Getting Out of Pain Isn’t the Same as Being Game-Ready

Your shoulder feels better, you’ve been doing your exercises, and you’ve even gotten stronger. So why aren’t you automatically ready to throw now following an injury? While these are definite improvements as part of the rehab process, there is still a bit of a gap between this and being prepared for the in-game demands of baseball and softball. This is because throwing a baseball (along with other movements in baseball) is a highly specific, high-speed movement that places substantial demands on the entire body. Eventually, though, rehab has to cross the line from preparing you to throw to actually throwing.

Rehab Has to Start Somewhere

In the early stages of rehab for most injuries, the goals are fairly straightforward: reducing aggravating loads, restoring movement, rebuilding strength, regaining confidence, and gradually increasing load and activity. This is important because it sets us up for success in the later stages of rehab, but people often mistake the improvements seen during this phase as meaning they are ready to return to sports.

Getting Stronger Doesn’t Automatically Mean You’re Ready to Throw

You can get stronger, restore your range of motion, and have less pain while still lacking the specific capacity required for throwing and other baseball-related activities. This is because after a period of inactivity, you lose some of your tolerance to throwing. Even if you are able to maintain some throwing, it still isn’t at the intensity or volume that you’re used to, and you still decondition to some degree. But gym exercises and throwing are not interchangeable; banded external rotation, heavy rows, and medicine ball slams aren’t throwing. They’re all useful pieces of the rehab process in preparation for throwing to bridge that gap, but they don’t instantly have you ready to throw 100% again. Eventually, throwing itself has to become part of the rehab process, because there is no substitute for exposing the arm to the demands of throwing.

Baseball Doesn’t Just Ask Your Shoulder to Work

Another thing to consider is that baseball is a full-body sport, and throwing involves the legs, hips, and trunk through to the shoulder, elbow, and hand. A good rehab plan will have you continuing to work on these areas as permitted by your injury, but it is easy to focus on just the injured shoulder or elbow. So just like throwing, there needs to be a gradual progression and reintroduction of these movements while accounting for your injury before you’re ready to return to games. Plus, baseball isn’t just one throw. Baseball asks you to repeat these movements, sometimes under fatigue, sometimes after some inactivity, sometimes at high intensity and sometimes with relatively little recovery between plays. So when considering if you’re ready to return to play, it isn’t just “does your shoulder hurt?”, but “can you tolerate what baseball is going to ask you to do?”

The Gym Prepares You. Throwing Finishes the Job

Strength and conditioning are important, but so are training the skills. Eventually, we do need to go from general capacity to specific capacity and throw. But there’s a distinction between throwing in a controlled session and in-game situations. We want to continue to build strength in the gym, but we need to start rebuilding throwing strength with a progressive throwing program. General conditioning needs to transition to look like game play. Exercises start off controlled and basic, but should add more movement and speed. Drills are controlled and basic to start, but build in complexity and speed to mimic in-game plays. We go from high tension eccentrics and powerful medicine ball slams to then adding in throwing, starting at a lower intensity and volume, and building from there to bullpens, live at-bats, and finally competition. How we progress this though depends on the individual athlete.

So What Does Good Baseball Rehab Look Like?

Good rehab isn’t “do these five magic exercises.” Good rehab involves assessing the injury, understanding the demands the athlete faces, calming down any sensitivity and pain, rebuilding physically and mentally, gradually exposing the athlete to the demands, and adjusting according to how they respond. This is why I am excited about my new partnership with Baseball Ireland. My role isn’t simply to tell players whether they should rest and do some banded exercises. It’s to help athletes understand their injury, determine how they can safely work around their injury, find their entry point to rehab for their injury, and work through the process of returning to what they actually want to do.

Rehab isn’t just about getting you pain-free; it’s to help you tolerate the demands of the sport you want to return to.