Home Posts tagged "Tommy John Surgery"

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.

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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!

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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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Long-Term Baseball Development: Part 2

Today is the second part of Cressey Performance Pitching Coordinator Matt Blake's article on long-term athletic development for baseball players. In case you missed it, check out Part 1.

blakeindexIn the first installment of this two-part article, I outlined the problem with respect to youth baseball injuries, discussed some of the causes, and emphasized the need for age-appropriate, individualized training programs over the course of the "baseball lifespan." Today, I want to look closer at this step-by-step developmental process.

I think it’s paramount to first teach young pitchers about rhythm, tempo and direction in the throw, before they learn how to just “air it out.” If they understand how to play catch with intent and focus for every throw on a daily basis, the velocity will usually take care of itself. One way to do that is to use drill constraints to create feel for these qualities, such as in this stride drill progression below:

If the velocity doesn’t begin to develop as you matriculate into your adolescent and teenage years, you have to begin to ask why? Is it a problem with athleticism, strength, delivery issues, or something else? Typically speaking, it will be a little bit of all these, but it’s not usually because the kid isn’t trying to throw the ball hard enough. More often than not, the players that I see getting hurt at a young age have an excessive amount of effort in a poorly sequenced throw, and no awareness for how to take care of their body or how to explain to an adult/coach what they’re feeling when they throw. They need a larger framework to understand movement, so they can understand what feels good and what doesn’t outside of simply throwing to get better.

If you can teach these kids simple concepts regarding core control, how to do a proper lunge, or how to do a proper un-weighted shoulder external rotation, you’ll go a long way towards opening up pathways to throw the ball harder. A great example of this is the exercise demonstration below, which you could certainly use to help educate your athletes:

They don’t need to know what joint centration is, or why adhering to certain muscular length/tension relationships are essential in creating force and resisting fatigue, but they’ll be able to feel it and move towards these positions more frequently on their own. To be honest, we very rarely even use a radar gun at our facility, and without trying to sound conceited, we have some of the hardest throwers in the country at every level of development. It all starts with a foundation that adheres to movement quality over quantity. Owning a routine that allows you take care of your body on a daily basis by taking inventory of tissue quality and adhering to a thorough warm-up and recovery process every time we throw is essential at every level of baseball. Something as simple as implementing the use of a foam roller on a day-to-day basis could go a long way in aiding this process.

Once the athlete understands movement quality, then we can begin to layer on force production, whether it be through a more general application like strength training or a more ballistic action like throwing a baseball. They need to understand how the force is generated, and where it’s dissipated; if they can’t decelerate or disperse what they’re producing, it’s unusable. There’s a laundry list of athletes in every town who threw harder than their peers, but couldn’t use it because they couldn’t throw strikes or couldn’t avoid pain. And, it’s not unusual to see the guys who don’t throw strikes to be more likely to end up in pain, because it’s a byproduct of having reckless motor control, which creates more stress by hitting joint end ranges more frequently, and in turn, creates more tissue damage than you’d see with a strike-thrower with a higher level of coordination.

As the athlete continues to advance through the high school and college years, there only comes more societal pressure to perform at a high level, so, if you don’t have a sound base of movement, you better bear down now. This 16-20 age group is probably the most at-risk population because of how strength really begins to come into the mix, how the wear and tear of poor deliveries and overuse in the youth development systems start to reach threshold, and the increased level of exposure at year round events fuels the fire. This is usually when the majority of players begin to realize that they want to be baseball players and start to specialize in the sport at a higher rate, and with that comes an even more detrimental aspect: not clearly identifying your developmental calendar.

If baseball is the only sport you play in the HS/college years, it’s essential that you understand what the year-long developmental calendar looks like. If you don’t, and you live in a warm weather region, you could theoretically start playing “spring season” games in January for your HS or college team and play into May/June. Once that season’s done, you would naturally transition right into your summer season, whether it be travel ball or a collegiate summer league and play another 45-60 games through July/August.

Once that season is over, the HS players who would normally shut it down and play another sport are now inundated with showcases and camps from every different angle, as well as fall leagues that run into November. The college athlete has his fall season, which is usually another six weeks of competitive baseball activity somewhere between September and November, and that leaves us with the window of November to January. This is where we’d normally be dormant, but now we have showcases and tournaments to attend to make sure the scouts and schools know who we are. And, college coaches are reluctant to shut pitchers down less than 10-12 weeks out from the start of a season.

Is it really a surprise that pitchers are getting hurt?

If you don’t step back and be sensible about this developmental process, your train will get derailed somewhere, so you have to set some clear boundaries.

For all of our athletes, it starts by encouraging them to get the ball totally out of their hand for 8-12 weeks of no-throwing each year. Now, this might sound excessive to some, but it still leaves you approximately 300 days of the year to work on your throwing. If you can’t get better in the other 300 days, you’re probably misusing this other 8-12 weeks anyways!

Aside from that, we typically try to adhere to keeping our high school pitchers under 100 competitive innings on the mound, and hopefully more like 80. So, as a HS athlete, if you compete from Feb/March until July/August as your two main competitive seasons, that allows you to shape your September-Feb/March in a multitude of ways. If college camps/showcases are an important aspect of your development so you can reach the next level, then make sure you give yourself adequate time to prepare for them. Going 0-60mph in these events is a recipe for injury, as we know the kids who attend more showcases end up getting hurt at a higher rate. If you’re aware of this and use the lead-up time and structure your throwing schedule properly, and understand the drastically different warm-up component at these events, you can likely head off some of these issues.

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If you’re a college athlete, you have to consider where your most important development is going to come. Obviously, the spring is a constant, but depending on how many innings you throw, and what level of development your college team offers, the fall season may be more important than simply adding another 60 innings in a summer league. So, you have to weigh out what makes more sense. Take the summer months and work on your strength base, while allowing your body to recover from a heavy workload, so you can be ready to continue developing in the fall; Or, play competitively in the summer for increased exposure and in-game development in a competitive summer league and then take the fall off from throwing. Too many times guys will throw 80+ innings for their college team in the spring and then another 50+ in the summer and now you’re carrying 130+ innings into the fall, which is a crucial time for your college pitching coach to develop your throwing ability or work on pitching skills in a controlled environment unlike the spring schedule or even the consolidated winter build-up.

The pro side might be the most cut and dry schedule wise, because you’re typically starting spring training in Mid-Feb/March and playing until September/October. It only becomes a little murky when you consider that some prospects have to attend instructional leagues in September/Oct or play in the Arizona Fall league, leaving a smaller window of off-season development. They may also need to pay bills so a winter league becomes more attractive. With that said, they have a nice window of time from September through February, which is crucial for them to get the ball out of their hand for an extended period of time and get their cuff strength back, while working on a general foundation of movement before they start the slow build-up back towards the season.

Obviously, there are some different concerns in the world of professional development where you’re constantly weighing the risk/reward for implementing certain training stimuli on both the strength training front and throwing program design side of things since these guys are generally already very successful at their craft. But, with how long their season is, and how quick they ramp up bullpens in spring training, it becomes essential they make good use of their window from September through February to avoid being a victim of the early season wrath we see unfold every year, as depicted by the charts below (click to expand):

chart
Sources: Epidemiology of Major League Baseball Injuries and
Incidence of Injuries in High School Softball and Baseball Players, respectively.

We could obviously go on and on here and not cover all of our bases on specific developmental concerns, so it’s important we reiterate the main driver behind all of this.

We’re going to continue to have arm issues in the sport of baseball if we insist on pushing the boundaries of the human species to see how much performance we can get out of these players. The money in the game is so large, and velocity has become such a huge component of success for these players and organizations, that the industry of baseball from top to bottom will constantly be looking to develop more of it.

The only problem is that the means for attaining this beloved velocity needs to be individualized and it’s such a complex recipe that goes beyond what you’re looking at in the present moment. It keeps every outing on short rest or poor warm-up before a cold rainy start on file, so you need to follow the body of work as best as you can to know where the next step needs to be for each athlete. Too many people are treating this like it’s a sprint from one MPH checkpoint to the next.

Slow down, be sensible about the developmental process, and just realize that this day and age, if you want to throw hard, there’s enough information out there to point you in the right direction. The key to all of this though, isn’t necessarily who can simply throw hard anymore, it’s who can stay on the field the most consistently while doing it, and for some reason, people don’t seem to be as willing to listen to that information.

In the meantime, if you're looking for more detailed information on long-term management of throwing athletes, be sure to check out our Elite Baseball Mentorships. The early-bird price for our June mentorship is May 15.

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Long-Term Baseball Development: Part 1

Today's guest post is the first half of a two-part article from Cressey Performance Pitching Coordinator, Matt Blake.  Matt is a key part of the Elite Baseball Mentorships team.

Unless you’ve been living under a rock, I assume you’ve heard that there seem to be a lot of pitchers getting hurt lately. Well, in light of the media spotlight recently shining on the injury epidemic we’ve been watching evolve over the last few years, I figured there’s no better time to contribute to this discussion.

This media attention has discussed a plethora of incredible information regarding some of the most relevant research and statistics pertaining to these arm injury rates. You can see experts call into question usage rates among amateur pitchers, pitch selection among youth/amateurs, recovery rates, mobility deficits, too much or too little strength, length of season, delivery flaws, and a host of other factors. In short, there’s clearly no one right answer in solving this issue, as there are just so many variables in this multi-factorial problem, and as a result, it is quickly making Tommy John the most famous pitcher of all time for all the wrong reasons.

TJ
 

This is probably exacerbated by the fact that I can almost guarantee you every single MLB pitcher whoever existed would fall into one of the categories deemed “detrimental” to healthy development at one point or another during their career. I’m sure they’ve been at risk of throwing too much, pitching on short rest, having a red flag in their delivery, lacking necessary range of motion, etc. It’s all part of the game, unfortunately. Beautiful game, isn’t it?

So, if this is the case – and I’m sorry to sound so negative about the future of this game and the problem that we’re currently experiencing – but this injury issue has way more to do with our society at large and the values we’re pushing into the game of baseball than simply little Johnny throwing too many pitches in his Babe Ruth game or throwing 95mph when he’s 17.

It’s not too dissimilar from the global climate discussion we’re having (apologies in advance if you don’t believe in global warming), where we seem to understand what the problem is and potentially what some of the solutions are. However, because these issues have huge monetary implications and there are large organizations and cultures set in their ways behind a lot of this, it’s very hard to change the direction of this tsunami that’s been building out at sea and is now crashing onto our shores.

UCL
Percentage Growth of ASMI Youth/High School UCL Reconstruction Surgeries (Original Article)

In order to narrow the discussion, though, I’m going to try to pick a couple key points out to help give the general population something to chew on and digest without burying them in a sea of research, stats and mechanical jargon. In my mind, there are two main social factors that are fueling this:

1) the burning desire as a culture to see and reach for more velocity at every level of development

2) the digital age giving us enough information to be dangerous in so many different ways

I can promise you neither of these will be going away, so we better learn how to manage them effectively.

When I talk about this insatiable desire for velocity at every level of development and this information age, I’m encompassing a lot of different thoughts. It could be Johnny Rocket throwing 70mph in the Little League World Series at 12yrs old while being broadcasted to the world on ESPN, or it could be the fact that we have a generation of fathers armed with a Pocket Radar at the backstop, and an Ipad in the dugout with up-to-the-minute strike % rates at all of Little Billy’s games.

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Once these players get out on the travel ball circuit, online scouting resources do their fair share to rank every single player/team that comes through their tournaments and showcases, so every kid knows where he stands against his peers. Like it or not, this encourages them to make it to as many events as they can, regardless of the time of year, which we know from the research carries a larger injury risk as well. These issues are a microcosm of this media blitz, and are simultaneously creating our greatest strength and becoming our biggest weakness.

Now, don’t get me wrong, these same reasons can also be tremendous developmental qualities, by allowing for more information to be processed, we can speed up the developmental curve. We know that fastball velocity is an important predictor of strikeout rate and success at any level of baseball. If that’s the case, why wouldn’t we want to speed up the developmental curve in an attempt to throw harder?

With that said, I’m sure there are people out there who point the injury bug finger at me in thinking I offer “Pitching Lessons” all year round, or point it at Eric Cressey for developing these athletes into physical monsters too soon, which allows them to throw the ball harder than the human species is supposed to do so. So, if we’re going to frame the discussion, we need to look at the process for how these athletes are being developed, because I think this becomes the crucial determinant.

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We have to have a big picture look at how we get Johnny Rocket to sustain his standard deviation of dominance at each level or how we get little Billy to have enough fastball so he can move from level to level and stay in the game he loves to play. But, if everything is causing problems, and you can’t play too much because you’ll get hurt, and if you don’t throw enough, you won’t be any good…How do we shepherd these athletes from level to level until they reach the promised land of the Big Leagues? Ultimately, it comes down to a few main principles for me.

At CP, we’ve had a lot of tremendous athletes and baseball players come through our doors ranging from Little Johnny Rocket at 10yrs old all the way to Curt Schilling on his last go round in the Big Leagues and everything in between. The three qualities that have resonated through all of the successful athletes regardless of level are – general athleticism, competitive instinct and an above average fastball that they can command.

curt-schilling1

I’d also include a caveat that the ability to be consistent and adhere to a plan is the glue to these qualities. We’ve had good athletes who were great competitors who sucked at simply showing up, or following the program as it was written, etc…and, it’s ultimately what keeps them from being reliable performers. It’s what can separate a guy who doesn’t have natural athleticism from a guy who doesn’t make the most of his athletic talents. Our most diligent and successful athletes don’t just randomly disappear for three weeks, or skip their warm-up for the heck of it. This can be a major separator if you’re willing to show up day in and day out and be diligent about executing your process.

Now, this may sound overly generic, but I think it’s important to consider what falls in each bucket and how it affects each developmental stage.

If you’re looking at the youth level – say 10-14 year-olds – who ends up pitching the most? Typically, your best athletes (because they’re coordinated enough at that age to throw strikes), or the kids who throw the hardest (because they generally miss more bats). Often, these two categories occur in the same kids, too, so they’re extra likely to throw every inning of every game. I don’t think anyone would question that.

youthpitcher

The same begins to take shape when you look at who gets recognized at the high school and college level. The best pitchers again end up being the guys who throw the hardest and strike the most guys out, and ultimately, end up with the college scholarships and are drafted the highest.

At the minor league level, there’s less of an emphasis on winning games, but there is definitely a premium placed on competing in the strike zone with an above average fastball in order to advance at each level through the system, regardless of organization. Finally, you have your big leaguers, who have made it to where everyone wants to go, and in this day and age, its few and far between the guys that don’t have premium stuff or aren’t voracious competitors with at least “average” stuff. Mark Buerhle and Jamie Moyer are the 0.01% of professional pitchers who were able to compete with below average fastball velocities, but they were able to compete at every level – including the big leagues – by relying on good movement, changing speeds, and impeccable command. So how does this factor into our greater discussion? You have to find what each athlete does well and find a way to maintain those strengths while filling in the weaknesses. You’d be foolish to give guys on opposite ends of the spectrum - say, Aroldis Chapman and Jamie Moyer - the same developmental plan.

chapmanmoyer



 

 

 

 

 

If you bring that thought further down the developmental chain, and have a 12yr old who throws hard, but doesn’t have a “sound delivery” or isn’t a good athlete, he probably needs to work really hard on his general athleticism first to provide a sound movement base for him to repeat his delivery. This can mean playing another sport, such as basketball or soccer, or simply riding his bike or playing at the park with his friends. It doesn’t mean he needs to engage in the 10,000 hours theory and practice pitching more. Could this help? Sure, but is it the best long-term solution or does it attack the greatest window of adaptation? I doubt it. If anything, he just needs to keep playing catch with his dad, brother, or a buddy and continue throwing a lot on his own to learn more about himself, but pitching in more games is just going to exacerbate the problem. Games are fun, and obviously one of the principles of long term success is developing that competitive spirit, but with what we know about the stress of throwing a baseball and what happens to kids who throw hard at an early age, this kid is seriously at risk for hurting himself down the road, if he doesn’t find other ways to develop.

bball

Too often, we see parents who think that the best way to get Johnny to become Nolan Ryan is to bring him to the local pitching instructor and get him signed up on the local travel ball team. Also, obviously, he still has to play with his town buddies, so now he’s on multiple teams, etc. This is not the answer. Let Johnny figure out a world of movement and compete with different people in different venues and you’ll be surprised what that does for his confidence and motor control. Having the ability to relate to other social environments, and physically move through different patterns will drastically shape Johnny’s ability to repeat his delivery and create force in the throw in healthier ways. With that said, below, I’ve provided a “Developmental Lifespan” for how successful athletes have generally progressed in their athletic focus:

Up to Age 10 – Complete fun, wide variety of activities
Ages 11-15 – Multiple (3+) organized sports with “seasons,” integration of strength and conditioning
Age 16-17 – Hone in on 1-2 sports
Age 18+ - Specialization

When they do play baseball, let’s not worry so much about velocity just yet, but let’s focus on establishing good daily routines - sound warm-ups, arm-care processes, and movement patterns – as well as focusing on the yearly calendar. These will have long-term implications for the athlete’s health and continued progress – and I’ll focus specifically on these things in Part 2, so stay tuned!

In the meantime, if you're looking for more detailed information on long-term management of throwing athletes, be sure to check out our Elite Baseball Mentorships.  The early-bird price for our June mentorship is May 15.

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