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Michael J. Axe and Jeff Konin

The decision of how to progress a baseball player through a throwing program following an injury has been a difficult one for the sports medicine population to address. Numerous programs have been suggested to allow a player a gradual return to competitive throwing. These programs are primarily based on previous experience of the clinician designing the program, simply because this may be the only objective material that can be used to determine parameters of a program of such diverse individualism. This paper identifies those components that play a critical role in the designing of any interval throwing program and outlines a program based on position and distance specific phases.

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Jeff Konin, Michael J. Axe and Ron Courson

The implementation of interval throwing programs during rehabilitation has been suggested in the literature to allow for a quicker and safer return of the throwing athlete to competition. Many programs have clearly focused on baseball players. This program is specifically designed for the football quarterback. The program encompasses a sound flexibility and strength training regime and provides for a supervised step-by-step progression of throwing. Although the authors have found success with early results, practitioners should apply this program with caution, as it may need to be modified for each athlete. The purpose of this paper is to establish a foundation for future work in the area of the throwing shoulder for the football quarterback.

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Michael J. Axe, Katherine Linsay and Lynn Snyder-Mackler

The purpose of this study was to determine whether there was a relationship between knee hyperextension and intra-articular pathology in 100 consecutive patients whose sole ligament injury was an arthroscopically confirmed anterior cruciate ligament (ACL) rupture. Hyperextension of both knees was measured using a supine heel-height measurement of high reliability. There was more articular damage to the total joint, lateral joint, and lateral meniscus in patients who hyperextended than in those who did not. There was more articular damage to the total joint and medial joint in patients who were chronically ACL deficient than in those who were acutely or subacutely ACL deficient. The results demonstrate that individuals with ACL injuries whose knees hyperextend 3 cm or more sustain significantly more joint damage at the time of injury than in those whose knees hyperextend less than 3 cm. This study further defines the role of knee hyperextension in ACL injuries and offers a useful and reliable means of measuring knee hyperextension.

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Michael J. Axe, Thomas C. Windley and Lynn Snyder-Mackler

Objective:

To design interval throwing programs for baseball players other than pitchers from 13 years of age to the college level.

Design:

The authors recorded throws to base, distance of throws, and perceived effort of throws at 4 levels of play. For catchers they also recorded number of throws to the pitcher, number of sprints to first or third base, and time in the squat stance. From these data they designed throwing programs specific to outfielders, infielders, and catchers.

Results:

No significant difference was found between the number of throws and distance of throws for infielders and catchers across all age groups. The mean distance of throws differed significantly between 13-year-olds and all other levels of play.

Conclusion:

The authors devised 1 program for infielders and catchers of all age groups, 1 program for 13-year-old outfielders, and 1 for all other levels.

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Michael J. Axe, Kirk H. Swigart and Lynn Snyder-Mackler

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Erin H. Hartigan, Joseph Zeni Jr., Stephanie Di Stasi, Michael J. Axe and Lynn Snyder-Mackler

Less than 50% of athletes pass criteria to return to sports (RTS) 6 months after ACL reconstruction (ACLR). Using data on 38 noncopers, we hypothesized that preoperative age, quadriceps strength index (QI), and knee flexion moments (KFM) during gait would predict the ability to pass/fail RTS criteria and that preoperative quadriceps strength gains would be predictive of passing RTS criteria. Gait analysis and strength data were collected before and after a preoperative intervention and 6 months after ACLR. Age, QI, and KFM each contributed to the predictability to pass or fail RTS criteria 6 months after ACLR. Collectively, the variables predict 69% who would pass and 82% who would fail RTS criteria 6 months after ACLR. Younger athletes who have symmetrical quadriceps strength and greater KFM were more likely to pass RTS criteria. Further, 63% of those who increased preoperative quadriceps strength passed RTS criteria, whereas 73% who did not failed. Increasing quadriceps strength in noncopers before ACLR seems warranted.