Q: I have a client who is 38 and plays league baseball. After playing for a few years when he finished high school, his career took a hit due to shoulder, elbow and knee injuries/over use. So, he left baseball, started his own business and after 15 years started playing in two leagues again…and the same old injuries flared up and now I have him. Can you recommend some elbow strengtheners I can prescribe for him?

A: First, make sure it’s not just a matter of too much, too soon. He should have progressed his throwing routine gradually from Day 1. Good thing to save…

1. Throw on a two-on, one off schedule.

2. Start with 25 throws at 25 feet per day.

3. Increase throws at 25 feet to 50 before extending the distance and breaking the volume down between distances (25 at 25, 25 at 50) and so on.

4. From a recent article I wrote:

Incorporate posterior capsule stretching in overhead throwing athletes. There is considerable research demonstrating that glenohumeral internal rotation deficit (GIRD) is highly correlated with shoulder injuries in overhead throwing athletes. Incorporating a very simple “sleeper” stretch daily can dramatically reduce the risk of shoulder problems in such athletes; if you aren’t including this stretch in your program, you shouldn’t be allowed to train overhead athletes!

I also like cross-body mobilizations, as this approach has proven more effective than the sleeper stretch for improving internal rotation range-of-motion. Sleeper stretches are preferred for those with shoulder problems, but if you’re only dealing with an elbow issue, you’ll be fine with the cross-body version.

You’ll also want to include some prone internal rotations – really important for subscap function.

You’ll also want to beat up on his posterior shoulder girdle with a tennis/lacrosse ball. Start with the soft tissue work, then move to the sleeper stretch, and then go to prone internal rotations.

This assumes that we’re dealing with medial elbow pain. Lateral elbow pain could be related (generally seen early-on, especially in younger athletes), but it’s often more related to myofascial restrictions in the forearm with older athletes, in my experience.

Eric Cressey

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