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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Since the Christmas pre-sale is over on the 95 MPH arm, I figured I would follow up with some more insight into the way we are working with a wide range of pitchers here at Cressey Performance.
To give you perspective, recent throwing sessions in the CP cage have included anything from minor leaguers working through controlled flat-ground drills and some simulated long-toss, to high-school guys working on velocity drills or throwing bullpens getting ready for college winter camps (for better or worse). We've also had a handful of players come to us following injuries as they try to build their arms back up from essentially scratch. With the wide variety of development and training that needs to take place as a result of these different situations, a strong need emerges for an effective communication style with your athlete.
For me, this is tremendously important if I expect to push a player in a sport that will have 57% of their population suffer some form of shoulder injury during a playing season (1). It seems a little absurd to think that more than half the athletes in this population will get hurt in a given season, but it's not that crazy when you consider the fact that we're asking the shoulder to internally rotate at velocities greater than 7,000 degrees/second and the elbow to extend at 2,000+ degrees/s during the throwing motion. If that's not bad enough, at maximum external rotation the torque placed on the elbow is equivalent to 40lbs pulling down on the hand. When all of this is considered, it becomes clear how serious it is to actually ask an athlete to perform 80-100 repetitions of a skill at near human capacity.
Once you understand the implications of what you are requesting your player to do, the ability to effectively communicate in a manner that gains quality feedback from your pitcher becomes essential. With the tremendous amount of stress being placed on the body and no objective way to know how a particular player's arm or body feels during practice or competition, we need to have open lines of communication to make sure each and every piece is monitored for stress.
Obviously the easiest way to gather information is to verbally ask players how they are feeling, or have them rate their fatigue on a 1-10 scale with 1 being, "My arm feels like gold", and 10 being, "I think I just tore something". The only problem with this is that every player will have a slightly different pain threshold and one person's "3" may be another person's "6." So, if you are going to use this scale, it is important to stay on top of it and ask the player on a regular basis to calibrate the stress and watch how it slides one way or the other as they get loose or as the discomfort begins to build.
The other problem with the verbal scale is that you have to account for each player's personality and level of competitiveness. Some players will run themselves through a wall and not think twice about the damage they could be doing. These players will under-report their pain levels in an attempt to continue throwing. With players like this, you need to resort to other means of monitoring pain levels. This is where understanding a player's natural temperament is important. By knowing how a player normally acts, picking up subtle behavioral cues can play a large part in identifying underlying pain.
These subtle behaviors can include anything from the way they make eye contact, their facial expressions and head talk, body gestures, postural changes, etc... For example, if they grimace after throwing, shake out their arm after throws, or cross their arms when they're standing still, then you are probably looking at some tenderness building somewhere in the arm. Mechanically, you can watch the elbow/arm slot begin to drop as they throw, the torso might become more upright, and the ball to begin to stay up in the zone more often. Velocity changes may or may not occur as well. As you begin to see one or more of these traits, it's important to make sure you open the dialogue with the player to make them verbalize how the arm feels.
Identifying these traits and gaining trust from your pitcher to speak honestly with you about his arm's health is the foundation for developing them to their ceiling. Once you understand how much a player can be pushed while maintaining a healthy volume or amplitude, driving the development with this same mindset becomes just as critical.
One of the problems that I believe stands in the way of a lot of players/athletes in their personal development tends to be their inability to relate to new information that you are trying to give them. It's not that they weren't listening or the fact that what you gave them was right or wrong, but more that it didn't fit neatly with what they had previously learned. Different personalities, different backgrounds, different learning styles, can't all be expected to work off the same lesson plan.
Each piece of the development needs to be looked at dynamically to see how the information is registering for the player. Two of the main things I work hard to identify early in the process are:
1) what style of learning does the player prefer?
2) where are they in their development?
Once you have the answers to these questions, you can begin to provide the necessary information in the right form for the player, so they understand why they would want to apply it and, more importantly, how they apply the new information.
By using multiple avenues to find out what the player is looking to learn or needs to learn, you can optimize the use of certain tools to flush out higher levels of performance. One of the main tools we use here is slow-motion video analysis. I find this to be very effective in getting everyone on the same page regarding what is actually happening during these highly complex movements. From there, we'll agree on a plan of action going forward that might use lead-up drills, velocity drills, weighted baseballs, medicine balls, etc. All of these pieces help to teach something, whether it be rate of force development, knowledge of the kinetic chain, or simply a consistent rhythm and tempo in the delivery.
Obviously, the examples I'm using here are baseball related, but this can be just as easily applied to strength and conditioning, as well as other skill-specific sports. It really just comes down to the proper application of each drill or exercise with targeted work that fits the developmental needs of the athlete. If player and coach are effectively communicating, the learning loop can certainly be shortened and the sky is the limit for your athletes' development. With that said, I hope everyone enjoys the holidays and the rest of 2009, and I certainly look forward to continuing this ongoing conversation with you guys in 2010.
References
1. Ouelette, H et al. Spectrum of Shoulder injuries in the baseball pitcher. Skeletal Radiol. 2007 Oct 3.
2. Fleisig, GS. The Biomechanics of Baseball Pitching. Spring 2008 Southeast ACSM Conference.
Matt Blake can be reached at mablak07@gmail.com.
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used by Cressey Performance Pitchers after they Throw!
1. Sorry for the slower week here on the blog. In addition to trying to catch up from my three days in Houston, I had a few projects that needed to get sorted out this week. For starters, we had to finalize the agenda for my seminar in Vancouver in March.
And, the bigger task of late has been finishing up a chapter (on baseball testing and training) that I'm contributing to Dr. Craig Liebenson's newest book. Others contributing include Dr. Stuart McGill, Sue Falsone (Athletes Performance), Dr. Ben Kibler, Dr. Pavel Kolar, Ken Crenshaw (Arizona Diamondbacks), and Mike Boyle (among others). Needless to say, I'm lucky to be in such awesome company, and you'll definitely want to check it out once it's available. In the meantime, you might be interested in Liebenson's most popular work, Rehabilitation of the Spine: A Practitioner's Manual.
2. Mike Reinold and I are also working on getting our seminar, Testing, Treating, and Training the Shoulder: From Rehabilitation to High Performance, ready for production and sale. We're hoping it'll be ready by the first of the year, but only time will tell; editing takes time, and it's out of our hands now! Speaking of Mike, he just posted a blog outlining the recently revised pitch count rules. If you coach young players or one of your kids plays ball, definitely check it out HERE.
3. On the topic of little league, the clinic with Matt Blake and I at Cressey Performance on Tuesday night was pretty popular with local coaches. One of the things that Matt and I tried to stress is that kids almost never get hurt for JUST one reason. Usually, injuries are multifactorial, so you have to look at a host of different causes - from overuse, to physical limitations (weakness or immobility), to mechanical flaws in the pitching delivery.
The questions we received gave me some ideas for future posts, so keep an eye out for those in the not-so-distant future. Along those same lines, if there are specific baseball development questions you'd like covered, feel free to post some suggestions here as a reply to this blog.
4. I got the following question the other day, and thought it might make for a quick Q&A here:
Q: I am planning on training Westside style but I do not have access to bands and chains (or any other special equipment for that matter). What should I do to change up my dynamic effort days? Should I just use variations of the lifts (i.e. close grip vs regular grip bench, sumo vs conventional deadlifts)?
A: The whole idea that you absolutely have to have bands, chains, and specialized bars to learn from the Westside school of thought (which is constantly evolving anyway) couldn't be further from the truth. There are bits and pieces borrowed from Westside teachings in Maximum Strength, and you'll see that there is plenty of rotation among movements in the four-month program - and the assumption is that you don't have any of these goodies. Rotating among back squats and front squats (without a box, with a box, or from pins) and deadlifts will give you a great rotation of movements.
Regarding dynamic effort days, I don't think it's as important to rotate exercises on a regular basis, as this speed work is there to improve bar speed on that specific movement and help you groove the movement pattern itself. However, if you want to change it up, it's not too difficult.
In the lower body, simply go to a different deadlift or squat variation, or change the percentage at which you're working. In the upper body, you can change the grip width on the bench press, do some plyo push-ups, or even just throw the medicine ball around.
5. I'm going to see The Nutcracker tonight with my fiancee. In the words of Forrest Gump, "That's all I have to say about that."
6. I will, however, say that I'm a little bummed that Jim Breuer is in town tonight about ten minutes from where I live, and I'm not going to get to see him. Doh!
This is another excellent guest post from Matt Blake.
Now that fall sports are beginning to wrap up and the winter training season is upon us, I thought it might be timely to contribute some more information for the youth baseball development community.
Recently, I have been running some pitching clinics on the weekends for the 9-12 year old age group - and it got me thinking a lot about the importance of proper development for the youth baseball player. This is especially true in what has been traditionally considered a "dead period" or off-season for baseball players in the Northeast.
For better or worse, I believe this mentality is beginning to change a lot, as the greater population is forcing players to become more and more specialized at earlier ages. This may not be true across the board, but there are definitely some undertones driving this movement, such as showcases during the December/January months, where players are expected to show up to a workout and light-up a radar gun in order to impress college coaches or scouts. This thought alone might send shivers down Eric's spine and will probably hold its own as a blog topic in the near future.
To give you an idea, one study published by Olsen et al (2006) at the American Sports Medicine Institute in Birmingham, AL actually documented that injured baseball players (requiring elbow or shoulder surgery) went to four times as many showcases as those who were in the healthy control group!
Now, I certainly can't say I think specialization at a young age is a healthy thing with regard to developing baseball players, as there are tremendous demands placed on the body in the act of throwing a baseball overhead. But at the same time, if players and parents decide that is what they would like to do and it is in the best interest of the kid, there needs to be a safe way to approach development during this time period for this population.
When I say this population, I'm speaking to the baseball population as a whole, but when I say a "safe approach," there obviously needs to be some clarification on the intended goals and ambitions of the particular player.
Some of the major concerns that I believe need to be addressed before engaging a player in a throwing session include:
-How much has this player thrown over the last day/week/month/year? Has he taken any breaks in his development to rest his arm for at least three weeks (at the very minimum)?
- Has he complained of arm pain during practice or competition during this period? If so, where was the pain? How often did it occur and to what degree?
These are just a few of the important signs and indicators that need to be tracked throughout the year, specialized winter training or not. The study referenced above by Olsen et al identifies a host of other variables found in the injured population and should be a must read for anyone who is working with amateur baseball players.
Now there are obviously a lot of different ways to look at this, so I'll try to explain what I think "proper development" means for players depending on their age range, and the level of performance they desire to reach.
This winter alone, I will be aiding the development of pitchers ranging from the professional and collegiate baseball players taking part in Eric's Elite Baseball Development Program all the way down to the 9-12 year old population, where players are trying to figure out how to throw a baseball in the right direction.
Obviously, the pro players are extremely specialized and probably have been for awhile. A lot of their development has already occurred and their windows for adaptation are a lot smaller, so we're working more towards preparing them to handle the stress of a 140+ games than we are skill refinement.
On the other end of the spectrum, the 9-12 year olds one might be dealing with are incredibly raw and undeveloped with huge windows of adaptation ahead of them from pure maturation of their bodies to the development of their motor patterns. This time period is huge for kids to begin ironing out the proper motor patterns that they will use to refine their athletic skills in their teen years of development.
With this in mind, a substantial amount of throwing might not be in their best interest and maybe getting more athletic in general would be more beneficial in the long term. How can you expect a player to repeat his mechanics with any sense of consistency if he doesn't understand how his body even works? One way that I like to spend time with this type of player is to extend the warm-up and movement training portion of these clinics to really drive home the importance of being in good physical shape. We also use more group oriented video analysis sessions for the players and parents to point out what common mechanical faults look like in this age group, and what verbal cues the parent might be able to use to help correct when playing catch on their own.
I actually find this portion of the clinic to be the most beneficial for all involved, because when you think about it, you only get about 3 to 4 hours with these players in a clinic setting. In order to get the information to settle in for these players, it needs to be constantly reinforced as their mind and bodies continue to develop. This is where mom or dad need to be informed, because they are the ones who will do much of the reinforcing, whether or not they are qualified to teach their son to throw a baseball. The more information they can have at their disposal and the more teaching tools you can give them, the better off they will be at aiding their child's development in the backyard.
This is the main reason why Eric and I are holding a FREE clinic this coming Tuesday, Dec 8th at 7pm for parents and coaches in the area, who are interested in learning more about how to prepare and protect the amateur baseball player. We'll be discussing the current injury epidemic in youth baseball, how it stems from overuse in competition, and what some of the major developmental needs are for the youth baseball player. If you're interested in attending, please RSVP to CresseyPerformance@gmail.com. Hopefully we'll see some of you there!
Matt Blake can be reached at mablak07@gmail.com.
