Today’s guest post comes from physical therapist Eric Schoenberg, who is an integral part of the Elite Baseball Mentorships team. Enjoy! -EC

Baseball is a game of ritual and tradition: lucky socks, pre-game meals, stepping over lines, special handshakes, and on-deck habits are all part of the “rhythm” of the game. Unfortunately, other “old-school” traditions are still the norm when it comes to the management and prevention of injury on the diamond. It is clear that we are moving in the right direction with new technologies and smarter training; however, injuries continue to pile up. A difficult question to answer is: are any of these injuries avoidable or are players already “damaged goods” by the time they get to the professional ranks? Some things are out of our control, but clearly we can do better.

Here are four opportunities for us to make a difference:

1. Identify the signs before there are symptoms.

The best form of treatment is prevention. The best rehab for a pitcher is one that does not exist at all. To support this point, a sign is a warning that something bad is about to happen. Some examples of objective signs in an at-risk pitcher are a decrease in velocity, loss of location/command, and ROM changes. This might be a loss of total glenohumeral ROM, internal rotation, or shoulder flexion; scapular upward rotation; elbow extension; forearm supination; and hip rotation. Or, it may be a significant increase in shoulder external rotation (see here and here for details). Some examples of subjective signs are poor body language, lack of confidence, altered communication, and working slower on the mound – just to name a few. Once a pitcher does become symptomatic, we need to take it seriously. I am not implying that we need to baby our athletes (there is enough of that going on!), but on the flip side, the solution is not to ignore the pain and “pitch through it.” As always, the truth is often found somewhere in the middle. In 15 years, I have yet to come across a pitcher that ended up needing surgery that did not first have signs and symptoms that were either missed or ignored.

2. There is no such thing as “normal soreness.”

To piggyback on point #1, the expectation is not that a pitcher will be pain-free 100% of the time. That is unrealistic. There is unavoidable stress and tissue breakdown associated with pitching. If there isn’t, my guess is the pitcher is not throwing very hard! However, I would like to make this point loud and clear: There is no such thing as “normal soreness.” By definition, if things were normal, then there would not be soreness (and certainly not pain). To this point, one could argue that throwing a baseball 100x at 85-100MPH is not “normal,” either, so what can we do about it? Let’s follow this rule: if a pitcher presents with pain, tightness, or fatigue in the front of his shoulder or the inside/outside of their elbow or forearm following an outing, then he needs an evaluation and treatment. If a pitcher presents with soreness in their glutes, core, and posterior cuff, then he needs some rest and a pat on the back for a job well done. Remember, just because the pain or soreness is common doesn’t make it right.

3. One size never fits all.

I can’t think of a situation in baseball (or life) where one approach works for everyone. For example, not every baseball player needs to stretch or “loosen up.” Most players are already too loose or lax and need to gain stiffness and stability with their pre-game routine. They need to warm-up and activate. Yet, at every level, we see teams line up and stretch before games. This robs their bodies of the good stiffness that they have worked to develop in the gym and during the off-season. We need to warm the tissues up and take the body through the appropriate ranges of motion to prepare to play; however, we don’t need to stretch these tissues right before asking them to generate massive amounts of force. For these loose-jointed individuals, throwing, sprinting, and hitting will provide all of the “stretching” that’s needed.

Another example that needs to be looked at is too many reps of strengthening or band exercises done right before activity on the field. If we don’t want to overstretch an athlete prior to playing, then we certainly don’t want to fatigue them. A fatigued pitcher has a 36x higher chance of getting injured than a non-fatigued pitcher. Let’s save the fatigue for the innings on the field and not with hundreds of band reps or a 50-pitch bullpen session before the 1st pitch is even thrown.

4. Avoid this question.

The worst question you can ever ask a pitcher on a mound visit or in the dugout is “How are you feeling?” This same question is asked every day on fields across the world and yields no valuable information. Any pitcher, at any level, will answer, “I’m good, coach.” If they don’t, they are playing the wrong sport.

Instead of asking this question, we should be using our experience as professionals to make unemotional decisions to best help our players stay healthy for the entire season.

It is our job is to acquire as much information as we can through experience and observation to make the best decision possible with the data that we have at that moment. Players lie. It is a way of showing their competitive spirit to stay in games and try to help their teams win. It’s called adrenaline. It’s not their fault. It is our fault for asking bad questions that have no good answers. The pitcher’s job is to get outs, not to decide what soreness is “normal.” That is what what we get paid to do.

Let’s close by comparing injury management in baseball to one of the world’s most successful companies. Apple talks about avoiding the “sameness trap.” This is the thought that if you ask a consumer what they want, they will tell you to do what other popular companies are doing. Steve Jobs worked to avoid this by not asking his customers what they wanted, but instead, giving them what they didn’t know they needed. So, let’s stop asking the same questions and getting the same generic answers and worked towards continuing to change the culture in baseball and help our athletes get better results.

If you are interested in learning more about our approach to managing baseball athletes, we’d love to see you at one of our Elite Baseball Mentorships.