We welcome Miami Marlins starting pitcher Braxton Garrett to the latest podcast. Braxton shares insights on how his mechanics and pitching approach has evolved, and how adversity has shaped his ability to compete at the Major League level.

A special thanks to this show's sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you'll receive a free 10-pack of Athletic Greens travel packets with your first order.

You can follow Braxton on Instagram at @BraxGarrett and Twitter at @BraxGarrett.

Sponsor Reminder

This episode is brought to you by Athletic Greens. It’s a NSF-certified all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today - 10 FREE travel packs - with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I'd encourage you to give it a shot, too - especially with this great offer.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

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!

It's time for another listener Q&A, so I cover three questions from our audience in this week's podcast:

1. Tommy John surgery rates have skyrocketed over the past decade across all levels of basebalI. I know you’ve supported some of the highest profile athletes through their rehabs at CSP during this time, so I’m curious as to whether there have been any evolutions in your thought process on how you view or manage them?
2. What’s your approach to an athlete that has a Hip ER/IR total motion difference of greater than 10 degrees?
3. The more I learn, the more stressful I find programming for athletes. Any tips for this?

A special thanks to this show’s sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you’ll receive a free 10-pack of Athletic Greens travel packets with your first order.

Sponsor Reminder

This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today – 10 FREE travel packs – with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I’d encourage you to give it a shot, too – especially with this great offer.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

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!

We welcome St. Louis Cardinals pitcher Packy Naughton to this week’s podcast. I've known Packy since early in his teenage years and seen his development as a high school, college, and professional pitcher. In this conversation, he shares some great insights on the Tommy John rehab process, and what young players can do to take ownership of their careers.

A special thanks to this show's sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you'll receive a free 10-pack of Athletic Greens travel packets with your first order.

You can follow Packy on Instagram at @Packy_Naughton.

Sponsor Reminder

This episode is brought to you by Athletic Greens. It’s a NSF-certified all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today - 10 FREE travel packs - with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I'd encourage you to give it a shot, too - especially with this great offer.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

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!

For this week's podcast, I'm flying solo as I tackle three questions from listeners:

1. Why do some pitchers come back to throw harder after Tommy John surgery?
2. What are some of the bigger mistakes you see athletes make with long toss?
3. What's your opinion of pitchers doing direct strengthening work for the forearm, wrist, and hand?

A special thanks to this show’s sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you’ll receive a free 10-pack of Athletic Greens travel packets with your first order.

Sponsor Reminder

This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today – 10 FREE travel packs – with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I’d encourage you to give it a shot, too – especially with this great offer.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

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!

About ten years ago, I was in the operating room to observe my first Tommy John surgery. Much like my time in gross anatomy class during my undergraduate studies, it was an invaluable experience that helped me to appreciate human structure (and, in turn, movement) in a way that anatomy textbooks couldn't offer.

Textbooks typically present a very "neat" anatomy where muscles, tendons, ligaments, bones, and nerves are predictably positioned. You can imagine my surprise, then, when the surgeon made the initial incision along the medial elbow and it yielded a bunch of "stuff" in the way. The fascia, the intermuscular septum, the ulnar nerve, and a host of other unrecognizable structures make you realize that a) every anatomy course or textbook you've ever undertaken hasn't done justice to what's really going on at the elbow (or anywhere else in the body, for that matter), b) it takes a lot of practice to become a great surgeon, and c) you shouldn't let just anyone cut you open for surgery.

Now, let's fast-forward to the post-operative timeline. After the repair is complete and the patient is stitched up, the elbow is splinted at 90 degrees of flexion for a week. Following that week, the arm is put in a hinged brace that gradually allows more motion over the course of weeks 2-6. After six weeks, the brace goes away. In short, it's quite a bit of time with the elbow in a limited range-of-motion situation as a means of protecting the repair.

Not surprisingly, some patients have a lot of trouble getting back their motion - both from the graft gradually stretching out and the musculotendinous structures regaining their length. We'd be crazy to think that the aforementioned fascia structures aren't implicated in the challenges of regaining ROM, though. And, if they've got a role in limiting ROM, they've certainly got a role in the associated stiffness (and, sometimes, pain) that post-operative patients feel. Here's where a variety of manual therapy interventions - ranging from dry needling to instrument-assisted work - have yielded outstanding results. While some folks like to scream and shout in opposition to this fact, it's hard to refute that manual therapy has endured the test of time to the tune of thousands of years.

Massage has been around for 4,300+ years, yet there are still people out there who deny the value of manual therapy? pic.twitter.com/uMUSPpPpJK

— Eric Cressey (@EricCressey) May 24, 2016

Only recently have there been technology advancements that allow us to better understand the role of the fascia system with respect to pain and performance (Bill Parisi spoke to this on our podcast a while back; listen here). In a seminar not too long ago, my friend Sue Falsone highlighted some great evidence on the "decompression" that takes place in this regard with a cupping intervention.

Now, let's take a step back and think about the big picture of diagnostic imaging. When we have chronic pain that alters movement patterns, we have adaptive changes of the fascial system. While the diagnostic imaging - MRI, CT scans, x-rays - might pick up on the structural defect, it might overlook the compensatory changes to the fascial system (much of which overlays the actual injury) that can't be appreciated by these types of scans. 

When we look at chronic shoulder pain, is the problem only the rotator cuff tear? Or is that problem magnified by the fascia limitations that arise from years of avoiding various ranges of motion (including at adjacent joints) that would normally be accessible?

I've written extensively about having both a Medical and Movement Diagnosis. The truth is that the discussion of the fascia system is probably a happy medium between the two. We may think too much about the injury the diagnostic imaging identifies and too little about the overlying and surrounding tissues. At the other end of the spectrum, we may be too quick to define a movement limitation as joint, musculotendinous, ligamentous, or motor control without first considering the role the fascial system is playing.

What's the most important lesson here? Professionals from all walks of sports medicine need to work together to thoroughly evaluate injuries and movement competencies in order to design the best performance and rehabilitation programs. And, we need to remain openminded to new technology that may make it easier for us to take an even more accurate and individualized approach to each case.

In this vein, I'd highly recommend checking out my new Thoracic Outlet Syndrome course, as this challenging diagnosis is a great example of how a condition often can slip past common diagnostic imaging.

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We're excited to welcome Colorado Rockies relief pitcher AJ Ramos to the latest podcast. As an athlete who has come back from both a Tommy John and a shoulder surgery, AJ has many insights to share on the rehab process to contribute to our sports medicine series.

A special thanks to this show's sponsor, Marc Pro. Head to www.MarcPro.com and enter the coupon code CRESSEY at checkout to receive an exclusive discount on your order.

You can follow AJ on Twitter at @TheAJRamos and Instagram at @TheAJRamos.

Sponsor Reminder

This episode is brought to you by Marc Pro, a cutting-edge EMS device that uses patented technology to create non-fatiguing muscle activation. Muscle activation with Marc Pro facilitates each stage of the body’s natural recovery process- similar to active recovery, but without the extra effort and muscle fatigue. Athletes can use it for as long as they need to ensure a more full and quick recovery in between training or games. With its portability and ease of use, players can use Marc Pro while traveling between games or while relaxing at home. Players and trainers from every MLB team - including over 200 pro pitchers - use Marc Pro. Put Marc Pro to the test for yourself and use promo code CRESSEY at checkout at www.MarcPro.com for an exclusive discount on your order.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

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!

We're excited to welcome Oakland A's starting pitcher Jesus Luzardo to this week's podcast. He talks about his quick ascent to the big leagues, things he learned during Tommy John rehab, sacrifices needed to compete at the highest level, and the things he's working on to keep improving.

A special thanks to this show's sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you'll receive a free 10-pack of Athletic Greens travel packets with your first order.

You can follow Jesus on Twitter at @Baby_Jesus9 and Instagram at @Baby_Jesus9.

Sponsor Reminder

This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today - 20 FREE travel packs (valued at $79) - with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I'd encourage you to give it a shot, too - especially with this great offer.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

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!

We’re excited to welcome physical therapist Stan Conte to this week’s podcast for a detailed discussion of expectations surrounding Tommy John surgery. Stan is not only an experienced clinician, but also a prolific researcher in the baseball sports medicine world. With the prevalence of ulnar collateral ligament injuries in today's game, this podcast is a must-listen.

A special thanks to this show's sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you'll receive a free 10-pack of Athletic Greens travel packets with your first order.

Show Outline

• How Stan’s career in professional baseball has evolved from the clinical setting into more research based work
• How Stan was a part of the group that began the Health and Injury Tracking System (HITS), the first injury surveillance system in Major League Baseball
• How the disabled list had long been utilized as more of a roster management tool than an injury prevention system
• Why DL data is still nonetheless relied upon when analyzing medical history in pro baseball
• What studies Stan has been a part of regarding Tommy John surgery, and how this research is shaping the way players are managed
• How the increase in pitching velocity throughout the game of baseball has redefined the pressure put on prospects and led to throwing injuries in younger arms
• Why no one really knows how long it takes a UCL graft to mature and what conclusions Stan has drawn from research and working alongside rehabilitating athletes
• When the best time to begin throwing after Tommy John surgery is
• Why having pain when throwing during Tommy John rehab is not normal and what protocols players can look to when setbacks arise
• When flat grounds, bullpens, and simulated games should fit into a return from TJ throwing program
• When Stan recommends the reincorporation of off speed pitchers in return to throwing programs
• What the true success rate of UCL reconstruction surgery is
• What common Tommy John perceptions are actually myths
• Why the number of Tommy John revisions is rising and how long post-op are the majority of these revision surgeries occurring
• What the difference is between UCL repair and UCL reconstruction, and when each is an option for patients
• Despite the high success rate for pitchers with TJ surgery, why catchers see the lowest success rate from Tommy John
• Where Stan would like to see more research done in the baseball performance industry

You can follow Stan on Twitter at @StanConte.

Sponsor Reminder

This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today - 20 FREE travel packs (valued at $79) - with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I'd encourage you to give it a shot, too - especially with this great offer.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

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!

We're excited to welcome Dr. Chris Ahmad, team doctor for the New York Yankees, to this week's podcast. Dr. Ahmad goes into great detail on the throwing elbow with respect to anatomy, diagnostic challenges, surgical complexities, non-operative strategies, and biological interventions. He also touches on important lessons for players, parents, and coaches who want to avoid youth baseball injuries.

A special thanks to this show's sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you'll receive a free 10-pack of Athletic Greens travel packets with your first order.

Show Outline

• What makes the anatomy and function of the elbow so complex, specifically in throwing athletes
• What the biggest mistakes are both surgically and diagnostically with respect to the elbow
• Why injuries of the elbow aren’t as binary as partial and full tears and how professionals can better evaluate and understand the health of elbows in throwing populations
• How UCL calcification and injury at a young age impacts the health of baseball players as they grow and advance in their career
• What makes a Tommy John surgery successful from a surgical perspective
• How Tommy John surgery has evolved since it was first performed in 1974
• What the clinical implications are for Dr. Ahmad to perform an ulnar nerve transposition during UCL reconstruction surgery
• What variables surgeons must consider when deciding where to take a tendon graft from for UCL reconstruction
• How Dr. Ahmad manipulates grafts to ensure an elbow is strong and sturdy for his patients post-surgery
• What key things Ahmad discusses with his patients as they begin their road to recovery post-surgery
• What key benchmarks Dr. Ahmad looks for patients to progress to through the Tommy John rehab process
• Why there isn’t a true standard timeline for athletes to return to performing in games after UCL reconstruction
• Why Dr. Ahmad is an advocate for biological interventions such as PRP injections and the use of stem cells to manage elbow injuries, and what benefits these methodologies offer beyond throwing injuries
• Where the future of biological treatments is headed, and what the drawbacks and dangers of using these powerful methods can be
• Where Dr. Ahmad sees the need for more research to be done in the prevention, reconstruction, rehabilitation, and recovery of arm injuries
• Why Dr. Ahmad has worked to create a registry with Major League Baseball to collect data on injured professional ball players and how this resource will be used to find answers to questions in the field without setting up a formal study

You can follow Dr. Ahmad on Twitter at @DrChrisAhmad and on Instagram at @DrChrisAhmad. And, you can learn more about him at www.DrAhmadSportsMedicine.com. Definitely check out his books:

Baseball Sports Medicine

Skill

Understanding Tommy John Surgery

Sponsor Reminder

This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today - 20 FREE travel packs (valued at $79) - with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I'd encourage you to give it a shot, too - especially with this great offer.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

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!

We're excited to welcome Washington Nationals relief pitcher Aaron Barrett to this week's podcast. Aaron is one of the most impressive comeback stories you'll ever hear. A special thanks to this show's sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you'll receive a free 20-pack of Athletic Greens travel packets with your first order.

Show Outline

• What major injuries and setbacks Aaron experienced that removed him from competitive baseball from 2014 to 2018
• What the medical priorities and overall rehab process were for recovering from this freak injury
• How Aaron managed his psychology as he endured a major setback
• How he incorporated and began to increase his hand speed as he progressed throw his rehab throwing program
• When in Aaron’s rehab protocols he felt more consistent and confident as he began throwing in professional baseball games once again
• What recovery modalities Aaron utilizes to help his arm bounce back
• How Aaron modified his routine after enduring these setbacks
• How Aaron remained process oriented and focused on his goals for the long haul of a four-year rehab period
• What lessons has Aaron learned after experiencing the workload of being a reliever in a major league bullpen
• How Aaron manages his throwing volume and intensity in-season
• What Aaron’s gameday routine is
• What the characteristics of coaches and rehab professionals that have been the most impactful on his career
• What Aaron’s next step is for his career as he transitions from this incredible recovery from injury to being a consistent performer for the Washington Nationals

You can follow Aaron on Twitter at @AaronBarrett30 and on Instagram at @AaronBarrett30.

Sponsor Reminder

This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today - 20 FREE travel packs (valued at $79) - with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I'd encourage you to give it a shot, too - especially with this great offer.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

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!