Enough said.

By the way, when I was watching this video on YouTube, one of the recommended videos was Will Ferrell's 2003 Harvard Commencement speech.  It is absolutely hilarious; talk about a way to make a graduation actually interesting!

We still have to plan our honeymoon soon as well, so it's going to be a very sunny year for a couple of Bostonians!

The funniest part is that Sahil is now pitching consistently over 90mph - and doing so at Stanford.  He's 1-0 with a 0.00 ERA through six outings in his freshman year. It's amazing that he's had this success just "training for football!"

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29. I already knew I had the greatest girl in the world, but when she took me to a Sox game last night for my birthday for the third year in a row, I was reminded once again!  Here we were last year - when I had more hair.

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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.

4. At the other end of the spectrum, you have THIS GUY, who was awarded (in a court of law) the title of "Worst Tennis Professional on the Planet."  I wonder if he gets a trophy for his mantle for that one....

5. Here's a book recommendation for you that's somewhat related to fitness: The 7 Rules of Achievement.  It's written by Tom Terwilliger, a former Mr. America.  I met Tom at a seminar back in January, and his enthusiasm is absolutely contagious.  He's got a pretty cool story himself, but the real gold in this book is how he breaks things down step-by-step in helping people get to where they want to be in their professional and personal lives.  It's self-help stuff, but more entertaining and less preachy than anything else I've read in this regard.

6. In addition to my own article at T-Muscle last week (Favorite Supersets), I also contributed on a compilation by Nate Green, Your Training Split Sucks.  Check 'em out, if you haven't already.

7. Here's a short, but solid piece about CP athlete and NY Mets Prospect Jim Fuller, who is having an excellent season this far: Marlborough's Fuller off to a Good Start in Class A.

8.  In the past two weeks, I've had four people email me asking about a mentorship at Cressey Performance.  If we were to do a 3-4 day mentorship consisting of lectures, hands-on teaching, and observing athletes in action, would you be interested?  If so, shoot us an email at cresseyperformance@gmail.com.  It would occur sometime between October and March.  Nothing firm, but I thought I'd throw it out there to gauge interest.

9. I'm looking for some good recommendations for books on CD.  I just finished up my last one, and always like to have a good one in my car for whenever I'm driving.  The last three good ones have been What the Dog Saw, Switch, and Born to Run.  I prefer non-fiction.  Thanks in advance to anyone who has some suggestions to make in the comments section!

10. Finally, a big happy birthday goes out to CP pitching expert Matt Blake, who - as you can tell from the following video - turns 11 today.

PS - Think this cameraman was drunk, or just laughing so hard that he couldn't keep the camera steady?

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…

One of the resounding themes of Mike's talks was that throwing hard is not the single-most important factor in being a successful pitcher.  Rather, success is all about changing speeds and hitting spots.  The point is an important one - and it's backed up by the success of the likes of Jamie Moyer, Tom Glavine, and Greg Maddux.

Why is it so important for youth pitchers and parents to understand this?  It's because it demonstrates that long-term success is not about dominating in little league; it's about acquiring skills that allow for future improvements.

Youth pitches should focus on commanding their fastballs with consistent repetition of their mechanics early-on - not just throwing hard.  If you think you have the fastball mastered at age 9 and simply learn a curveball so that you can dominate little league hitters, you're skipping steps and trying to ride too many horses with one saddle.  It's not that the curveball is inherently more stressful than any other pitch; it's just that - as the saying goes - "if you chase two rabbits, both will escape."

While kids need variety, they shouldn't try to master too many different complex skills at once.  Step 1 is to have command of your fastball - not just to throw it hard.

Step 2 is to learn a good change-up to start creating the separation to which Mike is referring.  Breaking pitches can come later.

Need proof?  I recently saw some statistics that demonstrated that the MLB average against off-speed pitches has decline each of the past three years.  Meanwhile, not surprisingly, the average MLB fastball velocity has increased by about 1mph.  Throwing harder made all those off-speed pitches more effective by creating more separation.  So, yes, throwing the crap out of the ball is still important - but only if you know where it's going - otherwise the average fastball velocity wouldn't be higher in Low A ball than it is in the big leagues.

Oh, and in case you need further proof of how MLB general managers perceive the importance of off-speed pitches, Phillies First Baseman Ryan Howard gave you $125 worth when he signed a new five-year contract last month.  While the MLB average against off-speed pitches has steadily declined over the past three seasons, Howard has gotten better.

The take-home message is that youth pitchers need to develop the mechanical efficiency and physical abilities that will eventually make them able to throw hard in conjunction with a solid assortment of off-speed pitches.  They don't need to light up radar guns and showcase curveballs when they're still regulars at Chuck 'E Cheese.

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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.

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.

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Also, don't forget that today is the last day to get the $20 early-bird discount on The Single-Leg Solution.  Don't miss out; the introductory price ends tonight at midnight.