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In baseball pitchers, lead hip dysfunction and low back pain often go hand-in-hand. When the lead hip can’t do its job, the lower back picks up the slack — leading to excessive stress, mechanical breakdown, and chronic pain.Properly identifying the root cause, addressing mobility and control deficits, and restoring the entire lumbopelvic-hip complex is critical to keeping pitchers healthy, powerful, and consistent on the mound.Prevalence&nbsp;<ul><li>Up to 30–40% of baseball pitchers experience low back pain during a season. </li><li>Limited lead hip internal rotation (IR) is a major risk factor for back and oblique strain. </li><li>Poor hip control forces pitchers to over-rotate or hyperextend the lumbar spine, increasing stress on facet joints, paraspinals, and hip capsule. </li></ul>Causes&nbsp; During the pitching delivery: The lead hip must internally rotate and stabilize during stride foot contact. If hip IR or strength/stability is lacking, the pelvis cannot decelerate properly.The lumbar spine compensates by rotating or extending too much. Repeated compensation leads to facet joint irritation, muscle strain, or SI joint overload.Over time, the pitcher may develop “pushy” mechanics or late trunk rotation, further stressing the back.Signs &amp; Symptoms<ul><li>Local pain in the lower back, usually on the lead side.</li><li>Pinpoint tenderness near lumbar paraspinals or SI joint.</li><li>Tightness in the lead hip, especially IR and extension.</li><li>Feeling of “pinching” in the groin when rotating the hip.</li><li>Back tightness after bullpens or multiple innings.</li><li>Velocity drop, control loss, or “flying open” mechanics.</li></ul>Diagnosis &amp; Key FindingsA solid evaluation should check:<ul><li>Lead hip IR ROM (should be 30°+)</li><li>Pelvic control in single-leg stance (Y-balance or single-leg squat)</li><li>Lumbar extension-rotation test (pain suggests lumbar facet overload)</li><li>Hip flexor and posterior chain tightness</li></ul>Imaging: Usually not needed initially, but an MRI may be useful if:<ul><li>Pain persists &gt;6 weeks</li><li>Radicular (nerve) signs appear</li><li>Suspected stress reaction or disk involvement</li></ul><h3>Treatment &amp; Corrective Solution&nbsp;</h3>Phase 1: Mobility &amp; Symptom Control (0–2 Weeks)<ul><li>Soft tissue work: glutes, TFL, adductors, hip capsule</li><li>Lead hip IR stretching (Frog Pose, Hip Sleeper Stretch)</li><li>Gentle core and pelvic control drills (dead bugs, bird dogs, planks)</li><li>Limit throwing volume or offload to dry mechanics</li></ul>Phase 2: Strength &amp; Control (2–4 Weeks)<ul><li>Single-leg hip stability (split squat, SL RDL)</li><li>Lateral hip strength (Clamshells, Lateral Plank Leg Raise)</li><li>Pelvic control (Bird Dogs, Anti-rotation holds)</li><li>Light plyos (DL-&gt;SL Depth Drops, Skater Jumps) once control is good</li></ul>Phase 3: Kinetic Chain Integration (4–6 Weeks)<ul><li>Medicine ball rotational throws (MB Split Stance Rotate and Press)&nbsp;</li><li>Dynamic lead leg blocking drills (RFE SL MB Slam)&nbsp;</li><li>Hip hinge patterning with trunk rotation (SL RDL Cross Body Row)&nbsp;</li><li>Integrate drills into flat ground sessions (MB Wind-up OH Slam)&nbsp;</li></ul>Our Return to Mound Criteria<ul><li>Pain-free lead hip rotation and load acceptance </li><li>Single-leg balance and rotation equal bilaterally </li><li>No lumbar pain during dry throwing or plyos </li><li>Full mound mechanics with no trunk over-rotation </li><li>Proper stride length and timing restored</li></ul>Typical timeline: 4–6 weeks for mild-moderate cases with structured rehab and throwing plan.Risk of RecurrencePitchers are at higher risk if they:<ul><li>Ignore hip mobility maintenance</li><li>Pitch fatigued with poor trunk timing</li><li>Lack posterior chain strength</li><li>Fail to address hip-pelvis dissociation</li></ul>Prevention Checklist<ul><li>Maintain lead hip IR during season (stretch, banded mobs)</li><li>Train single-leg eccentric strength &amp; pelvic control year-round</li><li>Prioritize posterior chain loading (deadlift, DL/SL RDL, hip hinge)</li><li>Include dynamic warm-ups: hip openers, lunges, skips</li><li>Video/3D motion capture mechanics to spot excessive lumbar extension or early opening</li></ul>Bottom LineLead hip restriction = lumbar overload.Fix the hip, control the pelvis, protect the back and keep the kinetic chain strong from ground to glove. Pitchers who maintain hip mobility and trunk control stay healthier, throw harder, and perform longer.References1. Camp CL, et al. (2016). Low back pain in baseball players: Epidemiology and risk factors. Am J Sports Med, 44(2): 449–456. 2. Laudner KG, et al. (2014). The relationship between lead hip internal rotation and lumbar mechanics in pitchers. J Sport Rehabil, 23(1): 32–37. 3. Kibler WB, et al. (2013). The role of the scapula and kinetic chain in pitching: Rehabilitation and prevention. Sports Health, 5(2): 153–156. 4. Reinold MM, et al. (2016). Rehabilitation for the overhead throwing athlete: Managing kinetic chain deficits. Int J Sports Phys Ther, 11(4): 586–601.

Lead Hip & Low Back Pain in Pitchers

Quadriceps muscle strains are one of the most common lower body soft tissue injuries in sports that involve sprinting, decelerating, and kicking—like baseball, soccer, and football. Whether it occurs during a sudden burst out of the batter’s box or when sprinting to field a ball, a quad strain can sideline athletes for weeks if not managed properly.Understanding the mechanism, rehabilitation, and return-to-play criteria is essential to ensure safe and complete recovery.<h3>What Is a Quad Strain?</h3>The quadriceps femoris is a group of four muscles on the front of the thigh:<ul><li>Rectus femoris&nbsp;</li><li>Vastus lateralis</li><li>Vastus medialis</li><li>Vastus intermedius</li></ul> A strain occurs when one of these muscles is overstretched or forcibly contracted, leading to microscopic tearing or, in more severe cases, partial or complete rupture.<h3>Frequency and Risk Factors in Sport </h3>Quadriceps injuries account for 10–30% of all lower extremity muscle injuries in field and court sports, with the rectus femoris being the most commonly injured muscle in the group (Cross et al., 2004).Risk factors include: <ul><li>Sudden sprinting or kicking motions</li><li>Eccentric overload during deceleration</li><li>Muscle imbalances or previous quad strain</li><li>Fatigue or poor warm-up</li><li>Inadequate recovery between games or practices</li></ul> In baseball, quad strains are often seen in outfielders, baserunners, and catchers during explosive movements.<h3>Signs and Symptoms </h3>Athletes with a quad strain may experience:<ul><li>Sudden sharp or pulling pain in the front of the thigh</li><li>Pain with sprinting, jumping, or kicking</li><li>Swelling or bruising within 24–48 hours</li><li>Tenderness to palpation along the muscle belly</li><li>Weakness or stiffness with active knee extension</li><li>Visible defect in severe or high-grade tears</li></ul><h3>Diagnosis and Imaging </h3>Diagnosis is primarily clinical:<ul><li>Palpation identifies tenderness and possible muscle gap</li><li>Active and passive range of motion testing</li><li>Resisted knee extension reproduces pain and weakness</li><li>Ultrasound or MRI may be used to confirm:</li><li>Muscle involved (typically rectus femoris)</li><li>Location (primarily muscle belly)&nbsp;</li></ul>Grade I (mild) <ul><li>Small number of fibers torn, minimal strength loss &nbsp;Return: 1–2 weeks</li></ul>Grade II (moderate) <ul><li>Partial tear with noticeable strength loss, moderate pain &nbsp;Return: 3–6 weeks</li></ul>Grade III (severe)<ul><li>Complete rupture or near-complete tear &nbsp;Return: 8+ weeks, possible surgical referral</li></ul><h3>Treatment and Rehab Process&nbsp;</h3>Phase 1: Acute Management (0–5 Days) <ul><li>Rest and activity modification (no running, sprinting)</li><li>Ice and compression</li><li>Gentle pain-free range of motion (heel slides, quad sets)</li><li>Avoid stretching the quad in this phase</li></ul> Phase 2: Controlled Mobility and Isometrics (5–14 Days) <ul><li>Begin isometric quad contractions</li><li>Light open-chain exercises (SLR, wall sits)</li><li>Gentle stretching if tolerated</li><li>Pain-free stationary bike or pool work for aerobic maintenance</li></ul> Phase 3: Strength &amp; Load Tolerance (2–4 Weeks) <ul><li>Progress to concentric and eccentric strengthening (knee extensions, step-ups)</li><li>Hip and core integration (e.g., glute bridges, clamshells)</li><li>Low-speed agility drills (ladder drills, cone steps)</li></ul> Phase 4: Dynamic Loading &amp; Return to Sport (4–6+ Weeks) <ul><li>Introduce sprint mechanics, high-speed eccentrics (Nordics, resisted eccentrics)</li><li>Plyometrics and reactive drills</li><li>Full field sprinting and position-specific movement</li><li>Gradual reintegration into practice or game-speed tasks</li></ul><h3> Return to Sport Criteria </h3>Athletes should meet all of the following:<ul><li>Full, pain-free range of motion</li><li>Strength within 90–95% of contralateral leg (we measure this with forceplate technology)</li><li>Less than 5% assymetry on all Forceplate tests</li><li>Completion of sprinting, deceleration, and agility drills without pain</li><li>No soreness 24 hours after high-intensity training</li><li>Athlete confidence in speed and power</li></ul> <h3>Risk of Recurrence and Prevention </h3>Common causes of reinjury: <ul><li>Incomplete strength recovery</li><li>Premature return to sprinting</li><li>Ignoring pain during sprint work</li><li>Poor eccentric load tolerance</li></ul> Prevention strategies: <ul><li>Include eccentric-focused quad strengthening (e.g., reverse Nordic curl)</li><li>Maintain hip and core strength</li><li>Warm-up with dynamic movements and activation drills</li><li>Avoid spikes in sprint volume or intensity</li><li>Use GPS or workload monitoring in team settings</li></ul><h3>Summary</h3>Quadriceps strains are a preventable and highly treatable soft tissue injury when diagnosed early and managed progressively. The key to safe return isn’t just absence of pain; it is restored strength, load tolerance, and movement confidence.Structured rehab, regular re-testing, and progressive loading are the athlete’s best defense against recurrence.References 1. Cross MJ, et al. (2004). Acute muscle strains in sport: Aetiology, clinical features, and management. Sports Medicine, 34(10): 793–809.2. van der Made AD, et al. (2016). Return to play after thigh muscle injury in elite football players: A systematic review. BMJ Open Sport &amp; Exercise Medicine, 2(1): e000086.3. Reurink G, et al. (2014). MRI observations at return to play of clinically recovered hamstring injuries. British Journal of Sports Medicine, 48(18): 1370–1376.4. Askling CM, et al. (2013). Acute first-time hamstring strains during high-speed running: A comparison of two rehabilitation protocols. British Journal of Sports Medicine, 47(15): 953–959.5. Mendiguchia J, et al. (2012). The use of MRI to evaluate the effects of injury prevention programs on muscle injury risk. International Journal of Sports Medicine, 33(7): 594–602.

Quadriceps Muscle Strains

In throwing sports like baseball, most athletes and coaches focus on arm strength, shoulder mechanics, or pitch count to prevent injury. But there is much more to the equation. Research shows that hip mobility, especially Internal rotation (IR) and External Rotation (ER) range of motion, play a significant role in reducing the risk of shoulder and elbow injuries.&nbsp;<h3>The Kinetic Chain&nbsp; </h3>Throwing is a full-body movement. Energy is generated from the ground up; from the ground, through the legs, hips, transfered through the trunk, and disepated through the arm. This sequence is known as the kinetic chain. When one link is restricted, such as limited hip internal or external rotation, the rest of the body must compensate. This often leads to excess stress on the shoulder or elbow.<h3>Supportive Reasearch&nbsp;</h3><ol><li>A study of Division I collegiate pitchers found that limited hip internal rotation (IR) and total rotational arc (TRARC) significantly increased elbow extension and valgus stress at ball release. These altered mechanics increase the risk of ulnar collateral ligament (UCL)/Tommy John injury. </li><li>Adolescent pitchers with decreased hip flexion and IR were more likely to report elbow pain over the course of a season. </li><li>&nbsp;Hip rotation defecits, specifically glove side hip IR, are associated with increased elbow vlagus torque.&nbsp;</li><li>Systematic reviews confirm that hip ROM deficits, particularly in the lead leg, are linked to altered trunk rotation timing and faster arm acceleration. Both of which are biomechanical risk factors for throwing injuries.</li></ol>In summary, limited hip mobility doesn’t just make your lower half stiff. It changes how your arm moves and absorbs stress.<h3>How We Measure Hip Mobility&nbsp;</h3><ul><li>Motion Capture/3D Motion Techology</li><li>Sports Medicine Physical Therapy Evaluation&nbsp;</li></ul><h3>How To Improve Hip Mobility&nbsp;</h3>Below is a link to our favorite hip mobility exercises/drills.<figure id="figure-elitkj4cltmbzsmz7t"><iframe id="elitkj4cltmbzsmz7t" src="https://www.youtube.com/embed/8nFXIzSRvOk" class="w-full bg-gray-100 rounded-sm md:rounded-md lg:rounded-lg" style="aspect-ratio: 16/9;" allowfullscreen="" data-url="https://www.youtube.com/watch?v=8nFXIzSRvOk&amp;list=PLceC67zz_JBCt1JFhuwNc5Nc3n5WXLw01" data-corners="small" data-fullwidth="false" data-mce-src="https://www.youtube.com/embed/8nFXIzSRvOk" data-mce-style="aspect-ratio: 16/9;"></iframe></figure>It is not just about flexibility. Athletes must also have elite control and strength throughout the full range of motion.&nbsp;<h3>Take Home Message&nbsp;</h3>If you’re only looking at the only the arm/shoulder, when evaluating injury risk in throwers, you’re missing a huge piece of the puzzle. Hip mobility is a critical foundation for healthy, high-velocity throwing. Whether you’re a youth pitcher or a hitter, screening and improving your hip ROM can be a game-changer in performance and longevity. References 1. Laudner, K. G., et al. (2010). The Relationship Between Range of Motion and Throwing Mechanics in Collegiate Baseball Pitchers. Journal of Shoulder and Elbow Surgery, 19(3), 366–370. 2. Sauers, E. L., et al. (2014). Hip and Shoulder Passive Range of Motion and Motion Timing Differences in Baseball Pitchers With Elbow Pain. Athletic Training &amp; Sports Health Care, 6(3), 129–136. 3. Camp, C. L., et al. (2017). Relationship Between Throwing Mechanics and UCL Injury Risk in Baseball Pitchers. The American Journal of Sports Medicine, 45(3), 728–735. 4. Oliver, G. D., et al. (2015). Differences in Hip Range of Motion Between Baseball Pitchers and Position Players. Sports Health, 7(2), 142–146. 5. Aguinaldo, A. L., &amp; Chambers, H. (2009). Correlating Elbow Valgus Torque With Hip and Shoulder Kinematics in Baseball Pitchers. Journal of Applied Biomechanics, 25(2), 140–148.

How Hip Mobility Impacts Elbow and Shoulder Injuries

Forearm and elbow tendonitis—whether on the medial/in-side (flexor-pronator mass) or lateral/out-side (extensor-supinator group)—is one of the most common overuse injuries in baseball players. These injuries can derail a throwing season if not addressed early. Fortunately, isometric training is a proven, low-load, high-value tool in both early-stage rehab and long-term tendon health. Understanding Elbow Tendonitis in Throwers In baseball players, repetitive throwing stress can cause:Medial elbow tendonitis (aka flexor-pronator tendinopathy) <ul><li>Common in pitchers, often coexists with UCL strain or overload</li></ul> Lateral elbow tendonitis (aka extensor tendinopathy or "thrower's tennis elbow") <ul><li>Less common but seen in hitters and some fielders</li></ul> These conditions typically involve microtrauma to the tendon near its attachment at the elbow, leading to inflammation, collagen disorganization, and pain with gripping, throwing, or resisted wrist movements. Isometrics are an excellent way to combat these injuries/pain.<h3> Isometrics </h3>Isometric exercises involve muscle contraction without joint movement—making them ideal for:<ul><li>Reducing pain via cortical inhibition</li><li>Maintaining strength during painful phases/flare-ups</li><li>Improving tendon load tolerance without irritation </li><li>Acting as a bridge between rest and dynamic loading</li></ul>Research (Rio et al., 2015) supports isometrics as an effective early intervention for tendinopathies, offering both pain relief and strength preservation.<h3> Our favorite Isometric Exercises for Elbow Tendonitis </h3>These drills should be pain-free to mild discomfort only (0–3/10) and held for 30–60 seconds per repetition. Perform 3–5 sets, once or twice per day, progressing intensity as tolerated.Pronation Club Iso Holds&nbsp;KB Club Pronation Iso HoldsFinger Palm Wall PressTricep Extension Iso Holds&nbsp;PowerBand Pronation/Supination Holds&nbsp;Seated PowerBand Pronation Holds&nbsp;<figure id="figure-ckx1pc7osmcagoqb8" class=""><iframe id="ckx1pc7osmcagoqb8" src="https://www.youtube.com/embed/3BuZlPCh6nc" class="w-full bg-gray-100 rounded-sm md:rounded-md lg:rounded-lg" style="aspect-ratio: 16/9;" allowfullscreen="" data-url="https://www.youtube.com/shorts/3BuZlPCh6nc" data-corners="default" data-fullwidth="false" data-mce-src="https://www.youtube.com/embed/3BuZlPCh6nc" data-mce-style="aspect-ratio: 16/9;"></iframe></figure>

Elbow Isometrics for Tendonitis in Throwers

While most shoulder injuries in baseball are associated with throwing, traumatic shoulder subluxations from diving into a base, sliding, or forceful swings are an under-recognized but serious issue—especially in infielders, outfielders, and hitters. These injuries can cause persistent instability, limit performance, and increase the risk of future dislocations if not managed properly. What Is a Shoulder Subluxation? A shoulder subluxation is a partial dislocation of the humeral head from the glenoid fossa that spontaneously reduces. It is different from a full dislocation (which often requires reduction by a medical provider).Mechanisms in baseball include:<ul><li>Diving or falling onto an outstretched hand (FOOSH)</li><li>Arm forcibly extended and externally rotated</li><li>Powerful eccentric follow-through during a swing</li></ul>This trauma can stretch or tear the anterior capsule, labrum, and inferior glenohumeral ligament complex, leading to instability.Signs and Symptoms Symptoms of shoulder subluxation can range from mild to severe:<ul><li>Sudden, sharp pain during the injury event</li><li>Feeling of the shoulder “slipping out” and back in</li><li>Localized pain in the front or deep inside the shoulder</li><li>Weakness or instability with reaching or swinging</li><li>Decreased power or confidence in shoulder function</li><li>“Dead arm” sensation after incident</li><li>In severe cases, swelling, guarding, or labral clicking may develop within 24 hours.</li></ul>Frequency and Risk&nbsp; Shoulder subluxations are less frequent than throwing-related pathologies but still significant in high-level baseball. They most commonly affect:<ul><li>Infielders diving into bases</li><li>Outfielders landing on an outstretched arm</li><li>Hitters with aggressive follow-throughs or torque-driven swings </li></ul>According to Owens et al. (2009), subluxation events account for up to 40% of all traumatic shoulder instability cases in contact and field sports, with baseball players making up a notable portion of non-contact subluxation presentations.Diagnosis and Imaging Evaluation includes:<ul><li>History of trauma (diving, fall, swing) with instability feeling</li><li>Physical tests:<ul><li>Apprehension and relocation tests (for anterior instability)</li><li>Sulcus sign (for multidirectional laxity)</li><li>Load and shift test</li></ul></li><li>MRI arthrogram is the gold standard to evaluate:<ul><li>Labral tears (e.g., Bankart lesions)</li><li>Capsule and ligament integrity</li><li>Hill-Sachs lesions (compression fractures of the humeral head)</li></ul></li></ul><h3>Treatment Options </h3>Conservative Treatment (for first-time or low-grade subluxation) Phase 1: Acute Protection (0–10 Days)<ul><li style="list-style-type: none;" data-mce-style="list-style-type: none;"><ul><li>Rest from throwing, hitting, and high-stress movements</li><li>Imbolization: Sling for 1-2 weeks</li><li>Ice, anti-inflammatories, and sling (if needed) for pain control</li><li>Avoid Abduction and External rotation (position of dislocation dependent)</li><li>Begin gentle pendulum and pain-free ROM</li><li>Initiate isometrics, if pain free</li><li>Elbow, wrist and hand AROM&nbsp;</li><li> </li></ul></li></ul>Phase 2: Mobility &amp; Scapular Control (10–21 Days) <ul><li style="list-style-type: none;" data-mce-style="list-style-type: none;"><ul><li>Begin pain free PROM and AAROM</li><li>Avoid ABD combined with ER motions</li><li>Restore full PROM, especially ER and IR in neutral and 90°</li><li>Progress/Initiate isometrics for rotator cuff and scapular stabilization</li><li>Begin rhythmic stabilization drills for dynamic control</li></ul></li></ul>Phase 3: Strengthening &amp; Stability (3–6 Weeks)<ul><li style="list-style-type: none;" data-mce-style="list-style-type: none;"><ul><li>Closed-chain and low load/intensity weight-bearing drills</li><li>Closed-chain exercises (wall walks, quadruped rhythmic stabilization).</li><li>Initiate proprioceptive work (e.g., body blade, ball on wall).</li><li>Avoid heavy overhead activities.</li><li>Progress to eccentric cuff strengthening, core integration, and med</li><li>ball control drills</li><li>Emphasize kinetic chain mechanics in hitting and fielding positions</li></ul></li></ul>Phase 4: Return to Play Progression (6–10 Weeks) <ul><li style="list-style-type: none;" data-mce-style="list-style-type: none;"><ul><li>Progress to OKC ER/IR, rows, prone T/Y/I exercises.</li><li>Initiate open-chain strengthening, double arm plyometrics</li><li>Begin light overhead work, push-up progressions.</li><li>Gradual reintroduction of hitting, diving, and throwing under supervision</li><li>Continue pre-activity scapular and posterior cuff activation</li><li>Monitor for any signs of instability or hesitation during full effort tasks</li></ul></li></ul>Phase 5: Return to Throw/Hitting and Play (10-16+ weeks)&nbsp;<ul><li style="list-style-type: none;" data-mce-style="list-style-type: none;"><ul><li>Must demonstrate:<ul><li>Symmetrical ROM and scapular control.</li><li>No apprehension or instability with ER and abduction.</li><li>Satisfactory performance on upper limb tests<ul><li>Follow a structured throwing progression:<ul><li>Phase 1: Flat-ground throws (45–90 ft)</li><li>Phase 2: Increase intensity and distance</li><li>Phase 3: Bullpens (~14+ weeks post-injury)</li><li>Phase 4: Live batting practice</li></ul></li></ul></li></ul></li></ul></li></ul>Surgical Consideration Indicated for:<ul><li>Recurrent subluxations</li><li>Presence of labral tears or Bankart/Hill-Sachs lesions</li><li>Failure to regain dynamic stability after 2–3 months of rehab</li><li>Procedures may include arthroscopic Bankart repair, capsular shift, or open stabilization depending on tissue damage.</li></ul>Return to Sport Timeline Conservative Rehab: 6–16+ weeks Arthroscopic Repair: 4–6 months Open Stabilization: 6–9 months According to Mair et al. (2002), 80–90% of athletes who undergo non-surgical management for a first-time subluxation return to sport successfully if rehab is completed properly. Surgical cases can also have high return rates but require longer recovery timelines and precise RTP criteria.Risk of Recurrence and Long-Term Outlook Up to 40% of first-time subluxation cases recur within two years, especially in contact or overhead athletes&nbsp; Poor scapular control and insufficient ER strength are common reinjury factors Labral damage or generalized hypermobility increases recurrence risk Prevention Strategies Posterior cuff and scapular endurance training Eccentric control drills (e.g., manual ER deceleration, plyometric med ball rebounders) Core and hip control during diving or reaching mechanics Use protective bracing or shoulder sleeves in high-risk players Monitor shoulder workload, especially in dual-role athletes (e.g., pitcher-infielder)<h3>Summary</h3>Anterior shoulder subluxations from diving or hitting are traumatic but manageable injuries in baseball athletes. Whether treated conservatively or surgically, success depends on full restoration of dynamic stability, scapular control, and athlete confidence.With structured rehab and return-to-play planning, athletes can return to competition safely and efficiently—stronger and more resilient than before. References <ul><li>Owens BD, et al. (2009). Incidence of shoulder instability in the United States military: demographic considerations from a high-risk population. Journal of Bone and Joint Surgery, 91(4): 791–796.</li><li>Mair SD, et al. (2002). Nonoperative treatment of shoulder instability in athletes. The American Journal of Sports Medicine, 30(5): 758–765.</li><li>Burkhart SS, De Beer JF. (2000). Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs. Arthroscopy, 16(7): 677–694.</li><li>Wilk KE, et al. (2011). Rehabilitation of the overhead throwing athlete: Current concepts and clinical applications. Journal of Orthopaedic &amp; Sports Physical Therapy, 41(2): 388–400.</li><li>Arciero RA, et al. (2006). Return to sport after first-time shoulder dislocation in collegiate athletes. The American Journal of Sports Medicine, 34(5): 772–776.</li><li>Paterson et al. Shorter immobilization has similar outcomes to longer immobilization but allows earlier rehab (Paterson et al., 2010).</li><li>AAOS Guidelines for Shoulder Instability</li><li>ARC Consensus Statement, 2022 – Youth shoulder instability management </li></ul>

Shoulder Subluxation/Dislocation in Baseball

<h3>Our Systematic Approach for all Overhead Athletes Recovering from Shoulder or Elbow Injuries</h3>Our goal is to provide a simplified and direct approach to return to throwing. This systematic approach ensures all variables are accounted for to ensure elite results.&nbsp;This checklist is intended to help clinicians, coaches, and athletes determine when a player is ready to begin a structured interval throwing program following rehab from any upper extremity throwing injury (e.g., SLAP tear, UCL sprain, posterior impingement, rotator cuff strain, flexor mass strain, etc.).Step 1: Clinical Clearance&nbsp;<ul><li>Injury-specific pain-free range of motion (active and passive) </li><li>No pain with palpation of affected structures (labrum, UCL, flexor mass, etc.)</li><li>No clicking, locking, or instability reported by athlete</li><li>Symmetrical Shoulder total arch of motion (with a goal of 150-160 degrees)</li><li>Shoulder Flexion PROM of greater than 150 degrees&nbsp;</li><li>Shoulder Horizontal Adduction of greater than 20 degrees&nbsp;</li><li>Thoracic Spine Rotation of greater than or equal to 60 degrees&nbsp;</li><li>Negative or normalized provocative orthopedic tests (e.g., O’Brien’s, valgus stress, posterior impingement)</li><li>No night pain or post-activity soreness that lasts &gt;24 hours</li><li>Physician or rehab provider has cleared return to throwing</li></ul>Step 2: Strength &amp; Stability<ul><li>Greater than or euqal to non-domanate isometric strength scores<ul><li>Tested with out force plate technology:&nbsp;&nbsp;<ul><li>Shoulder Flexion&nbsp;</li><li>Shoulder Abduction&nbsp;</li><li>Shoulder I, Y, and T tests&nbsp;</li><li>Shoulder Internal Rotation&nbsp;</li><li>Shoulder External Rotation&nbsp;</li><li>Bicep and Tricep&nbsp;</li><li>Pronation/Supination&nbsp;</li><li>Wrist Flexion/Extension</li><li>Grip strength&nbsp;</li></ul></li></ul></li><li>Normal Scapular-Humeral Mechanics and Neuromusular Controll</li><li>Normal Glenohumeral and Scapulothoracic Stability&nbsp;</li></ul>Step 3: Kinetic Chain Readiness<ul><li>Functional hip and thoracic spine mobility&nbsp;</li><li>Single leg balance within 90% of opposite side&nbsp;<ul><li>Objectively measured on our motion capture and force plates&nbsp;</li></ul></li><li>Motion Capture Functional Movements all within normal values&nbsp;<ul><li>Squat&nbsp;</li><li>Single Leg Squat&nbsp;</li><li>Lunge&nbsp;</li><li>Single Leg Balance&nbsp;</li></ul></li></ul>Step 4: Plyometric and Movement Preparation<ul><li>Complete a progressive plyometric drill program&nbsp;<ul><li>Double arm medicine ball throws</li><li>Single arm mechcine ball throws<ul><li>Visit our youtube channel for examples&nbsp;</li></ul></li></ul></li></ul>Step 5: Throwing-Specific Readiness<ul><li>Mentally confident and motivated to begin throwing </li><li>Understands and agrees to interval throwing progression and soreness rules </li><li>Completed education on:<ul><li>Arm care<ul><li>Pre-throw routine&nbsp;&nbsp;</li><li>Recovery strategies</li><li>Pain monitoring</li></ul></li></ul></li><li>Athlete can demonstrate:</li><li>Proper throwing mechanics at submaximal effort</li><li>Trunk and scapular sequencing in dry throws or shadow drills</li><li>No fatigue, loss of control, or “dead arm” during mock or light-velocity drills</li></ul>Additional Benchmarks we regularly assess to determine readiness&nbsp;<ul><li>Shoulder ER/IR ratio: &gt;66% on dynometer testing&nbsp;</li><li>Core rotational strength&nbsp;</li><li>SL squat mechanics/form&nbsp;</li><li>Hip ER &gt; 40 degrees&nbsp;</li><li>Hip IR &gt; 30 degrees&nbsp;</li></ul>Final Notes<ul><li>Use daily readiness logs or soreness monitoring to guide progression.</li><li>Athletes must remain symptom-free during and 24 hours after each session.</li><li>If pain, loss of mechanics, or fatigue occurs—pause, regress, and reassess.</li><li>A supervised interval throwing program is strongly recommended.</li></ul>

Athlete Resources: Move Med U

Lead Hip & Low Back Pain in Pitchers

Quadriceps Muscle Strains

How Hip Mobility Impacts Elbow and Shoulder Injuries

Elbow Isometrics for Tendonitis in Throwers

Shoulder Subluxation/Dislocation in Baseball

Return-to-Throwing Checklist