Interval Throwing Program for the Baseball Return to Play Program
A proper return to play program can make or break an athlete’s career after an injury. In baseball, the throwing arm is at risk for many overuse injuries. Poor biomechanics can decrease performance and increase injury risk. The number of Tommy John Surgery procedures continues to rise in all levels of baseball. This is a surgical procedure to fix the ulnar collateral ligament (UCL). As a side note, this surgery will never make your UCL stronger than the original ligament.
Throwing is an extremely demanding load on the inside of the elbow. The proper name for this stress placed on the elbow is elbow varus torque. The best way to limit the need for surgery is to participate in a good shoulder program such as the Thrower’s Ten Program or the Modified Thrower’s Ten program for youth athletes. For more on the importance of a shoulder program for baseball athletes, check out this previous SciSport blog post.
Improve Baseball Performance and Reduce Injury Risk with an In-Season Shoulder Program
Interval Throwing Program for Return to Play
Transitioning from an injury back to pitching must include an interval throwing program to progressively reload the elbow, arm, and shoulder back to optimal pitching performance. The interval throwing program starts with a flat-ground throwing phase (also known as the long-toss). The program will then progress to partial-pitching on the mound, slowly increasing in intensity until full-effort pitching is restored. The flat ground phase starts at 30-45ft and progresses to 120ft without pain for pitchers and 180ft for position players.(2) (A baseball mound is 60.5 ft from home plate.) If pain-free, a pitcher will then transition back to the mound for the next phase, partial-effort pitching.
A recent article from this month’s International Journal of Sports Physical Therapy, “Biomechanical Basis of Interval Throwing Programs for Baseball Pitchers: A Systematic Review,” by Dias, et al. (2023) confirms the effectiveness of an interval throwing program as part of the return to play process.(1) This recent article by Dias et al. compares the joint kinetics and kinematics of the interval throwing program to full-effort pitching.
Long-Toss Phase
As the long toss distance increases, shoulder external rotation increased, shoulder internal rotation velocity (arm speed) increased, and arm slot decreases.(3,4) Arm slot is the forearm position relative to the horizontal plane. In the lower extremity, stride length was consistently shorter compared to pitching from the mound.(3) The elbow varus torque in is not likely to increase more than full-effort pitching, further confirming the usefulness of the progressive increase in long toss distance as part of the return to play interval throwing program.
Returning to the Mound
When partial-effort pitching from the mound, elbow varus torque increased as pitching effort increased.(5) This is good as we want to progressively load the elbow back to full-effort pitching; however, the percent of elbow torque and percent effort do not match up perfectly. Pitching with 50% effort produces 75% torque, and pitching 75-80% effort produces 80-95% elbow torque.(1) This should guide the progression in intensity during the return to play process. Keep the intensity of pitching lower than the athlete might expect due to the correlation of corresponding high elbow torque.
Ball velocity and percent of effort are also not equally matched. At 50% effort, ball velocity is thrown at 85% max. At 75% effort, ball velocity reaches 90% max.(5)
Shoulder external rotation, internal rotation velocities, and elbow extension velocities were significantly less in partial-effort pitching compared to full-effort pitching. It’s important to have definitive evidence that the kinematics of partial-effort are less than full-effort. This allows us to progress the intensity appropriately to match an athlete’s pain and symptoms during the return to play program.
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References
Dias T, Lerch BG, Slowik JS, et al. Biomechanical Basis of Interval Throwing Programs for Baseball Pitchers: A Systematic Review. IJSPT. Published online October 2, 2023:1036-1053.
Reinold MM, Wilk KE, Reed J, Crenshaw K, Andrews JR. Interval sport programs: Guidelines for baseball, tennis, and golf. J Orthop Sports Phys Ther. 2002;32(6):293-298.
Fleisig GS, Bolt B, Fortenbaugh D, Wilk KE, Andrews JR. Biomechanical comparison of baseball pitching and long-toss: Implications for training and rehabilitation. J Orthop Sports Phys Ther. 2011;41(5):296-303.
Lizzio VA, Smith DG, Guo EW, et al. The effect of the crow hop on elbow stress during an interval throwing program. Am J Sports Med. 2021;49(2):359-363.
Fleisig G, Zheng N, Barrentine S, Escamilla RF, Andrews J, Lemak L. Kinematic and kinetic comparison of full-effort and partial-effort baseball pitching. In: Fyhrie D, Gregor R, eds. Twentieth Annual Meeting of the American Society of Biomechanics. American Society of Biomechanics; 1996:151-152.
Disclaimer: This SciSport blog post is a summary of an article printed in an academic research journal. The purpose of this blog post is to provide readers with academic and educational content in an easy-to-understand format. We take no credit for the material and knowledge presented, and we encourage readers to take a look at the original source provided in the References section.
