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It's time for another listener Q&A, so I cover three questions from our audience in this week's podcast on the following topics:
- Do you have any tentative guidelines for working with post-op Tommy John patients who are trying to maintain a training effect during their rehab?
- What do you think when you hear that a MRI is “clean?”
- Why do shoulder surgeries in throwers have such a lower success rate than elbow surgeries?
A special thanks to this show’s sponsor, AG1 (formerly Athletic Greens). Head to http://www.athleticgreens.com/cressey and you’ll receive a free 10-pack of travel packets with your first order.
Sponsor Reminder
This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today - 20 FREE travel packs (valued at $79) - with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I'd encourage you to give it a shot, too - especially with this great offer.
Podcast Feedback
If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.
And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.
Thank you for your continued support!
Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!
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It's time for another listener Q&A, so I cover three questions from our audience in this week's podcast:
- Tommy John surgery rates have skyrocketed over the past decade across all levels of basebalI. I know you’ve supported some of the highest profile athletes through their rehabs at CSP during this time, so I’m curious as to whether there have been any evolutions in your thought process on how you view or manage them?
- What’s your approach to an athlete that has a Hip ER/IR total motion difference of greater than 10 degrees?
- The more I learn, the more stressful I find programming for athletes. Any tips for this?
A special thanks to this show’s sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you’ll receive a free 10-pack of Athletic Greens travel packets with your first order.
Sponsor Reminder
This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today – 10 FREE travel packs – with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I’d encourage you to give it a shot, too – especially with this great offer.
Podcast Feedback
If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.
And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.
Thank you for your continued support!
Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!
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We're excited to welcome renowned orthopedic surgeon, Dr. Jeffrey Dugas, to the latest podcast. He shares some great insights related to the history, present, and future of elbow surgeries. Dr. Dugas is on the cutting edge of baseball sports medicine, so we're fortunate to tap into his expertise on this episode.
A special thanks to this show's sponsor, Marc Pro. Head to www.MarcPro.com and enter the coupon code CRESSEY at checkout to receive an exclusive discount on your order.
Sponsor Reminder
This episode is brought to you by Marc Pro, a cutting-edge EMS device that uses patented technology to create non-fatiguing muscle activation. Muscle activation with Marc Pro facilitates each stage of the body’s natural recovery process- similar to active recovery, but without the extra effort and muscle fatigue. Athletes can use it for as long as they need to ensure a more full and quick recovery in between training or games. With its portability and ease of use, players can use Marc Pro while traveling between games or while relaxing at home. Players and trainers from every MLB team - including over 200 pro pitchers - use Marc Pro. Put Marc Pro to the test for yourself, and use promo code CRESSEY at checkout at www.MarcPro.com for an exclusive discount on your order.
Podcast Feedback
If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.
And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.
Thank you for your continued support!
Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!
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We're excited to welcome Oakland A's starting pitcher Jesus Luzardo to this week's podcast. He talks about his quick ascent to the big leagues, things he learned during Tommy John rehab, sacrifices needed to compete at the highest level, and the things he's working on to keep improving.
A special thanks to this show's sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you'll receive a free 10-pack of Athletic Greens travel packets with your first order.
Sponsor Reminder
This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today - 20 FREE travel packs (valued at $79) - with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I'd encourage you to give it a shot, too - especially with this great offer.
Podcast Feedback
If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.
And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.
Thank you for your continued support!
Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!
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We’re excited to welcome physical therapist Stan Conte to this week’s podcast for a detailed discussion of expectations surrounding Tommy John surgery. Stan is not only an experienced clinician, but also a prolific researcher in the baseball sports medicine world. With the prevalence of ulnar collateral ligament injuries in today's game, this podcast is a must-listen.
A special thanks to this show's sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you'll receive a free 10-pack of Athletic Greens travel packets with your first order.
Show Outline
Sponsor Reminder
This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today - 20 FREE travel packs (valued at $79) - with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I'd encourage you to give it a shot, too - especially with this great offer.
Podcast Feedback
If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.
And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.
Thank you for your continued support!
Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!
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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.
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.
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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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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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:
This is an adaptation to the incredible valgus stress during the lay-back portion of throwing.
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.
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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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.
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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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.
(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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LEARN
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DEADLIFT
- Avoid the most common deadlifting mistakes
- 9 - minute instructional video
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