In a recent presentation in front of a bunch of baseball coaches, I made the following statement - and it turned a lot of heads:

I think most people overtrain the rotator cuff nowadays, and they do so with the wrong exercises, anyway.

To illustrate my point, I'm going to ask a question:

Q: What is the most common complication you see in guys as they rehabilitate following a Tommy John Surgery?

A: Shoulder problems - generally right around the time they get up to 120 feet.

Huh?  Shoulder pain is a post-operative complication of an elbow surgery?  What gives?

First, I should make a very obvious point: many of these guys deal with shoulder stiffness as they get back to throwing simply because they've been shut down for months.  That I completely expect - but remember that it's stiffness, and not pain.  They always throw their way out of it.

The more pressing issue is what is taking place in their rehabilitation - and more specifically, what's taking place with the synergy between their rehabilitation and throwing program. Let me explain.

Rehabilitation following a UCL reconstruction is extensive.  While different physical therapists certainly have different approaches, it will always be incredibly heavy on rotator cuff strength and timing, as well as adequate function of the scapular stabilizers.  Guys always make huge strides on this front during rehab, but why do so many have shoulder pain when they get further out with their long tossing?  The answer is very simple:

Most people don't appreciate that throwing a baseball IS rotator cuff training.

Your cuff is working tremendously hard to center the humeral head in the glenoid fossa.  It controls excessive external rotation and anterior instability during lay-back.

It's fighting against distraction forces at ball release.

And, it's controlling internal rotation and horizontal adduction during follow-through.

Simultaneously, the scapular stabilizers are working incredibly hard to appropriately position and stabilize the scapula on the rib cage in various positions so that it can provide an ideal anchor point for those rotator cuff muscles to do their job.

A post-op Tommy John thrower - and really every player going through a throwing program - has all the same demands on his arm (even if he isn't on the mound, where stress is highest).  And, as I wrote previously in a blog about why pitchers shouldn't throw year-round, every pitcher is always throwing with some degree of muscle damage at all times during the season (or a throwing program).

Keeping this in mind, think about the traditional Tommy John rehabilitation approach.  It is intensive work for the cuff and scapular stabilizers three times a week with the physical therapists - plus many of the same exercises in a home program for off-days.  They're already training these areas almost every day - and then they add in 3-6 throwing sessions a week.  Wouldn't you almost expect shoulder problems?  They are overusing it to the max!  This is a conversation I recently had with physical therapist Eric Schoenberg, and he made another great point:

Most guys - especially at higher levels - don't have rotator cuff strength issues; they have rotator cuff timing issues.

In throwing - the single-fastest motion in all of sports - you're better off having a cuff that fires at the right time than a cuff that fires strong, but late.  Very few rotator cuff exercise programs for healthy pitchers take that into account; rather, it's left to those doing rehabilitation.  Likewise, most of the programs I see altogether ignore scapular stability and leave out other ways to train the cuff that are far more functional than just using bands.

Now, apply this example back to the everyday management of pitchers during the season. Pitchers are throwing much more aggressively: game appearances, bullpens, and long toss.  They need to do some rotator cuff work, but it certainly doesn't need to be every day like so many people think.

I'll cover how much and what kind in Part 2.  In the meantime, if you'd like to learn more about the evaluation and management of pitchers, check out Optimal Shoulder Performance.

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In Part 1 of this series, I outlined the first three reasons that I'm opposed to baseball pitchers using year-round throwing programs.  Here are the next four:

4. They need to get their shoulder and elbow range of motion back.

As I noted in Part 1, throwing a baseball is the single-fastest motion in sports.  With the crazy arm speeds one encounters, you have to keep in mind not only the muscles trying to accelerate the arm, but also the ones trying to slow it down.  This "braking" challenge is called eccentric stress - and I'll talk more about it in a second.

What you need to know now, though, is that when left unchecked, significant eccentric stress can lead to tissue shortening.  If you need further proof, Reinold et al. reported that immediately after a pitching outing, pitchers lose an average of 9.5° of shoulder internal rotation and 3.2° of elbow extension - and that these losses persisted at 24 hours post-throwing.

Now, imagine these acute range of motion losses being left unchecked for an entire season - or a season that simply never ends because pitchers are always throwing.  That's how elbows wind up looking like this:

(For more information, I'd encourage you to check out my Everything Elbow In-Service Video.)

Fortunately, we can prevent losses in range of motion during the season with appropriate mobility exercises, manual therapy, and breathing exercises - but the truth is that not everyone has access to these initiatives in terms of expertise, finances, or convenience.  So, while we work to educate the masses on arm care, emphasizing time off from throwing programs is also a key component of an overall strategy to reduce injury risk.

One last thing on this topic: it is a nightmare to try to improve shoulder or elbow range of motion in a pitcher during a season, as the very nature of throwing works against everything you're trying to achieve.  The off-season is "where it's at" in terms of optimizing range of motion in throwers.

5. They need to “dissipate” eccentric stress.

Okay, here's where I take #4 and geek out a bit.  I apologize in advance.

Sometimes, you have to get away from the baseball world in order to learn about the baseball world.  To that end, I need to think Mike Reinold for bringing this great 2004 study from Tomiya et al to my attention.

These researchers created eccentric stress in muscle tissue of mice using an electrical stimulation model, and monitored blood markers of muscle damage for a period of time thereafter.  What you'll see in the graph below is that myofiber disruption really peaks at three-days post-exercise, then start to return down to baseline, yet they still aren't even there at seven days post-intervention.

Source: Tomiya A, et al. Myofibers express IL-6 after eccentric exercise. Am J Sports Med. 2004 Mar;32(2):503-8.

Now, let's apply this to the world of pitching.  Every single pitcher who throws more than once every 7-10 days is surely pitching with some degree of muscle damage.  And, I can tell you that the two toughest challenges pitchers have reported to me are:

a) moving from starting to relieving

b) going from a 7-day high school or college rotation to a 5-day professional rotation

I'm firmly believe that pitchers need to throw in-season to stay strong, but I also know that we can't trump physiology.  Sure, we need to have optimal nutrition and regeneration strategies in place, as we can't just baby guys and expect them to get better.  However, make no mistake about it: high-level pitchers simply have to get good at pitching at 90% capacity (at best) if they are going to succeed.

If I already have a guy whose arm is working at a deficit for 8-9 months of throwing, the last thing I want to do is beat him up for the other three months with the same kind of volume and stress.

6. They need to allow any undetected low-grade injuries to heal.

As I discussed in an old blog, Pitching Injuries: It's Not Just What You're Doing; It's What You've Already Done, most injuries (especially ulnar collateral ligament tears) come from the accumulation of chronic, low-level stress.  Maybe you get some calcification on your ulnar collateral ligament or a low-level rotator cuff tendinosis, and it takes a few years and hundreds of innings before something finally "goes."

Old, low-level injuries are less likely to reach threshold if you give them some downtime and work on redistributing training stress.  By strengthening the rest of your body in the off-season, you're dramatically reducing the demands on your rotator cuff with throwing.

You can't teach other joints to share the burden if the burden is never removed temporarily.

7.  They need a chance to prioritize other competing demands.

Throwing is a good 20-30 minute endeavor each time you do it - and possibly even more.  When I think about all the things that pitchers can be doing to get better in the off-season from a strength and conditioning standpoint, I have a really hard time justifying giving away that much time and recovery capability.  There are other things that need to be prioritized at this time - and year-round throwing is an especially tough pill to swallow when you know that throwing is working against many of the very qualities - rotator cuff strength, scapular stability, mobility, and tissue quality - that you're trying to establish.

Closing Thoughts

The lack of downtime from throwing is especially problematic in younger populations, as they are skeletally immature and weaker.  I’d argue that a really weak 15-year-old kid throwing 74-76 mph does far more damage to his body on each throw than a moderately strong professional player throwing 90-92 mph, especially given that the pro pitcher’s mechanics are more optimized to protect the arm.  This underscores the importance of "syncing up" mechanics, throwing programs, and the overall baseball strength and conditioning program.

Last, but certainly not least, remember that two weeks doesn't constitute "time off."  Rather, I firmly believe that pitchers need the ball completely out of their hands for at least two month per year, preferably continuously.  In other words, eight one-week breaks throughout the year is far from ideal, as it doesn't really allow for positive adaptations to occur.

If you're interested in learning more about managing the throwing shoulder, I'd encourage you to check out our DVD set, Functional Stability Training of the Upper Body.

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When Thanksgiving rolls around, many of our professional baseball players at Cressey Sports Performance will start up their winter throwing programs after a full 10-12 week break from throwing.  They're always a bit rusty in the first week of tossing after the layoff, but every single one of them always "figures it out" in a matter of a few weeks - and still has plenty of time to get in a solid throwing program prior to heading off to spring training.  And, because they've been working hard in the gym on their strength, mobility, and soft tissue quality, they're always better off in the end.

Still, there are those who insist that baseball pitchers don't need time off from throwing.

I couldn't disagree more.

I'm sure this will rub some folks the wrong way, but I can't say that I really care, as most of those individuals can't rationalize their perspectives outside of "guys need to work on stuff."  I, on the other hand, have seven reasons why baseball pitchers need time off from throwing:

1.  They need to lose external rotation to gain anterior stability.

Having external rotation - or "lay back" - when is important for throwing hard, and research has demonstrated that simply throwing will increase shoulder external rotation range-of-motion over the course of a season.  This does not mean, however, that it's a good idea to just have someone stretch your shoulder into external rotation, as I wrote previously: Shoulder Mobility Drills: How to Improve External Rotation (if you even need it).

You see, when you externally rotate the humerus (ball) on the glenoid (socket), the humeral head has a tendency to also translate anteriorly (forward).  In a well-functioning shoulder girdle, the rotator cuff musculature should prevent anterior instability, and it's assisted by adequate function of the scapular stabilizers, which offer the dynamic stability to reposition the scapula in the right place to "accommodate" the humeral head's positioning.  For the athletic trainers and physical therapists out there, this is really what you're testing with an apprehension/relocation test.

The apprehension comes about because of either anterior instability or actual structural pathology (SLAP tear, rotator cuff impingement, or biceps tendinosis).  The relocation component is just the clinician posteriorly directing the humeral head to create the stability that should otherwise be created by the rotator cuff and scapular stabilizers.

The take-home message is that while just going on year-round throwing programs in hopes of increasing external rotation seems like a good idea on paper, it's actually a terrible idea in the context of injury prevention.  Pitchers should actually lose a few degrees of external rotation each off-season intentionally, as it affords them an opportunity to improve their stability.  This leads us to...

2. They need a chance to get their cuff strength and scapular stability up.

Baseball pitching is the single-fastest motion in all of sports, as the humerus internally rotates at velocities in excess of 7,000°/second.  So, it should come as no surprise that at the end of a season, the strength of the rotator cuff and scapular stabilizers is significantly reduced.  Having dealt with many of our players for up to five off-seasons now, I have a unique appreciation for how they each respond differently to not only the stress of the season, but also to arm care programs that we initiate at season's end.

It's important to remember that improving rotator cuff strength is no different in terms of adaptation than improving a bench press or squat.  Adding 10% to a guy's bench press might take three months in an intermediate population, or 12 months in a high-level lifter!  Adaptation of the rotator cuff and scapular stabilizers is comparable.  I need every minutes of those three months without throwing to get guys back to at least baseline, and hopefully a bit above it.

Can you imagine if some clown trying to improve his bench press went out and benched an additional 4-5 times a week on top of his regular strength and conditioning program?

His progress would be minimal, at best, and he'd be at a dramatically increased risk of injury.  Throwing during a dedicated, appropriate structured early off-season arm care program is no different.

3. They need an opportunity to do dedicated manual resistance rotator cuff exercises.

Ask anyone who has worked with throwers for any length of time, and they'll always tell you that manual resistance exercises are the single-best option for improving rotator cuff strength.  This rotator cuff exercise approach allows you to emphasis eccentric strength better than bands, cables, and dumbbells allow.  It also keeps athletes more strict, as the one providing the resistance can ensure that the athlete isn't just powering through the exercise with scapular stabilizers or lower back.

 The only downside to manual resistance rotator cuff exercises, though, is that because they generally prioritize eccentric strength, they will create more soreness.  With that in mind, we use them much more in the off-season than in the in-season, as we don't want a pitcher throwing with added soreness.  They're a great initiative in a comprehensive off-season baseball strength and conditioning program, but guys just don't seem to like them as much in-season, presumably because both throwing and manual resistance rotator cuff exercises can be too much eccentric stress when combined.  As such, we used them a lot during the September-November periods, and then hold back in this area the rest of the year.

Of course, if you throw year-round, then you can forget about getting these benefits, as the last thing you want is to be sore while you're "working on stuff" in the off-season.  That was sarcasm, in case you weren't picking up on it.

In Part 2, I'll be back with four more reasons baseball pitchers shouldn't throw year-round.

In the meantime, to learn more about the management of throwers, I'd encourage you to check out Functional Stability Training of the Upper Body.

Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!

Why President Obama Throws Like a Girl - A lot of people took this as a political commentary, but to be honest, it was really just me talking about the concept of retroversion as it applies to a throwing shoulder - with a little humor thrown in, of course!

Overbearing Dads and Kids Who Throw Cheddar - This one was remarkably easy to write because I've received a lot of emails from overbearing Dads asking about increasing throwing velocity in their kids.

What I Learned in 2009 - I wrote this article for T-Nation back at the beginning of the year, and always enjoy these yearly pieces.  In fact, I'm working on my 2010 one for them now!

What a Stressed Out Bride Can Teach You About Training Success - I wrote this less than a month out from my wedding, so you could say that I had a good frame of reference.

Baseball Showcases: A Great Way to Waste Money and Get Injured - In case the title didn't tip you off, I'm not much of a fan of baseball showcases.

Cueing: Just One Piece of Semi-Private Training Success - Part 1 and Part 2 - These articles were featured at fitbusinessinsider.com.  I enjoy writing about not only the training side of things, but some of the things we've done well to build up our business.

Three Years of Cressey Performance: The Right Reasons and the Right Way - This might have been the top post of the year, in my eyes. My job is very cool.

How to Attack Continuing Education in the Fitness Industry - Here's another fitness business post.

Want to Be a Personal Trainer or Strength Coach?  Start Here. - And another!

The Skinny on Strasburg's Injury - I hate to make blog content out of someone else's misfortune, but it was a good opportunity to make some points that I think are very valid to the discussion of not only Stephen Strasburg's elbow injury, but a lot of the pitching injuries we see in youth baseball.

Surely, there are many more to list, but I don't want this to run too long!  Have a safe and happy new year, and keep an eye out for the first content of 2011, which is coming very soon!

Should Pitchers Overhead Press? - This was an excerpt from Mike Reinold and my Optimal Shoulder Performance seminar (which became a popular DVD set for the year).

Shoulder Impingement vs. Rotator Cuff Tears - Speaking of Mike, here's a bit from the man himself from that seminar DVD set.

Thoracic and Glenohumeral Joint Mobility Drills - The folks at Men's Health tracked me down in the lobby at Perform Better in Providence and asked if I could take them through a few shoulder mobility drills we commonly use - and this was the result.

Cressey West - This kicks off the funny videos from the past year. A few pro baseball players that I program for in a distance-based format created this spoof video as a way of saying thank you.

Tank Nap - My puppy taking a nap in a provocative position.  What's more cute?

Matt Blake Draft Tracker - CP's resident court jester and pitching instructor airs his frustrations on draft day.

1RM Cable Horizontal Abduction - More from the man, the myth, the legend.

You can find a lot more videos on my YouTube page HERE and the Cressey Performance YouTube page HERE.