Episode 21: Throwing Athlete Rehab and Injury Prevention with Dr. Matt Gauthier

SHOW OUTLINE

Gauthier ML, Unverzagt CA, Davies GJ. Evaluation and Treatment of Baseball Pitchers: There’s More to Assess than the Arm. Int J Sports Phys Ther. 2025 Jan 1;20(1):113-126. doi: 10.26603/001c.127461. PMID: 39758696; PMCID: PMC11698006.

Tabaracci B, Sudhir S, Gauthier M, Hannigan L. Preseason Workload in Collegiate Baseball Pitchers. Int J Sports Phys Ther. 2025 Feb 1;20(2):221-230. doi: 10.26603/001c.128051. PMID: 39906050; PMCID: PMC11788086.

Liu JM, Knowlton C, Gauthier M, Tropp Z, Verma N, Nicholson G, Romeo A, Zaferiou A. Roles of each leg in impulse generation in professional baseball pitchers: preliminary findings uncover the contribution of the back leg towards whole-body rotation. Sports Biomech. 2025 Oct;24(10):2884-2899. doi: 10.1080/14763141.2022.2108490. Epub 2022 Aug 16. PMID: 35972861.

Liu JM, Knowlton C, Gauthier M, Tropp Z, Verma N, Nicholson G, Romeo A, Zaferiou A. How maximal whole-body and segmental angular momenta relate to fastball speeds in high school baseball pitchers. J Biomech. 2025 Oct;191:112919. doi: 10.1016/j.jbiomech.2025.112919. Epub 2025 Aug 18. PMID: 40858090.

Gajda S, Liu JM, Molino J, Knowlton C, Gauthier M, Tropp Z, Verma N, Nicholson G, Romeo A, Zaferiou A. Linear and angular impulse generated by high school pitchers during fastballs and changeups. J Biomech. 2025 Mar;181:112550. doi: 10.1016/j.jbiomech.2025.112550. Epub 2025 Jan 23. PMID: 39864349.

Pontillo M, Bellm E, Barber P, Gauthier M, Unverzagt C, Davies G. Upper Extremity Return to Sport Functional Testing: A Systematic Review. Sports Med Open. 2026 Feb 23;12(1):13. doi: 10.1186/s40798-026-00984-4. PMID: 41724878; PMCID: PMC12926263.

Gauthier ML, Unverzagt CA, Mendonça LM, Seitz AL. Missing The Forest For The Trees: A Lack Of Upper Extremity Physical Performance Testing In Sports Physical Therapy. Int J Sports Phys Ther. 2023 Apr 1;18(2):419-430. doi: 10.26603/001c.73791. PMID: 37020447; PMCID: PMC10069373.

• (00:29) Bio /Intro
• (03:43) What is most common kinetic chain impairment/pathology you see in pitchers
• (05:08) Spinal/trunk rotation mechanics and in injury risk. 
  • Bullock GS, Thigpen CA, Zhao H, Devaney L, Kline D, Noonan TJ, Kissenberth MJ, Shanley E. Neck range of motion prognostic factors in association with shoulder and elbow injuries in professional baseball pitchers. J Shoulder Elbow Surg. 2025 Feb;34(2):421-429. doi: 10.1016/j.jse.2024.08.026. Epub 2024 Oct 11. PMID: 39396612.
  • (08:36) Cervicothoracic and Thoracolumbar Trunk Screening
    • Johnson KD, Kim KM, Yu BK, Saliba SA, Grindstaff TL. Reliability of thoracic spine rotation range-of-motion measurements in healthy adults. J Athl Train. 2012 Jan-Feb;47(1):52-60. doi: 10.4085/1062-6050-47.1.52. PMID: 22488230; PMCID: PMC3418115.
  • (10:20) Thoracic Rotation, trunk strength, and trunk control in injury risk. Importance for proximal control.
    • Hoogenboom BJ, Voight ML. ROLLING REVISITED: USING ROLLING TO ASSESS AND TREAT NEUROMUSCULAR CONTROL AND COORDINATION OF THE CORE AND EXTREMITIES OF ATHLETES. Int J Sports Phys Ther. 2015 Nov;10(6):787-802. PMID: 26618059; PMCID:
• (13:04) Hip ROM and throwing delivery mechanics- drive leg and lead leg
  • Liu JM, Knowlton C, Gauthier M, Tropp Z, Verma N, Nicholson G, Romeo A, Zaferiou A. Roles of each leg in impulse generation in professional baseball pitchers: preliminary findings uncover the contribution of the back leg towards whole-body rotation. Sports Biomech. 2025 Oct;24(10):2884-2899. doi: 10.1080/14763141.2022.2108490. Epub 2022 Aug 16. PMID: 35972861.
  • Dun S, Fleisig GS, Loftice J, Kingsley D, Andrews JR. The relationship between age and baseball pitching kinematics in professional baseball pitchers. J Biomech. 2007;40(2):265-70. doi: 10.1016/j.jbiomech.2006.01.008. Epub 2006 Mar 3. PMID: 16516219.
• (18:02) Hip strength, influence on throwing and injury risk, and screening
• (20:20) Hip Extension strength and flexibility on stride length influence and mechanics.  Screening considerations with opposite LE and pelvic positioning.
• (22:08) Distal LE factors in screening and importance of closed chain ankle dorsiflexion
• (23:34) Return to throw programs- Ideal timeframes, volume, intensity, rate of progression, etc.
  • Reinold MM, Dowling B, Fleisig GS, Macrina LC, Wilk KE, Streepy JT, Andrews JR. An Interval Throwing Program for Baseball Pitchers Based upon Workload Data. Int J Sports Phys Ther. 2024 Mar 1;19(3):326-336. doi: 10.26603/001c.94146. PMID: 38439773; PMCID: PMC10909315.
  • Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016 Mar;50(5):273-80. doi: 10.1136/bjsports-2015-095788. Epub 2016 Jan 12. PMID: 26758673; PMCID: PMC4789704.
• (27:00) Technology and wearables for workload monitoring, variability in stress and intensity with throwing
  • Martin CL, Evenson KR, Moore JB, Marshall S, Wolf J, Fernandez G, Nicholson K, Impellizzeri F, Ward P, Shrier I, O’Connell N, Thigpen C, Shanley E, Kline D, Hartshorne M, Bullock G. Using Biomechanical Devices in Elite Baseball Pitchers: A Preliminary Feasibility Study. Int J Sports Phys Ther. 2025 May 1;20(5):687-695. doi: 10.26603/001c.134013. PMID: 40322517; PMCID: PMC12048362.
  • MOTUS sleeve (now PULSE) – https://www.drivelinebaseball.com/2020/03/the-motusthrow-sleeve/?srsltid=AfmBOorb7IaLa-z-fr-jCuJitjVKa6A6N3_r32gIOhTm9ZH4PchmccKF
  • 4d- https://4dmotionsports.com/

• (29:35) What is ideal distance to get up to for flat ground throwing before transition to throwing off mound?
  • Fleisig GS, Bolt B, Fortenbaugh D, Wilk KE, Andrews JR. Biomechanical comparison of baseball pitching and long-toss: implications for training and rehabilitation. J Orthop Sports Phys Ther. 2011 May;41(5):296-303. doi: 10.2519/jospt.2011.3568. Epub 2011 Jan 5. PMID: 21212502.
• (32:26) Youth Pitch count guidelines and enforcement- how effective are they truly?
  • Kriz PK, Collins CL, Staffa SJ, Zurakowski D, Zaremski JL, Bowers RL, Kriz JP, Sugimoto D. Do Pitching Restriction Policies Reduce Shoulder and Elbow Injuries in High School Baseball Players? Orthop J Sports Med. 2026 Feb 2;14(2):23259671251412404. doi: 10.1177/23259671251412404. PMID: 41640453; PMCID: PMC12864705.
  • Matsuura T, Takata Y, Iwame T, Iwase J, Yokoyama K, Takao S, Nishio S, Arisawa K, Sairyo K. Limiting the Pitch Count in Youth Baseball Pitchers Decreases Elbow Pain. Orthop J Sports Med. 2021 Mar 18;9(3):2325967121989108. doi: 10.1177/2325967121989108. PMID: 33796588; PMCID: PMC7983445.
  • STOP Sports Injuries- https://ncys.org/safety/stop-sports-injuries/
  • Pitch Smart- https://www.mlb.com/pitch-smart/pitching-guidelines

• (37:39) Functional testing and RTS assessment- Tailoring test battery to your athlete
  • Pontillo M, Bellm E, Barber P, Gauthier M, Unverzagt C, Davies G. Upper Extremity Return to Sport Functional Testing: A Systematic Review. Sports Med Open. 2026 Feb 23;12(1):13. doi: 10.1186/s40798-026-00984-4. PMID: 41724878; PMCID: PMC12926263.
  • Roush JR, Kitamura J, Waits MC. Reference Values for the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) for Collegiate Baseball Players. N Am J Sports Phys Ther. 2007 Aug;2(3):159-63. PMID: 21522211; PMCID: PMC2953295.
  • ASH (Athletic Shoulder) Test – Ashworth B, Hogben P, Singh N, Tulloch L, Cohen DD. The Athletic Shoulder (ASH) test: reliability of a novel upper body isometric strength test in elite rugby players. BMJ Open Sport Exerc Med. 2018 Jul 23;4(1):e000365. doi: 10.1136/bmjsem-2018-000365. PMID: 30057775; PMCID: PMC6059329.
  • Garrison JC, Arnold A, Macko MJ, Conway JE. Baseball players diagnosed with ulnar collateral ligament tears demonstrate decreased balance compared to healthy controls. J Orthop Sports Phys Ther. 2013 Oct;43(10):752-8. doi: 10.2519/jospt.2013.4680. Epub 2013 Sep 9. PMID: 24256174.
• (43:16) UCLR- conservative mgmt. for partial tears vs. reconstruction
• (45:19) Use of biologics, stem cells, etc.
• (47:23) What are current gaps in pitching rehab literature or questions we still need to answer?  Neurocognitive screening and training.