The point I want to make, though, is that an injury like this can never, ever, ever, ever be pinned on one factor.  We have seen guys with "terrible mechanics" (I put that in quotes because I don't think there is such a thing as "perfect mechanics") pitch pain-free for their entire careers.  Likewise, we've seen guys with perfect mechanics break down.  We've seen guys with great bodies bite the big one while some guys with terrible bodies thrive.

The point is that while we are always going to strive to clean things up - physically, mechanically, psychologically, and in terms of managing stress throughout the competitive year - there is always going to be some happenstance in sports at a high level.  As former Blue Jays general manager JP Ricciardi told me last week when we chatted at length, "you've only got so many bullets in your arm."

Strasburg used up a lot of those bullets before he ever got drafted, so it's hard to fault the Nationals at all on this front.  In fact, from this ESPN article that was published when the team thought it was a strain of the common flexor tendon and not an ulnar collateral ligament injury (requiring Tommy John surgery), "Strasburg has told the team he had a similar problem in college at San Diego State and pitched through it."  It's safe to assume that the Nationals rule out a partial UCL tear in their pre-draft MRIs, but you have to consider what a common flexor tendon injury really means.

As I wrote in in my "Understanding Elbow Pain" series (of interest: Anatomy, Pathology, Throwing Injuries, and Protecting Pitchers) the muscles that combine to form the common flexor tendon are the primary restraints - in addition to the ulnar collateral ligament - to valgus stress.  If they are weak, overused, injured, dense, fibrotic, or whatever else, more of that stress is going on that UCL - particularly if an athlete is throwing with mechanics that may increase that valgus stress (the Inverted W I noted above) - the party is going to end eventually.  Is it any surprise that this acute injury occurred just a few weeks after Strasburg dealt with a shoulder issue that put him on the disabled list for two weeks?  The body is a tremendously intricate system of checks and balances, and it bit him in the butt.

There are other factors, though.  As a great study from Olsen et al. showed, young pitchers who require surgery "significantly more months per year, games per year, innings per game, pitches per game, pitches per year, and warm-up pitches before a game. These pitchers were more frequently starting pitchers, pitched in more showcases, pitched with higher velocity, and pitched more often with arm pain and fatigue. They also used anti-inflammatory drugs and ice more frequently to prevent an injury."  And, they were also taller and heavier.

Go back through the last 12-15 years of Stephen Strasburg's life and consider just how many times he's ramped up for spring ball, summer ball, fall ball, and showcases - only so that he can shut down for a week, just to ramp right back up again to try to impress someone else.  Think of how many radar guns he's had to pitch in front of constantly for the past 5-7 years - because velocity is all that matters, right?

Stephen Strasburg's injury wasn't caused by a single factor; it was a product of many.  And, it can't be pinned on Strasburg himself, any of his coaches or trainers, or any of the scouts that watched him.  Blame it in the system that is baseball in America today.

We already knew that this system was a disaster, though.  Yet, people still keep letting their kids go to showcases in December.  Heck, arguably the biggest underclassmen prospect event of the year - the World Wood Bat Tournament in Jupiter, FL - takes places at the end of October.  When they should be resting, playing another sport, or preparing their bodies in the weight room, the absolute best prospects in the country are pitching with dead, unprepared arms just because it's a convenient time for scouts and coaches to recruit - because the season is over.

They're wasting their bullets.

Now, I'm not saying that Strasburg's injury could have been avoided in a different system - but I'd be very willing to bet that it could have been pushed much further back - potentially long enough to allow him to get through a career.  An argument to my point would be that if it wasn't for all these exposures, he wouldn't have developed - but my contention to that fact was that it is well documented that Strasburg "blew up" from a good to an extraordinary pitcher with increased throwing velocity when he made a dedicated effort to getting fit when he arrived at college.

My hope is that young pitchers will learn from this example and appreciate that taking care of one's body is just as important as showing off one's talent.

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Shoulder Range-of-Motion Norms Mobilizing the Throwing Shoulder: The Do and Don't

As anyone who reads my posts regularly surely knows, I've devoted a significant portion of my life to figuring out how to make guys throw baseballs faster.  However, my interest in velocity isn't just limited to how to get to "X" miles per hour; it also extends to understanding how to stay (or improve upon) "X" miles per hour over the course of a single appearance, season, or career while staying healthy and developing the rest of one's pitching arsenal.  Erratic radar gun readings are as much a problem as insufficient radar gun readings.

My foremost observation on this front has been that velocity is much more erratic in high level teenagers than any other population. At Cressey Sports Performance, we've had loads of high school guys top the 90mph mark over the years, so we've built up a good sample size to consider.  While some of these guys are quite consistent, I find that they tend to have more 4-6mph drop-offs here and there than any other population with which I've worked.  A guy that is 90-94 on one day might come back at 86-88 five days later - seemingly out of the blue.

However, I don't think it's just a random occurrence.  Rather, in my experience, EVERY single time it happens, it's because he has let his body weight drop - usually due to being on the road for games and not packing enough food.  We see it all the time in kids who throw great up in New England, but then head down South for tournaments.  All of a sudden, they are living out of hotels and eating out of restaurants multiple times per day - which certainly isn't going to be as conducive to maintaining body weight as "grazing" around the house and chowing down on Mom's home-cooking multiple times per day.  To make matters worse, a lot of kids lose their appetites when they get out in the heat - and not many people from across the country are prepared for the weather in Georgia or South Carolina in July.  So, insufficient caloric intake becomes completely inadequate caloric intake - and that's not exactly a recipe for throwing the baseball faster.

Beyond just the body weight factor, though, you also have to look at the fact that the advanced teenage pitchers are generally also the best athletes - so their coaches almost always have them out in the outfield or at SS/3B when they aren't pitching.  Playing a position interferes with a solid throwing program and just doesn't give a kid a chance to rest. There are more calories burned, too!

What's interesting, though, is that kids who don't throw as hard - say, 70-82 - never have variability in their velocity readings; they are super consistent.  Why? Well, for one, they usually aren't quite good enough to get on travel teams and in competitive scenarios that would require them to have to consciously consider how to maintain their weight.  Rather, it's Mom's home-cooking all the time - so it's easier to maintain their weight.  And, they may not be talented enough to be able to play other positions when they aren't pitching.

This difference is really interesting because both populations - independent of strength and conditioning - are at ages where their bodies are changing and (presumably) getting heavier naturally as they go through puberty and gain muscle mass. 

This rarely applies to anyone who has pitched in the professional ranks for more than a year or two.  You never see a professional pitcher go out and throw 5-7mph slower than normal unless he is hurt or coming back on very short rest.  These guys have found their "set points," and have learned over the years how to get in enough calories when on the road (out on their own means cooking for themselves, plus eating whatever their clubhouse dues gets them at the park).  Plus, they aren't playing the field.

All that said, regardless of your age, experience level, and current velocity, don't skimp on calories.  If you look at every bit of research on the pitching motion, body weight predicts pitching velocity. If you're on the road, make sure you pack some shakes, trail mix, bars, fruit, nuts, jerky, or whatever other convenience food helps you to get in the calories you need to light up the radar gun.  Also, 8 Nutritional Strategies for Those Who Can't Gain Weight is one of my most popular articles of all time, if you're looking for some succinct thoughts on the topic.

And, if you're one of the pitchers who desparately needs to put on 15-20 pounds to make a big jump in velocity this summer, then the CSP Collegiate Elite Baseball Development Program is for you. For more information on this 10-week program, click here.

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However, what is very interesting to me is that 9/10 cases were treated non-operatively; in other words, Tommy John surgery is much less prescribed in football quarterbacks than baseball pitchers - meaning that the quarterbacks respond better to conservative treatment. What's up with that?  They are the same injuries - and presumably the same rehabilitation programs. In my eyes, it's due to the sheer nature of the stress we see in a baseball pitch in comparison to a football throw.  As a quarterback, you can probably "get by" with a slightly insufficient UCL if you have adequate muscular strength, flexibility, and tissue quality.  While this is still the case in some baseball pitchers, the stresses on the passive structure (UCL) are still markedly higher on each throw, meaning that your chances of getting by conservatively are probably slightly poorer.

Finally, I'd like to see pitchers lift more - because they simply don't do enough of it during the season.  With limited time between outings, it's important to get in the most important stuff first - and I just don't see swimming as "important" when compared to flexibility training, soft tissue work, the throwing program, and strength training.

Just paying close attention to (and asking about) where folks have their pain during overhead motion can tell you quite a bit.  In an external impingement - where we're talking about the rotator cuff tendons and bursa rubbing up against the undersurface of the acromion - you'll usually get pain as folks approach 90 degrees of abduction (arm directly out to the side).  That pain will persist as they go further overhead, and in my experience, start to die off as they get to the top.

Conversely, for those with AC joint impingement - what is essentially bone rubbing up against bone - you see a "painful arc" only at the last portion of abduction:

You can usually confirm your suspicions on this front with direct palpation of the AC joint and checking to see if folks have pain when reaching across the chest.

Much of the training modifications will be the same for these two conditions, but there are also going to be several key things that should be managed completely differently.  For instance, front squatting someone with an AC joint issue would not be a good idea due to the direct pressure of the bar on the AC joint; it would, however, be just fine for most cases of external shoulder impingement.  In another example, some serious AC joint issues are exacerbated even by just doing the end-range of a rowing motion (to much shoulder extension/horizontal abduction) - whereas even folks with full-blown rotator cuff tears can generally do rows pain-free.

Assess, don't assume!

For more information - including loads more assessments like these - check out the Optimal Shoulder Performance DVD set.

Of course, if you compare the perturbations to stability that the Bodyblade provides, it appears to simulate some of what you'd get with a rhythmic stabilization drill.  So, it's probably a good alternative to a pitcher who doesn't have a training partner, therapist, or coach who can provide those destabilizing torques.  Shirts, apparently, are optional.

That said, to me, using a Bodyblade is a more closed-loop (predictable) drill, whereas manual rhythmic stabilizations are more open-loop (unpredictable).  So, it goes without saying that the benefits of "surprise" stabilization probably extend a lot further - and they don't cost a penny.  Moreover, I've heard claims about the Bodyblade being an effective way to build muscle, which (outside an untrained population) just isn't going to happen.  There are also much better ways to train the core.

For more information, check out the Optimal Shoulder Performance DVD set.

In the same grain as Monday's post on lower back pain, today, I thought I'd highlight some of the common findings in diagnostic imaging of the shoulder, as these findings are just as alarming.

Do you train loads of overhead throwing athletes (especially pitchers) like I do?  Miniaci et al. found that 79% of asymptomatic professional pitchers (28/40) had "abnormal labrum" features and noted that "magnetic resonance imaging of the shoulder in asymptomatic high performance throwing athletes reveals abnormalities that may encompass a spectrum of 'nonclinical' findings."  Yes, you can have a torn labrum and not be in pain (it depends on the kind of labral tear you have; for more information, check out Mike Reinold's great series on SLAP lesions, starting with Part 1).

This isn't just limited to baseball players, either; you'll see it in handball, swimming, track and field throwers, and tennis as well.  And, it isn't just limited to the labrum.  Connor et al. found that eight of 20 (40%) dominant shoulders in asymptomatic tennis/baseball players had evidence of partial or full-thickness cuff tears on MRI. Five of the 20 also had evidence of Bennett's lesions.

The general population may be even worse, particularly as folks age. Sher et al. took MRIs of 96 asymptomatic subjects, finding rotator cuff tears in 34% of cases, and 54% of those older than 60 - so if you're dealing with older adult fitness, you have to assume they're present in more than half your clients!

Also, in another Miniaci et al. study, MRIs of 30 asymptomatic shoulders under age 50 demonstrated "no completely 'normal' rotator cuffs."  People's MRIs are such train wrecks that we don't even know what "normal" is anymore!

As is the case with back pain, these issues generally only become symptomatic when you don't move well - meaning you have insufficient strength, limited flexibility, or poor tissue quality.  For more information on how to screen for and prevent these issues from reaching threshold, check out Optimal Shoulder Performance from Mike Reinold and me.

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