PT Protocols

Post-surgical progressive throwing program For baseball

The Post-Surgical Progressive Throwing Program is designed for post-surgical overhead athletes. It can also be used in non-surgical candidates with significant injuries. It covers a period of two and one-half to three months. For minor shoulder injuries, please refer to the Non-Surgical Progressive Throwing Program.

During warm-up, it is important to use heat prior to stretching (e.g., hot pack, whirlpool, hot shower, etc.). Heat increases circulation and activates some of the natural lubricants of the body. Perform stretching exercises after applying the heat modality and then proceed with the throwing program. Use ice after throwing to reduce cellular damage and decrease the inflammatory response to microtrauma.

  1. Proceed through each step in order (DO NOT SKIP STEPS).
  2. Proceed to the next step only if you are able to throw without pain or discomfort.
  3. If at any time during any step you experience pain or discomfort, STOP AND REST. If the pain or discomfort is not relived after your day of rest, do not proceed with the next step. Rest an additional day if necessary and repeat the step in which you experienced the discomfort before progressing to a new step.

STEP 1:

  1. Toss the ball (no wind-up) on alternate days, not more than 20 feet. Tossing should be limited to 2 -3 times per week, 10 - 15 minutes per session, for one week.

STEP 2:

  1. Increase the tossing distance to 30 - 40 feet. Continue 2 - 3 times per week, 10 – 15 minutes per session, for one week.

STEP 3:

  1. Lob the ball (playing catch with an easy wind-up) not more than 30 feet. Continue 2 - 3 times per week, 10 - 15 minutes per session, for one week.

STEP 4:

  1. Increase the distance to 40 - 50 feet while still lobbing the ball (easy wind-up). Schedule the throwing program and strengthening program on alternate days. Increase the throwing time to 15 - 20 minutes per session, 2 - 3 times/week for one week.

STEP 5:

  1. Increase the distance to 60 feet while still lobbing the ball with an occasional straight throw at not more than one-half (1/2) speed. Increase the throwing time to 20 - 25 minutes per session, 2 - 3 times per week, for one week.

STEP 6:

  1. Perform long, easy throws from the mid-outfield (150 - 200 feet), getting the ball barely back to home plate on 5 - 6 bounces. This is to be performed for 20 - 25 minutes per session on two consecutive days. Then rest the arm for one day.
  2. Repeat this sequence 3 times over a 9-day period. You may progress to the next step only if you are able to complete the throwing sequence without pain or discomfort. (THROW two days, REST one day x 3)

STEP 7:

  1. Perform long, easy throws from the deepest portion of the outfield, with the ball barely getting back to home plate on numerous bounces. This is to be performed for 25 - 30 minutes per session on two consecutive days. Then rest the arm for one day. Repeat the same routine over a 9-day period and progress to the next step if there is no pain or discomfort.

STEP 8:

  1. Execute stronger throws from the mid-outfield, getting the ball back to home plate on 1 - 2 bounces. This should be performed approximately 30 - 35 minutes per session on two consecutive days. Rest the arm for one day. Repeat the same routine 3 times over a 9-day period. If there is no pain or discomfort, progress to the next step.

STEP 9:

  1. Perform short, crisp throws with a relatively straight trajectory from the short outfield on one bounce back to home plate. These throws should not be performed more than 30 minutes on two consecutive days. Rest the arm for one day. Repeat this sequence over a 9-day period.
  2. Continue your body conditioning program (i.e., strength, flexibility, and endurance). On days in which strengthening and throwing programs occur on the same day, schedule the throwing program in the morning and the strengthening program in the afternoon.
  3. If you are able to throw without pain or discomfort, proceed to the next step.

STEP 10:

  1. Return to throwing from your normal position (e.g., from the mound if you are a pitcher). The throw should be at one-half to three-fourths speed, with emphasis on technique and accuracy. Throw for two consecutive days then rest the arm for one day. A throwing session should not be more than 25 minutes. Repeat this step over the next 9 days, then advance to the next step if there is no pain or discomfort.

STEP 11:

  1. Throw from your normal position at three-fourths to full speed. This should be done following the same 9-day sequence, throwing for two consecutive days and resting for one day. Throwing sessions should not be more than 30 minutes.

STEP 12:

  1. Simulate a game day situation. Warm-up with the appropriate number of pitches and throw your average number of innings. Take the usual rest breaks between innings. Repeat this simulation two to four times with a three to four day rest period in between. Return to the normal pitching regimen or routine based on input from the team doctor, physical therapist, athletic trainer, coach, and most important of all, the athlete.

*If problems arise, contact your therapist, athletic trainer or physician.