By Loyd van Pamelen, PT, CSCS
Interval sports programs and, more specifically, interval throwing programs provide a structured, graduated return to practice and games. With any progressive “return to sports” program, there is both an art and science to designing and then following each step of the program. In specific cases of surgery (i.e. shoulder surgery or elbow surgery in the thrower), the athlete will be given a very specific interval throwing program that will take months to complete. Most other injuries can and should include a similar, albeit shorter, interval program that incorporates essentials principles integral to every post-operative protocol.
Here’s the science part: interval programs need to initiated, esp. following a major injury or surgery, by the athlete’s physician and performed under the supervision of the rehabilitation team (athletic trainer, physical therapist, physician). These programs emphasize repetition of proper form at progressive levels of effort and volume over time. They are designed to minimize chances of re-injury and emphasize good warm up and stretching. As related to throwing, the athlete needs to have pain-free range of motion (dependent on injury or surgery, at least a few weeks to a few months prior to throwing) of the involved joint along with good muscle power and resistance to fatigue. If the athlete is allowed to compensate or throw improperly, even if pain-free, it can lead to poor habits, decreased performance, and increased chances of the same or another injury to return. An example would be allowing an runner with a stiff knee to run full speed on the track; he or she would almost be certain to develop calf and/or hip soreness in addition to his or her knee pain. If the athlete doesn’t “look right”- whether it’s throwing a baseball, kicking a soccer ball, or performing any activity relating to his or her sport- he or she is not ready and may need more time with the interval program and may even need more time with rehabilitation prior to resuming the interval program.
The art of designing these interval programs is in the adjustments. There are a multitude of reasons that can either accelerate or delay an interval program. If your athlete is not seeing his doctor or rehab professional the same day or day after throwing, it is important for you, as a parent, to gauge his or her “bounce back” following the day’s throwing activity. During the recovery process, it is also important to differentiate “normal soreness” as compared to “pain” with your athlete. Atlanta Braves Team Doctor Emeritus, Joe Chandler MD, frequently recommends that young, prepubescent throwers simply should not have any pain at all with their throwing. For older throwers, having a dull, diffuse aching sensation in muscles and tendons that goes away within 1-2 days after throwing is typically “normal.” However, experiencing sharp pain that deep into the joint or having a duller pain that lasts for a few days is not normal and should be consider a reason to stop throwing and, until further consultation with your doctor, forego the interval throwing program.
As for actually performing or assisting your child with an interval program, make sure he or she warms up properly before throwing. Have your athlete “get a sweat on” by warming up the entire body by jogging and using a dynamic warm up routine for the upper and lower body. This should not take much longer than 10-15 minutes. With throwing, make sure the athlete utilizes a four seam grip (fastballs always precede change ups and breaking balls) and incorporate his or her legs into the throwing. American Sports Medicine Institute (ASMI, Birmingham AL and Pensacola FL) has long advocated utilizing a Crow-Hop method, even at 30-45 feet. It is essential that athlete try to throw with normal mechanics while still have a slight arc on the path of each baseball throw. Throwing programs typically start at 30 or 45 feet and, progressively over time as based on injury, surgery, and athlete’s throwing mechanics, build up to a “long toss” distance of 120 to 180 feet. For example, athletes who are recovering from UCL reconstructions (Tommy John surgery), follow a 7-10 month throwing program that incorporates 30-45 of “catch”, long toss, “flat ground” mechanics, and then “off the mound” bullpens, all at progressive effort levels and progressive volumes.
As parents, don’t feel like you need to follow a custom interval program for the recovery of every ache and pain your child feels. Remember that “common sense” is your best guide. Just as you would never allow your child to run full speed immediately after an ankle sprain or hamstring strain is the same reason you would not allow your child to pitch full speed off the mound immediately following a strain of the shoulder or elbow. Always be patient and always remember that form and technique, even at 50% effort, as has great value if repeated several times prior to “full return” to practice and games. As stated by many professional pitchers and pitching coaches, velocity comes from being able to repeat good, efficient mechanics, over and over again. Most importantly, interval throwing programs are safest way an athlete can transition from injury to full recovery.
