Return to Throwing: A Rehab Program

Let’s say a college baseball player injures his shoulder pitching. After completing medical treatment, surgery, therapy, or some combination of the three, the orthopedist gives him a return to throwing program. A college ultimate player who does the same? An orthopedist asks him what ultimate is, prescribes treatment, then when treatment is complete, says “Ok, you’re good to go.”

I’m currently the strength and conditioning coach for the University of Central Florida Dogs of War, as well as a physical therapy student, and I frequently consult our guys on injuries. A guy on our team had had a nagging shoulder injury since before he joined this season. When he brought up the issue of his shoulder he told me he’d seen a doctor, had physical therapy, got an MRI, which came back negative, and had a cortisone shot, and still, nothing had fixed his shoulder in over two years. The pain came back every time he played. “What’s missing?” I asked myself.

I was working with a high school pitcher in my physical therapy clinic one day as a student intern. The kid had a labral tear and was absolutely killing his rehab program at 10 weeks post-operation. “When can I throw?” he asked. “Not until the doc clears it man.” When the follow-up appointment with his surgeon arrived, we gave him our progress note to take with him, and expected him to come back cleared. Nope. The doc said he couldn’t begin throwing until next month, and even then he could only start with an ultra-conservative throwing program. And this kid had been pain free for weeks.

Eventually I bridged the gap in my mind. Ultimate is a throwing sport, so why should we treat return to throwing in ultimate any different that we do in baseball?

So I came up with this return to ultimate throwing program. It’s based very loosely off of Kung Fu Throwing, which our team has been using for the past few seasons. It also uses principles in programs designed to get baseball players back to throwing, as well as programs for returning to running. It progresses in volume and distance in each phase, and progression (or regression) through the phases is based on your own pain response. The difference between baseball and ultimate is this: all baseball throws are overhead and involve internal rotation of the shoulder, whereas in ultimate most throws aren’t overhead and there’s a good mix of internal rotation (flick) and external rotation (backhand). I thought about doubling the volume for this reason but decided against it because external rotators act eccentrically to decelerate the shoulder during follow-through after a flick, and vice versa for backhands. For further explanation on this, here is a helpful article. It also includes some good supplemental exercises. After I made the program, I went back and added hammers since overhead throws are much different and need to be addressed as well. This is what I came up with:

Return to Throwing Program

Rules:

• Do each stage a minimum of 2 times with no pain (during or after, typical muscle soreness is fine) before progressing to the next stage.
• If there’s pain, stop and go back to the previous stage the next day
• One stage per day

Procedure: Stage 1:

• Stand 10 yards apart. Complete 15 flicks, 15 backhands, rest 2 min, repeat.

Stage 2:

• Stand 10 yards apart. Complete 10 flick, 10 backhand, rest 1 min, repeat.

• Stand 20 yards apart. Complete 15 flicks, 15 backhands.

Stage 3:

• 10 yards. 5 flick, 5 backhand, 5 hammer, rest 1 min, repeat.

• 20 yards. 15 flick, 15 backhand, rest 2 min, repeat.

Stage 4:

• 10 yards. 5 flicks, 5 backhands, 5 hammers.

• 20 yards. 10 flicks, 10 backhands, 10 hammers, rest 2 min, repeat.

• 30 yards. 5 flicks, 5 backhands.

Stage 5:

• 10 yards. 5 flick, 5 backhand, 5 hammer.

• 20 yards. 5 flicks, 5 backhands, 5 hammers, rest 2 min, repeat.

• 30 yards. 5 flicks, 5 backhands, 5 hammers, rest 2 min, repeat, rest 2 min, repeat.

Stage 6:

• 10 yards. 5 flicks, 5 backhands, 5 hammers.

• 20 yards. 5 flicks, 5 backhands, 5 hammers, rest 2 min, repeat.

• 30 yards. 5 flicks, 5 backhands, 5 hammers, rest 2 min, repeat.

• Hucks. 5 flicks, 5 backhands.

During all six stages, be sure to get a solid mix of outside-in and inside-out throws. You want to make sure you’re working and strengthening the muscles used for each.

I also strongly recommend incorporating the Thower’s Ten resistance training program. It involves strengthening to all the rotator cuff muscles as well as the muscles of the scapula. Imbalance or poor dynamics between the shoulder blade and the shoulder are often what lead to shoulder injuries in the first place. For each of these exercises, do high volume and low resistance. Finally, don’t throw and lift on the same day.

This program ended up working great for my guy. He took off all winter break, throwing only with his right (non-dominant) hand and performed rehab exercises included in the Thrower’s Ten on his left. When he began the current college season he continued to throw righty in practice, and began progressing through the program. He has had minimal pain since and has been able to return to full function.

Hopefully it’ll work for others out there too. I’d love feedback.