Lewis Physical Therapy & Sports Rehabilitation

Lewis Physical Therapy & Sports Rehabilitation We help active adults and athletes get out of pain, get strong & do what they love

05/02/2026

Proper isometric & eccentric loading of the flexor-pronator mass is crucial for long-term elbow health and UCL protection in pitchers. There’s nothing wrong with doing dumbbell wrist curls or rice bucket drills early on in rehab to build a foundation, but in my opinion they don’t properly prepare the tissue for a return-to-throwing.

Here is a pronation-specific isometric we will use to further stress the ability of the FPM to protect the UCL and stabilize the medial elbow. The trick here is making sure that force is being primarily generated from the forearm, rather than through the shoulder. To gradually acclimate the elbow to this type of loading, we start with a low intensity, longer duration prescription (typically 4x30-45”) before progressing to more strength and rate of force development variations.

We also can’t forget the importance of consistently loading the FDS & FCU, which are the 2 primary dynamic stabilizers of the elbow that protect the UCL.

For non-baseball athletes dealing with flexor tendon issues, this can also serve as an appropriate way to load the medial elbow.

04/28/2026

One of the primary things we focus on during the early stage of meniscus rehab is restoring full passive AND active knee extension. For many people that have dealt with a chronic meniscus injury, it’s surprising how atrophied/weak that quadriceps is by the time they are evaluated.

In these cases, we will use a variety of manual therapy techniques (in my experience with these cases, dry needling typically provides the most relief) to help calm the joint down and THEN follow it up with some loading of the quadriceps to achieve terminal knee extension. We will typically use BFR for our quad work as well to further accelerate quad strengthening without adding excessive load to the knee. Loading in this manner becomes even more imperative if there is effusion (joint swelling) present.

In general, I don’t push flexion too much (or really at all unless truly needed) in the early stages of these rehabs. I’ve found that focusing on the above approach helps get pain under control and restores passive + active extension via quad strengthening. In doing so, this helps create a “quiet” knee that then allows flexion to come a bit more naturally throughout the rehab process.

04/27/2026

Meniscus tears can be a frustrating injury for athletes, recreational runners and lifters to navigate. These can occur either due to acute (twisting or traumatic injury, etc) or chronic mechanisms (impact-based tasks such as running/jumping, repetitive deep knee flexion tasks, etc.)

These are some of the typical complaints we hear patient’s have and present with on clinical exam that are in line with some type of meniscal injury:

*Joint line tenderness (possible swelling)
*Pain with knee hyper extension and/or maximal knee flexion (passively or actively via bottom position of a squat or lunge)
*Pain with twisting motions (either in weight bearing or done passively through varying degrees of knee flexion)
*Pain during initial steps after sitting/staying in a flexed position for a prolonged period of time
*Pain with knee-dominant hamstring tasks (i.e. machine hamstring curls)
*Painful clicking or locking of the joint

In these cases, activity modification during the EARLY stages (not forever) are crucial to help the joint calm down. Specifically, I have patients eliminate or heavily reduce their overall training volume for running, lunging, squatting or other similar tasks. During that time, we primarily focus on restoring quad strength, knee extension ROM and other deficits we identified.

As a side note, don’t push flexion early on (regardless whether surgical or non-surgical). Forcing flexion tends to further irritate the joint and prevent progress, so we let it come naturally as we focus on the above.

04/22/2026

Hip hinge mechanics are a crucial component to look at in pitchers who have a hard time getting into their back hip. Inability to do so can have a multitude of negative downstream effects in the throwing motion, including but not limited to, “pinching” in the rear hip due to inability to “hold” proper limb positioning as they stride, insufficient stride length and ultimately limited hip shoulder-separation. Each of these will negatively impact throwing velocity and, in some individuals, can be the cause or byproduct anterior hip/groin pain.

In general, it comes down to helping teach these pitchers how to “feel” proper posterior chain (specifically glute and deep rotator) engagement that they can then utilize during the stride phase.

This is a drill we will use early on to teach both proper hinge mechanics from both a hip and pelvic positioning. The beauty of this drill is it can be used in many different applications: warm-ups, rehab/prehab or even as a loaded hinge pattern during training. The possibilities are endless, but dependent on each athlete’s goal.

The key here is to make sure you are feeling it in the posterior hip/glute area without any pinching in the anterior hip or groin.

04/20/2026

Hamstring Strain Injuries are one of the more common soft tissue injuries in field-sport athletes.

Early stage hamstring rehab is all about implementing effective loading strategies. Specifically, the hamstring needs to be loaded as both a knee flexor, hip extensor and then in combined hip extension + knee flexion (as this is typically the position these injuries occur during high-speed running).

This drill is an isometric we work to introduce early in the rehab process at lower-intensity, longer duration holds to help both pain control and muscle recruitment. The key here is to ensure the athlete is create tension through the hamstring as both a knee flexor and hip extensors, while maintaining good trunk & pelvic positioning. As the rehab process goes on, we will work to increase the intensity of this drill and use it as a warm-up for running.

04/10/2026

When looking to improve hip-shoulder separation in pitchers, we have to look at the ability to achieve rear leg hip extension, pelvic rotation (toward front side), shoulder/scap loading and thoracic rotation towards arm side. These can be limited individually or in their ability to occur simultaneously, thus limiting separation and requiring greater stress to occur on the arm.

When performing these drills, it’s important to minimize compensating from the shoulder/lat or hip, which can create the illusion of getting more separation.

Give this drill a try in your warm-up and make sure you feel this in your spine while keeping a closed hip position.

04/08/2026

Shoulder pain with lifting overhead? This could be due to a variety of factors, but for many people it is typically a result of poor scapular mechanics in that overhead position.

These Banded Multidirectional Overhead Taps will not only challenge the scapular muscles, but the rotator cuff as well.

For adults that are dealing with rotator cuff pain, I’ve nearly moved exclusively away from doing isolated External Rotation exercises (I.e. “rotator cuff exercises”) as I’ve found it typically provokes symptoms. Challenging the cuff in different positions, like this drill, while encouraging proper scapular work is typically much more effective tolerable and effective for loading.

04/07/2026

When returning from an arm injury, pitchers MUST be able to effectively load in the weight room through a variety of patterns before they resume throwing.

Examples of some basic principles we follow for this include:�• Horizontal push/pull patterns (DB bench & row variations)�• Vertical push/pull patterns (Cable pulldowns & landmine press variations)
• Gripping through heavy compound or unilateral lifts (trap bar deadlifts, DB lunges)�• Consistent exposure to loading throughout the lower body & core to maintain kinetic chain efficiency

While I’m not looking to see athletes return to their pre-injury level of strength before resuming throwing, they should be able to produce & recover from higher levels of loading. From there, they must CONTINUE to load throughout the course of their rehab to not only help with performance but durability.

04/03/2026

If you’re a pitcher coming back from an elbow injury, you absolutely MUST be assessing your shoulder range of motion & strength BEFORE returning to throwing.

While the main focus is the elbow when returning-to-throwing, the shoulder MUST be able to withstand some extra stresses that will naturally occur as throwing resumes. If it can’t, this is unfortunately when shoulder injuries can derail and slow down an elbow rehab throwing progression.

This is the exact reason why I require every pitcher undergoing elbow rehab to undergo rotator cuff dynamometry (strength) testing AND a full shoulder range of motion screen before they begin throwing. If those 2 areas are limited or not in a good spot, the risk of a setback becomes too high.

There have been countless times I didn’t clear a pitcher for throwing (despite a satisfactory elbow exam) for an additional 1-2 weeks due to poor cuff strength. Take a bit more time on the front end to put yourself in a good position for long-term success.

03/31/2026

Think you’re ready to start throwing again?

Most pitchers rush back based on time, not objective strength numbers — and that’s where problems start.

Here’s what actually matters 👇

👉 ER:IR Strength Ratio ≥ .67

This is the MINIMUM number I like to see before beginning a throwing program. Ideally, we want that number to be as close to .80-.85, but it takes some pitchers (especially when post-op) a bit longer than others to get to that point. Either, I believe this ratio needs to be at least .85 before they return to pitching in games. If not, we begin to worry about excessive stress placed on both the shoulder AND elbow.

👉 Side-to-Side Difference ≤ 10%

If your throwing arm is still significantly weaker than your non-throwing arm, you’re NOT ready to begin throwing. You need to have a satisfactory ER:IR strength ratio AND symmetry to non-throwing side before starting.

👉 Don’t Rush It

Some pitchers need to be held back 1-2 weeks past the standard “timeline”, which is okay! Never jeopardize long-term success for short-term gain. If either ER or IR is limited, we will use a heavy dose of isometrics AND eccentrics to get their cuff going

🚨 Remember:
�Feeling good ≠ being ready�Having proper a strength symmetry & ratio will protect your arm long term.

03/30/2026

When working with pitchers coming back from an arm injury, we follow a specific return-to-throw checklist to ensure a safe and effective return-to-competition.

The first box on the checklist before ANY return to throwing is a sufficient range of motion & clinical exam, such as 👇

• Total shoulder range of motion must be symmetrical (within ~5° side to side)�• Cross-body adduction should hit ~90°�• Flexion (scap pinned & unpinned) must be symmetrical (within ~5° side to side)�• Elbow flexion + extension must match baseline�• AND a clean clinical exam (no pain with stress testing)

👉 Here’s the reality…

Most players skip this.

They jump straight into a throwing program because:�“I feel good”�“My arm doesn’t hurt anymore”
But “feeling good” ≠ being ready.

If you’re off by 15–20° range of motion, unable to effectively load in the weight room or insufficient rotator cuff or grip strength…�you’re setting yourself up for another setback.

⚠️ This is EXACTLY why arm pain keeps coming back.

Instead 👇�• Measure your baseline�• Compare side-to-side�• Rebuild deficits BEFORE you ramp up throwing

Because the goal isn’t just getting back…

It’s staying on the field for the rest of the year.

📩 DM me “THROW” and I’ll help you figure out if you’re actually ready to start throwing again

03/09/2026

Why Training Like a Bodybuilders Isn’t The Best For Athletes

Many athletes are following bodybuilding-style splits like:
• Chest & Biceps
• Back & Biceps
• Shoulders & Triceps
• Random “leg day”

While athletes have some success developing muscle mass and physique initially, this type of training over a long period of time typically doesn’t yield positive carryover to the sport.

A comprehensive plan for athletic performance focuses on things like:
✅ Double-leg & Single-leg strength
✅ Posterior chain development (glutes, hamstrings)
✅ Speed & explosive power
✅ Total body strength
✅ Movement quality

The goal should never be to look like a bodybuilder. It’s to put yourself in a position to not only stay healthy & on the field, but perform at the highest level.

Address

824 Route 88
Point Pleasant, NJ
08742

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Monday 8am - 5pm
Tuesday 3pm - 8pm
Wednesday 8am - 5pm
Thursday 12pm - 6pm
Friday 8am - 5pm
Saturday 8am - 11am

Website

https://linktr.ee/lewisptsr

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