Medical experts discuss rehab challenges

Medical experts discuss rehab challenges

Medical experts discuss rehab challenges
NEW YORK -- A healthy pitcher is nothing to take for granted. Any glance at the disabled list of a Major League team provides all the evidence needed. From blisters on fingers to calf strains and foot problems, pitchers at all levels count themselves fortunate to be healthy. And those who aren't hope to change that -- and do it without making things worse.

To stay healthy -- and return to the mound -- Major Leaguers work with talented and experienced physical therapists who make sure the athletes' bodies are ready for whatever adjustments their coaches want to make. Throwing a baseball of a mound requires more than a strong arm -- it takes balance and a strong core, and people like Michael Levinson, a physical therapist and certified strength and conditioning specialist, who works for the Mets.

Levinson spoke at the fifth annual Current Concepts in Sports Medicine conference at New York's Hospital for Special Surgery, located on the Upper East Side of Manhattan. In a panel on injured athletes moderated by Dr. Frank Cordasco, Levinson discussed the challenges of rehabilitating pitchers for their return to the field in a competitive fashion.

The conference, a three-day affair, helped physical therapists, athletic trainers and coaches learn more about injuries across all sports, and the best means of recovery. Sessions covered specific body parts ranging from the rotator cuff to the knee. Saturday morning's session discussed rehabilitation and included speakers on jumper's knee, hip injuries in golfing and overuse among runners.

Pitching is unique for many reasons. It requires activities of short duration but maximum intensity. Those are followed by periods of extended rest.

The nature of the profession makes for specialized therapy and exercises that emphasize balance, core strength and flexibility. As Levinson pointed out Saturday, there's more to pitching than just the act of throwing the baseball.

"You need a lot of flexibility and muscular balance," Levinson said in his 20-minute presentation. "Imbalance is often the cause of the problems that we see. You need power, obviously core stability, which is something that was often overlooked many years ago. Balance is so critical to not only velocity, but control."

Pitchers use their whole body. They take giant steps toward home plate, and Levinson said that the length of their stride is the main factor behind their velocity.

"There are some pitchers that aren't very tall that I've dealt with whose strides are greater than their actual height," Levinson said. "And that's probably where they're getting their velocity."

For pitchers with equally strong arms, the chance to differentiate themselves often comes from the rotation of their hips.

"Watch the real hard throwers as their hip opens up to the plate," Levinson said. "Their upper torso stays way back until the last minute."

Pitching coaches notice when their pupils get tired, but physical therapists like Levinson can see the tell-tale signs as well.

"There's certainly an endurance factor," Levinson said. "The most obvious is the loss of dynamic stability. One of the things that the pitching coaches will look at when a guy is getting tired is the arm will drop down. They'll let other muscles take over. That obviously can affect performance and increase the chance of injury."

Working with an injured pitcher presents plenty of challenges to team's medical staffs, no matter the age level of the athlete. For one, Levinson says, nothing can reproduce the act of throwing a baseball. The motion, unnatural to begin with, has no comparable act that can ease a pitcher back to throwing.

With so many different throwing styles, no two rehabilitation plans are the same. In general, however, teams begin by having their pitchers throw off flat ground and then progressing to a mound. Some teams, like the Yankees, make us of a half-mound.

Levinson said that rehabilitating pitchers must work from the stretch and understand the difference between throwing in a bullpen and the game.

"Throwing in a bullpens is much less intensive than throwing in a game," Levinson said.

Fans often hear about long-toss plans and throwing programs, but as Levinson points out, much more goes into pitching. Nothing can make a pitcher immune to injuries, but a thorough rehabilitation program can help minimize the time he misses.

Thomas Boorstein is a reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.