Home Posts tagged "Tommy John Surgery" (Page 2)

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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Strength and Conditioning Stuff You Should Read: 1/29/14

Here's this week's list of recommended strength and conditioning reading:

5 Myths of Tommy John Surgery - Mike Reinold dispels five of the most common myths regarding Tommy John surgery, and also highlights some very surprising research on the perceptions of this surgery by the lay population.

IMG_7810

Detox Diets and Juice Cleanses: Could They Make You More Toxic? - As usual, the good folks at Precision Nutrition kick out some great content here.  I'll be referring folks to this article every time they ask about cleanses from here on out.

3 Things You Need to Unlearn - This is an excellent piece by Chris Colucci at T-Nation.  I especially liked point #2.

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Training Athletes with Funky Elbows: What a Valgus Carrying Angle Means

I talk a lot about how there's a difference between simply "training baseball players" and actually training baseball players with a genuine appreciation of the unique demands they encounter - as well as their bodies' responses to those demands.  Today's post will be a great example of how you can't just throw every throwing arm into a generic program.

One of the adaptations you'll commonly see in throwers is an acquired valgus carrying angle at the elbow.  For the laymen in the crowd, take note of how the throwing arm (in this case, the right arm, which is to the left side of the picture) has a "sharper" angle: 

 

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This is an adaptation to the incredible valgus stress during the lay-back portion of throwing.

layback

While the research on the subject isn't really out there, it's widely believed that a sharper valgus carrying angle predisposes throwers to elbow injuries, particularly ulnar collateral ligament (UCL) tears.  My good friend Mike Reinold actually has a lot of very good unpublished data on the topic, too. In my eyes, this verifies that we need need to treat throwers like this with extra care in light of this increased susceptibility to injury. 

From my perspective, I think it means more time off from throwing each off-season in order to regain passive stability, as the UCL is already stretched out more than in the normal pitcher.  Additionally, it may take longer for these athletes to regain good soft tissue quality, as the musculature at the medial elbow is likely working harder to make up for this loss of passive stability and the increased range-of-motion demands.  Another key point is that this valgus carrying angle may increase the likelihood of ulnar nerve hypermobility (snapping back and forth over the medial epicondyle during flexion/extension) or ulnar neuritis (irritation of the nerve from excessive stretch). If this nerve only has a limited number of flexion/extension cycles before it really gets irritated, then we need to use each throw wisely to put off the possibility of needing an ulnar nerve transposition surgery to set it where it needs to be.

Additionally, I think it means less aggressive throwing programs, particularly with respect to extreme long toss.  I think long toss has a ton of merit for a lot of throwers, but one concern with it is that it does increase valgus stress slightly as compared to throwing on a line at shorter distances.  With that in mind, these folks might respond better to other throwing initiatives, or simply less long toss than they otherwise might do.

From a training standpoint, we need to work to gain more active external rotation to ensure that more of the range-of-motion is occuring is at the shoulder than the elbow.  This should not be confused with simply stretching the shoulder into external rotation, which does much more harm than good in 99% of cases.  Rather, we need to educate athletes on how to get to lay-back without compensation. I like supine external rotation - an exercise I learned from physical therapist Eric Schoenberg - as a starting point.

Once we've been successful working with gravity, we'll progress this drills to prone to work against gravity, and then add in various holds at end-ranges of motion to strengthen athletes in external rotation closer to end-range.  Here's an example you can try at home:

In terms of contraindications, I can't say that it changes much as compared to what we avoid - back squats, Olympic lifts, etc. - with the rest of our throwers.  However, I think the fallout could be even more dramatic; just imagine these elbows catching a snatch overhead in the off-season after 200+ innings of wear and tear.

crazyvalgus

This picture also teaches us that one can simply be born with a more significant valgus carrying angle, but throwing during the adolescent and teenage years would make it more extreme.

Beyond training implications, for the reasons I noted above, it's also extremely important to take care of tissue quality at the common flexor tendon and pronator teres. I like a combination of instrument-assisted soft tissue mobilization and hands-on work like Active Release.

I hope this post brings to light an additional assessment and follow-up training principles you can use to give your throwers the quality training and (p)rehabilitation they need. If you're looking for more insights on training throwers, I'd highly recommend you check out our Elite Baseball Mentorships; the next course takes place on December 8-10.

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Strength and Conditioning Stuff You Should Read: 7/18/13

This week's list of recommended strength and conditioning reading (and listening) will have a heavy baseball focus.  Check out these websites:

Elite Baseball Mentorships - We've run two of these, and the feedback has been fantastic.  With that in mind, today is the early-bird registration deadline for the August 18-20 Phase 2 (no prerequisites required). We'd love to see you there!

Talking Shoulders and Elbows with Eric Cressey - This is the audio of a podcast I did for the Blue Jays Plus Podcast.  We discuss baseball injuries, player development, and a host of other topics. I come on the show at the 34-minute mark, in case you want to fast-forward to it.

EverythingElbow

The Surgery that Changed Baseball Forever - With the upcoming induction of Dr. Frank Jobe (who thought up and did the first Tommy John surgery) to the Baseball Hall of Fame, Will Carroll wrote this outstanding four-part article for Bleacher Report.  Here are the links to check out each of the articles: Part 1, Part 2, Part 3, and Part 4.

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Strength and Conditioning Stuff You Should Read: 6/3/13

It's time for this week's installment of recommended strength and conditioning reading:

Half of College Grads Are Working Jobs That Don't Require A Degree - This article ran at Forbes.com the other day, and while it doesn't speak directly to the fitness industry, I thought it drew some interesting parallels to this old two-part series of mine:

----> Is An Exercise Science Degree Really Worth It? - Part 1
----> Is An Exercise Science Degree Really Worth It? - Part 2

Functional outcomes following revision ulnar collateral ligament reconstruction in Major League Baseball pitchers - It's well documented that UCL reconstructions (Tommy John surgeries) have a very high success rate when it comes to returning to previous (or better) levels of competition.  However, they've been around long enough that surgeons are sometimes seeing the same throwers back again for a second UCL reconstruction on the same elbow. Guys like Joakim Soria and Brian Wilson are the most recognized examples of late. As would be expected, the results aren't quite as good the second time around, but there is still a solid success rate, and it's better among relief pitchers than starters.

EverythingElbow

(if you're interested in learning more about the injury mechanisms for UCL tears as well as my experiences working with post-op Tommy John cases, be sure to check out my Everything Elbow in-service)

Rack Hip Thrusts - This was a short, but very useful article by Ben Bruno over at T-Nation.  If you've ever had problems with the set-up on barbell hip thrusts, it's a must-read.  Plus, I found it wildly entertaining that Ben referred to the male reproductive anatomy as "tackle."

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Why Baseball Players Shouldn’t Olympic Lift

I've been very outspoken in the past about how I am completely against the inclusion of Olympic lifts in baseball strength and conditioning programs because of injury risk and the fact that I don't believe the carryover in power development is as good as many folks think.  I've taken a lot of heat for it, too, as it's essentially blasphemy for a strength and conditioning coach to not think the Olympic lifts are a "Holy Grail" of performance enhancement.

Truth be told, I think there is merit to the Olympic lifts for a lot of athletes and general fitness folks.  However, baseball players aren't like most athletes or general fitness folks.  They have far more joint laxity, and it's a key trait that helps to make them successful in their sport.  While I hate to ever bring additional attention to an extremely unfortunately event, a weightlifting injury that occurs in this year's Olympics reminded me of just one reason why I don't include the Olympic lifts with our throwers.  Please keep in mind that while this isn't the most "gruesome" lifting injury video you'll see, some folks might find it disturbing (if you want to see the more gruesome "after" photo, read this article).  If you're one of those folks, don't push play (Cliff's notes: he dislocates his elbow).

Now, without knowing for sure what the official diagnosis is, an elbow dislocation could mean two things.  First, it could have been elbow hyperextension; I doubt that's the case, as the elbow appears to be slightly flexed when it "buckles."  Second - and more likely - we're talking about a valgus stress injury; not the joint angle below, which is approximately 20-30 degrees of elbow flexion:

You know what's remarkably coincidental about that elbow flexion angle?  It's where you do a valgus stress test to assess the integrity of the ulnar collateral ligament.

I don't know for sure if Sa Jae-hyouk is going to have a Tommy John surgery, but I can't say that I would be surprised if it does occur.  And, he certainly wouldn't be the first Olympic lifter to have one.

Now, I want to bring up a few important items.

1. I think this essentially kills the "they're safe for baseball players if it's in good form" argument that some folks throw out there.  For those who might not know, this was a gold medalist in Beijing in 2008, and he was expected to medal at this year's Olympics, too.  I suspect he knows a few things about proper Olympic lifting technique.

2. According to research from Bigliani et al, 61% of pitchers and 47% of position players at the professional levels had sulcus signs (measure of instability) in their throwing shoulders.  And, 89% of the pitchers and 100% of the position players ALSO had it in their non-throwing shoulders, meaning that this is the way that they were born, not just something they acquired from throwing. I've never met an accomplished male Olympic lifter with a sulcus sign, though, which tells me that laxity is virtually non-existent in this athletic population, particularly in comparison with baseball players.  We need to fit the exercises to the athlete, not the athlete to the exercises.  

3. The obvious next question for most folks is "what about cleans and high pulls?" With cleans, the wrist and elbow stresses are even more problematic than with snatches, and there is also the issue of direct trauma to the acromioclavicular joint on the catch phase.  Plus, when folks hang clean, the distraction forces on the lowering component of the lift (assuming no drop) can be a big issue in "loose" shoulders and elbows.  High pulls are a bit better, but all of the aggressive shrugging under load with minimal scapular upward rotation can really interfere with the improvements to scapular stability that we're trying to make with our overhead throwing athletes.

4. For those curious about what I meant with respect to the power carryover from linear modalities (like Olympic lifts) not being great to rotational sports, check out this recently published research study from Lehman et al. You'll see that it backs up what I'd proposed from my anecdotal experience back in 2010; that is, power development is very plane specific.  Get to doing your med ball work!

This is one case where the injury prevention battle isn't just about adding the right exercises; it's about taking some away, too.  

With all that said, I hope you'll join me in keeping Sa Jae-hyouk in your thoughts and send him good vibes for a speedy recovery and quick return to competition.

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Should Pitching Coaches Understand Research Methods and Functional Anatomy?

Quite some time ago, I met a pitching coach who made a bold statement to me:

"Most Major League pitchers have terrible mechanics."

I don't know if he meant that they were mechanics that could lead to injuries, or simply mechanics that would interfere with control and velocity development, but either way, I shrugged it off.  Why?

Their mechanics are so terrible that they're in the top 0.0001% of people on the planet who play their sport.  And, they're paid extremely well to be terrible, I suppose.

Kidding aside, this comment got me to thinking about something that's been "festering" for years now, and I wanted to run it by all of you today to get your impressions on it.  In other words, this post won't be about me ranting and raving about how things should be, but rather me starting a dialogue on one potential way to get the baseball development industry to where it needs to be, as it clearly isn't there yet (as evidenced by the fact that more pitchers are getting hurt nowadays than ever before).

The way I see it, mechanics are typically labeled as "terrible" when a pitcher has:

1. Trouble throwing strikes

2. Pitching velocity considerably below what one would expect, given that pitcher's athleticism

3. Pain when throwing

4. Mechanical issues that theoretically will predispose him to injury 

In the first three cases, anyone can really make these observations.  You don't need to be trained in anything to watch the walk totals pile up, read a radar gun, or listen when a pitcher says, "It hurts."  Moreover, these issues are easier to coach because they are very measurable; pitchers cut down on their walks, throw harder, and stop having pain.

Issue #4 is the conundrum that has lead to thousands of pissing matches among pitching coaches.  When a pitcher gets hurt, everyone becomes an armchair quarterback.  The two biggest examples that come to mind are Mark Prior and Stephen Strasburg.

Prior was supposed to be one of the best of all-time before shoulder surgeries derailed his career.  After the fact, everyone was quick to pin all the issues on his mechanics.  What nobody has ever brought to light is that over the course of nine years, his injuries looked like the following (via Wikipedia):

1. Hamstrings strain (out for 2002 season)
2. Shoulder injury (on-field collision - missed three starts in 2003)
3. Achilles injury (missed two months in 2004)
4. Elbow strain (missed 15 days in 2004)
5. Elbow injury (missed one month in 2005 after being hit by line drive)
6. Rotator cuff strain (missed three months in 2006)
7. Oblique strain (missed two starts in 2006)
8. Rotator cuff strain (ended 2006 season on disabled list)
9. Shoulder surgery (missed entire 2007 season, and first half of 2008)
10. Shoulder capsule tear (out for season after May 2008)
11. Groin injury (missed last two months of 2011 season)

By my count, that is eleven injuries - but four of them were non-arm-related.  And, two of them (both early in his career) were contact injuries.  Who is to say that he isn't just a guy with a tendency toward degenerative changes on a systemic level?  How do we know one of the previous injuries didn't contribute to his arm issues later on?  How do we know what he did for preventative arm care, rehabilitation, throwing, and strength and conditioning programs? We don't have his medical records from earlier years to know if there were predisposing factors in place, either.  I could go on and on.

The issue is that our sample size is one (Mark Prior) because you'll never see this exact collection of issues in any other player again.  It's impossible to separate out all these factors because all issues are unique.  And, it's one reason why you'll never see me sitting in the peanut gallery criticizing some teams for having injured players; we don't have sufficient information to know exactly why a player got hurt - and chances are, the medical staff on those teams don't even have all the information they'd like to have, either.

Strasburg has been labeled the best prospect of all-time by many, and rightfully so; his stuff is filthy and he's had the success to back it up.  Of course, the second he had Tommy John surgery, all the mechanics nazis came out of their caves and started berating the entire Washington Nationals organization for not fixing the issue (an Inverted W) proactively to try to prevent the injury.  Everybody is Johnny Brassballs on the internet.

To that end, I'll just propose the following questions:

1. Did Strasburg not do just fine with respect to issues 1-3 in my list above?

2. Would you want to be the one to screw with the best prospect of all-time and potentially ruin exactly what makes him effective?

3. Do we really know what the health of his elbow was when the Nationals drafted him?

4. Do we know what his arm care, throwing, and strength and conditioning programs were like before and after being drafted?

There are simply too many questions one can ask with any injury, and simply calling mechanics the only contributing factor does a complex issue a disservice - especially since young athletes are growing up with more and more physical dysfunction even before they have mastered their "mature" mechanics.

The Inverted W theory is incredibly sound; Chris O'Leary did a tremendous job of making his case - and we certainly work to coach throwers out of this flaw - but two undeniable facts remain.  First, a lot of guys still throw with the Inverted W and don't have significant arm issues (or any whatsoever).  They may have adequate mobility and stability in the right places (more on this below) to get by, or perhaps they have just managed their pitch counts and innings appropriately to avoid reaching threshold.  I suspect that you might also find that many of these throwers can make up for this "presumed fault" with a quick arm combined with a little extra congenital ligamentous laxity, or subtle tinkering with some other component of their timing.

Second, a lot of guys who don't have an Inverted W still wind up with elbow or shoulder injuries. Good research studies bring issues like these to light, and nobody has really gotten a crew of inverted W guys and non-inverted W guys together to follow injury rates over an extended period of time while accounting for variables such as training programs, pitch counts, and pitch selection (e.g., sliders vs. curveballs). We don't know if some of these other factors are actually more problematic than the mechanics themselves, as it's impossible to control all these factors simultaneously in a research format.

As such, here we have my first set of questions:

Don't you think that pitching coaches need to make a dedicated effort to understand research methods so that they can truly appreciate the multifactorial nature of injuries?  And, more importantly, wouldn't learning to read research help them to understand which mechanical issues are the true problem?  

The Inverted W is certainly an issue, but there are many more to keep in mind. Just my opinion: I think the baseball industry would be much better off if pitching coaches read a lot more research.

Now, let's move on to my second question.  First, though, I want to return to the Inverted W example again. I have not met more than a few pitching coaches who can explain exactly what structures are affected by this mechanical flaw because they don't understand what functionally is taking place at the shoulder and elbow.  They don't understand that excessive glenohumeral (shoulder) horizontal abduction, extension, and external rotation can all lead to anterior glide of the humerus, creating more anterior instability and leading to injuries to the anterior glenohumeral ligaments and labrum.  Meanwhile, the biceps tendon picks up the slack as a crucial anterior stabilizer.  They also don't appreciate how these issues are exacerbated by poor rotator cuff function and faulty scapular stabilization patterns.  And, they don't appreciate that these issues are commonly present even in throwers who don't demonstrate an Inverted W pattern.

At the elbow, they also can't explain why, specifically, the Inverted W can lead to problems. They don't understand that the timing issue created by the "deep" set-up leads to greater valgus stress at lay-back because the arm lags.  They can't explain why some players have medial issues (UCL injuries, ulnar nerve irritation, flexor/pronator strains, and medial epicondyle stress fractures) while other players have lateral issues (little league elbow, osteochondritis dissecans of radial capitellum) from the same mechanical flaws.  They can't explain why a slider thrown from an Inverted W position would be more harmful than a curveball.

I can explain it to you - and I can explain it to my athletes so that they understand, too. I've also met a lot of medical professionals who can clearly outline how and why these structures are injured, but we aren't the ones coaching the pitchers on the mounds.  The pitching coaches are the ones in those trenches.

To that end, I propose my second set of questions:

Don't you think pitching coaches ought to make an effort to learn functional anatomy in order to understand not just what gets injured, but how those injuries occur?  Wouldn't it give them a more thorough understanding of how to manage their pitchers, from mechanical tinkering, to pitch selection, to throwing volume?  And, wouldn't it give them a more valid perspective from which to contribute to pitchers' arm care programs in conjunction with rehabilitation professionals and strength and conditioning coaches? 

The problem with just saying "his mechanics suck" is that it amounts to applying a theory to a sample size of one.  That's not good research.  Additionally, this assertion is almost always taking place without a fundamental understanding of that pitcher's functional anatomy.  It amounts to coaching blind.

To reiterate, this was not a post intended to belittle anyone, but rather to bring to light two areas in which motivated pitching coaches could study extensively in order to really separate themselves from the pack.  Additionally, I believe wholeheartedly in what Chris O'Leary put forth with his Inverted W writings; I just used it as one example of a mechanical flaw that must be considered as part of a comprehensive approach to managing pitchers.

With that said, I'd love to hear your opinions on these two sets of questions in the comments section below. Thanks in advance for your contributions.

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Strength and Conditioning Stuff You Should Read: 3/27/12

Here are some recommended strength and conditioning readings for the week: Recovery: Athlete vs. Average Joe - Patrick Ward summarized some great research on how it takes a lot more to negatively impact performance when you reduce the outside stress in one's life. Force of Habit - This article by Lindsay Berra just ran in ESPN The Magazine.  Lindsay interviewed me for the piece on Tommy John surgery (ulnar collateral ligament reconstruction), and while I wasn't mentioned in the final version, I thought she did an outstanding job of outlining some complex topics - everything from the mechanics to the politics - in the piece. 21 Strength Exercises for Injury-Free Mass - Bret Contreras provides some great options - and the rationale for them - for those looking to make their strength training programs a little more joint-friendly over the long-term. Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!
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Baseball Strength and Conditioning Programs: How Much Rotator Cuff Work is Too Much? – Part 1

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

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

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

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

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

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

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

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

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

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

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

It's fighting against distraction forces at ball release.

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

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

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

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

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

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

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

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

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