Own your rehab process
INTRO
When something physically happens to remove you from your normal every day process of being a baseball player, it feels like a never-ending gut punch. Suddenly, you fill your days of being an athlete grinding both physically and mentally to get that chance just to compete again. It rocks your world. It challenges you in a way no athlete wants. But, you can own it. You can use it to become a better ball player and a better human.
All Injuries are Different
Depending on the diagnosis and medical advise, every rehab program will be different. The same exact injury to two different movers at different parts of their career bring their own individual hurdles. That being said, there are absolutes that every athlete needs to win this process.
Buy in.
The day to day can suck. But, you can win “rehab” by being all in.
Find help.
From physical therapists to mental performance coaches. Use them to guide you through.
Inch by inch.
The best part is the daily process. Win each inch without searching for the goal line until it’s right in front of you.
From working with over 100 rehab cases, the only things guaranteed are it will be hard and there will be bumps in the road. The light at the end of the tunnel will brighten and darken, but it is still there.
All Rehab Processes are Different
Not one return to throw, throwing program, or return to game progression will match another. While this blog is based on the throwing and pitching side, here is some advice:
Listen to your body. Do the things that work.
Prepping to throw is as important as your throwing program.
Throwing program is YOURS. Not the trainers or the pitching coaches. Discuss, communicate, and adjust as needed.
If something is not comfortable in throwing, speak. An adjustment is better than a shutdown.
Take care of your body. Create a better engine and brakes.
Each week of throwing will be scripted out based on volume, distance, and at times intensity. Research and medical studies go into these progressions to provide a steady increase in “load” on your throwing program. The most important piece that is often missed or undervalued in a prescribed return to mound progression is the intensity and documentation of intensity throughout. For example, every thrower plays catch to 60’ differently. Same goes for 90’-180’. How hard you throw, the mechanics of the throw, the amount of constraint (standing still vs shuffling), and overall body effort are all key components in your progression.
No return to play progression is complete by providing distance and volume. Tracking intensity via velocity readings throughout the program will provide more objective data to use along the way.
Every thrower will have personal preferences within pre-throw work (weighted balls, tubing, drills, etc) as well as within their throwing program. The goal is not to create a handcuffed environment but to allow freedom and personal preference within guardrails of intensity and velocity barriers. Some programs will suggest an RPE (rate of perceived effort) but most will simply have a distance and volume of throws. Putting objective numbers and player feedback with velocity tracking and a progression of intensity will provide important information to the physical therapist and medical team to make necessary adjustments to programming and aid progress.
From seeing countless data points between Catapult and Pulse combined with player feedback, everyone’s 90’ catch play will produce different data on workload and stress.
What velocity readings should you track?
Medicine ball shot-puts for weights 4-6LB in a pre-throwing progression.
Does the athlete trust and recover from a medicine ball progression before starting a throwing program?
Is the velocity in a range that shows comfort in higher intensity plyometrics?
Plyo balls / Weighted Baseball Throwing
Most throwers have experience with plyo balls in their pre-throw routine. While not forced, the plyo ball progression of differing weight implements can prepare tissue, movement quality, and trust for the thrower before a baseball progression.
Each injury and athlete will need an individualized program to meet their needs. In early phases, athletes will stay in a 5-11oz range for plyo throwing program for 4-8 weeks.
Programming typically starts 2 weeks prior to prescribed baseball throwing progression and continues with adjustments throughout the return to mound progression.
For most, staying in 5-11oz range early in return to throw progression works best.
Build in volume and intensity with plyo program. Plyo velocity should increases with added distances and velocities in throwing program.
Mound plyo progression should begin by week 6 (90ft range) with specific drills and programming.
Throwing Program
Every throw should be tracked. This can be difficult throughout the process whether it be on site or remote, private or in groups. Practically, getting velocity ranges at each distance and level of the return to mound progression is incredible helpful to the player and staff.
Velocity ranges should be set for plyo programs and throwing program within the given distance and volume each day.
Adjustments to the velocity ranges within the throwing program based on how the thrower feels and checks out with medical prior to throwing allow immediate adjustments necessary to progress while allowing the big picture of the rehab progression to monitor individual progressions.
A very important part of the velocity tracking is the end of the return to mound progression. Most end at 120’ with higher volume before pitchers are expected to be ready for the mound. Tracking velocities at 120’ along with compression throws on the way in from 120’ can provide important feedback on the pitcher’s ability to progress to onus work.
See below for a velocity range chart!
Throwing Programming
Every return to play progression will be different depending on surgical or non-surgical, time missed, and individualized adjustments based on recovery and progress.
A key factor to understand for any return to play is managing progressive workload. Small additions and gains through workload and stress adaptation is the safest and most efficient way back to games. Big jumps in volume, intensity, and/or frequency can put the end goal in jeopardy.
How do we progress efficiently? It begins with adding volume at low intensity. For example, throwing 3 days a week with moderate volume and low intensity is typical for week 1-8 of a throwing arm surgery rehab plan. Through these 8 weeks, the throwing volume and distance will increase to around 90-120’. Intensity will also increase throughout the 8 weeks. The goal is to give more time for recovery with 4 days off a week and adding workload throughout.
Once this phase is “complete”, a new component to the program will be throwing 4 days per week which requires the athlete to throw back to back days with 1 off day in between. The days will be split up into light-medium-heavy days to allow the body to split up the workloads and gradually add stress. For example, 60-75’ throwing on Monday with light-medium intensity and 105’-120’ on Tuesday with medium-heavy intensity before an off day on Wednesday. This is also a great time to begin adding mound plyo throws, low volume off-speed in catch play, and more detailed velocity tracking.
Weeks 9-14 are a crucial phase as the 4 day throwing week begins and intensity continues to climb. Again, steady increases in the intensity tracked with velocity readings will help the athlete manage intensity better than a distance or volume prescription.
Need help managing a velocity based throwing program in your progression? See below:
Example is for a surgical procedure on throwing arm. Each column is representing pre-injury fastball velocity.
Blending to the Mound
Mound work should begin early and often in the return to play progression. In fact, we have players touching the mound 3-4x a week before they touch a ball. Providing movement drill sets with core velocity belt, PVC pipes, water bags/tubes, medicine balls, 3D straps, and more for each athlete is key to their movement progression. In my experience, we begin these drill work days 3-4 weeks before first day of throwing. They continue through the first 8 weeks of throwing program with minor adjustments as needed.
Once the athlete is in the 4x a week throwing program, we will begin adding more mound work with throwing plyo balls. On medium-heavy days, each thrower will have drill sets for mound throws with plyo balls with velocity tracking.
This phase should be individualized for each thrower depending on objective data from velocity tracking, recovery, grip/shoulder strength, and other areas being monitored. For most throwers, it is best to get moving off the mound by week 12 in small increments. From experience, throwing off 1/2 slope or full slope into a net at controlled intensities (65-80% range) is more beneficial for their mound prep than increasing workload with flat grounds after 120’ throwing program. By combining mound plyo throw and drill work in pre-throw training with a slow mound progression, the athlete is gaining more comfort with the environment he must work in.
Another component of understanding player readiness for a mound progression is the velocity readings at 120’ and in their compressions at 90’. From experience, building up intensity in the compressions when we get to the 120’ phase can show how comfortable the athlete is at higher intensity throws. Most throwers should be able to get to 96-100% of their fastball velocity by the 3rd week (6th session) of compressions. Prescribing 5-8 compression after 120’-135’ and tracking velocity is a good place to start. For example, a player’s average fastball velocity was a 92-95 before injury would expect compression velocity to range between 88-95mph. For some, this will be difficult but is a good way to track their max outputs before tracking velocity on the mound.
Key points that often get discussed and challenged:
There are differing opinions on when to begin mound work, what is “mound work”, are flat grounds “good”, and how much mound work is needed before a live BP progression.
Begin mound work early in a controlled setting (radar, prescribed intensity, net as target, low volume)
Mound work is throwing off the mound to a target. This can be controlled and progressed from going halfway up the slope to full slope, short box (target in front of plate) to full distance, and net to a human catcher. The longer time the player has to adjust to the game environment with similar skill training the more likely they are going to have trust and conviction in their mound phase.
Flat grounds are not good. It is as simple as no data proves a flat ground is safer AND the throwing mechanics are different due to timing of landing down a slope and key positions that create easier ball velocity being optimal on the mound.
Minimum of 12 official mound sessions for a surgical repair rehab program building up to 40+ pitches. Ideally, combined with the unofficial mound work completed earlier in the program at lighter intensities, the player should be able to get 20 or more mound sessions in. The level of recovery, fastball velocity, and player’s feedback should help drive this answer.
When do you begin throwing off-speed?
There are several different opinions out there with some research supporting earlier off-speed usage compared to most modern day programs. Typically, change-ups are thrown first as the off-speed progression around week 10 of throwing. Some strongly believe that the earlier the better. We have found success beginning around week 6 (90ft) with change-ups an week 9 for breaking balls. There should be comfort with all spin before maximal output throws as studies show stress is highest in high output, high velocity throws not breaking balls.
In the mound progression, adding change-up in the 3rd bullpen and breaking ball in the 5th has led to success with feeling comfortable and ample time to focus on pitch design in the mound progression.
Conclusion
Rehabbing an injury is hard and there are several challenges along the way. To our first point, buy in is key. Trust the help. Any progress is progress. In time, the trust behind a throw without fear will come back. Put yourself in an environment where you have trusted help and a support system. As always, email us with more questions!