In case you missed them, check out Part 1 (Functional Anatomy) and Part 2 (Pathology) of this series from last week. With that housekeeping out of the way, let's move forward to today's focus: elbow injuries in throwing athletes. I work with a ton of baseball players and I know we have a lot of not only players, but parents of up-and-coming baseball stars that read this blog - so it's a topic that is near and dear to my heart. While my primary focus within the paragraphs that follow will be baseball, keep in mind that the many these issues can also be seen in other overhead athletes. They just tend to be more prevalent and magnified in a baseball population.
Obviously, in dealing with loads of baseball guys, I see a lot of elbow issues come through my door. The overwhelming majority of those folks are medial elbow pain, but we also see a fair amount of lateral elbow pain. What's interesting, though, is that in a baseball population, most of these issues are purely mechanical pain; that is, the discomfort is usually only present with throwing, as it is tough to reproduce the velocities and joint positions present during overhead (or sidearm/submarine) throwing.
The question, logically, is why do some throwers break down medially while others break down laterally, or even posteriorly?
In other to understand why, we first have to appreciate the demands of throwing. And, that appreciation pretty much always leads back to the valgus and extension forces (termed valgus-extension overload by many) that combine to wreak havoc on an elbow during throwing.
At late cocking - where maximal external rotation (or "lay-back") occurs - there is a tremendous valgus force of 64Nm on the elbow, according to Fleisig et al.
As Morrey et al. determined, the ulnar collateral ligament (UCL) "takes on" approximately 54% of this valgus force - meaning that it's assuming about 35Nm of force on each pitch. This is all well and good - until you realize that in cadaveric models, the UCL fails at 32Nm.
If the valgus forces are so crazy that they actually exceed the UCL's tolerance for loading, why don't we just rip that sucker to shreds on every pitch?
It's because the UCL doesn't work alone. Rather, we've got soft tissue structures (namely, the flexor carpi ulnaris and radialis) that can protect it. This is why cadavers don't usually pitch in the big leagues. The closest thing I've seen is 84-pound Willie McGee, but he was an outfielder.
Keep in mind that it isn't just the UCL that's stressed in this lay-back position. Obviously, the flexor-pronator mass takes a ton of abuse in transitioning from cocking to acceleration. It's also a tremendously vulnerable position for the ulnar nerve as it tracks through some tricky territory. That just speaks to the medial side of things; there is more to consider laterally.
You see, the same valgus force that can wreak havoc medially also applies approximately 500N on the radioulnar joint during the late cocking phase of throwing; that's about one-third of the total stress on the elbow. In this case, a picture is worth a thousand words:
So, the same forces can cause a thrower to break down in multiple areas both medially and laterally! What usually separate the medial from the lateral folks?
Let me ask you this: when was the last time you saw an 8-year old rupture his ACL? Never.
Now, when was the last time you saw an 8-year-old break a bone? Happens all the time.
This same line of reasoning can be applied to the pitching elbow. The path of least resistance - or the area of incomplete development - will generally break down first. As such, in a younger population, we generally see more lateral, compression-type injuries to the bones. These are your growth plate issues and Little League Elbows, usually.
As athletes mature and the bones become sturdier, we get more muscle/tendon, ligament, and nerve issues on the medial side.
This isn't always the case, of course; you'll see young kids with medial elbow pain, and experienced throwers with lateral issues as well. It generally holds pretty true, though.
The issues at the cocking-to-acceleration transition would be bad enough by themselves, but there is actually another important injury mechanism to consider: elbow extension.
This lateral area also takes on about 800N of force at the moment arm deceleration begins with elbow extended out in front as posteromedial impingement occurs between the ulna and the olecranon fossa of the humerus. This bone-on-bone contact at high velocities (greater than 2,000 degrees/second) can lead to fractures and loose bodies within the joint.
This wraps up the causative factors with respect to elbow pain in throwers - but I need to now go into further detail on the specific physical preparation and mechanical factors one needs to consider to avoid allowing these issues to come to fruition. Stay tuned for Part 4.
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In case you missed Part 1 of this series (Functional Anatomy), you can check it out HERE.
Elbow issues can be really tricky at times from a diagnostic standpoint.Someone with medial elbow pain could have pronator and/or flexor (a.k.a. Golfer’s Elbow) soft tissue issues, ulnar nerve irritation or hypermobility, ulnar collateral ligament issues, or a stress fracture of the medial epicondyle – or a combination of two or more of these factors.All of these potential issues are “condensed” into an area that might be a whopping one square inch in size.Throw lateral elbow pain (commonly extensor overuse conditions - a.k.a. "Tennis Elbow" - and bony compression issues) and posterior (underside) pain in the mix, and you’ve got a lot of other stuff to confound things.
To make matters more complex, it’s not an easy diagnosis.The only way to recognize soft tissue restrictions is to get in there and feel around – and even when something is detected, it takes a skilled clinician with excellent palpation skills to determine just what is “balled up” and what nerves it may affect (especially if there is referred pain).
In these situations, I’ll stick with the terms “soft tissue dysfunction” and “tendinopathy” or “tendinosis” to stay away from the diffuse and largely incorrect assumption of “elbow tendinitis.”We’re all used to hearing “Tennis Elbow” (lateral) and “Golfer’s Elbow” (medial), and to be honest, I’d actually say that these are better terms than “epicondylitis,” as issues are more degenerative (“-osis”) than inflammatory (“-itis”).
Ulnar nerve pain patterns can present at or below the elbow (pinky and ring finger tingling/numbness are common findings), and may originate as far up as the neck (e.g., thoracic outlet syndrome, brachial plexus abnormalities, rheumatologic issues, among others) and can be extremely challenging to diagnosis.A doctor may use x-rays to determine if there is some osseous contribution to nerve impingement or a MRI to check on the presence of something other than bone (such as a cyst) as the cause of the compression. Nerve conduction tests may be ordered.Manual repositioning to attempt to elicit symptoms can also give clues as to whether (and where) the nerve may be “stuck” or whether it may be tracking out of course independent of soft tissue restrictions.
Childress reported that about 16% of the population – independent of gender, age, and athletic participation – has enough genetic laxity in the supporting ligaments at the elbow to allow for asymptomatic ulnar nerve “dislocation” over the medial epicondyle during elbow flexion.In the position of elbow flexion, the ulnar nerve is most exposed (and it’s why you get the “funny bone” pain when you whack your elbow when it’s bent, but not when it’s straight).Ulnar nerve transposition surgeries has been used in symptomatic individuals who have recurrent issues in this regard, and it consists of moving the ulnar nerve from its position behind the medial epicondyle to in front of it.
An ulnar collateral ligament (UCL) issue may seem simple to diagnosis via a combination of manual testing and follow-up diagnostic imaging (there are several options, none of which are perfect), but it can actually be difficult to “separate out” in a few different capacities.
First, because the UCL attaches on medial epicondyle (albeit posteriorly), an injury may be overlooked acutely because it can be perceived as soft tissue restrictions or injuries. The affected structures would typically be several of the wrist flexors as they attach via the common flexor tendon, or the pronator teres.
Second, partial thickness tears of the UCL can be seen in pitchers who are completely asymptomatic, so it may be an incidental finding.Moreover, we have had several guys come our way with partial thickness UCL tears who have been able to rehab and return to full function without surgery.While the UCL may be partially torn and irritated, the pain may actually be coming to “threshold” because of muscular weakness, poor flexibility, or poor tissue quality.
Medial epicondyle stress fractures can be easily diagnosed with x-rays, but outside of a younger population, they can definitely be overlooked.For instance, I had a pro baseball player – at the age of 23 – sent to us for training by his agent last year as he waiting for a medial epicondyle fracture to heal.
While these are the “big players” on the injury front – particularly in a throwing population – you can also see a number of other conditions, including soft tissue tears (flexor tendons, in particular), loose bodies (particularly posteriorly, where bone chips can come off the olecranon process), and calcification of ligaments.So, long story short, diagnosis can be a pain in the butt – and usually it’s a combination of multiple factors. At a presentation last weekend, Dr. Lance Oh commented on how 47% of elbow pain cases present with subluxating medial triceps ("snapping elbow"), but this is rarely an issue by itself.
That’s one important note.However, there is a much more important note – and that is that many rehabilitation programs are outrageously flawed in that they only focus on strengthening and stretching the muscles acting at the elbow and wrist.
As I’ll outline in Part 3 of this series, a ton of the elbow issues we see in throwers occur secondary to issues at the glenohumeral and scapulothoracic joints.And, more significantly, not providing soft tissue work in these regions grossly ignores the unique anatomical structure of the elbow and forearm and its impact on tendon quality.If you’ve got elbow issues, make sure you’ve got someone doing good soft tissue work on you.Just to give you a little visual of what I’m thinking, I got a video of Nathaniel (Nate) Tiplady, D.C. (a great manual therapist who works out of Cressey Performance a few days a week) performing some Graston Technique® followed by Active Release ® on my forearms. Here's the former; take note of the sound of his work on the tissues; the instruments actually give the practitioner tactile (and even audible) feedback in areas of significant restrictions. You'll see that it is particularly valuable for covering larger surface areas (in this case, the flexors of the anteromedial aspect of the forearm):
As for the ART, you'll see that it's more focal in nature, and involves taking the tissue in question from shortened to lengthened with direct pressure.
As you can probably tell (even without seeing me sweat or hearing me curse), it doesn’t feel great while he’s doing it – but the area feels like a million bucks when he’s done.
While there is no substitute for having a qualified manual therapist work on you, using The Stick on one’s upper and lower arms can be pretty helpful.
More on that in Part 3…
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Today's piece kicks off a multi-part series focusing specifically on the elbow. I'm going to start off this collection by talking about the anatomy of the elbow joint, but in appreciation of the fact that a lot of you are probably not as geeky as I am, I'll give you the Cliff's Notes version first:
The elbow is the most "claustrophobic" joint in the body; there is a lot of stuff crammed into very little space. This madness is governed not just by the joint itself, but (like we know with all joints) by the needs of the forearm/wrist and what goes on at the shoulder and neck.
Even for the geeks out there, in the interest of keeping this thing "on schedule," I'm just going to focus on your pertinent information. I would highly recommend The Athlete's Elbow to those of you interested in learning more; it's insanely detailed.
Your big players on the osseous (bone) front are going to be the humerus, ulna, and radius. At the humerus, in the context of this discussion, all you really just need to pay attention to are the medial and lateral epicondyles, as they are crucial attachment points for both tendons and ligaments (as well as sites of stress fractures in younger athletes).
Posteriorly, you'll see that olecranon process of the ulna sits right in the olecranon fossa of the humerus. This is a pretty significant region, as it gives the elbow its "hinge" properties and prevents elbow hyperextension. Fractures of the olecranon can occur and leave loose bodies in the joint that will prevent full elbow extension. And, not to be overlooked is the attachment site of the triceps (via a common tendon) and anconeus on the olecranon process.
The "elbow" may just be a hinge to the casual observer, but in my eyes, it's important to distinguish among the humeroulnar joint (described above) and the humeroradial (pivot) and proximal radioulnar joints - which give rise to pronation and supination.
Likewise, the wrist (and the fingers, for that matter) is directly impacted in flexion/extension, radial deviation/ulnar deviation, and pronation/supination by muscles that actually attach as far "north" as the humerus. Muscles aren't just working in one plane of motion; they're working for or against multiple motions in multiple planes.
In all, you have 16 muscles crossing the elbow. For those counting at home, that's more than you'll find at another "hinge" joint, the knee, in spite of the fact that the knee is a much bigger joint mandating more stability. More muscles equates to more tendons, and that's where things get interesting.
As any good manual therapist, and he'll tell you that soft tissue restrictions occur predominantly at:
A. Areas of increased friction between muscles/tendonsB. Areas where forces generated by a myofascial unit come together (termed "Zones of Convergence" by myofascial researcher Luigi Stecco): this is generally the muscle-tendon-bone "connection," as you don't typically see prominent restrictions in the mid-belly of a muscle.
This is a double whammy for the muscles acting at the elbow. In terms of A, you have many muscles in a small area. Most folks overlook the importance of B, though: a lot of them share a common (or at least directly adjacent) attachment point. The flexor carpi radialis, flexor carpi ulnaris, palmaris longus, and flexor digitorum superficialis all attach video the common flexor tendon on the medial epicondyle, with the pronator teres attaching just a tiny bit superiorly. There's ball of crap #1.
Ball of crap #2 occurs at the lateral epicondyle, where you have the common extensor tendon, which is shared by extensor carpi radialis brevis, extensor carpi ulnaris, supinator, extensor digitorum, and extensor digiti minimi - with the extensor carpi radialis longus attaching just superiorly on the lateral supracondylar ridge. Ball of crap #3 can be found posteriorly, where the three heads of the triceps converge to attach on the olecranon process via a common tendon, with the much smaller anconeus running just lateral to the olecranon process. You can see both balls of crap (double flusher?) coming together here:
Ball of crap #4 is a bit more diffuse consisting of the attachments of biceps brachii (radial tuberosity), brachioradialis (radial/styloid process), and brachialis (coronoid process of ulna) on the anterior aspect of the forearm.
This last graphic demonstrates that there are a few other factors to consider in this already jam-packed area. You've got fascia condensing things further, and you've also got a blood supply and nerve innervations - most significantly, the ulnar, median, and radial nerves - passing through here. The median nerve, for instance, passes directly through the pronator teres muscle.
Oh, and you've also got ligaments mixed in - some of which are attaching on the very same regions that tendons are attaching. The ulnar collateral ligament attaches on the medial epicondyle in close proximity to the flexors and pronator teres, for instance. These ligaments are heavily reliant on soft tissue function to stay healthy. As an example, flexor carpi ulnaris is going to be your biggest "protector" of the UCL during the throwing motion.
So what's the take-home message of this functional anatomy lesson? Well, there are several.
1. Lots of stuck is packed in a very small area.
2. When things are stuck together, they form dense, fibrotic, nasty balls of crud.
3. These gunked up muscles/tendons can impact everything from nerve function to ligamentous integrity - or they can just give out in the form of a tear or tendinopathy.
4. Diagnosis can be tricky because all the potential issues take place in a small area, and may have very similar symptoms. Different pathologies take place in different athletic populations, too. We'll have more on this in Understanding Elbow Pain - Part 2: Pathology.
I have written a bit in this blog about elbow pain - both in throwers and lifters - but will be devoting some very specific, detailed articles to it in the near future. In the meantime, however, here is an interesting population-specific fact. Many baseball players wind up with elbow issues secondary to shoulder range of motion deficits. Most lifters run into trouble because of excessive gripping and terrible tissue quality in the region. Apparently, though, certain NBA players run into elbow issues because of KARMA.
Huh? Well, apparently if you treat ballboys like crap, it comes back to haunt you sooner than later.
Q: I was wondering the other day about why guys often come back from Tommy John surgery pitching better and harder than they did before. My first thought was they can't do any upper-body strength training for months while they recover from the surgery, so they're forced to work on lower body, core, and mobility - and, in turn, come back as better conditioned athletes with more control and velocity. Or, do you think their improved velocity and command is just an illusion made possible because we're comparing them to the way they pitched while they were hurt, but not yet "disabled?" Or, is there another factor I'm missing altogether? I figure there's a sample-size issue -- we're just looking at the guys who make it all the way back, and ignoring the ones who don't.
A: It's an excellent question - and one I actually get quite a bit. I'd say that it's a combination of all three.
In my eyes, an ulnar collateral ligament tear is usually an injury that speaks to YEARS of dysfunction and accumulated stress. Guys usually have a history of elbow pain/soreness in their teenage years, some calcification on the UCL, and then it finally goes in their college/pro years. They may have been managed conservatively (physical therapy) for a long time just because doctors don't like doing surgeries on 16-year-olds. However, when they're 20, it becomes "acceptable" to do a Tommy John surgery.
In the meantime, many of these injured pitchers will modify their deliveries to avoid the pain and end up with some crazy mechanics that leave the ball all over the place at erratic radar gun readings. So, that can usually cover the velocity drop and control issues. This is in stark contrast to what you'll see with serious injuries to the labrum (SLAP2 lesions), which generally give you the quick velocity drop, and eventually, loss of control - even in the absence of pain. Elbow stuff doesn't usually directly influence velocity as quickly; a lot of guys can throw through it for years.
So, yes, we are comparing them to their pre-injury numbers. However, there is - at least in my eyes - a better reason.
They are often lazy and inconsistent with their training and arm care before they get hurt. Quite often, you'll see an ACL reconstruction leg coming back and being stronger than the uninjured side long-term. The same thing can happen with a Tommy John. The rehab is crazy long, so guys have time to learn arm care as religion and - as you noted - focus on athletic qualities that are often partially or entirely "squeezed out" by competing demands.
I remember talking with Curt Schilling along these lines - although it was with respect to his shoulder. He had a shoulder surgery in 1995, and it made him "religious" about arm care. His best years came years after that even though he'd gotten older.
So, usually, the guys who wind up throwing harder are just the ones who were lazy in the first place and were finally forced into actually taking care of their bodies. The guys who DO take good care of their arms and wind up tearing UCLs rarely come back throwing harder, and to be frank, probably have a lower chance of returning to their former selves than their lazy counterparts.
Of course, this obviously excludes issues with the graft type (autograft or allograft), graft site (Palmaris longus, hamstrings, or another site), surgeon's abilities, physical therapy, athlete motivation, strength and conditioning, and return-to-throwing progression.
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Today's smart guy isJohn Pallof, a great physical therapist with whom I am lucky to collaborate on a weekly basis.
The message if very clear and simple - and the practice of this lesson yields marked improvements in outcomes: once you've had soft tissue work done, it's imperative to stretch the tissues that have just been worked. Once you have "disrupted" the tissue and created the desired response, the next step is to re-establish proper lengthening of the involved tissues.
We typically encourage athletes to use multiple sets of 60-second holds over the course of the day following the soft tissue work for most beneficial results. So, if an athlete has aggressive soft tissue work on the elbow flexors, he would do this stretch over the course of the rest of the day to re-establish the elbow extension range-of-motion we're trying to attain.
Recommended Viewing: Check out this cool free slideshow about how Graston Technique (R) works:
Back in early May, I published a newsletter discussing some alternatives I've used as replacements for traditional interval training. Basically, the goal was to show that one can work to address inefficiencies while still getting some good energy systems development training.
One of the key concepts I briefly outlined in this newsletter - and also thoroughly in Mike Robertson and my Building the Efficient Athlete DVD Set - is the Law of Repetitive Motion. This law is expressed as the equation I=NF/AR. In this equation, injury equals the number of repetitions multiplied by the frequency of those repetitions, divided by the amplitude of each repetition times the rest interval.
Looking at this equation and understanding each of these factors sheds some light not only on how we can prevent injuries, but also address these issues once they reach threshold. Truth be told, as I related in another previous newsletter, I'm a firm believer that we're always just see-sawing back and forth, getting closer to threshold when tissues are loaded in excess of their capacity.
Providing adequate stability, mobility, recruitment patterns, and tissue quality with the appropriate training loads and recovery measures ensures that we stay below this threshold. All of these issues are covered in one way or another by the equation from above.
"I" is the injury, or insult to the tissues. In the active restraints - muscles and tendons - this may present in the form of soft tissue restrictions that can be addressed with manual therapy and foam rolling. In other words, sometimes simply doing some soft tissue work can bring someone back below threshold (one reason why I refuse to refer any athletes or clients to physical therapists who do not put their hands on patients, but that is a whole other newsletter altogether).
"N" is the number of repetitions imposed on the tissues. This may be working on a factory line doing the same motion over and over again. It may also be simply sitting with poor posture, which is the equivalent of a high number of reps (constant activation). Or, it could come from doing as many chin-ups as possible simply because your business partner told you that he didn't think you could do it - and the Mudvayne in the background motivated you to action (but I wouldn't know anything about that).
With respect to "N," the general assumption is that simply reducing the number of repetitions is what it takes to reduce insult to the tissues. That's absolutely true, but not exhaustively true.
Take someone who bench presses with the elbows flared, and teach them to tuck the elbows and activate the upper back and scapular stabilizers. You may instantly relieve their pain without altering the number of repetitions; you're just redistributing the load.
The same is true of someone with anterior knee pain who has pain with forward lunging, but not with reverse lunges. So, the lesson to be learned isn't just to modify the number of repetitions, but also the manner in which those repetitions are performed.
"F" is the force of each repetition, and it's important to remember that this force is expressed as a function of maximum muscular strength. So, in other words, the "F" figure will be higher - and more injurious - on a weak tissue. This is one reason why resistance training is a big portion of modern physical therapy - including physical therapy that the brighter minds in the PT community wouldn't consider "comprehensive" or "good."
Here's an example. Average Joe gets anterior knee pain and, of course, he gets diagnosed with patellar tendinitis when it's really more of a tendinosis (but I won't digress on that). He spends six weeks in PT to really "build up his quads." It's obvious that the patellar tendon was just weak and inflamed, so strengthening it and knocking back NSAIDs like candy will fix everything. Riiiiight.
Chances are that the patellar tendon was just overused because Joe had no hamstrings or glutes. Getting the quads strong just reduces the "F" figure in the equation above. They push him away from threshold, but not as far as he'd have gone if they'd also worked on recruiting glutes and hamstrings better, optimizing hip and ankle mobility, or performing soft tissue work. Or, maybe he just got better because they reduced the "N" we discussed above by resting the knee. Regardless, Joe's not in the clear and very well might be back in PT in a few months if he doesn't address the other issues in the equation.
And, with that in mind, I'll get to the final two components of the Law of Repetitive Motion in my next newsletter. In the meantime, check out the Building the Efficient Athlete DVD Set for more details.
It's been a while since my last dose of Friday Randomness, but when you're got so much intern hazing going on, it's hard to even imagine topping that kind of content!
1. I recently contributed to another T-Muscle feature; check out Advice You Don't Want to Hear: Volume 2 for a little dose of tough love. I'm the last one down.
2. I have to say, I'm pretty proud of myself. My fiancee's been out of town since Monday morning, and while the fridge is just about empty and I'm down to one pair of clean underwear, the place didn't burn down, and I didn't put an eye out.
3. Here's a quick takeaway from a great Elbow Biomechanics talk by Mike Reinold earlier this week...
Obviously, in dealing with loads of baseball guys, I see a lot of elbow issues come through my door. The overwhelming majority of those folks are medial elbow pain, but we also see a fair amount of lateral elbow pain - even though we program for these individuals very similarly, as their inefficiencies are pretty much identical. I've seen it in practice, but never actually gotten the numbers on the forces involved.
The same medial tensile force that can wreak havoc with an ulnar collateral ligament or ulnar nerve also applies approximately 500N on the radioulnar joint during the late cocking (maximum external rotation) phase of throwing; that's about one-third of the total stress on the elbow. This lateral area also takes on about 800N of force at the moment arm deceleration begins (elbow extended out in front). As always, a picture is worth a thousand words:
I always knew it was going on, and always worked to prevent problems in the area, but suffice it to say that it was nice to get some numbers on this. If you see these issues, you've obviously got to look at mechanics, but more importantly, tissue quality, all the common flexibility deficits we see in pitchers, and overall strength of the rotator cuff, scapular stabilizers, core, lower body, and muscles acting at the elbow to provide valgus stability. For more information, I highly recommend you check out the 2008 Ultimate Pitching Coaches Boot Camp DVD set.
4. Bill, Mike, and I film our new DVD next weekend out in Indianapolis, so I'm going to end this one here and get to work on finishing up the script. Stay tuned on this front; we are excited about how thorough this is.
Have a great weekend!
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used by Cressey Performance Pitchers after they Throw!
I've written previously about the many flexibility deficits we see in baseball players (particularly pitchers). One of the biggest issues we face is a loss of elbow extension range-of-motion. This adaptive change most likely occurs because of the insane amounts of eccentric muscle action required to decelerate the 2,500 degrees/second of elbow extension that occurs during pitching. You'll find some serious shortness/tissue restrictions in biceps brachii, brachioradialis, brachialis, and all the rest of the muscles acting at the elbow and wrist.
Unfortunately, it's not an area you can really work on with the foam roller or baseball, as it's in a tough spot. For that reason, we prefer using The Stick - and hold it in place with the j-hooks in a power rack. Here is how it works when rolling out the anterior forearm musculature (this same technique can be utilized on the elbow flexors):
Follow that up with some longer duration holds of this stretch, and you'll get that elbow extension back in no time.
For the entire Cressey Performance foam roller series, click HERE.
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used by Cressey Performance Pitchers after they Throw!
Q: My son pitches for a Division II baseball program - well, at least, until recently. Since he began his strength training regimen one year ago, his pitches have gained velocity, but he no longer has control over the ball. Is it possible that his training has changed the mechanics in his arm so much that he has no idea where the ball is going after it leaves his hand? He's frustrated - we are talking about one of the best and strongest in collegiate baseball and now they won't even put him on the mound. I asked some baseball veteran friends about it and they suggested he has to retrain his arm since he has become so much stronger. What are your thoughts?
A: I've definitely seen guys who have gained muscle mass and lost velocity because they didn't train the right way, and it can absolutely go in the opposite direction as well and affect control.
I agree with your pitching coaches that he probably needs to retrain his mechanics with the added weight, but to be honest, it's something that should have been happening with a gradual weight gain anyway. I would be more inclined to look to address any range of motion (ROM) deficits he may have acquired through the process of gaining weight.
For instance, if he lost some hip rotation ROM, it could markedly affect control. A guy without enough hip internal rotation will fly open early on his front leg and, as a result, the arm lags behind (and out of the scapular plane, which can also lead to arm problems). A guy who loses external rotation tends to stay closed, which means he either throws more across his body (increased arm stress) or miss high and inside frequently (in the case of a RHP vs. right-handed batter, or LHP vs. left-handed batter).
Likewise, a pitcher who bench presses until he's blue in the face can lose both external rotation and horizontal abduction ROM. These ROM factors are two (of many) predictors of velocity, and while a decrease in one or both normally equates to a drop in velocity, it could also cause a pitcher to change his arm slot. I actually wrote more about this in an old newsletter: Lay Back to Throw Gas.
These are just some thoughts. I'd need to do some ROM tests and see some videos of him throwing to know for sure if any of my impressions are on the money.
For more information, I'd definitely recommend you check out the 2008 Ultimate Pitching Coaches Bootcamp DVD Set.
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used by Cressey Performance Pitchers after they Throw!
