Return to Throwing Using the Rebounder for Shoulder Rehabilitation
Throwing injuries to the shoulder among baseball players are very common, often due to overuse and the repetitive high stress of overhead throwing. Rehabilitation after a shoulder injury involves a gradual restoration of range of motion, strength, muscular endurance, dynamic stabilization, and neuromuscular control in the shoulder via targeted therapeutic exercise, manual therapy, rebounder therapy, and aquatic therapy. When preparing for a return to throwing, using the rebounder can be a highly effective way to prepare the shoulder gradually and safely for the dynamic act of throwing. Mangiarelli Rehabilitation physical therapist Bobby demonstrates a return to throwing progression using the rebounder to rehabilitate after a shoulder injury.
Shoulder Throwing Injuries
Throwing injuries to the shoulder among baseball players are very common, often due to overuse and repetitive high stresses. The rate of shoulder injury due to throwing is highly correlated to the number of pitches thrown per game, the number of innings pitched per season, and the number of months spent pitching each year. Upper extremity injuries comprise more than half of all baseball injuries, the majority of which are shoulder injuries and affect pitchers.
The shoulder is a highly mobile joint with a wide range of motion, which allows for powerful overhead throwing; however, the price for such mobility is less stability in the shoulder. The stabilizing forces of the shoulder are incredibly complex and can be vulnerable to injury. Common throwing-related shoulder injuries include SLAP tears (a shoulder labral tear at the top of the labrum), biceps tendinitis, rotator cuff tendinitis and tears, shoulder internal impingement, shoulder instability, GIRD (glenohumeral internal rotation deficit), and scapular rotation dysfunction.
Risk factors in baseball pitchers that can increase the risk of a throwing injury include shoulder range of motion deficits, strength deficits in the shoulder and upper back, improper biomechanics, inadequate rest and recovery after competition, inadequate training and overuse, or growth-related risk factors in youth players.
Phases of the Throwing Motion
Overhead throwing is an extremely complex movement that places significant stress on the shoulder joint. The shoulder is vulnerable to injury from the repetitive high stress of pitching due to its hypermobility and extreme range of motion. There are six phases of the throwing motion: windup, stride, early and late arm cocking, acceleration, deceleration, and follow-through. A deficiency at any stage of the throwing cycle can contribute to increased stress on the thrower’s shoulder.
Overhead throwing involves the entire kinetic chain of the body: the physics of throwing includes a transfer of kinetic energy from the feet through the legs, pelvis, and trunk and out to the shoulder through the elbow and hand. Each phase of the throwing motion requires stability from the ankle, leg, and trunk; thoracic mobility and lumbar stability; extreme shoulder range of motion and dynamic power; and strength, coordination, and power in the shoulder, arm, and upper back in order to throw a powerful pitch and safely decelerate the muscles and forward motion of the entire body as the pitch is thrown.
Using the Rebounder for Shoulder Rehabilitation and Return to Throwing
When preparing for a return to throwing, using the rebounder can be a highly effective way to prepare the shoulder gradually and safely for the dynamic act of throwing. A rebounder is a mini trampoline with a firm bound mat that uses the bounce and movement of the trampoline to improve strength and endurance in the injured area.
At Mangiarelli Rehabilitation, our rebounder is adjustable with a handle. We move the rebounder from a flat trampoline to a 45-degree angle for shoulder rehabilitation. At our clinic, we utilize the rebounder for sports-related shoulder injuries like a rotator cuff tear or a shoulder labral tear to help condition the shoulder muscles and practice the movement of throwing and catching against the rebounder before progressing to a return to throwing program.
Mangiarelli Rehabilitation physical therapist Bobby demonstrates how you can use the rebounder during shoulder rehabilitation after a throwing-related injury:
Return to Throwing Program
Rehabilitation with a sports medicine physical therapist after a shoulder injury involves a gradual restoration of range of motion, strength, muscular endurance, dynamic stabilization, and neuromuscular control in the shoulder via targeted therapeutic exercise and strengthening, manual therapy, rebounder therapy, and aquatic therapy.
The physical therapist begins the return to sport program with a functional movement screen assessment to evaluate all parts of the kinetic chain used during an overhead throw: leg strength and stability, pelvic and trunk control, core strength, shoulder muscle endurance and power, and elbow and hand strength and agility. This assessment helps identify whole-body muscular imbalances to correct during physical therapy.
The return to play progression is a multi-step process with specific goals for each stage of the progression: 1) achieve no pain or swelling in the shoulder, 2) restore baseline range of motion in the shoulder through manual therapy and exercise, 3) regain baseline strength in the shoulder and address muscular imbalances throughout the kinetic chain, 4) assess athlete for normal scapular positioning to prepare for throwing, 5) progress athlete to plyometric strengthening, utilizing the rebounder for throw and catch drills, 6) begin the interval throwing program, 5) assess throwing mechanics and correct incorrect biomechanics to prevent future injury, and 6) full return to competition.
The goals of the return to throwing program are to improve functional strength and conditioning of each component of the kinetic chain, assist in developing a smooth transfer of energy through the kinetic chain, increase the endurance of the core and shoulder muscles, implement a proper pre-throwing warm up, enable the athlete to return to pain-free throwing by gradually increasing the stress placed on the throwing arm, and help the athlete maximize their performance post-injury.
An effective interval throwing program gradually returns motion, strength, and confidence in the throwing arm by slowly progressing through graduated throwing distances. The athlete starts throwing flat-footed using the crow hop method, which simulates the throwing act with proper body mechanics: hop, skip, throw. The athlete then progresses to throwing off the mound, slowly increasing the length and volume of pitches thrown pain-free and symptom-free. The final progression is to throw a simulated game, increasing the distance of the pitches without pain, before moving on to a return to practice and competition with their team.
Overhead throwing places an extreme amount of stress on the shoulder and can lead to repetitive overuse shoulder injuries. It’s important to work with a sports medicine physical therapist to rehabilitate the injured shoulder and help the athlete return to throwing and competition through progressive exercise, rebounder therapy, and an interval throwing program.
