A New Exercise for Strength and Stability of the Shoulder

The PronatorThere is not doubt that we need a strong and stable shoulder to maximize performance.  I recently started playing with a new device called The Pronator.  It’s a device designed to strengthen the forearm musculature.  Honestly, this little thing is a fantastic device for grip and forearm strength, but I also started using it with my shoulder exercises and think this may be a game changer!

Take a look at the video below.

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I see this very similar to performing bottom-up kettlebell exercises.  By having an offset weight, you need to work the shoulder in 3D to stabilize and move at the same time.  Pretty cool.  It essentially allows you to:

  • Develop stability in one plane of motion and strength in another
  • Train the cuff to fire and stabilize while moving the scapula

The product is brand new and very affordable at only $55.   I don’t often tell my audience that they need to buy a product, but I really think everyone should have this one.  I like it that much!

 

The Keys to Tommy John Rehabilitation

The latest Inner Circle webinar recording on the Keys to Tommy John Rehabilitation is now available.

The Keys to Tommy John Rehabilitation

Keys to Tommy John RehabilitationThis month’s Inner Circle webinar was on The Keys to Tommy John Rehabilitation.  in this presentation, I overview what I feel are the most important concepts to understand when rehabbing from UCL reconstruction surgery, or Tommy John Surgery.  If you follow these key principles, the rehabilitation process will go smoothly and you can maximize your chances of returning to full competition.  These principles are the perfect complement to the rehabilitation protocol following Tommy John surgery, giving you more details on the most important concepts.

To access the webinar, please be sure you are logged in and are a member f the Inner Circle program.  If you are currently logged in, you will see the webinars below.  If not, please log in below and then scroll down to the “webinar archives” section.  If you are not a member, learn how to access this and ALL my other webinars for only $5.

Inner Circle Log in:

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Functional Stability Training for the Upper Body

My latest educational program with Eric Cressey, Functional Stability Training for the Upper Body, is now available!  

FST for the Upper Body is the third program in out Functional Stability Training system, adding to the popular Core and Lower Body programs.  When Eric and I started to brainstorm what we wanted to teach with these programs, we wanted to share our approaches to rehabilitation and performance training, but more importantly how we integrate the two together.  This makes the FST products a great resource for any rehabilitation, fitness, or performance specialist.

 

Functional Stability Training for the Upper Body

Functional Stability Training for the Upper BodyIn order to function properly, our body needs to be strong and mobile, but control and stabilization of this mobility is often less than optimal.  Unfortunately, stabilization is often overlooked in the design of rehabilitation and performance programs.  Traditional program design relies too much on mobilizing what is tight and strengthening what is weak.  We are missing the boat on stabilization and it’s effect on enhancing optimal movement patterns.

Proper function of the upper extremities is complicated and requires the arm to work in conjunction with the scapula, thorax, cervical spine, and core to provide mobility, strength, and power to the entire body.  Any deficits in stability throughout the body’s kinetic chain can lead to injury, dysfunction, and a decrease in performance in the upper body.  FST for the Upper Body aims to help formulate rehabilitation and training programs designed to optimize how the upper body functions.

By addressing alignment, strength, mobility, and dynamic motor control, you can maximize your rehabilitation and training programs to reach optimal performance.

Think about a few of these:

  • Can the lumbopelvic and thoracic regions impact shoulder function?
  • Can the cervical spine impact the elbow?
  • Can scapular position decrease shoulder performance?

The answer to all of these questions is ABSOLUTELY!  Functional Stability Training for the Upper Body discusses all this and more, showing you exactly how you can assess and correct issues within the kinetic chain to optimize stability and performance of the upper extremity.

Here is an outline of the presentations and lab demonstrations that we perform.  Eric and I combine presentations with real life examples so you can see how we both manage specific individuals based on our assessments.  You get to see Eric and I at work together working with people:

  • How posture and position influence upper extremity function
  • Understanding and managing joint hypermobility
  • Understanding the elbow: functional anatomy, common injuries, and conditions
  • Elbow injuries: evaluation and management
  • Assessment and management of thoracic mobility restrictions
  • Assessment and management of muscles imbalances of the shoulder and scapula
  • Assessment and management of scapular position
  • Assessment and management of elbow epicondylitis

 

Optimal Shoulder Performance

For those that are familiar with Eric and I’s other education program Optimal Shoulder Performance, Functional Stability Training for the Upper Body takes this information to the next level by showing how we integrate the entire body to optimize upper body function.  

FST for the Upper Body integrates the concepts learned from FST for the Core and FST for the Lower Body, and serves as the sequel to their previous educational program, Optimal Shoulder Performance.  FST for the Upper Body is perfect as a stand alone program, but also builds off Optimal Shoulder Performance to help take your knowledge to the next level.  Putting the information from all of these products together will give you a complete understanding of how we approach our integration of rehabilitation and performance.

We had great reviews from the live filming of this program:

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Special Sale Price This Week Only

Functional Stability Training for the Upper Body is available now and is on sale for $20 off to celebrate the launch.  

If you haven’t purchased any of the other FST products in the past, you can get all three FST programs for the Upper Body, Core, and Lower Body together in one bundle and save another $20.

These special sale prices are for this week only and end Sunday May 18th at midnight EST.  Click below to learn more and order before this sale price ends!

 

large-ordernow

 

5 Reasons Why There Are So Many MLB Tommy John Injuries

The baseball season is only a few weeks old and we’ve already seen an impressive amount of MLB pitchers need Tommy John surgery.  This pace could lead to a record breaking amount of injured pitchers.  While many have speculated about the causes of this rise, I wanted to share my perspective as someone that has worked with healthy and injured players from Little League to Major League Baseball.

 

Injuries Are Higher in the First Month of Season

It’s probably not going to be as bad as we think.  The big league trends have been studied and have shown that MLB injuries are higher in the first month of the season.  I feel like every year at this time we all comment on how Tommy John surgeries are on the rise and will reach new records.  Over the course of the season, this tends to slow down and even out.

baseball injury rates

Looking at the amount of Tommy John surgeries over the last decade, the number per year is fairly consistent, especially if you consider 2012 an anomaly.  Sports Illustrated showed a nice graph of this recently.  Perhaps this year does show another trend upward.  But I wouldn’t be surprised if we saw a slow down and ended up right around 20 Tommy John’s this season.

 

Preparation for the Season

So considering that injuries are higher during the first month of the season, what could be the reason for this?  I think there are probably two reasons why we see so many Tommy John surgeries near the beginning of the season: 1) poor preparation, and 2) lingering issues.

I think a big factor is preparation for the season.  Over the last two decades we have improved offseason strength and conditioning.  I don’t think it is that players are sitting around on the couch all offseason.  Rather, I think it has more to do with their throwing programs.

There are two ends of the spectrum, the established player that knows that they have a spot on the roster, and the player trying to make the team.  For the player trying to make the team, they need to show up on day one of camp ready to go and ready to impress.  This requires more throwing in the offseason and a more aggressive progression, knowing that roster cuts are just a week or two away.  These players also tend to throw through soreness, fatigue, and tightness in spring training and avoid the training room like the plague.

I’m not sure if this is fixable, though creating a more unbiased and proactive medical department may be a start.  Players shouldn’t fear coming into the training room, but many do.  It is the organizations job to assure players that treatment is preventative with the goal of staying on the field and enhancing performance.  This education starts in player development.

The established player, especially the veterans, may be trying to save some bullets and start throwing a little later, and ramp up a little slower.  I actually like this approach as the goal is to pitch all the way through October.  This is where spring training may need to be evaluated.

Spring training usually begins with several bullpens and live batting practice in the first week.  Some teams will throw up to 5 pens and live BP’s in 10 days.  The starters would then start pitching every 5th day for 1-2 innings.  That represents a huge jump, and then a huge slow down.

This was always my least favorite week of the year, and I think most of the pitchers agreed.  Guys arms were hanging every year. Players go from a casual offseason progression to an excessive amount of high intensity pitches in a short amount of time.  It is a grind.  This approach may be necessary for some, but I’ve talked to many MLB pitchers that disagree.  There are reasons for this progression that range from tradition, to roster decisions, to simply a lack of time to prepare all the pitchers.

I was always a fan of pitchers coming to camp a little early to ease into this progression.  Pitchers do not need to work through a “dead arm.”  That is just silly.  The goal is to avoid the dead arm.

I also feel that many players have been dealing with elbow issues in past seasons and hope that a good offseason will heal them up.  Realize that although it may come as a surprise to you when you hear of a MLB pitcher needing Tommy John surgery, many times both the team and the player have been following their elbow symptoms and trying to avoid the surgery.  They give it a good offseason but come to camp and still have symptoms.

 

Velocities are Increasing

Another interesting trend that we are seeing is a large jump in average velocity in MLB.  We know that velocity is one the factors that is associated with Tommy John injuries.  A recent article by Travis Sawchik of TribeLive noted the trend in MLB towards higher velocity.  In 2008, the average fastball in MLB was 90.8 MPH, in 2013 the average fastball was 92.0 MPH.  in 2003, Bill Wagner was the only MLB pitcher to throw 25 pitches over the speed of 100 MPH.  In 2013, there were 8.

Take this with a grain of salt as I tried to look at this myself using Pitch/FX data, but my data shows almost a 1 MPH increase in velocity from 2007 to 2013.  More interesting is that there has been a near linear increase in velocity each year (with the exception of 2010, as 2009 saw a large jump).  On average, as you can see with the straight line, velocity is trending upward each year.

Average MLB Fastball Velocity

When I was a kid playing Little League we would all wish we could throw 90 MPH.  90 MPH is close to unemployed now.

This comes down to simple physics.  F = M*A.  Force equals mass times acceleration.  If the trend in velocity continues to rise, the trend in Tommy John injuries will also continue to rise and pitchers will be experiencing these injuries earlier in the career.

Teams still want to draft for velocity, which isn’t surprising, we just need to realize that these guys are going to break down faster.  That is OK, just don’t be shocked when the 26 year olds all start getting Tommy John instead of the 32 year olds.

 

What Goes Around Comes Around

Tommy John InjuriesWe are starting to see the results of what these kids did 10 years ago.  The excessive pitching from youth and high school baseball is catching up.  There is a lifespan on your ligament.  Many kids are injuring themselves as kids and may not even know it.  Remember that week your elbow was soreness in High School?  Yup, that may have been the beginning.

In addition to avoiding overuse, which has repetitively been proved to be the #1 factor in youth pitching injuries, youth pitchers need to proactively manage their soreness and injuries.  Don’t ignore your symptoms, get them worked on by a physical therapist.

My friend Dr. Glenn Fleisig from the American Sports Medicine Institute said this to me once: “If you give a kid a pack of cigarettes in Little League, they probably aren’t going to get cancer right away, but they may down the road.”  What we do to our arms as youth carries over to our career.

If you ask a lot of MLB pitchers about a decade ago what position they played in Little League and High School baseball, many would have said shortstop or center field.  If you asked that same question now there is no doubt in my mind that most pitched throughout their youth.  We are specializing early.  You could argue that this creates a better pitcher, and I bet it does, however they are breaking down earlier.  Just like velocity, it is a trade off.  (photo credit)

 

Pushing Past Our Physiological Limits

MLB pitching injuriesSimilar to the overuse and early specialization we have seen in pitchers, we are now seeing a large trend towards focusing on velocity at an early age.  I get it, velocity is what gets you drafted.  Perhaps that is the actually problem.

However, I feel like we are excessively trying to push pitchers past their physiological limits to develop velocity.  But at what cost?  It is not advisable for youth players to begin aggressive long toss and weighted ball programs that are not customized to their unique body and goals.  Yet this is exactly what we are seeing.  Kids do not want to wait to grow, develop, get strong, and perfect their mechanics, they want velocity now.

So they start aggressive long toss and weighted ball programs on a weak frame, before their body matures, and with poor mechanics.

I am not against long toss and weighted balls, I am against the sloppy use of these training techniques.  These are tools in a system that absolutely must be customized for each player.

We are seeing a trend towards being too aggressive.  If throwing a 6 oz overweight ball has been shown to increase velocity, than throwing a 2 lb overweight ball will increase it even more!  If long tossing to 180 feet has been shown to increase velocity, then throwing to 300 feet will increase it more!  Realize there is always a diminishing return with a huge rise in risk.  I’ve written about this when discussing baseball long toss programs and the concept of the minimum viable exercise (your should read these both).

There are ways to safely and effectively increase velocity that do not require you to excessive push past your physiological limits.  I’ve written about this in the past and if you are a parent, coach or athlete you should read this article about how baseball players can enhance performance while reducing injuries.

 

 

To summarize, I don’t think Tommy John injury rates in general are going to slow down, as I don’t think any of the above factors are going to change anytime soon.  If what I wrote above is correct, we should see Tommy John surgies increase even more over the next decade.  Remember, what we are seeing now is the summation of the last 10+ years of players career.

I hate seeing all the articles in the media asking about why injuries continue to rise despite the greater focus on injury prevention.  It’s not the medical teams fault.  It’s not the strength coach’s fault.  It’s not the players fault.  It’s the nature of baseball right now.

 

8 Keys to Tommy John Rehabilitation

Tommy John Surgery

With the baseball season almost officially in full swing, we are starting to see several players needing UCL reconstruction, or Tommy John surgery.  We know that injuries are most common in the first month of the baseball season.

For those unfortunate to have injured their elbow, sorry to hear that.  But luckily Tommy John surgery is fairly successful.  With the right Tommy John rehabilitation, your should be able to return to pitching with minimal complications.

Knowledge is power, so in order to recover as best as possible, I want to education you on what I consider the keys to Tommy John rehabilitation.  You should probably go back and read my past article on the 5 Myths of Tommy John Surgery as well.  Follow these keys and put yourself in the best position to succeed.

 

Avoid Loss of Elbow Motion

elbow extension tommy johnOne of the most common complications following Tommy John surgery is loss of elbow motion, especially elbow extension.  The elbow is a very congruent joint, there isn’t a lot of empty space and room for error.  So anytime you have surgery and scar tissue formation, you risk the chance of losing motion.  The problem is, once you get behind with motion, you end up being behind for a long time.  This can slow down your return to throwing.

Over the years we have progressed our rehabilitation program to focus on restoring full extension of the elbow a little faster.  My goal is to have full elbow extension by 3-4 weeks if possible.

The key to this is early rehabilitation and finding a skilled physical therapist with experience in Tommy John rehab.  Despite the media coverage that this surgery receives, in the grand scheme of things it is a relatively rare surgery so many therapists have never worked with one.  A skilled therapist will know when to push and when to back off, you want them guiding you through this process.

It still amazes me that in this day and age, there are still surgeons who do not emphasize early rehabilitation.  Take it upon yourself and make sure you don’t get behind with your motion.

 

Work on Imbalances During the Early Phases

manual therapy tommy johnI tell my athletes undergoing UCL reconstruction that there are three phases of Tommy John rehabilitation – The Boring Phase, The Monotonous Phase, and the Fun Phase when you get back to advanced exercises and eventually throwing.

To break this down, the first 4-6 weeks are focused on recovering from the surgery, reducing your pain and swelling, restoring your motion, and starting basic exercises.

The next two months consist of building back your strength, mobility, and stability.  This involves shoulder program exercises and using those little dumbbells, slowly progressing week by week,  Think of this phase as laying the foundation for more advanced exercises.  It gets really monotonous laying those bricks down, but without them you are not going to have a good outcome or maximize your potential.

This is where I see most rehabilitation programs miss a huge opportunity to work on the some of the imbalances that likely led to you needing Tommy John surgery.  These often include issues with your posture, core stability, and alignment of your scapula.  This is a great time to work on those long standing soft tissue restrictions of the throwing arm.  Manual therapy here is key.

Throwing a baseball places a lot of stress on your UCL ligament.  But I often wonder if it is restrictions in your soft tissue, mobility, and strength from the shoulder, scapula, trunk, and core that placing the extra strain on your elbow that led to the injury.  Use this time to get back to neutral so that way when you are ready to start throwing, you have put yourself in the best position to succeed.

 

Focus on the Shoulder and Scapula

Most of my athletes are amazed at how much my focus of rehabilitation is on the shoulder, scapula, trunk, core, and legs, and NOT the elbow.  Don’t get me wrong, we do plenty of elbow work.  The flexor carpi ulnaris and flexor digitorum superficialis muscles of the forearm lay directly over the UCL ligament and have been shown to provide 24% of the dynamic stability of the joint.

But the emphasis of any throwing athlete is often on the shoulder and scapula.

Think of the throwing motion as a wave of energy transferring from your legs, through your core, and eventually down your arm to the ball.  Any restrictions or deficiencies in mobility, strength, or stability will cause an inefficient transfer of energy and often times your elbow takes that extra load.  Most of the predisposing factors to injuring your UCL involve reduced strength and alterations in shoulder motion.

 

Integrate Core and Lower Body Training

Similar to emphasis on the shoulder and scapula, to really achieve optimal performance when you come back from Tommy John surgery, you must integrate proper core and lower body training.  The above comments on the kinetic chain are applicable here too.

The days of just doing some treatments on the elbow and a few exercises for the shoulder are over.  Proper rehabilitation programs must include attention to the core and legs to reach peak performance.

 

It’s Not Just About Strength

kinetic chain tommy johnWe’ve talked a lot about working the elbow, shoulder scapula, trunk, core, and lower body.  Most people, however, take this to mean get these areas strong by performing strengthening exercises.  That is absolutely true and important.  However, throwing strength on top of all your past problems is only going to mask your real issues.

Equal attention must also be spent on restoring mobility and dynamic stability.

To throw a ball effectively, you must be strong and stable.  Throwers tend to have laxity in their joints that allow them to bend and stretch further than most.  This is extremely effective in making you a better pitcher with more velocity on your fastball.  But it is also the reason why throwers get injured.

So we know that the joints of the elbow and shoulder have some underlying inherent instability.  The must have pristine dynamic stability to counteract this.

Dynamic stability is simply your muscles ability to contract at the right time and intensity to stabilize your arm, and essentially prevent your arm from flying off your body.  This is trainable, but it is difficult to do on your own.  We perform a series of progressively advanced exercises to enhance your neuromuscular control and maximize your muscles’ ability to dynamically stabilize.

 

Don’t Skip or Rush Steps in the Progression

One of the flaws that I often see in athletes that come to me from a consult, but are rehabilitating elsewhere, is the expectation that the rehabilitation progression is simply a protocol and based on time.  I often here, “It is week 16 and my doctor said I can start throwing.”

OK, sounds good, on the inside your UCL ligament is healed enough to throw in the doctor’s mind.  But are you “ready” to throw?

What I mean is, do you look good on my examination?  Did you restore your motion?  Do you move well?  Did you restore your strength? Do you exhibit proper dynamic stabilization?

Most importantly I always review their rehab program to date and assure that have went through the proper sequence.  If you haven’t done the right program to date to prepare yourself to throw, you aren’t picking up a ball with me.  I don’t care how weeks ago you had Tommy John surgery.

 

Use Your Throwing Program to Work on Your Mechanics

release pointI think there are 3 main reasons you injure your UCL.  The number one factor is overuse.  The more you throw, the more stress you put on your ligament.  I also think improper physical preparation can also lead to UCL injuries.  But don’t forget that your pitching mechanics have a large impact on your chances of hurting your ligament as well.

There are many mechanical faults that have been scientifically proven to increase stress on your UCL, such as throwing with and inverted W.

If you are serious about pitching, you need three key consultants on your team to help you achieve your goal, a physical therapist, a strength coach, and a pitching coach.  Together, this team covers all your major bases for a strong and healthy return.

Your throwing progression is going to be long.  Initially, I like you to just worry about throwing and playing catch, and NOT your mechanics.  But this switch flips once we get closer to pitching and throwing off a mound.  Create good habits early and work with a pitching coach on some of the mechanical factors that may have led to your Tommy John injury in the first place.

 

Follow a Slow and Gradual Throwing Progression

Many times people have a really good comeback from Tommy John surgery during the rehab process, but have issues during their throwing program.  Here is an important thing to consider:

There are going to be bumps in the road.

I usually see these bumps at the transition points such as when you start long toss, or when you start throwing off a mound.  Any time you have a jump in intensity or volume, this may occur.  These are common and expected.  If you put in the proper effort and progression to date, you have put yourself in position to successfully deal with these events.

The key is to avoid a roller-coaster progression of speeding-up, slowing-down, and speeding-up again.  A slow and gradual progression is always best.

I’m going to let you in on a very super secret that most doctors and therapists do not want you to know.  Your are probably going to feel great about 1-2 months into your throwing program and think you can throw 100 mph.

Resist this urge.  You are not ready and you will flare up your elbow (or even shoulder).

Please, please, please do not rush back to returning to pitching, especially for the youth and parents reading this.  Yes, our research has shown that pitchers return to throwing at 9-12 months following surgery.  Realize there are a large variety of people in a study like this.  Many of my MLB pitchers have return in 10-11 months, especially the veterans.  There are a lot of factors in determining this return date.

But I do not even feel good about a veteran all-star returning at 9 months after Tommy John surgery, let alone a 16 year old.  For the youth and even collegiate pitchers, a good timeframe to shoot for is 12 months.  Do it right the first time.

SEE ALSO: Watch my full presentation on the Keys to Tommy John Rehabilitation

With the right care and attention, UCL reconstruction surgery can have a really good outcome.  Follow these 8 keys to Tommy John Rehabilitation and you’ll be back on the mound in no time.

 

5 Myths of Tommy John Surgery

One the big topics at the 2014 ASMI Injuries in Baseball course this year was our evolving understanding of the outcomes follow UCL reconstruction, better known as Tommy John surgery.  As each year goes by, we have more data on the results of people who have previously had Tommy John surgery since Dr. Frank Jobe first performed the procedure.

Dr. James Andrews and Dr. Frank Jobe

Dr. James Andrews and Dr. Frank Jobe

Over the last few years we have seen very important outcomes studies from Dr. James Andrews, who undeniably performs the most Tommy John surgeries of anyone in the world.  In 2010 they published the short term 2-year results of 1281 athletes over a 19 year period.  More recently, they have presented their results on 256 people with at least 10 years follow up, meaning that they all had surgery at least 10 years ago.

Based on the information we have obtained from these landmark studies, we now know more about the outcomes of Tommy John surgery.  However, has some of the public perceptions around Tommy John remained true or has our opinions been swayed by sensationalized media reports?

Dr. Chris Ahmad, of the New York Yankees, recently released a paper asking players, coaches, and parents about their perceptions regarding Tommy John surgery.  The authors report:

  • 28% of players and 20% of coaches believed that performance would be enhanced by having Tommy John surgery.
  • 23% youth, 32% HS, 53% of college pitchers, 33% of coaches, and 36% of parents believed velocity increases after Tommy John  surgery.  (I polled my followers on Twitter and Facebook yesterday too and I would say the majority do believe that velocity increases after Tommy John surgery)
  • 24% of players, 20% of coaches, and 44% of parents believed that return would occur in less than 9 months.

And get ready for the most shocking one:

  • 33% of coaches, 37% of parents, 51% of high school athletes, and 26% of collegiate athletes believed that Tommy John surgery should be performed on players without elbow injury to enhance performance.

That is absolutely crazy!

Based on Dr. Ahmad’s study and recent research on this topic, I wanted to discuss many of these perceptions to help people understand that many of these are myths.

Here are 5 myths of Tommy John surgery that any player, coach, or parent needs to fully understand.

 

Everyone Returns From Tommy John Surgery

If 37% of parents and 51% of high school athletes believe that they should have Tommy John surgery even if they don’t have an elbow injury, then the assumptions must be that every returns to throwing, so why not?

Well, first off, Major League Baseball disagrees.  Stan Conte, the Head Athletic Trainer of the Los Angeles Dodgers, presenting interesting data at the 2014 ASMI Injuries in Baseball Course.

SEE ALSO: Presentations from the ASMI Injuries in Baseball Course can be seen at RehabWebinars.com

He noted that 16% of all professional baseball pitchers, both Major and Minor League combined, have had Tommy John Surgery, and 25% of Major League Baseball pitchers have undergone Tommy John Surgery.  So if Tommy John surgery was a slam dunk, that number would be closer to 100%.

According to both the short term and long term Dr. Andrews studies, 83% of pitchers return to play at the same level or higher.  83% is a really good result, but it is not 100%.

Simply put, no one wants Tommy John surgery unless they need it.  Returning from surgery is not guaranteed.

 

There are No Complications with Tommy John Surgery

Tommy John Surgery

Tommy John Surgery

While I would certainly agree that complications can be kept to a minimum with good surgery and rehabilitation, don’t forget that Tommy John surgery does not always go smoothly and can have complications.

In the above mentioned study perform by Dr. Cain and Dr. Andrews, they noted that 20% of all the procedures performed by Dr. Andrews had complications, though 16% were considered not major complications.  These can range from issues with your ulnar nerve, to infection, to even failure of the graft.

Keep in mind that this rate of complication was reported by the surgeon that is considered the best at this procedure and performs the most Tommy John surgeries.

No surgery is 100% perfect, there will always be some complications.

 

Recovery From Tommy John Surgery is Quick and Easy

The false sense of comfort that the general public has adopted over the years also implies that the general assumption is that recovery from surgery is quick and easy.  Again, Dr. Ahmad reported that 44% of parents believe their child can return to pitching in less than 9 months.

In general, we have always said that return to play takes 9-12 months.  This was based on past studies that showed this range was common.  I must admit that I have seen a mild trend in baseball with people attempting to come back quick, closer to the 9 month range.

Results from Dr. Andrews’ studies have shown the average time to competition has been 11.6 months.

There are a lot of factors involved with deciding when a safe return to play show happen with each individual.  These include your age, level of play, timing of the surgery, and how well your rehab has gone to date.  I honestly don’t remember the last time I have had someone return at 9 months.  Some of the elite level MLB players that I have worked with have returned around 10.5-11.5 months after surgery, but I really don’t recommend that for younger players.

I personally am going to stop citing the 9-12 month range, as I feel that may bring some false hope and information to many people.  I am personally going to start simply saying Tommy John recover is 1 year.  I may individualize this for each person, but as a rule of thumb, I think elite level players returning around 11 months and amateurs around 12 months is probably in the athletes’ best interest.

Assume going into surgery that it is going to be 12 months before you return to competition.

 

Velocity Improves After Tommy John Surgery

Of all the myths discussed so far, I think the myth that velocity increases after surgery is likely the most important to dispel.  This fact has been sensationalized in the media for years.

Two preliminary research projects have recently been conducted that looked at MLB pitchers velocity before and after having Tommy John Surgery.  Rebecca Fishbein presented a report at the 2013 Sabermetrics meeting in Boston.  She analyzed the average velocity of 44 MLB pitchers before and after undergoing Tommy John surgery between 2007 and 2011.

She reported no significant difference with velocity after surgery (she actually found a mild 0.875 mph decrease in velocity, though this was not significant).  Stan Conte reported a similar finding at the 2014 ASMI Injuries in Baseball Course in 32 pitchers from 2007 to 2012.  In Stan’s study, there again was no significant difference in velocity before and after surgery (he also found a 0.79 mph drop in velocity, but again not statistically significant).

I personally have seen many players increase their velocity after surgery, but the important point here is that on average, velocity does not change.  There are many reasons why it may go up in some people.  Perhaps they were pitching with a deficient ligament or in pain for several years, perhaps they never worked out before surgery, or perhaps the hit a big growth spurt while rehabbing.

Despite popular belief, velocity has not been shown to go up in MLB pitchers after Tommy John surgery.

 

All Tommy John Rehabilitation is the Same

Tommy John Rehabilitation

Tommy John Rehabilitation

This last myth is personal one for me!  Baseball pitchers are such unique athletes that to truly get the best outcomes, you really need to work with a person that has extensive experience.  There are many subtleties and things to watch out for that could easily slow down the rehab process if you aren’t on the look out.

I have spent my entire career working with baseball players and I can tell you I continue to learn more and more about what makes them unique every year.  Just when you think you have figured out something, someone comes around and amazes you with what they can do with their body.

Tommy John rehabilitation requires the understanding of the unique attributes of the baseball pitcher, the unique nature of how these injuries occur, and knowledge of the stress involved while throwing during the recovery.  Anyone can follow a protocol, it is understanding how to individualize the protocol to each person to avoid speeding up and slowing down the program like a roller coaster.

Losing range of motion is going to be a problem, assuring the ulnar nerve isn’t stressed is an issue, gradually progressing activities to make sure the ligament is ready to start throwing is always important, and controlling strength and conditioning workloads while progressing a throwing program takes skill and experience.

Everyone rehabbing after Tommy John surgery is going to have some bad days and even bad weeks.  It is how these periods are handled that will assure you return to competition safely and effectively.

 

Summary

In summary, 83% of people undergoing Tommy John surgery have been shown to return to play at the same level or higher, without an increase in velocity, in 11.6 months [Click Here to Tweet].

Tommy John surgery is not a slam dunk, so the best strategy is ALWAYS to avoid surgery as much as possible.  While this isn’t always possible, programs should be built that work on enhancing performance AND reducing injuries in baseball players.

SEE ALSO: How Baseball Players Can Enhance Performance While Reducing Injuries

Despite popular belief, if you have Tommy John surgery you are not guaranteed to return to your previous level without complications, and rehab is not a quick and easy process that results in improved velocity.

 

 

5 Things You Must Understand About Baseball Long Toss Programs

Long toss programs have become one of the most popular forms of baseball training over the last several years.  It seems like everyone on the internet has a long toss program that guarantees to increase your pitching velocity.  The number of youth pitching injuries continues to increase at alarming rates, despite our pitch count guidelines and improved medical knowledge.  This has caused some to question the role of aggressive long toss programs on the increased rate of injuries, which may or may not be fair, as there are many different ways of integrating long toss training programs.

The intent of this article is not to offer an opinion on whether or not long toss is appropriate, safe, effective, or anything else.  The purpose is not to recommend a specific throwing program or distance either.   Rather, I simply want to make sure you completely understand what long tossing does to your body before you start a training program.  There are several things you need to understand to best implement a program that is specific to your needs.

 

Long Toss is Important

baseball long toss program

Let’s get this point out of the way first – long toss programs are important.  I don’t think this is much of a debate as long toss, in some form, is a normal part of almost every baseball training program.  Saying you do or do not like long toss is like saying you do or do not like Pizza.  There is a large difference between Dominos pizza and something from Boson’s North End.  Same goes for long toss.  How you define long toss is probably more the debate.

Some consider 120 feet long toss, while others will say over 300 feet.  That is a big difference.  I don’t know the answer but I know that things change the further you throw.  You need to understand this too.

While long tossing is important, it is also often blown out of proportion.  People that are advocates of long toss programs will excitedly tell you which big leaguers utilize long distance long toss programs in their training.  But realize there are also plenty of professional baseball players that do not incorporate a lot of long toss into their routines.  I know many big leaguers who do not often throw more than 120-150 feet, and I’ve talked to many that live in colder climates and throw indoors in places like basketball courts all offseason, limiting the distance they can throw.

I only bring this up because I hear from many of my patients and clients about all these great MLB players that long toss, and while that is true, just realize there are many that do not.

I think long tossing is important to help get the arm in shape and accustomed to developing and dissipating forces.  But you really need to understand many of the points below to truly appreciate what long toss does to your body.

 

Long Toss Does Not Increase Arm Strength

I’m not really sure where the concept of long tossing developing “arm strength” came from but it certainly is common.  This may just be a garbage term that is thrown out there, or just an easy term to relate to the player, but to be clear and specific, I actually think throwing DECREASES arm strength.

long toss arm strengthIn fact, I published a few years ago that Major League Baseball pitchers lose between 3-4% of rotator cuff strength over the course of a season, and that is with a well designed strength and conditioning program.  It has also been shown that pitchers lose between 11-18% of arm strength from fatigue over the course of a game.

So I think it is safe to say that throwing doesn’t increase arm strength.  Rather, it may actually  be counterproductive for arm strength as throwing seems to fatigue the shoulder.  Long tossing may improve something else, such as muscular endurance or arm speed, but there is a fine line between building speed and endurance and overloading and causing fatigue.  If you cumulatively fatigue the arm, you will get strength loss, not gain, and put yourself at risk for injury.

This is an important concept to understand as young baseball players are hearing that long toss increases velocity and assuming that the more they long toss, the harder they will throw.  This is resulting in more throwing over the course of the year.   Now young baseball players are competitively pitching and then long tossing both during the inseason and offseason.   Remember that pitching for more than 8 months out of the year increases your chance of getting injured by 5x!

There is a place for long toss, but it does not build arm strength.  To build arm strength you need downtime from throwing and good arm care and strength and conditioning programs.

 

The Rehab World Does Not Say Stop at 120 Feet During Long Toss Programs

I’m going to take the blame for this one.  One of the most common disputes I hear from advocates of long toss programs is that throwing to 120 feet isn’t long enough.  I’ve heard and read many people criticize the baseball community for applying the same long toss programs for healthy players and players returning from injury, citing the that the published rehab throwing programs stop at 120 feet.

This is actually a misunderstanding and I speak from experience.  I actually helped develop the most popularly utilized long toss rehabilitation programs used by Dr. James Andrews and I published these programs in the Journal of Orthopedic and Sports Physical Therapy over a decade ago.  If you actually read the manuscript, you’ll see that I don’t say that throwing programs should stop at 120 feet.  In fact, the program actually goes out to 180 feet.

We simply state that you need to throw out to 120 feet before meeting the criteria to begin throwing off a mound.  Some players will want to go past 120 feet (and should), while others will not.  The point is, you don’t have to throw past 120 feet but in order to progress to throwing off a mound, long tossing to 120 feet is just one of the criteria.

Now I readily admit that these published long toss programs are not perfect, and I in fact do not quite follow these programs as I wrote myself.  You see, it’s hard to develop a long toss program that is applicable for everyone.  A certain amount of generalization needs to occur in the rehabilitation setting.  We’ll talk more about this in my last point below.

 

Long Toss Does Not Promote Proper Pitching Mechanics

It is really impossible to use consistent pitching mechanics when long tossing.  This is just simple physics.  I’m not sure how people can state that long tossing helps with your pitching mechanics as you need to throw differently the further you go.  Glenn Fleisig and the American Sports Medicine Institute recently analyzed the difference in mechanics between pitching off a mound and long tossing at 120 feet, 180 feet, and at maximum distance.

This study revealed significant mechanical changes during long toss.  You are not throwing downhill, like on a mound.  In fact you are actually throwing uphill, as your trunk is more upright and your front knee is less flexed the further you go back.  Your upper trunk angle actually quadruples from pitching to throwing max distance.

These both have implications on throwing as your more upright position will change your trunk and front side’s contribution to throwing and your release point will vary dramatically.

Also, of interest is that you land with your foot position more open the further you throw.  Essentially, you long toss more on a line than slightly across your body (which is normal).  To me, this implies you need to have less rotational motion to throw the ball for maximum distance.  You essential throw more like a ferris wheel than a carousel when you long toss, which utilizes different muscle recruitment patterns and motor planning from when you pitch.

So in light of all our recent research on motor control, neuromuscular planning, and specificity of training, it would appear long tossing does not support improving your mechanics.

I know from my experience with elite level pitching that your ability to repeat your mechanics over and over again is one of the most sought after skills and something the separates the elite from everyone else.  Remember my first point above, long toss is important, but it is not because it helps with your mechanics or encourages repeating your delivery.

 

The Longer you Throw the More Stressful it is on Your Body

When our long toss programs were originally being developed, one of the first questions that we sought to answer was what happens to the forces on your body as you throw from certain distances.  We know from the above information that you have kinematic changes, but what about the kinetic forces on the body?  Dr. Fleisig also looked at the forces observed on the body in the above mentioned study.

long toss forcesLong tossing at 180 feet has significantly more elbow varus torque and shoulder internal rotation torque, essentially the two types of forces that cause injuries to your shoulder and elbow, especially Tommy John injuries.

We know that pitching a baseball places near maximal stress on the body with each pitch.  Long tossing to 180 feet and beyond increases this stress more than pitching off a mound.  This is one of the main reasons that the criteria for an injured player to start throwing off the mound is only 120 feet.  At 120 feet, the forces observed are similar to pitching.  So if you can throw to 120 feet, you can technically handle the stress of throwing off a mound.

Athletes can handle the stress observed during long tossing to 180 feet and beyond, but for how long and at what consequence?  I had a discussion with Dr. Fleisig and Dr. Andrews about this concept and the analogy that was used was rather alarming – You can observe a group of Little League aged kids smoke a pack of cigarettes a day and none of them will likely get lung cancer while in Little League, but they may one day.  What are we doing to them in the long-term?

Realize that the pitch count guidelines that were developed by Little League and USA Baseball are designed to prevent injuries by avoiding overuse.  Long toss to 180 feet and beyond needs to be included in this equation as well.  If you want to decrease you chances of getting injured by 5x, you need to not pitch or long toss for 4 months out of the year.

There is a time and place for long toss, but this needs to be treated like pitching and considered in the overall equation for overuse.

 

Maximum Distance Long Tossing is Stressful on Your Body

To me, the most interesting part of the studies from Dr. Fleisig and ASMI is when they analyzed maximum distance long tossing.  In addition to analyzing how your biomechanics change as you throw from certain distances, they also assess the biomechanics of simple throwing as far as you can.

The results were staggering.

When asked to throw as far as they could, with a crow hop and with no restrictions on the amount of arc on the throw, pitchers averaged a throw of 264 feet, far below the recommendations seen in some baseball training programs.

This resulted in a 10% increase in both elbow varus torque and shoulder internal rotation torque.  So while long tossing to 180 feet showed an increase in torque to your shoulder and elbow, these forces went up dramatically when throwing for maximum distance.

There is a risk / reward equation with long tossing to 180 feet, but this equation appears to heavily lean towards the risk when throwing further.

 

The Best Baseball Long Toss Program

I wrote this article for one simple reason – there is no such thing as the best baseball long toss program.  Everyone wants one, but it just doesn’t exist.  Everyone is different, including their body type, size, age, experience, and mechanics.  Recommending one generic long toss program for everyone seems overly simplified.  While it may help a small percentage of people, it appears that it could harm a much larger percentage.  That is why the rehab throwing programs I published seem so basic.

Now that you understand some of the finer points of long toss programs, I hope this allows you to understand that the best long toss program needs to be individualized.  You shouldn’t be doing a program just because some big leaguer is doing it, you should be doing it because it has been specifically developed for you in combination with a well designed arm care and strength and conditioning program.

To follow this up, I will write an article soon on what I believe long toss is actually doing and why it may be beneficial to include in baseball training programs, if designed appropriately.

 

 

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Are We Putting Our Kids at Risk for Youth Baseball Injuries?

Over the years I haven’t been shy about discussing the rise in youth baseball injuries and some of my thoughts regarding how to reduce the amount of pitching injuries.  I have written about the reason there are so many youth pitching injuries and presented my tips on reducing youth baseball injuries.

In the past, I have stated that the real reason that the amount of youth throwing injuries is rising is not because they are throwing more curveballs, or pitching with poor mechanics, or performing too aggressive long toss programs, or any of the other proposed claims.  They may be involved, but I simplified my response and said that the real reason why there are so many youth baseball injuries is due to abuse.

Notice I didn’t say “overuse,” I said “abuse.”

 

Are Youth Baseball Injuries from Overuse or Abuse?

youth baseball injuries

There is a big difference between overuse and abuse.  Overuse implies that the athlete is simply throwing too much, which is often in fact accurate.  To date, there have been excellent studies from the American Sports Medicine Institute that has shown that the primary factors that correlate to injury in youth baseball are related to overuse.  (Photo by Edwin Martinez1)

Specifically, the more you pitch, the more you raise your chances of getting hurt.  This includes factors such as:

  • Pitching competitively for more than 8 months of the year
  • Pitching on back-to-back days
  • Pitching for more than one game in the same day.
  • Pitching for more than one team during the same season
  • Pitching and also playing catcher on the same team

To combat this, both Little League Baseball and USA Baseball have provided pitch count rules and guidelines to follow.

 

Are We Following the Guidelines to Reduce Youth Baseball Injuries?

However, abuse is when our parents and coaches simply neglect the stated pitch count guidelines and youth safety information that has been provided for our youth athletes.

You may recall that I wrote about a study that polled 95 youth baseball coaches regarding youth pitch count rules.  The results indicated that 57% of questions regarding the rules were answered incorrectly, essentially stating that the coaches did not understand the rules.  27% of coaches admitted to not following the safety guidelines, however only 53% of coaches felt that other coaches in the league followed the safety guidelines.  Furthermore, 19% of coaches reported that they pitched a player while having a sore or fatigued shoulder or elbow.

Keep in mind that these are only the coaches that admitted to not following the rules!

Early results from an AOSSM sponsored study of over 700 pitchers around the country between the ages of 9 and 18 have started to surface.  One-third of the pitchers reported having a pitching-related injury in the past 12 months, seven out of 10 reported significant arm tiredness in the past 12 months, and nearly 40 percent reported significant arm pain within the past 12 months.

More importantly, the study was able to quantify the percentage of youth baseball pitchers that were performing activities that have been correlated to increase injury risk:

  • 40% pitched in a league without pitch counts or limits
  • 13% of pitchers pitched competitively for more than 8 months of the year
  • 57% pitched on back-to-back days
  • 19% pitched more than one game in the same day.
  • Nearly 33% of these pitchers pitched for more than one team during the same season
  • 10% also played catcher on the same team

The results of the study demonstrate that quite a large percentage of youth baseball players are putting themselves at risk.

 

The Key to Reducing Youth Baseball Injuries May Be Awareness

The first step in injury prevention is awareness.  We now know several factors that correlate to injury.  We now have rules and guidelines that have been designed with this information in mind.   We now know the percentage of coaches that understand and are actually following these rules.  We now know how many players are putting themselves at risk.

This is a lot of information.  Now it is time to start promoting this information and raising awareness.  Who is with me and how are you going to help promote this information to help reduce youth baseball injuries?

 

 

 

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