Monitoring Strength to Determine Rehabilitation Progression in a Collegiate Baseball Player
Baseball pitchers are unique athletes that use their arm at extreme ranges of motion with tremendous angular velocity, thus producing a significant amount of force to the shoulder and elbow (1).
This occurs in athletes that often have a combination of acquired microinstability on top of generalized laxity (2), making stability of the glenohumeral joint important.
Because of these forces and the repetitive nature of the sport, rotator cuff strength is important to maintain to assist with the ability to dynamically stabilize the glenohumeral joint.
It has been documented that strength of the rotator cuff is decreased immediately following a baseball game (3), and gradually over the course of a season (4). It is often the goal to maintain strength, but due to imbalances on workloads and capacity, this is often difficult.
Because of this, it is important to routinely measure the strength of the rotator cuff in overhead athletes to evaluate the relationship to the athlete’s workload and assure strength is not decreasing too rapidly.
Case Study in a Collegiate Baseball Player
To illustrate this, I wanted to share a case study of a typical baseball pitcher that we see at Champion PT and Performance (5).
The athlete is a 21-year-old college baseball pitcher. During the spring season, they gradually reported a loss in velocity and ability to command their pitches, while developing general shoulder pain.
An MRI was performed and showed some chronic adaptations but no specific pathology to the rotator cuff, capsule, or labrum.
On examination, one of his primary findings was a significant weakness and asymmetry of his shoulder external rotation. We measured this using the Vald Dynamo Handheld Dynamometer (6) during his initial evaluation, which showed a 7% side-to-side deficit, though his overall strength was also low in comparison to other pitchers his size.
We shut him down from throwing and started a rehabilitation program to work on this strength deficit.
After 6 weeks, we retested his strength and were pleased to find a 10% increase in strength with his dominant arm now stronger than his non-dominant arm. Based on the results of strength testing, it was determined that he may begin a gradual interval throwing program while continuing to develop strength.
Because of the stresses of throwing, it is imperative that we continued to monitor his strength by testing to assure he is continuing to progress. After 8-weeks of his long toss program, we rested to find a significant jump in strength of 27% from baseline, and 6% greater strength in his dominant throwing arm. This is great progress while simultaneously performing a throwing program.
Based on the results of our strength testing, it was determined that he may begin a mound progress and gradual return to pitching. He will continue to test his strength every 4-6 weeks to monitor his progress.
Strength testing to quantify your baseline measurements are important. Without this knowledge it is difficult to determine the best course of action for your athletes. But more important, serial testing to show progress can be used to determine when to progress to the later phases of rehabilitation.
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