Should Pitching Coaches Understand Research Methods and Functional Anatomy?
Written on July 9, 2012 at 8:53 pm, by Eric Cressey
Quite some time ago, I met a pitching coach who made a bold statement to me:
"Most Major League pitchers have terrible mechanics."
I don't know if he meant that they were mechanics that could lead to injuries, or simply mechanics that would interfere with control and velocity development, but either way, I shrugged it off. Why?
Their mechanics are so terrible that they're in the top 0.0001% of people on the planet who play their sport. And, they're paid extremely well to be terrible, I suppose.
Kidding aside, this comment got me to thinking about something that's been "festering" for years now, and I wanted to run it by all of you today to get your impressions on it. In other words, this post won't be about me ranting and raving about how things should be, but rather me starting a dialogue on one potential way to get the baseball development industry to where it needs to be, as it clearly isn't there yet (as evidenced by the fact that more pitchers are getting hurt nowadays than ever before).
The way I see it, mechanics are typically labeled as "terrible" when a pitcher has:
1. Trouble throwing strikes
2. Pitching velocity considerably below what one would expect, given that pitcher's athleticism
3. Pain when throwing
4. Mechanical issues that theoretically will predispose him to injury
In the first three cases, anyone can really make these observations. You don't need to be trained in anything to watch the walk totals pile up, read a radar gun, or listen when a pitcher says, "It hurts." Moreover, these issues are easier to coach because they are very measurable; pitchers cut down on their walks, throw harder, and stop having pain.
Issue #4 is the conundrum that has lead to thousands of pissing matches among pitching coaches. When a pitcher gets hurt, everyone becomes an armchair quarterback. The two biggest examples that come to mind are Mark Prior and Stephen Strasburg.
Prior was supposed to be one of the best of all-time before shoulder surgeries derailed his career. After the fact, everyone was quick to pin all the issues on his mechanics. What nobody has ever brought to light is that over the course of nine years, his injuries looked like the following (via Wikipedia):
1. Hamstrings strain (out for 2002 season)
2. Shoulder injury (on-field collision – missed three starts in 2003)
3. Achilles injury (missed two months in 2004)
4. Elbow strain (missed 15 days in 2004)
5. Elbow injury (missed one month in 2005 after being hit by line drive)
6. Rotator cuff strain (missed three months in 2006)
7. Oblique strain (missed two starts in 2006)
8. Rotator cuff strain (ended 2006 season on disabled list)
9. Shoulder surgery (missed entire 2007 season, and first half of 2008)
10. Shoulder capsule tear (out for season after May 2008)
11. Groin injury (missed last two months of 2011 season)
By my count, that is eleven injuries – but four of them were non-arm-related. And, two of them (both early in his career) were contact injuries. Who is to say that he isn't just a guy with a tendency toward degenerative changes on a systemic level? How do we know one of the previous injuries didn't contribute to his arm issues later on? How do we know what he did for preventative arm care, rehabilitation, throwing, and strength and conditioning programs? We don't have his medical records from earlier years to know if there were predisposing factors in place, either. I could go on and on.
The issue is that our sample size is one (Mark Prior) because you'll never see this exact collection of issues in any other player again. It's impossible to separate out all these factors because all issues are unique. And, it's one reason why you'll never see me sitting in the peanut gallery criticizing some teams for having injured players; we don't have sufficient information to know exactly why a player got hurt – and chances are, the medical staff on those teams don't even have all the information they'd like to have, either.
Strasburg has been labeled the best prospect of all-time by many, and rightfully so; his stuff is filthy and he's had the success to back it up. Of course, the second he had Tommy John surgery, all the mechanics nazis came out of their caves and started berating the entire Washington Nationals organization for not fixing the issue (an Inverted W) proactively to try to prevent the injury. Everybody is Johnny Brassballs on the internet.
To that end, I'll just propose the following questions:
1. Did Strasburg not do just fine with respect to issues 1-3 in my list above?
2. Would you want to be the one to screw with the best prospect of all-time and potentially ruin exactly what makes him effective?
3. Do we really know what the health of his elbow was when the Nationals drafted him?
4. Do we know what his arm care, throwing, and strength and conditioning programs were like before and after being drafted?
There are simply too many questions one can ask with any injury, and simply calling mechanics the only contributing factor does a complex issue a disservice – especially since young athletes are growing up with more and more physical dysfunction even before they have mastered their "mature" mechanics.
The Inverted W theory is incredibly sound; Chris O'Leary did a tremendous job of making his case – and we certainly work to coach throwers out of this flaw – but two undeniable facts remain. First, a lot of guys still throw with the Inverted W and don't have significant arm issues (or any whatsoever). They may have adequate mobility and stability in the right places (more on this below) to get by, or perhaps they have just managed their pitch counts and innings appropriately to avoid reaching threshold. I suspect that you might also find that many of these throwers can make up for this "presumed fault" with a quick arm combined with a little extra congenital ligamentous laxity, or subtle tinkering with some other component of their timing.
Second, a lot of guys who don't have an Inverted W still wind up with elbow or shoulder injuries. Good research studies bring issues like these to light, and nobody has really gotten a crew of inverted W guys and non-inverted W guys together to follow injury rates over an extended period of time while accounting for variables such as training programs, pitch counts, and pitch selection (e.g., sliders vs. curveballs). We don't know if some of these other factors are actually more problematic than the mechanics themselves, as it's impossible to control all these factors simultaneously in a research format.
As such, here we have my first set of questions:
Don't you think that pitching coaches need to make a dedicated effort to understand research methods so that they can truly appreciate the multifactorial nature of injuries? And, more importantly, wouldn't learning to read research help them to understand which mechanical issues are the true problem?
The Inverted W is certainly an issue, but there are many more to keep in mind. Just my opinion: I think the baseball industry would be much better off if pitching coaches read a lot more research.
Now, let's move on to my second question. First, though, I want to return to the Inverted W example again. I have not met more than a few pitching coaches who can explain exactly what structures are affected by this mechanical flaw because they don't understand what functionally is taking place at the shoulder and elbow. They don't understand that excessive glenohumeral (shoulder) horizontal abduction, extension, and external rotation can all lead to anterior glide of the humerus, creating more anterior instability and leading to injuries to the anterior glenohumeral ligaments and labrum. Meanwhile, the biceps tendon picks up the slack as a crucial anterior stabilizer. They also don't appreciate how these issues are exacerbated by poor rotator cuff function and faulty scapular stabilization patterns. And, they don't appreciate that these issues are commonly present even in throwers who don't demonstrate an Inverted W pattern.
At the elbow, they also can't explain why, specifically, the Inverted W can lead to problems. They don't understand that the timing issue created by the "deep" set-up leads to greater valgus stress at lay-back because the arm lags. They can't explain why some players have medial issues (UCL injuries, ulnar nerve irritation, flexor/pronator strains, and medial epicondyle stress fractures) while other players have lateral issues (little league elbow, osteochondritis dissecans of radial capitellum) from the same mechanical flaws. They can't explain why a slider thrown from an Inverted W position would be more harmful than a curveball.
I can explain it to you – and I can explain it to my athletes so that they understand, too. I've also met a lot of medical professionals who can clearly outline how and why these structures are injured, but we aren't the ones coaching the pitchers on the mounds. The pitching coaches are the ones in those trenches.
To that end, I propose my second set of questions:
Don't you think pitching coaches ought to make an effort to learn functional anatomy in order to understand not just what gets injured, but how those injuries occur? Wouldn't it give them a more thorough understanding of how to manage their pitchers, from mechanical tinkering, to pitch selection, to throwing volume? And, wouldn't it give them a more valid perspective from which to contribute to pitchers' arm care programs in conjunction with rehabilitation professionals and strength and conditioning coaches?
The problem with just saying "his mechanics suck" is that it amounts to applying a theory to a sample size of one. That's not good research. Additionally, this assertion is almost always taking place without a fundamental understanding of that pitcher's functional anatomy. It amounts to coaching blind.
To reiterate, this was not a post intended to belittle anyone, but rather to bring to light two areas in which motivated pitching coaches could study extensively in order to really separate themselves from the pack. Additionally, I believe wholeheartedly in what Chris O'Leary put forth with his Inverted W writings; I just used it as one example of a mechanical flaw that must be considered as part of a comprehensive approach to managing pitchers.
With that said, I'd love to hear your opinions on these two sets of questions in the comments section below. Thanks in advance for your contributions.
Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!