensity, as that determines to some degree how quickly you can progress through the program
• At what level were you playing baseball or softball, for example, before the break, as higher level competitive athletes will need to progress back to greater speeds and distances of throwing which can take more time?
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If you decide to work with a physical therapist to help with return to throwing related issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your PT sessions yet in the comfort of your own home.

WHY DO I NEED TO RETURN TO THROWING GRADUALLY?

If you are a throwing athlete, you might be wondering why therapists put you through such a rigorous and gradual program when returning to throwing. Throwing is an activity that places fairly high and powerful stresses across the shoulder, elbow, wrist and hand and depending on your position on the team can be very repetitive. Repetitive motions like throwing at a fast speed place a high degree of stress throughout the joints, bones, tendons, muscles and ligaments of the arm. Most throwing athletes begin when they are kids and as they move through their years of sports they gradually increase in volume and intensity, speed and distance of throwing during practices and games and increase the volume and specificity of their training room programs. This gradual progression promotes physiologic adaptations in body tissues so that they are able to gradually withstand the increasing load they place on it as they progress.

So while the body can positively adapt to the increasing volume of throwing and training, the opposite is also true. When you take time off, especially more than 4 weeks, these adaptations begin to reverse. Your tissues are no longer capable of withstanding the forces placed on it by your earlier throwing volume and intensity. The longer the break, the more those adaptations decrease and eventually returning to throwing too quickly or at too high of an intensity will overload the deacclimatized tissues in a way that will likely cause injury.

Add to this mix an arm injury like a SLAP tear or an ulnar collateral ligament sprain, where the tissues are not as healthy as they normally are, and you have a recipe for ongoing or new injuries if you don’t approach returning to throwing the right way. A return to throwing protocol aims to combat these concerns and with the help of your physical therapist you can feel confident you are progressing in a safe and effective manner.

WHAT DOES A RETURN TO THROWING PROTOCOL LOOK LIKE?

• Rehab is needed to address the injury and ensure the injured tissues are ready to begin loading more aggressively
• Your therapist, doctor and/or surgeon should clear you to begin a throwing program
• It is essential to initiate and progress a program of upper extremity stretching, plyometrics, motor control, strengthening and sport-specific exercises before reintroducing throwing
• Core stability and strengthening exercises as well as lower extremity strengthening exercises should be a part of the early phase of return to throwing and progress throughout the program
• Throwing begins at short distances, fewer reps and fewer sets
• Throwing progresses every few days or every week by increasing the distance thrown and the number of reps and sets
• Specific criteria exists to evaluate any onset of pain or stiffness, i.e. when it is ok to continue with the program and when an athlete needs to stop progressing or regress to a previous phase
• Guidelines are provided on how to order throwing, hitting and strengthening exercises and practices
• Specific criteria exists for taking rest days
• Mechanics and form when throwing are just as important as pain levels, speed and distance of throws
• A warm up and cool down should always be implemented around throwing exercises