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Return-to-Throw Rehab Lessons - Part 1
Lesson 1- Failing to Prepare is Preparing to Fail
Prior to ever starting your RTT program, you’ll likely be working with a Physical Therapist. In a perfect world, you’ll be working with one who has a history of competing as, training or rehabbing baseball athletes. They understand what it means to throw a ball and the demands it requires. Unfortunately, this is not always the case. Let me ask you this…Would it ever make sense to have a severe leg injury that required surgery, avoid strengthening the leg beyond basic bodyweight table exercises, but then send you out to start sprints even though you haven’t squatted, deadlifted, jumped or even jogged yet. No, Right? Well this is sometimes what happens in RTT Rehab. The PT/Doc limits upper body lifting beyond basic Rotator Cuff exercises with less than 5 or 10lbs, does no higher intent medball work, but then suddenly clears you to make 50 throws on Day 1. If you could see me, you’d know I'm face down in my palm shaking my head. This approach is haphazard and frankly incorrect.
Take a look at the hierarchy posted below.
While you may see “Injury Prevention” and think “well I’m already injured, how does this apply?” That is exactly why it applies. If I was a betting man, I would put money on that before your injury you placed the top 3 aspects of the pyramid (circled in the second picture) at a higher priority than the other 4 foundational aspects (circled in the third picture).
If your priorities in development are backwards, your chance of injury is higher. If you didn't focus on the foundation, and only focused on the roofing, it’s sure to crumble sooner or later.
That’s great, how does that help you in the rehab process? Guess where most rehab emphasizes?
20 bucks says the majority of your rehab focused on:
Using ice/heat/medication for pain relief.
Scraping/cupping/needling/massage or other recovery modalities.
A throwers 10 type arm care program and some low level scapular stability exercises.
Exercises the PT thought was “sport specific."
A copy/pasted throwing program with the only method of progression being total number of throws and distance (which are often very poorly progressed).
Looks a lot like what was circled above. Instead your emphasis should be on what's circled below.
Here's what your rehab** should emphasize:
Developing and improving your aerobic capacity for better recovery.
Building lower and upper body strength and power to ensure your body is capable for the demands of your sport.
Developing your ability to produce and accept force with reactive ISOs, high-intent medball drills, heavy eccentrics, and deceleration training prior to starting your RTT.
Lastly, implementing a customized and data influenced throwing program with specific metrics for tracking progression with education of proper workload management.
**Side Note - This is not to say your early stage rehab should NOT be focusing on restoring range of motion, building specific strength and tissue capacity in the surgically affected area. That is vital. More on this below.
If I’m wrong, and you did all of this before you picked up a baseball, please let me know and I’ll happily fork over 20 dollars (not really) because you are one of the lucky ones who found a PT or a team of professionals that knows their stuff when it comes to rehabbing baseball athletes.
If I’m right, keep your 20 dollars. Spend it on a gym membership and start training.
So, what should the rehab process look like?
(The following recommendations are generalized guidelines and should not be used without consultation with your rehab professional, please listen to any and all of your medical providers and their specific recommendations regarding your injury).
Phase 1: Immediate Post-Surgical (First Couple Weeks)
Respecting the Surgeons Guidelines - During this time, you need to allow the surgical site and any new hardwire to have the time to settle and heal. Strictly adhere to your restrictions, but do absolutely everything else you can.
Aerobic Capacity Development - Whether it's incline treadmill, a recumbent bike, going on hikes, etc., now is not the time to sit around. 20-30 minutes a day, at a minimum, your heart rate should be up. You'll be surprised how out of shape you are when you get back into moving if you just sit around for the first 3+ weeks. This will also boost your recovery capabilities when you can start doing more, as that's a primary role of the aerobic system.
Train the Legs and Other Arm - There are many, many ways to modify a training plan around one arm that's out of commission. Research clearly shows those that participate in a modified lifting program in conjunction with their early stage rehab work are going to have a better rehab. Your PT, should be able to help you out here. Whether that's by providing a plan for you, or helping you modify an existing one, ask for help on how to keep training around the injury. If they tell you to take it easy, find someone else.
Phase 2: Early - Mid Stage Rehab (First Month or Two)
Continuing to Follow Protocol - Depending on your surgery, you will likely still have restrictions you are working through. Emphasizing regaining certain ranges of motion, active strength and stability, improved movement quality, etc. Keep up with this. You're likely able to now do some of this stuff at home, and can easily be incorporated into the rest of your training routine.
Extensive Power Development - At this point, you may be clear to start bouncing around a little bit. you may need to keep your hand on your hips, but now is a great time to start reincorporating some basic jump/bound/hop progressions at submaximal intent. It'll help you start to feel a greater connection to your lower half and you can start feeling like an athlete again.
Phase 3: Mid-Late Stage Rehab (Pre-RTT) (A Few Months Out)
Re-Integration - At this point, you should have adequate range and strength to start re-integrating your surgical side back into your standard lifting routine. You should be able to Press and Pull, Vertically and Horizontally, at this stage. At first, you'll likely be working the arms unilaterally with two different weights for your surgical and non-surgical sides. Typically at this point, I prescribe a higher volume for the surgical side than the non-surgical side. For example, if we are doing a single arm row, the non-surgical side may have 3x5 @ 70#, but the surgical side may be only up to 25#, so somewhere along the lines of 10-15 reps per set is a good place to be until the load starts to get back up there.
Force Acceptance and Absorption - Extensive (sub-maximal) upper body medball/ballistic motions should be started in this time frame. This is when you should be starting to regain some of the elastic qualities of that surgical side in preparation for throwing.
Higher Intent Speed and Power Development - At this point, you should be able to initiate and progress to higher intent (maybe not maximal, but higher) jumping and and/or sprinting protocols. Get guidance from your rehab professional regarding arm swing when jumping/running, but now is a great time to start making progress here.
Phase 4 - Return-to-Throw
More on this in future installments to this series...
So to recap, what's the lesson here?
Your pre-throw rehab should be preparing your body to handle the initiation and progressing of throwing. You should still be training like an athlete. While the surgical side may need its own attention to begin with, the goal should be re-integration prior to starting a throwing plan, not afterwards.
In future installments, we will discuss early RTT and how we can better shape and guide this process.