Evidence Based Arm Care: The Throwers 10 Revisited

Abstract

Over the past 40 years sports medicine physicians, physical therapists and performance experts have continually worked to advance treatment paradigms for the throwing athlete. The progression of evidence-based arm care has taken generations of innovators to get to where we are today. In 1983, Dr. Frank Jobe pioneered the original EMG study on the deltoids, subscapularis and what they referred to as the "SIT" muscles (supraspinatus, infraspinatus, and teres minor) during the pitching motion. 1 This work continued to advance through the 1980s and early 1990s with Jobe et al. 1 and DiGiovine et al. 2 giving clinicians a better understanding of the muscle activity and performance demands of the entire upper extremity during the pitching motion. This work set the stage for researchers like Mosely et al. 3 , Blackburn et al. 4 and Townsend et al. 5 to investigate which exercises would be most beneficial for the throwing athlete, allowing innovators like Kevin Wilk and James Andrews to develop the Thrower's Ten Exercise Program in 1991. 6 In 2011, Wilk et al. 7 introduced the "Advanced Thrower's Ten". This expanded program incorporated throwing motion-specific exercises and movement patterns performed in a discrete series, utilizing principles of coactivation, high-level neuromuscular control, dynamic stabilization, muscular facilitation, strength, endurance, and coordination, which all serve to restore muscle balance and symmetry in the overhead throwing athlete. 7 The evolution of these arm care programs has been an asset to the baseball community, offering the opportunity for pre-season and off-season strengthening for injury prevention and sports performance.The Yokahama Baseball-9 (YKB-9) and the modified Yokahama are prime examples of an arm care program that has been researched and modified to show its efficacy. 8,9 Although the exercises do not appear to all be evidence-based, the testing and modification of the program has shown desired effects. The goal of any arm care program is to not only show strength improvements, but also show the desired effects on injuries. Evolving the arm care programs needs to include a research-based program that can offer in-season strengthening and maintenance that can easily be performed in any setting, on the road, with minimal equipment.

Preliminary Insights into the Diagnostic Accuracy of the Modified Arm Care Screen Test for Overhead Athletes: An On-Field Tool for Injury Prevention

“…In an effort to reduce the occurrence of these injuries, coaches have introduced arm care programs focused on enhancing muscle and joint strength, dynamic stability, and range of motion (ROM) [5]. These programs aim to address musculoskeletal injury risk factors and promote injury prevention among players [4,6]. Nonetheless, these arm care programs often lack specificity since coaches without access to an athletic trainer or physical therapist (PT) find it challenging to identify individual injury risk factors for each player [7,8].…”

Flexor-Pronator Mass Training Exercises Selectively Activate Forearm Musculature

“…These exercises were included in the Evidence Based Arm Care program previously published with links to exercise videos. 25 Randomization was done by pulling a card out of an opaque envelope with the exercise written on the chosen card to be done first. Wrist ulnar deviation was performed by the subject holding the resistance band with elbows extended, palms facing down, and arms held at shoulder height.…”

Comparison of instrument-assisted soft tissue mobilization and proprioceptive neuromuscular stretching on hamstring flexibility in patients with knee osteoarthritis

“…It has also been observed that decrease mean hamstring flexibility has been found in KOA ( Onigbinde et al, 2013 ). This decreased flexibility may increase the compressive stress on the patello-femoral joint and lead to patellofemoral syndrome, which often contributes to osteoarthritis and can result in pain and limitations in physical functioning ( Jyoti & Yadav, 2019 ; Mahant & Shukla, 2021 ; Mullaney & Fukunaga, 2016 ; Onigbinde et al, 2013 ; Sherazi et al, 2022 ; Walli, McCay & Tiu, 2023 ).…”