Home Posts tagged "Tommy John Surgery"

CSP Elite Baseball Development Podcast: Understanding the Throwing Elbow with Dr. Chris Ahmad

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 20-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!

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CSP Elite Baseball Development Podcast: Aaron Barrett

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!

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Strength and Conditioning Stuff You Should Read: 8/6/19

Today, I've got a list of recommended reading to get you through the week. Before we get to it, though, just a quick heads-up that we're doing a pre-sale on Cressey Sports Performance bucket hats. If you're interested in buying one, you can do so at THIS LINK. They'll be available for shipment in early-mid September.

As for the reading recommendations, check out the following:

Is It Really "Biceps Tendonitis?" - In light of a recent Instagram post I made on a related topic, this video blog deserves a reincarnation this week.

10 Habits that are Just as Important as Tracking KPI - My business partner, Pete Dupuis, wrote this article that examines some of the overlooked areas in which you can evaluate fitness business success.

Professional and Amateur Pitchers' Perspective on the Ulnar Collateral Ligament Injury Risk - This was an interesting study on a number of fronts. It was surprising to see how many pro guys think UCL injuries are unavoidable, but not at all surprising to hear that 55% of those who have UCL injuries in pro ball had a previous history of elbow injury in their youth baseball days. The biggest risk factor for an injury is...shocker...a previous injury.

Top Tweet of the Week

Top Instagram Post of the Week 

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Elite Baseball Development Podcast with Alex Wood

We're excited to welcome Cincinnati Reds starting pitcher Alex Wood to this week's podcast. 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

  • How undergoing Tommy John surgery his senior year of high school impacted Alex’s progression as a ballplayer
  • How arriving to the University of Georgia with an elbow injury his freshman year was a blessing in disguise
  • How Alex was game ready 10 months post Tommy John but why he instead chose to redshirt his freshman season and wait to return to playing until summer ball
  • How Alex has mastered his unorthodox pitching delivery through the course of his career
  • What positions Alex strives to hit consistently in his throwing motion
  • How Alex fast tracked through the minor leagues and what lessons Alex learned quickly as a young big leaguer
  • How MLB veterans like Brian McCann and Mike Minor aided in his transition into a MLB starter
  • What changes Alex made to his pitching approach to have a breakout season with the Los Angeles Dodgers in 2017
  • How Alex succeeded with only a fastball and change-up all the way up to the big leagues and why he chose to add a spike breaking ball into his arsenal upon make it to “the show”
  • How Alex manages his in season and off season throwing regimes
  • What Alex does pitch-by-pitch, in-game to control the flow of the game
  • How pitchers can build rapport and better manage the minute details of an outing with their catcher
  • What coaching qualities Alex sees as most impactful, and how players should utilize great coaches to take accountability of their own career and develop into their own best coach
  • You can follow Alex on Twitter at @AWood45 and on Instagram at @AWood45.

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!

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Elite Baseball Development Podcast with Tyler Skaggs

 We're excited to welcome Anaheim Angels starting pitcher Tyler Skaggs to the podcast. A special thanks to this show's sponsor, Jaeger Sports. Head to www.JaegerSports.com and enter the coupon code CSP to get 20% off on your order through May 31.   

Show Outline

  • How Tyler’s experience as a multi-sport high school athlete facilitated his development as an athlete
  • Why Tyler progressed through minor league baseball and up to the big leagues quickly after being drafted out of high school in 2009
  • How Tyler has refined his curveball in pro baseball
  • How Tommy John surgery impacted Tyler’s career in 2014 and what his advice is for young pitchers who are going through major setbacks in their career
  • How Tyler is working to develop a slider and learning to differentiate this pitch from his curveball
  • How Tyler structures his throwing and training in season as a starting pitcher in a 5-day rotation
  • What Tyler’s routine is on the day of his start
  • How the game of baseball has evolved since Tyler was drafted a decade ago
  • How the use of technology in baseball has allowed Tyler to better understand his pitches and develop a plan to more precisely refine his craft
  • What characteristics in coaches have benefited Tyler’s development throughout his baseball career
  • How the role of the pitching coach is evolving to include a more holistic approach to player management
  • What the most common mistakes Tyler sees pitchers making when throwing curveballs

You can follow Tyler on Twitter at @TylerSkaggs37 and Instagram at @tskaggs45.

Sponsor Reminder

This episode is brought to you by Jaeger Sports, who specializes in arm health, arm conditioning, and mental training. Best known for their long toss protocols and popular J-Bands, Jaeger Sports has been helping baseball and softball athletes reach their potential on the field since 1991. Alan Jaeger has been a trusted resource to me for close to a decade, and many of our athletes use J-Bands every single day. Through May 31, you can get 20% off on your order at www.JaegerSports.com using the coupon code CSP.

 

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!

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Random Thoughts on Sports Performance Training – Installment 29

I didn't get in a May installment of this series, but the good news is that it gave me two months to gather my thoughts for a big June! Here goes...

1. Athleticism is doesn't have to be max effort if you have a strength and power "reserve."

Cressey Sports Performance athlete Logan Morrison is currently second in Major League Baseball in homeruns. I came across this video of #22 on Twitter and it immediately got me thinking:

Hitting bombs in the big leagues - particularly on 95mph sinkers - is really challenging, but that looked absurdly easy. He put some force into the ground, got himself in a good position to succeed, and athleticism "happened."

The only reason this is possible is that he's developed a strength and power "reserve." LoMo is strong - and more importantly, he's a powerful dude. When he throws a medicine ball, in many cases, the entire gym stops and watches because it sounds like he's going to knock the wall down. When you've got a foundation of strength and know how to use it quickly, this kind of easy athleticism happens. It does not, however, happen if you're a) weak or b) strong and not powerful. I'd call LoMo a nice blend on the absolute strength-to-speed continuum.

2. If you're struggling to feel external rotation exercises in the right place, try this quick and easy fix.

One of the reason some throwers struggle to "keep the biceps" quiet during external rotation drills is that they start too close to the end-range for external rotation. A quick strategy to improve this is to simply build a little success in a more internally rotated position. This video goes into more depth:

3. Be cautiously optimistic with new surgical advances.

On a pretty regular basis, we hear about remarkable sports medicine breakthroughs that will revolutionize the way we prevent and treat both acute and chronic diseases and injuries/conditions. Unfortunately, they usually don't live up to the hype. Most of the time, we're talking about a "miracle" supplement or drug, but sometimes, we have to ponder the benefits of a new surgical procedure.

In the mid 1990s, the thermal capsulorrhaphy procedure was introduced to attempt to treat shoulder instability. It gained some momentum in the few years that followed, but the outcomes didn't match the hype in spite of the fact that the initial theory seemed decent (heat can shorten capsular tissues, which would theoretically increase shoulder stability). Failure rates were just too high.

Conversely, in 1974, Dr. Frank Jobe revolutionized the way elbow pain was treated in baseball pitchers - and saved a lot of careers - when he performed the first successful ulnar collateral ligament reconstruction (better known as Tommy John Surgery). More than 1/4 of MLB pitchers have had Tommy John, so you could say that this procedure revolutionized sports medicine even though it's taken decades to fine-tune it.

More recently, a new surgery - the UCL repair with internal brace -  has been gaining some steam as an alternative to Tommy John surgery. The initial results have been very promising, particularly in situations where the patient is a good match (depending on age, activity level, and location and extent of the UCL tear). I've actually seen two of these surgeries in the past week myself. One pitcher (Seth Maness) was able to successfully return to the Major Leagues after having it - but we still have a long way to go to determine if it might someday dramatically reduce the number of Tommy John surgeries that take place. Why? 

Right now, we only have statistics on a limited number of these cases, and they're usually in the high school and college realms. All that is reported on is return to previous level of competition (e.g., varsity baseball). We don't know whether a kid that has it at age 16 is still thriving with a healthy elbow at age 22 during his senior year of college.

Additionally, Seth Maness has really been an 88-90mph pitcher throughout his MLB career. We don't know if this same level of success will be seen with 95-100mph flamethrowers. 

Dr. Jeffrey Dugas has become known as "the guy" when it comes to these procedures, and I loved the fact that he reiterated "cautious optimism" in his webinar at the American Sports Medicine Institute Injuries in Baseball course earlier this year. If this gets rolled out too quickly and in the wrong populations, the failure rate could be significantly higher and give an otherwise effective surgery a bad name.  I think it's important for all of us to stay on top of sports medicine research to make sure we don't miss out on these advancements, but also so that we know to be informed consumers so that we don't jump behind new innovations without having all the information we need.

Speaking of the ASMI Injuries in Baseball Course, it's on sale for $100 off through this Sunday, June 24, at midnight. I've enjoyed going through this collection of webinars, and I'm sure you will, too. You can check it out HERE.

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Looking Closer at Pitching Injuries: An Interview with Jeff Passan

Today, I'm fortunate to have an interview with Yahoo Sports baseball writer, Jeff Passan. Jeff spent the past few years traveling the country to research why arm injuries in pitchers are at an all-time high, and his efforts culminated with the recent release of The Arm. I've read it, and it's fantastic.

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EC: Why did you write this book?

JP: Originally, I wrote it because I thought maybe, just maybe, through reporting and research I could find a fix-all for elbow injuries and help rid the sport of Tommy John surgery. What I learned was that I was foolish to even conceive of that, considering people far smarter than I am have dedicated their careers to ramming dead ends. Because of that, while I still think the recoveries of Daniel Hudson and Todd Coffey are the heart of the book, I began to realize just how acute this is for children. When nearly 3 in 5 Tommy John surgeries is done on a teenager, and the rise of teenage surgeries has gone in lockstep with the ascent of the showcase circuit and desire for velocity, something is very wrong. This is a book about a lot of things. I hope amid those, the lessons to parents resonate and cause them to think twice this spring about sending their young kids especially back out for an extra inning or keeping them in the game too long.

EC: Let's stay with the teenage discussion, as I've been preaching about this problem it for a decade now! When you investigated the current state of teenage baseball, what did you find? And, what surprised you the most?

I found a wasteland of ignorance, greed and scars on the elbows of children. I always heard executives complaining off-handedly about the showcase circuit but didn't realize the pervasive grasp it has on the youth space. Major League Baseball's greatest failure was allowing a for-profit company to co-opt its pipeline. As much as Perfect Game wants to claim moral superiority and a concern for the arms of children, reality tells a different story. Showcases 11 months of the year. Radar guns trained on infielders throwing across the diamond. Out-of-control pitch counts for arms simply too young to handle the workload. And that's to say nothing of actively seeking out sub-standard players to fill out an event. The commodification of children is gross, and encouraging performance and winning over development at young ages simply reinforces some of the same principles that I fear ultimately lead to arm injuries.

EC: Many people claim these issues are isolated to just the United States, and that the Far East and Latin American are immune. They deny that arm injuries are occurring at high rates in these areas; what did you find?

At the major league level, one's ethnicity does not make him any likelier to hurt himself. The numbers are pretty flat across the board. We see with Latin American players how that manifests itself because so many spend their formative years in the minor leagues and we witness their ascent and, in unfortunate cases, injury. Japanese pitchers, on the other hand, have a reputation of clean mechanics and hard work, and while that may be true, the results are devastating. It's not just the recent study that showed 40 percent of a sample of 9- to 12-year-old Japanese children had suffered ulnar collateral ligament damage. It's what I saw first-hand: Little boys, some so young their adult teeth still weren't fully grown in, coming into a clinic especially for baseball players and being diagnosed with an arm injury. Avulsion fractures. Frayed ligaments. OCD lesions. You name it, these kids had it. And it made me wonder how the Japanese baseball culture can live with itself knowing that it's choosing blind tradition over something as fundamental as the health of children.

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EC: Everyone likes to play Major League Baseball general manager on the internet, but I'm going to do you one better. I'll let you be MLB commissioner and task you with determining how to address the injury epidemic that's spanning from youth leagues all the way to MLB veterans. How do you handle it?

JP: Wow. OK. So, I'm assuming an unlimited budget here, because a lot of these things are going to take money. Let's start with the kids first. I appreciate what Pitch Smart is trying to do. I also think it's not conservative enough with the youngest kids. If baseball is injuring its youngest players -- and doctors and studies alike believe it is -- we need to focus on the two likeliest culprits: overuse and excessive maximum-effort throwing. Curb the first with lower pitch limits. It's not like 8- or 9-year-old kids need to be building toward triple-digit pitches. And in concert with that, advocate an epistemological change in how we approach youth baseball: as an apparatus for development over competition. Don't get me wrong. Competition is great. But if competitiveness in this space leads to the things that lead to an increase in injuries, we can satisfy our competitive jones elsewhere and instead emphasize developing safer development and the importance of control and command over velocity. This demands better coaching, and free coaching clinics run by MLB-trained advocates at least gives us a better chance of empowering those whose voices are critical with the necessary education.

There are so many more things in the youth space I could do, but I want to move on to the pros, because if I were in power and had carte blanche, the first thing I would do is force the 30 teams to abandon their injury-prevention fiefdoms and band resources to help start solving this problem. This is a matter of the greater good. Baseball as a sport is facing another generation of pitchers arriving with Tommy John surgery scars on their elbows, and if a team found something that could mitigate injuries, those children deserve to know. I understand the desire for a competitive advantage. I also see this as a moral imperative for baseball to do what it can to solve it. Beyond that, continuing to fund the current epidemiological studies, working hand in hand with the tech companies -- so many of which seem to have a problem getting their products to market -- and pioneering in-house research through a think tank-like establishment devoted not just to the arm but varying other ends of research. In other words, I'd throw the full weight of MLB behind this, not just monetarily but starting with the first commercial of the World Series, which is a close-up camera shot first on Matt Harvey's elbow, then Stephen Strasburg's, then Jose Fernandez's. And as the camera pans back to reveal their familiar faces, each says: "This could be you." Then some stats on year-round baseball -- oh, yeah; as commissioner, I'd shut that down and hold twice-a-year showcases at which the top prospects can show up and show off their stuff for everyone in the industry, like a combine -- and some other scary numbers and, boom: Immediate education on Tommy John surgery through people not wearing white lab coats.

EC: Thanks for joining us, Jeff! Whether you're a baseball player, coach, parent, scout, or fan, I'd strongly encourage you to  pick up a copy of The Arm.

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Making the Case for Training in the Post-Surgery Period

If you were to spend a day at either the MA or FL Cressey Sports Performance location, invariably, you’d see something that might surprise you: athletes training in spite of the fact that they recently had surgery. On a regular basis, we have athletes referred our way after everything from Tommy John surgeries to knee replacements. They may be on crutches, using an ankle boot, in an elbow brace, wearing a shoulder sling, or even rocking a back brace. Working with post-operative athletes has become a big niche for us; we work hand-in-hand with surgeons and rehabilitation specialists to make sure that we deliver a great training effect in spite of these athletes’ short-term limitations.

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Unfortunately, athletes will sometimes run across hyper-protective therapists and doctors who are overly cautious in this period. Certainly, for a period, this is incredibly important, as there are risks of not only the repair being vulnerable to movements and direct pressure, but also it being compromised by infection in the first few weeks. However, in my opinion, it’s absolutely unnecessary to tell an athlete to just take 3-4 months off completely from exercise and instead just “rehab” – and yes, I have heard this before.

With this in mind, I wanted to outline six reasons I think strategically implemented strength and conditioning work in the post-surgery period is incredibly important.

1. It’s important to make an athlete feel like an athlete, not a patient.

There is a different vibe in a physical therapy clinic or training room as compared to a strength and conditioning setting. This isn't intended to be a knock on rehabilitation specialists, but athletes would rather hang out in the latter realm! And, while great therapists make rehabilitation upbeat and keep the athlete's competitive psyche engaged, getting back into the gym affords a big mental boost - a break from their current physical reality - for athletes.

Speaking of mental boosts, I won't even bother to highlight the favorable impacts of exercise on mood and the reduction in risk of a wide variety of chronic diseases. Suffice it to say that there are a ton, and it's important that athletes continue to have these benefits during their rehabilitation period. If you really want to dig deeper, I'd highly recommend this recently published meta-analysis: Exercise as a treatment for depression.

2. Small hinges swing big doors in terms of behaviors.

Most people eat healthier when they train. Whether this is conscious or subconscious is dependent on the individual, but it's something I've seen time and time again.

Likewise, many student athletes perform better in the classroom when exercising regularly, and struggle to stay on task when they’re given too much free time.

What's my point? Effectively, training pushes out certain bad behaviors. Likewise, on a physiological level, it supports better brain activity that makes for more productive members of society.

3. Injuries don’t occur in isolation.

Pitchers don’t just blow out their elbows because of functional deficits at the elbow. Rather, the elbow usually gets thrown under the bus from a collection of physical deficits all along the kinetic chain. As an example, Garrison et al (2013) demonstrated that players with ulnar collateral ligament tears scored significantly worse on the Y-balance test than their healthy peers.

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With this in mind, it would be silly to spend months and months only focusing on rehabilitating the arm to the exclusion of the rest of the body. Unfortunately, physical therapists only have so much time with athletes because of insurance restrictions, so they may not get to these important complementary rehabilitation approaches. This is a great place for a competent strength and conditioning professional to pick up the slack.

4. Training improves body composition, which facilitates a number of favorable outcomes.

It drives me bonkers when I hear about an individual dropping a bunch of muscle mass and gaining substantial body fat during the post-surgery period. This should never happen. 

Just as a healthy body composition will help a grandfather avoid setbacks following a hip replacement, having a good strength-to-body weight ratio will increase the likelihood that a college soccer player will avoid setbacks after a meniscal repair.

These benefits aren't just conferred to weight-bearing scenarios. Remember, obesity is arguably the biggest limitation to diagnostic imaging accuracy. In other words, if you have a setback in your rehabilitation and need an MRI or x-ray, being fatter makes it hard for your radiologist to give you an accurate reading. An ounce of prevention is worth a pound of cure.

5. Exercise facilitates motor learning improvements.

When rehabbing, you’re trying to acquire new, favorable movement patterns. Research (good reads here and here) has demonstrated improved motor learning when new tasks are introduced alongside exercise (particularly aerobic exercise).

Maintaining a robust aerobic system and solid work capacity makes rehabilitation efforts more effective.

6. Contralateral strength training has carryover to immobilized limbs.

Via a mechanism known as cross-transfer (or cross-education), an untrained limb's performance improves when the opposite limb is trained. As an example, if you have knee surgery on your right leg, but do what you can do to safely train your left leg while your right knee is immobilized, you'll still get carryover to the post-surgery (right) side. It won't do much to attenuate the atrophy of muscle mass on an immobilized limb, but it will absolutely reduce the fall-off in strength, power, and proprioception. Effectively, it's "free rehab" that offers a huge leg up with respect to return to play.

As an aside, research on cross-transer from Hortobagyi et al has demonstrated that the strength carryover seems to be stronger with eccentric exercise, so prioritizing this approach seems to have extra merit.

Some Important Notes

Before I sign off on this one, I should be clear on a few things:

1. Not every trainer and strength and conditioning coach is prepared to take on every injury.

If you’ve never heard the word “spondylolysis,” you shouldn’t be programming for a kid in a back brace. And, if you don’t know the difference between an ulnar nerve transposition and an ulnar collateral ligament reconstruction, you’re not ready to take on a post-op baseball elbow. Don’t be a cowboy.

2. Effective post-operative training mandates outstanding communication.

You should be speaking on a regular basis with the physical therapist or athletic trainer who is overseeing the rehabilitation plan. They’ll let you know if an athlete is prepared for progressions, and also to help you avoid overlapping with what they do in the rehabilitation sessions. I’d even encourage you to sit in on some of their rehabilitation sessions not only to monitor progress, but also as continuing education.

3. When in doubt, hold athletes back.

One of my graduate school professors, Dr. David Tiberio, once said that physical therapists “should be as aggressive as possible, but do no harm.” I’ll take this a step further and say that fitness professionals conditioning “should be conservative and do no harm” during the rehabilitation process. It’s our job to maintain/improve fitness and facilitate return-to-play, but in no way set back the recovery process. In short, let the rehab folks take all the chances when it comes to progressions.

4. Remember that progressions occur via many avenues.

Progressions don’t just come in terms of exercise selection, but also absolute loading, speed of movement, volume, frequency, duration, and a host of other factors. You need to keep all of them in mind when programming and coaching, as even one factor that is out of whack can set a rehabilitation program back. Additionally, there will be times when stress in one area goes up, which means it must be reduced in another area. As an example, during rehabilitation from Tommy John surgery, the stress on the medial elbow increases when an athlete begins throwing at the 4-6 month mark, and many athletes will benefit from a reduction in the amount of gripping they do in their strength training and rehabilitation programs. 

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5. Watch for "accidental" stabilization demands.

Many muscles work reflexively, with the rotator cuff being the absolute best example. After a shoulder surgery, you have to be careful training the opposite side too soon (or with too much loading) because the cuff on the surgery side can turn on reflexively. As the aforementioned cross-transfer effect dictates, it's not as simple as right vs. left training effects; our nervous system governs everything - and in curious ways. 

Wrap-up

I hope that in publishing this article, I made a strong case for the importance of appropriate exercise during the post-surgery period. Remember that what is "appropriate" will be different for each individual, and should be determined via a collaborative effort with input from a surgeon, rehabilitation specialist, strength and conditioning professional, and the athlete. And, it should always be a fluid process that can be progressed or regressed based on how the athlete is doing.

For the fitness professionals out there, if you're looking for more information, here are a few good reads:

4 Reasons You Must Understand Corrective Exercise and Post-Rehab Training
7 Random Thoughts on Corrective Exercise and Post-Rehab Training


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Strength and Conditioning Stuff You Should Read: 6/1/15

Happy June, everyone! Let's kick this month off on the right foot with some recommended strength and conditioning reading:

Give and Take: Why Helping Others Drives Our Success - I just finished up this best-seller from Adam Grant, a professor at The Wharton School. It was an outstanding look at some factors that characterize those who are successful in the business world, and there are definitely a lot of applications to coaching. I've already recommended it to several friends who manage training facilities.

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Why Tommy John Surgeries Won't Cease Any Time Soon - This ESPN The Magazine article does a good job of addressing the social (as opposed to physiological rationale) for why arm injuries continue to be such a problem.

Are You Consuming, Producing, or Engaging? -  Todd Hamer is a good friend of mine who always has great insights on coaching, and this is no exception.

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How Limited Shoulder Flexion Relates to Elbow Injuries in Pitchers

Today, I want to introduce you to one of the screens we do with all our throwing athletes - and what the implications of "failing" this test are.  Check out this six-minute video:

If you're looking for more information along these lines, I'd encourage you to check out one of our upcoming Elite Baseball Mentorships, with events running in both October and November.

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LEARN HOW TO DEADLIFT
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