Thursday, March 28, 2013

Tightening the "Thrower's Coil": Rehab, Prehab and Power Up Throwing Performance

Baseball players perform one of, if not, the most violent tasks in sports. The act of throwing a baseball requires the highest amounts of torque, angular velocity and power than any other single sport task. With our experience in sports rehab, strength and conditioning and coaching, we have been able to develop a great niche in treating these athletes. In this post, I’d like to point out some of the “typical” findings and how we’re getting them off the table and back out onto the field for good. 

'Tommy Baseball’: a 17 year-old, 5’11”, 180lb high school baseball player walks into your clinic complaining of right shoulder pain he recently started feeling after a tournament over the weekend. He is a right handed pitcher and has been playing for years without shoulder pain so he “doesn’t understand why all of a sudden this is happening”. He has an exercise program that he has been on for the past year. The program was written for him by his PE teacher. He received a scholarship to a DII university and needs to be pain-free and ready to play at a much higher level within the next 3-4 months.

Where do you start? Almost all rehab professionals are familiar with the tests that we would use to come to the actual diagnosis. There are also some tests that coaches and trainers could use to see if an issue is serious or not. This is a great start but how do you relate this back to throwing a baseball and MOST IMPORTANTLY, how can we get this player back to competition without increasing his risk of being back in PT  soon thereafter?

What are the most important items you need to assess and then how do you treat those limitations/dysfunctions related to throwing? If you’re just giving pendulums out to every painful shoulder that comes through the door, you’re not doing anyone any favors.

What types of things are you looking for when you watch this young baseball player move? The following is a list of common limitations we see in these young athletes:

1.      Limited internal rotation of throwing shoulder
2.      Limited thoracic spine rotation and extension toward throwing arm
3.      Limited internal rotation of opposite hip
4.      Weak, ‘knotted’ rotator cuff muscles
5.      Unstable and weak lower and middle traps of throwing arm
6.      Slackened “coil” between the hips and the shoulders
If you’re not closely examining these top movements you’re missing the big picture. If you do find these dysfunctions, how do you treat them so as to be specific to baseball?

1.      Manual rehab techniques to improve the soft tissue (muscle) and joint mobility  
2.      Progress exercise to involve TONS of hip extension and rotation with power
3.      Single leg stability exercises to involve baseball specific positioning and movements
4.      Rotator cuff and lower trap stabilization in varying positions specific to baseball throwing mechanics

Strengthening the shoulder retractors and depressors as well as the rotary power ‘coil’ are the keys to keeping these athletes on the diamond.

We hope that this gives parents, coaches and rehab pros another place to begin this process. We are excited to be going into great detail on all of the above and MORE during our “Elite Thrower’s Seminars” Our aim is to provide a rock solid foundation for local physical therapists, baseball/softball coaches and strength & conditioning pros to treat, train or coach these athletes for maximum gains.

Advanced Rehab and Treatment of the Elite Thrower
Interested in hosting a seminar for your coaches or athletes? We're looking forward to hearing from you. Together we can make northern VA a powerhouse of baseball and softball athlete development. For more details, feel free to contact us at

Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist and a Certified Myofascial Trigger Point Therapist. He has treated high school, collegiate, recreational, and professional athletes of various sports including baseball, softball, football, hockey, tennis, swimming, golf and the martial arts. His experience as a collegiate and semi-professional athlete as well as a professional baseball coach make him a sought after resource among elite level athletes on the field and in the training room. Carlos remains active in several sports and is an avid agility training, power lifting and adventure race runner.  He can be reached at

Friday, March 1, 2013

Insults abound but do credible and effective solutions follow?

There is a new wave of facebook page and blog site out there. Without mentioning all of them here, they include such presences as "Awkward Gym Moments", etc. This page and the ones like it highlight the failings of normal folks who are trying to get involved in exercise but very clearly do not have the first clue as to where to begin. Here is a good example of this.

As is the case in gyms all over the world, without proper instruction, gym members are doomed from the beginning having to figure out where to begin and mostly by passive observation or cursory 'research'.

To be honest, I personally LOVE 'Awkard Gym Moments' (AGM). I spend several hours a week on facebook conversing with colleagues and friends alike. Most conversations center around our work and some new blog post we read or conference we attended. This may not be what most consider fun but there is little I like talking about more than our work. Us next breed PTs are fortunate I guess.

That said, I am always sure to check out the latest posting to AGM. It is a nice break from my work and almost always gives me chuckle fits. While the people in the videos and pictures are unwilling participants, the work that appears to be going on is so bizarre sometimes that you have to wonder: "What/Why in the world would that person be doing this?" The comments that follow the videos are also amusing but this is where the issues come up and where I think we should be more vocal as the true movement experts.

Some of the movements pictures are completely legit. They might not be done correctly or with some 'interesting' wrinkles, but the move itself is ok. Recently, I felt a great need to defend a movement and the conversation that continued simply reflected that the majority of people who are vocal in this forum may be as clueless as the people in the videos!

Another recent development is the speaking out against sites like AGM. Again, I'm not defending teasing anyone who is doing something wrong or not-perfectly. However, when someone does something in direct contradiction of readily available evidence or basic instruction, then I feel less bad about pointing it out and making a teachable moment out of it. This goes for almost anything too. I don't care if you're a grocery stacker. If there is an easy and efficient way to do that job but you chose to do it the opposite way, it should be pointed out and corrected.

Everyone: Go to the gym! Lift something heavy! But do us all a favor: Let us help you. Find the best physical therapist. Find the best personal trainer. Hell, I don't care if you just look up the move on youtube. There is no bad exercise! There are just a LOT of ways to do exercise poorly (read: dangerously/ineffectively). Just please understand NOT ALL ADVICE IS CREATED EQUAL. Do more research on the person giving the advice than on the specific move itself. You may find that you've been educating yourself in a dangerous way this entire time.

Be well.