How to Prepare Before You Throw – Part 2: Prepare Your Throwing

As I said in part 1 of this 2-part article on How to Prepare Before Your Throwing Program, one common theme that I often hear when players describe how they got hurt was that they did not properly warm up and prepare themselves to throw.

To prepare before your throwing program, you really need to do two things: 1) Prepare your body and 2) Prepare your throwing.  If you haven’t yet, please go back and read part 1 of this article to learn how to prepare your body:


How to Prepare Before Your Throwing Program – Part 2: Prepare Your Throwing

Now that your body is ready to roll and start your throwing program, I want to shift gears and talk about how to use your throwing program to prepare to throw.  I think it is really import to “prepare to throw, not throw to prepare.”

What I mean by that is that you need to make sure you are properly warmed up, even within your throwing program, before you can start your throwing “work.”  You shouldn’t just jump on the mound, or throw at full intensity, or quickly progress to long tossing.  That is throwing to prepare, and as I stated in part 1 of this article, I don’t want aggressive throwing to be the first things your body feels.

To prepare to throw, you need to prepare your body (again, in part 1) and then prepare your throwing program.  There is a BIG difference between your “warm-up” throwing and your “work” throwing.

Would you ever just throw your max weight on the bar and start squatting or deadlifting without doing warm up sets?  Never, right?  In strength and conditioning we usually incorporate a gradual increase in load with the weight of an exercise before getting to the weight we want to use to train.  You have warm-up sets and then work sets.  As an example, if you are supposed to perform 5 sets of 5 reps of deadlifts at 285 lbs, if you first set is 185, second set 205, and third set 225, those don’t count as your 5×5 work sets.

The same goes with throwing.


Prepare to Throw Step 4 – Ease Into Throwing

I’ve played catch with 100’s of professional baseball pitchers.  I honestly only remember one that would start throwing 90 MPH at my knees by the third or forth throw (and he’s been injured his entire career).  Big leaguers get it and gradually get loose.  You’d actually be surprised at how easy they actually play catch initially as they warm up.

On the flip side, one of the more common tweaks I make to my younger athletes is to ease into throwing.  Not a week goes by without someone gunning a ball at my ankles on the 3rd throw (I love you GD…).

This is extremely stressful on the body.  Remember throwing itself is stressful.  You have to gradually apply that stress to get the tissue used to the force.

Not all throwing has to be designed to gain arm strength or velocity.  Some throwing should be more similar to just riding a bike with your arm to get blood flow and gradually apply stress to the elasticity of the tissue.


Prepare to Throw Step 5 – Let The Distance Dictate the Intensity

The next step to prepare to throw builds on step 4.  Now that you’ve played light catch to get loose, it’s time to start walking back and increasing the distance.

Distance in your long toss program is a variable we use to adjust your intensity.  Realistically there isn’t much difference between throwing with full intensity at 150 feet or 200 feet.  Full intensity is pretty much full intensity.

Again, resist the urge to start throwing on a line at new distances.  Rather, I tell my athletes to “let the distance dictate the intensity,” meaning throw the ball with a bit of an arc to firmly hit your partner in the chest on the descent.

If the ball would sail past your partner another 100 feet if they missed your throw, you are throwing too hard for the stretch out phase of throwing.

baseball long toss arc


There will be time to throw on a line, that is next step…


Prepare to Throw Step 6 – Get Your Work In

OK, you’ve made it!  You prepared your body.  You’re mobile.  You activated your muscles.  You did a dynamic warm up.  You eased into throwing and long toss.  Congrats!  Now you can “throw.”

Just to reiterate, there is a difference between “warm-up” throwing and “work” throwing.  Step 6 is now incorporating your “work” throwing, whatever that may be for you that day.

It could be long toss, weighted balls, bullpen work, even throwing in a game.  That is your “work” throwing and you are now ready for it.


By going through the proper steps to prepare to throw you’ll find that you actually get better work in and throw better, plus you’ll be much more resilient to injuries.  These are some of the key steps I outline to all of my athletes and what we follow in the big leagues.


Want to Learn More?

I have an entire Inner Circle webinar dedicated to detailing these 6 steps to prepare for and perform a throwing program.


I also have a free 45-minute video on How Baseball Players Can Safely Enhance Performance While Reducing Injuries.  Enter your name and email below and I will send you access to the video as well as a handout of the above arm care warm-up exercises that you can take to the field:

How to Prepare Before You Throw – Part 1: Prepare Your Body

Working with so many injured pitchers over my career, one common theme that I often hear when players describe how they got hurt was that they did not properly warm up and prepare themselves to throw.  I’m not sure if this is always the true cause of the players’ injuries, however, I hear it often enough that it has to have some significance.

throwing long toss programThis seems to make sense, though.  Throwing is very dynamic and aggressive on the body.  In fact, it is the fastest known motion that the human body performs!  If it could, your shoulder would rotate a full 360 degrees around up to 27 times in 1 second!  That is unbelievable.

I often say injury is just a simple physics equation.  Force = mass x acceleration.  The faster your body moves and the harder you throw, the more forceful it is on your body.

Because of this, you can see how just grabbing a baseball and starting to throw can be stressful on the body.  Throwing is so dynamic and forceful that you want to do your best to put yourself in a position to succeed before you start throwing.  This will help foster a long and healthy career.

To prepare before your throwing program, you really need to do two things: 1) Prepare your body and 2) Prepare your throwing.  In this two part article I will discuss both.


How to Prepare Before Your Throwing Program – Part 1 – Prepare Your Body

It’s funny how common sense tells us to prepare our body for common athletic activities, like running and jumping, yet people often neglect throwing.  The first three steps to prepare before your throwing program involve getting your body ready.


Prepare to Throw Step 1 – Get Loose

The first step in preparing your body to throw is to get loose and work on your mobility.  We’ve studied 1000’s of baseball pitchers and have found a few things when it comes to throwing a baseball:

  1. Throwing a baseball causes your muscles to tighten and you loose mobility of your shoulder and elbow
  2. Not addressing this becomes cumulative and you eventually get a little tighter and tighter over the course of a season
  3. Working to maintain your motion is effective and can prevent lose of motion

One of the phrases I use a lot with my athletes is “I want you to be you BEFORE you pick up a ball.”  What that means is, if you just threw 100 pitches yesterday in a game, I know you are tight.  If you ignore it and pick up and ball and try to throw, you are setting yourself up for trauma.  Throwing will loosen you up (before you tighten up again), but it’s a much more aggressive way to get your mobility back.

Rather, perform some self-myofascial release by using a foam roller, massage stick, and baseball ball.  Here are the ones I use the most on Amazon and because the foam roller is hollow, you can put your other tools inside and all fit nicely in your gear bag:

  • Foam roller – One of the best and hollow to put your other tools in it in your gear bag.
  • Massage stick – The best one on the market, the other more popular ones don’t compare.
  • Trigger point ball – You can use a baseball, but I also like the reaction balls.  The nubs help you get in there and hold it in position on the wall.

How to prepare before your throwing programYou should focus on the entire body with particular emphasis on your lat, back of the shoulder, rotator cuff, pec, biceps, and forearm.  You should avoid the front of your shoulder.  There really aren’t a lot of muscles there and your just smashing your rotator cuff and biceps tendons.

Hit each spot for 30-60 seconds and hold on any really tender spots for 10 seconds.

Notice how I intentionally didn’t say to “stretch” your arm or perform a “sleeper stretch” (here is why you shouldn’t perform the sleeper stretch).  Most baseball pitchers are too loose to stretch effectively and they end up torquing themselves too much and making things worse.  There is a difference between muscles and joints, it’s possible to have tight muscles and loose joints.

There is one shoulder stretch that is effective on the muscles and not too aggressive on the joint, the cross body stretch I call the Genie Stretch.  This can be enhanced even more by using a trigger point ball in the posterior shoulder muscles.  You can and should stretch your forearm, you can’t really hurt yourself here.


Prepare to Throw Step 2 – Warm-Up Your Muscles

Now that you have worked on restoring mobility back to your baseline BEFORE you throw, it is time to get your muscles ready to throw.  In the strength and conditioning world, we refer to this as “activating” the muscles.

You want to hit all the muscles and movement patterns that are need to accelerate and decelerate your arm.  These essentially include the scapula and rotator cuff muscles.  By turning on these muscles, the body will be better prepared for the upcoming activities and throwing.

Shoulder activation throwing programThe simplest way to do this is with resistance tubing.  We use a combination of tools at Champion, but tubing is quick, easy, and portable.

You do need to be careful of your volume of exercises.  These warm-ups are designed to prepare the muscle, not fatigue them, and are not a substitute for strengthening the muscles.  That is a completely different program to be performed at a different time.  We use tubing to simply activate the muscles with low volume sets and reps of 2×10

I use Theraband tubing with handles.  They are the best and far superior to the cheap bands you can buy at the local stores, which have odd resistance and can lose resistance over time.  They are even ~$15 on Amazon.  You can attach the band to a fence or post, or take turns holding with a partner.

I like the tubing with handles and want you to have to grip the tubing, rather that velcro strap them around your wrist.  Grip the tubing helps warm up your grip and forearm muscles and also has a reflexive stimulus to your rotator cuff to engage.

Here is a link to to purchase the Theraband Exercise Tubing I use in the video at the end of this article.  I recommend the green band for Little League age, the blue band for middle school and early high school age, and the black band for the older or experienced pitcher:


Prepare to Throw Step 3 – Getting Moving

The third step to prepare to throw now involves dynamic movements.  You can see that we are building on a logical progression here: restore mobility, activate the muscles, and perform dynamic mobility exercises for movement prep.

Throwing is a very dynamic activity, obviously, that needs elasticity of the muscles.  Stretching and mobility work alone will not turn on the elastic components of your muscles.  Similar to my comments above on stretching, I don’t want a baseball being the first elastic stimulus your body faces.  I want to slowly work up to that so it is less traumatic and aggressive of a jump in stress on the tissue.

We want to dynamically move the joints and have the muscles produce quick contractions,.  This helps prepare the muscle for  by improving mobility and activation.

At Champion, our athletes have a whole portion of their program dedicated to these three steps and assuring that the entire body is prepared to throw, however, I demonstrate a simple arm version of this in the video below.  Perform this and you’ll be head and shoulders above most other athletes.

For pitchers, we use movement prep exercises that mobilize and activate the muscles groups needed to throw, like the chest, posterior shoulder, and rotator cuff.  It doesn’t take a lot of repetitions to prepare the body.


My Warmup Program Before Throwing

Perform this 3-minute arm warm up program prior to starting your throwing program for the day.  This is our bare minimum program that we teach our athletes that are new to the concepts of preparing their body before throwing.  As you can see, you don’t need dozens of exercises or many sets and reps, even just performing this quick warm-up will put you in a more advantageous position to throw than most other athletes.

It is quick and easy and can be performed on the field before practice.  Look out into the bullpen next time you are at a MLB game and you’ll see many players performing this during the game.

I’ve adjusted the order of how I prepare the body a little bit since the filming of this video, so it is a little out of order per the above information, but serves as a great example of a quick and easy 3-minute warm up to be performed after your self-myofascial release and before throwing.


In part 2, I will discuss the next three steps involved in preparing to throw and how I actually start off my throwing programs.


Want to Learn More?


I also have a free 45-minute video on How Baseball Players Can Safely Enhance Performance While Reducing Injuries.  Enter your name and email below and I will send you access to the video as well as a handout of the above arm care warm-up exercises that you can take to the field:

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 0f the Inner Circle program.

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!




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 1000’s of 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.

Also, realize that many of the Tommy John injuries in spring training were well know by the player and team.  They likely had issues the prior year and were hoping the offseason would help, which isn’t really the case with Tommy John injuries.  This also inflates the number of TJ’s early in the year.

So just because it’s a surprise to you doesn’t mean it was a surprise to them.  If you have surgery in October, you are going to miss the entire next season.  Many take the chance and know that surgery next spring training likely won’t impact their return date significantly, so why not give rest and rehab a try?  More on this in the next point.


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.  At the MLB level, the damage is already done.

So focusing our attention on reducing MLB Tommy John injuries is likely the wrong approach.  The focus needs to be earlier.

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 culture 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

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.



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.



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