Paper
Interval Throwing Program and Baseball Pitching: Response
Published Jun 1, 2014 · Nicholas R. Slenker, Orr Limpisvasti, K. Mohr
The American Journal of Sports Medicine
2
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Influential Citations
Abstract
Dear Editor: This letter is written in response to the article ‘‘Biomechanical Comparison of the Interval Throwing Program and Baseball Pitching: Upper Extremity Loads in Training and Rehabilitation’’ by Slenker et al. The authors should be commended for their attempt to better define the shoulder and elbow kinetics in various distances of an interval throwing program and variable effort with fastball pitching because of the scarcity of published data pertaining to such. The researchers had good intentions of trying to add beneficial information to the existing knowledge with the hopes of improving training, return-to-throw, and rehabilitation recommendations in the care of baseball athletes. However, we would like to raise our own concerns as to the methodology of the study that may have led to a false conclusion, that is, the similarity in loads to the upper extremity in long toss at all distances and mound throwing. Specifically, the most critical aspect of the study relates to the instructions given to the subjects before throwing on the degree of effort that should be utilized when they were throwing. Our personal recommendations to our athletes, supported by a review of the literature, are such that the athlete is advised to throw the ball on an arc and have only enough momentum to travel the desired distance. Typically, the program is initiated by throwing on flat ground beginning at 13.7 m (45 ft) and gradually progressing to 18.3, 27.4, 36.6, 45.7, and 54.8 m (60, 90, 120, 150, and 180 ft, respectively). Others have advocated beginning the program with short throws from 30 ft at 50% effort, an even more conservative approach, with progression to the longer throws through the same sequential steps, with the ultimate goal being to build progressive arm strength and endurance for pitchers of all levels. Critically, while the athlete is performing the interval throwing program, the clinician should carefully monitor the thrower’s mechanics and throwing intensity. The progression of throwing should be gradual in nature and not specifically instructed with maximum throws in the early phase of throwing. Thus, it is probably not the instructions of throwing ‘‘hard, on a horizontal line with all the flat-ground throws at full effort,’’ as used in the methods by Slenker et al, but instructions to throw ‘‘to the target, and not through the target,’’ as utilized in our sports medicine clinic, that are the more accepted, safe, and logical progression to truly build strength and endurance in a safe and graduated way. Interestingly, after doing a careful review of the existing body of literature, we noticed that other researchers may have misinterpreted the methodology of previous publications used to design their own methods, also incorrectly concluding the correlation between the flat-ground long toss to fastball pitching. They, too, erroneously assumed that flat-ground throwing should be thrown hard on a horizontal line with a low trajectory, even though they referenced the same papers that came up in our literature review with a different and more practical methodology. Throwing in an interval throwing program has not been defined as throwing at all distances with a maximal effort. Our own review of the literature and personal experience supports our current clinical implementation of instructing the player to ‘‘throw to the target and not through the target’’ to ensure a progression of forces to the shoulder and elbow that only throwing gradually, by controlling intensity, can provide. Unfortunately, Slenker et al had their subjects throw hard on a horizontal line and with full effort with all flatground testing distances of 18 m (60 ft), 27 m (90 ft), 37 m (120 ft), and 55 m (180 ft). Thus, the conclusions drawn from their data (no statistically significant difference in either normalized humeral internal rotation torque [nHIRT] or normalized elbow valgus load [nEVL] between any of the flat-ground distances and throwing from the mound [P . .5]) should not be surprising and perhaps reinforcing of the more common approach in the initiation of a proper interval throwing program that should be by design submaximal in effort. If the goal is to minimize injury risk to a baseball player returning back from surgery to the shoulder or elbow, the rehabilitation team must control for intensity, distance, and volume. Suggestion for a future study would be to replicate the current study but tell the athlete to ‘‘throw to the intended target and not through it.’’ This would provide more useful information to better understand the effect of a properly prescribed throwing program on the recovering shoulder and elbow. If anything, the results from the two published biomechanical studies pertaining to flatground long toss with maximum effort and variable-effort fastball pitching, support our clinical experience and instruction for recovering baseball athletes to not throw on a line to best provide the safest healing environment on the affected body part.
The study by Slenker et al may have led to a false conclusion due to the methodology used in the study and the instructions given to athletes on throwing effort.
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