My feeling is that the bigger muscles - particularly scapular stabilizers, the core, and the lower half - will decelerate the crazy velocities we see as long as mechanics are effective and the deceleration arc is long enough.

2. The shoulder internally rotates at over 7,000°/s during acceleration; that's the fastest motion in all of sports.  There's no way that the rotator cuff muscles alone with their small cross-sectional area can decelerate it.  And, to take it a step further, there isn't much that some rubber tubing is going to do to help the cause (aside from just promoting blood flow - although I'd rather get that in a more global sense with full-body flexibility circuits, as I discussed HERE).

More important than blood flow is getting range of motion (ROM) back (particularly elbow extension and shoulder internal rotation) after a pitching outing.  In my experience, losses in ROM get guys injured faster than weakness, in my experience.  I've seen quite a few people come to me who have healthy shoulders, but test poorly on classic rotator cuff strength measures.  Why?  Perhaps they are very strong in their scapular stabilizers, core, and lower half and have become efficient enough to handle more of the deceleration demands in areas other than the rotator cuff.  Or, they may just be lucky; rotator cuff strength is still important!

I've had multiple discussions with Mike Reinold that reaffirm this indirectly; he emphasizes that one should never train the rotator cuff to failure, as that's not how it works in the real world.  Our job is to enhance not just its strength, but also its proprioception and rate of force development.  If we chronically abuse it with training on top of the crazy demands of throwing, we never really know how strong the rotator cuff actually is. It makes you wonder how many guys in the baseball world actually have exhausted and chronically overtrained rotator cuff muscles as opposed to weak rotator cuff muscles!

The other two days are more classic rotator cuff work that prioritizes external rotation and horizontal abduction (we never do empty cans).  I do a lot of work with cables here, plus a lot in the side-lying position (EMG activity for the cuff is highest here).

We'll also do a lot of manual resistance external rotation stuff, as it kind of "blends" conventional cuff work with rhythmic stabilizations due to the unstable load. Here's one option:

Later in the off-season, we'll throw in some one-arm medicine ball deceleration catches and external rotation tosses to the wall to get the thoracic spine and hips ready for the full-body demands of throwing.

Keep in mind that - as I noted - rotator cuff exercises are just one piece of the puzzle.  These are one component of a larger overall plan that addresses not only scapular stability, but also total body strength and mobility, soft tissue quality, medicine ball work, movement training, and the actual throwing program.

For more information (actually a LOT more information), check out the DVD set, Optimal Shoulder Performance: From Rehabilitation to High Performance from Mike Reinold and I.

However, for every one of these folks (the experienced trainees - not the horny, drunk, bearded dudes with Confederate flag hats), there is another individual who is male, with limited training experience, subpar strength, and not enough muscle mass on him to really even demonstrate that he regularly trains.  He might be 6-1, 180 pounds at 20% body fat.  For those of you keeping track at home, that's 144 pounds of fat free mass, and 36 pounds of fat mass. Well, here's a question: if this hypothetical guy dropped 10 pounds of body fat right now and somehow managed to maintain all his muscle mass (and recovered any water weight reductions he got from lower carb dieting), would he be happy with how he'd look?  That'd still put him at 144 pounds of fat free mass, but lower his body weight to 170 with 26 pounds of fat mass (15.3% body fat).  Sorry, but while respectable, 15.3% body fat isn't super lean.  And, 170 pounds at 6-1 will only earn him points with insurance companies who calculate premiums based on body mass index. Imagine taking about the ideal NFL cornerback, and then stripping 25 pounds of muscle off him and adding back 15 pounds of body fat.  Be sure to kill off all the athleticism in the process, too.  Not a very impressive picture. In other words, a program that might have been perfect for a guy who was 30 pounds heavier with the same body fat percentage - but two more years of training experience - just isn't a good fit for a guy who can become "skinny-fat" really quickly.

Would some gradual weight loss and an emphasis on improving body composition help him?  Absolutely.  Would taking 80 pounds off him be a smart or specific off-season goal?  In my opinion, no.  The research has demonstrated that body mass is one factor that predicts velocity.

As you can see, this drill is looking to iron out multiple pieces of a player's delivery, while we still have them in a rather stationary position.  When this drill is introduced to the player, I like to channel their focus toward the importance of having a consistent rhythm and tempo while developing hand speed during their throw. There should be coordination between the upper and lower body as they make horizontal figure 8's with their hands, and this should coincide with them shifting their weight from the front leg to the back leg. Typically, I have them make three figure 8s before they throw, and eventually manipulate the amount of time spent developing rhythm as deemed fit over the course of their progression. As they finish their third figure 8 with their lower half weight shift going to the back leg, they should begin to break their hands and load up to throw. Typically, at this point in the lead-up drill progression, they are finishing their throw and allowing their back leg to come through, whereas we might cue them to focus on the timing and completion of their back hip rotation by keeping their feet on the ground in preceding drills. Some players can be a little rigid through this drill the first few times. I think this is mostly because they can't believe I'm actually asking them to make silly figure 8s with their hands and display their lack of rhythm in front of their friends. Once they get over this anxiety, they tend to gravitate towards using variations of this drill on their own, because it provides a lot of feedback for them while getting loose.

In the early going, I think it's important to avoid too much cueing of the player into certain positions and more about allowing the pitcher to find a rhythm that he is comfortable with. I also typically allow the player to interpret how the actual figure 8 is made with the hands, because the drill is really more about understanding how the upper and lower body work in coordination than it is about us arguing over the shape of an hourglass. This is apparent in the videos themselves, where you can plainly see that each player interprets the drill slightly different and uses his signature style in creating the 8s.

As a coach, this allows me to get a better feel for a player's ability to shift his weight, his sense of posture and balance, and his understanding of extension at release, among other things. Several of these features will usually be covered up front by the stride drill, which I skipped over discussing today, but I could certainly address at a later time if people are interested. By adding in the extra movement to the otherwise static stride drill, we are able to flush out a player's natural movement patterns a lot better and I can begin to see which pieces of their overall delivery may be easier to address. This information will continue to build into the next drill, which we call "balance and break," and is really a blend of the traditional balance drills with a little more movement and repetition tied in with the timing of the hand break and arm action. For the most part, all of the lead-up drills I choose to put in before I get a player on the mound are designed to incorporate certain principles of throwing that have been demonstrated in the research of elite level throwers over the years. This may include anything from hip/shoulder separation, degrees of external/internal shoulder rotation, degrees of trunk extension, etc. With that being said, I don't necessarily have one mechanical model in my head, but more of a host of models that fit each particular body type and level of coordination.  This is especially true concerning their current mobility and flexibility limitations. This idea that each player has a mechanical model that is unique to them is the key component, and in order to flush this model out, the player has to be able to breathe while working through his drills. If you suffocate a player with too much technical talk, it takes away from what they want to do naturally and forces them into something that you think they should do, rather than what is right for the player. The other challenge in all of this is that you may have the ultimate mechanical model in your head of how every pitcher should pitch, but until that player understands what mechanical model best fits his genetic traits, your model is irrelevant. The only way to get a player to understand this information is for him to feel it for himself. Yes, we have a lot of science out now that describes what positions elite throwers are in at certain points in their delivery. The problem rests with the fact that there is a lot of gray area for how these players are getting to each of these positions in coordination with the end result of throwing to a target. I've seen some of the ASMI motion analysis reports of players, which are very comprehensive in nature, but even so, these leave room for interpretation.  As has been seen over the years (and is currently being demonstrated, and will continue to be displayed down the road), there is more than one way to throw a ball 90+ mph hour. If I were to tell a 5'7" 165lb pitcher and 6'4" 245 lb pitcher to throw the baseball the same way, I wouldn't be doing either of them justice. We obviously advise players away from certain motor patterns that have demonstrated more stress than others, but ultimately this is the challenge in training baseball players. There is so much going on inside the body of a baseball player - not just creating velocity, but also command and deception (and with multiple pitches) - that I'm going to trust the player when he tells me what feels right and what doesn't. To create unnecessary tension in a player because my eyes think they interpret a better position would be absurd. Don't get me wrong, we address a lot of mechanical issues with the use of slow-motion video analysis, but I always listen to the player over what a playback device tells me.

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.

To learn more about assessment and management of the throwing elbow, check out my Everything Elbow In-Service video.

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