Master the King of All Exercises

Deadlifting Secrets 101

Everything you need to know about this complex exercise.

Free Video Training

Name:
Email:* 
The High Performance Handbook

The High Performance Handbook Is Like Nothing You've Ever Seen Before...


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

Written on September 23, 2013 at 8:34 am, by Eric Cressey

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: 

 

img_0282

 

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  My good friend Mike Reinold actually has a lot of very good unpublished data on the topic, too.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.

footer_logo-3

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!

Name
Email

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

Written on July 18, 2013 at 6:32 am, by Eric Cressey

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.

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!

Name
Email

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

Written on June 3, 2013 at 7:10 am, by Eric Cressey

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."

Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

Name
Email

Pitching Injuries and Performance: Understanding Stride Foot Contact and Full External Rotation

Written on October 2, 2012 at 1:53 pm, by Eric Cressey

At the end of the day yesterday, I took a quick glance at my Facebook feed and was quickly drawn to a "highlight" video from a baseball strength and conditioning program.  The athletes' energy was great, and there was a ton of camaraderie.  The only problem was that if you had watched the video without first seeing the word "baseball" in the title, you would have never known it was a baseball team training. The exercises - and the way that they were/weren't coached - clearly didn't reflect the unique demands of the sport.

With that in mind, I thought I'd use today's post to quickly highlight the most important positions you need to understand when you're training throwing athletes: stride foot contact/full external rotation.

Stride foot contact occurs just before maximum external rotation takes place.  As the foot touches down, the pelvis has started rotating toward home plate while the torso is still rotated in the opposite direction to create the separation that will enhance velocity.  Maximum external rotation - or "lay-back" - signifies the end of this separation, as the energy generated in the lower extremity is already working its way up the chain.  Nissen et al. (2007) presented this tremendous diagram to illustrate the separation that takes place.  This image represents a right handed picture, where the top image is the hips, and the bottom image is the torso (right and left shoulder joint centers of rotation).

Source: Nissen et al.

Based on this image alone, you should be able to see where most oblique strains and lower back pain originate; this is ridiculous rotational stress.  Additionally, you can appreciate why hip injuries are higher in throwers than they ever have been before; it takes huge hip rotation velocities to play "catch up" so that the pelvis and thorax are squared up at maximum external rotation (if they aren't, the arm drags).  This just refers to what's happening at the lower extremity and core, though.  Let's look at the shoulder.

At full lay-back (maximum external rotation), we encounter a number of potentially traumatic and chronic injuries to the shoulder.  In a pattern known as the peel-back mechanism, the biceps tendon twists and tugs on the superior labrum. The articular side (undersurface) of the rotator cuff may impinge (internal impingement) on the posterior-superior glenoid, leading to partial thickness cuff tears. Finally, as the ball externally rotates in the socket, the humeral head tends to glide forward, putting stress on the biceps tendon and anterior ligamentous structures. 

Likewise, at the elbow, valgus stress is off the charts.  That can lead to ulnar collateral ligament tears, flexor/pronator strains, medial epicondyle stress fractures, lateral compressive injuries, ulnar nerve irritation, and a host of other isssue.  I don't expect most of you to know what much of this means (although you can learn more from Everything Elbow), but suffice it to say that it's incredibly important to train throwers to be functionally strong and mobile in these positions. 

And, this brings to light the fundamental problem with most strength and conditioning programs for overhead throwing athletes; they commonly don't even come close to training people to be "safe" in these positions. "Clean, squat, deadlift, bench, chin-up, sit-up" just doesn't cut it.  You need to be strong in single-leg stance to accept force on the front side with landing.

You need to be able to apply force in the frontal and transverse planes.

You also need to transfer this force to powerful movements.

You need to have plenty of rotary stability to effectively transfer force from the lower to upper body.

You need to be strong eccentrically in the 90/90 position.

You need to have outstanding hip mobility in multiple planes of motion.

You need to attend to soft tissue quality in areas that other athletes rarely have to consider.

These demands are really just the tip of the iceberg, though, as you have to see how all the pieces fit together with respect to throwing and hitting demands at various times of year.  Training for baseball isn't as simple as doing the football strength and conditioning program and then showing up for baseball practice; there are far more unique challenges when dealing with any rotational sport, particularly those that also integrate overhead throwing.  Watch the sport, talk to the players, appreciate the demands, and evaluate each individual before you try to write the program; otherwise, you're simply fitting athletes to existing programs.

For more insights like these, I'd encourage you to check out one of our Elite Baseball Mentorships; we have two of these events scheduled for this fall.

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!

Name
Email

Why Baseball Players Shouldn’t Olympic Lift

Written on August 2, 2012 at 8:22 am, by Eric Cressey

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.

Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

Name
Email

Should Pitching Coaches Understand Research Methods and Functional Anatomy?

Written on July 9, 2012 at 8:53 pm, by Eric Cressey

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.

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!

Name
Email

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

Written on March 27, 2012 at 12:54 pm, by Eric Cressey

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!

Name
Email

Baseball Strength and Conditioning Programs: How Much Rotator Cuff Work is Too Much? – Part 1

Written on January 9, 2012 at 8:15 am, by Eric Cressey

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.

Sign-up Today for our FREE Baseball Newsletter and Receive a Copy of the Exact Stretches used by Cressey Performance Pitchers after they Throw!

Name
Email

Ulnar Collateral Ligament Injuries in Quarterbacks vs. Pitchers

Written on July 26, 2010 at 5:39 am, by Eric Cressey

Here’s an interesting study on the incidence of ulnar collateral ligament (UCL) injuries in professional football quarterbacks.  With only ten reported cases between 1994 and 2008, it’s obviously (and not surprisingly) much lower than the rates we see in professional baseball players.  This is right in line with what I discussed in Weighted Baseballs: Safe and Effective or Stupid and Dangerous?

Bengals Seahawks Football

However, what is very interesting to me is that 9/10 cases were treated non-operatively; in other words, Tommy John surgery is much less prescribed in football quarterbacks than baseball pitchers – meaning that the quarterbacks respond better to conservative treatment.

What’s up with that?  They are the same injuries – and presumably the same rehabilitation programs.

In my eyes, it’s due to the sheer nature of the stress we see in a baseball pitch in comparison to a football throw.  As a quarterback, you can probably “get by” with a slightly insufficient UCL if you have adequate muscular strength, flexibility, and tissue quality.  While this is still the case in some baseball pitchers, the stresses on the passive structure (UCL) are still markedly higher on each throw, meaning that your chances of getting by conservatively are probably slightly poorer.

elbow

I’m sure that the nature of the sporting year plays into this as well.  Football quarterbacks never attempt to throw year-round, so there isn’t a rush to return to throwing.  There are, however, a lot of stupid baseball pitchers who think that they can pitch year-round, so kids often “jump the gun” on their throwing programs and make things worse before they can heal completely.

That said, we’ve still worked with a lot of pitchers who have been able to come back and throw completely pain-free after being diagnosed with a partial UCL tear and undergoing conservative treatment (physical therapy).  It’s an individual thing.

Related Posts

Understanding Elbow Pain – Part 3: Throwing Injuries
Understanding Elbow Pain – Part 4: Protecting Pitchers


Please enter your email below to sign up for our FREE newsletter.

Name
Email

Inefficency vs. Pathology

Written on February 29, 2008 at 5:50 pm, by Eric Cressey

In Newsletter 95, I wrote about how pathologies often don’t become symptomatic until inefficiencies get to be too bad. Here is a perfect example of a guy who has basically learned how to work around a pathology to remain competitive at a high level.

New Twist Keeps Dickey’s Career Afloat

You can bet that he’s got a lot of efficiency working in his favor.

Thanks, Paul Vajdic, for passing this along!


New Balance

Featured Product
Assess and Correct

YouTube Twitter Facebook