How to Assess for a Tight Posterior Capsule of the Shoulder

Over the years, the idea of posterior capsular tightness and glenohumeral internal rotation deficit (GIRD) in baseball pitchers has grown in popularity despite not much evidence.

I routinely see baseball players ranging from kids to MLB pitchers that have been told they have GIRD and need to aggressively stretch their posterior capsule and into shoulder internal rotation.  One of the first recommendations I make is essentially addition by subtraction – stop focusing on these areas!  I’ve discussed at length my feelings on why I don’t use the sleeper stretch, which is something I haven’t used in over a decade and none of my athletes have a loss of internal rotation.

Many people assume that GIRD is caused my posterior capsular tightness, without assessing the posterior capsule itself.  Blindly applying treatments without completely assessing the person is always a bad idea, especially considering GIRD may be normal and not even an issue.

Assessing the posterior capsule can be tricky and most text books continue to demonstrate the technique poorly.  I wanted to share a quick video showing how to assess the posterior capsule of the shoulder.



Perform your assessment of the posterior capsule this way and you’ll realize most people can actually sublux posteriorly and that mobilizing the posterior capsule isn’t what they need for GIRD!  Keep in mind this is applicable for athletes, you can certainly get a tight posterior capsule for many reasons, I just don’t think this is the primary cause of GIRD so shouldn’t be the primary treatment.


Learn Exactly How I Evaluate and Treat the Shoulder

If you are interested in mastering your understanding of the shoulder, I have my acclaiming online program teaching you exactly how I evaluate and treat the shoulder!

ShoulderSeminar.comThe online program at takes you through an 8-week program with new content added every week.  You can learn at your own pace in the comfort of your own home.  You’ll learn exactly how I approach:

  • The evaluation of the shoulder
  • Selecting exercises for the shoulder
  • Manual resistance and dynamic stabilization drills for the shoulder
  • Nonoperative and postoperative rehabilitation
  • Rotator cuff injuries
  • Shoulder instability
  • SLAP lesions
  • The stiff shoulder
  • Manual therapy for the shoulder

The program offers 21 CEU hours for the NATA and APTA of MA and 20 CEU hours through the NSCA.

Click below to learn more:





3 Ways to Improve Throwing Velocity by Enhancing Lower Body Force Production

Pitching a baseball takes a tremendous amount of skill to throw with velocity and accuracy.  Improving velocity tends to be the primary concern of many pitchers, especially youth baseball players.  In order to learn how to enhance velocity, it’s more important to study scientific evidence than to rely on anecdotal information and traditional baseball concepts.

pitching velocityA recent study was published in the Journal of Sports Science and Medicine by a group of researchers in Japan that compared how youth and college pitchers use their trunks and legs during their pitching mechanics.

They found that youth and college pitchers threw with similar biomechanical kinematics, meaning that their mechanics were similar.

However, what they did find was that momentum and force generation were higher in the college pitchers.  College pitchers exhibited:

  • Greater push off on the pivot leg during stride
  • Greater pelvis and trunk rotation throughout the pitching sequence
  • Greater stride leg control during acceleration
  • Greater stride leg extension explosive force approaching ball release

It should be noted that the data was normalized to body mass to take into consideration the lower weight and size of adolescent pitchers.  This make the comparison fair.

These results correspond well to a previous report by the same authors that showed college pitchers with higher velocity also showed greater ability to produce force in their legs and trunk in comparison to college pitchers with low velocity.

In addition, the results were also similar to what Glenn Fleisig, Dr. James Andrews, and ASMI showed in regard to the upper body and trunk when comparing youth and older pitchers.


To Maximize Velocity, Generate More Force with the Legs and Trunk

Again, mechanics of youth are similar, but their ability generate force is different.  Generating more force with your legs and trunk results in greater velocity.

But getting stronger probably isn’t enough.

Based on these two studies it is apparent that getting stronger isn’t the only thing needed to increase your pitching velocity.  You also need to be able to generate more speed and power.

Part of this is simply getting older and bigger.  A stronger body and a longer arm generates more force, that’s just simple physics.  But there are also some tweaks you can perform to generate more force.  Here are three things youth baseball pitchers can train to improve their pitching velocity based on this new scientific evidence


Improve Strength

Leg and Trunk Power VelocityWhile strength probably isn’t enough alone, strength is probably the first factor youth should focus on to improve velocity.  To develop more power, you need to be stronger.  The more force you can exert, the harder you will throw.

Based on these studies, lower body strengthening is an area that deserves a lot of attention.  The legs are used during the early phases of pitching, so the amount of force produced early in the delivery will result in more force being developed and transferred through the body for the rest of the pitching sequence.

Take a look at professional baseball pitchers.  The majority that look like they throw effortlessly have big legs, hips, and butts.  Jon Lester is a great current example, and Roger Clemens is probably a great former example.

The shorter and smaller framed pitchers tend throw with much more effort.

The bigger and stronger your legs, the more force you can generate, which has been shown in numerous studies to correlate to velocity.


Enhance Speed

medicine ball pitching velocityI think a lot of youth baseball players stop at strength, and that can actually be detrimental.  Research in the strength and conditioning world has shown that training certain qualities, like strength and speed, results in adaptations of the body.

Better stated – train slow and you’ll throw slow. [Click to Tweet This]

Once a baseline of strength is established, I tend to focus on “intent.”  What I mean by that is you want to develop the athlete’s ability to explode.  This is an area that many youth do not understand.  They don’t know how to explode.

Once a young athlete understands how to move a heavy weight slowly, you want them to transition this to moving a moderate weight faster, and eventually a lighter weight even faster.

Exercises like plyometric jumps, medicine ball throws, kettlebell swings, and speed trap bar deadlifts are all very effective in this spectrum of training.

On the baseball training side of the equation, this is where long toss and overweight/underweight balls become important for pitchers (there is a right way and wrong way to implement these).  I’m not sure any of these develop “arm strength” as much as they develop “arm speed.”

Big difference.


Maximize Stability

youth baseball velocityLastly, and probably the least well understood and implemented, is training for stability.  To improve throwing velocity, you need the proper motor control and dynamic stability to stabilize both the arm and the stride leg.  People to tend to understand the arm more these days, but I wouldn’t ignore the stride leg.

To properly transfer force that is developed from your pivot leg, you need a strong AND stable stride leg.

You need stride leg stability for force transfer, but don’t forget the body has internal regulations to avoid injury.  If the stride leg can’t stabilize the force, theoretically you body won’t allow you to develop the force.

This also goes for the arm, and I believe why using weighted balls the WRONG way can be harmful, especially for youth pitchers.  Your arm needs to be able to withstand the force to produce the force.  Otherwise, your brain is smart enough to regulate force development.

To maximize velocity, you need to train the body to develop and withstand force.  Too many of us only focus on developing force alone.  This can result in ineffectiveness of training programs as well as injury by pushing past your physiological limits.


Understand that maximum velocity in a baseball pitcher occurs through a combination of many qualities.  Work on enhancing each of these will result in a maximum amount of velocity while reducing the chance of injury.


Free Presentation on Maximizing Performance and Reducing Injuries in Baseball Pitchers

To learn more about how I enhance performance in baseball players while reducing the chance of injury, enter your email below and I’ll send you access to my FREE 45-minute presentation where I discuss why injuries occur in baseball players and the 5 principles that I follow to build my programs to safely enhance performance while reducing injuries.

Simply enter your name and email below to join my baseball-specific newsletter where I update you on all my baseball content.  After you confirm your subscription, you’ll get an email with instructions on how to access the webinar:

4 Keys to Staying Healthy During the Baseball Season

The latest Inner Circle webinar recording on my 4 Keys to Staying Healthy During the Baseball Season is now available.

4 Keys to Staying Healthy During the Baseball Season

4 Keys to Staying Healthy During Baseball SeasonThis month’s Inner Circle webinar is on 4 Keys to Staying Healthy During the Baseball Season.  In this webinar I’ll discuss:

  • How and why injuries happen in baseball
  • What you should watch out for in regard to loss of mobility
  • My criteria you should achieve before picking up a ball everyday
  • The #1 thing I see youth players do wrong that causes injuries
  • How to maximize performance by minimizing overuse

To access this webinar:

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:

5 Things We Can All Learn from Derek Jeter

5 Things We Can All Learn From Derek JeterGrowing up in Boston as a Red Sox fan, I never thought I’d be writing an article about Derek Jeter (we all know that Nomah is bettah than Jettah…).  I think that working in Major League Baseball for so many years and having the opportunity to work with players from every Major League team has made me a bigger fan of the game in general.  (Photo Credit)

Perhaps I’ve lost some of the magic, but I’m just as much of a Yankees fan as I am a fan of the Red Sox and a fan of every other MLB team. 

I’m a fan of an excellent performance.  I’m a fan watching young players blossom.  I’m a fan of watching the game played the right way.  I’m a fan of the players I work with and help become better.  I’m a fan of the game, so I’m a fan of Derek Jeter.

5 Things We Can All Learn from Derek Jeter

As Jeter says his farewell to baseball, it made me think about what we can all learn from his amazing career.  Here are 5 things about Derek Jeter that stand out to me.


There is a big difference between willpower and discipline.  Chris Brogan speaks about this well in his latest book The Freaks Shall Inherit the Earth.  People often ask me how I have the time or willpower to contribute to my website, make more programs, own a physical therapy and performance center, and still somehow have a life and family.

As Chris says, it has nothing to do with willpower, it’s all discipline.  Chris says:

“Willpower is when you want to do something different and force yourself to do what you believe is the better choice.”  Discipline is actually working hard to REPEAT the task that you know will make you better.

Do you think Jeter took a lot of days off from batting practice?  Do you think Jeter had donuts for breakfast every morning?  You think Jeter showed up late to the park and was unprepared for the game?


I get it, there are a lot of conflicting interests in this world.  Discipline is crafting your long term vision of what you want out of your life and then making decisions based on this vision.


Honestly, what good is discipline with out consistency?  I would say the two things that impressed me most about Jeter’s career were his discipline and his consistency.

Take a look at Jeter’s career stats over at

Notice a trend here?  There are really no significant dips and jumps in his performance.  Sure there are some years that are better than others, but that is one heck of a consistent career.

To illustrate this, lets compare his rookie year of 1996 to 2012:

  • 1996 – 157 games, .314 batting average, 104 runs, 10 home runs, 78 RBIs, and 14 steals
  • 2012 – 159 games, .316 batting average, 99 runs, 15 home runs, 58 RBIs, and 9 steals

Pretty impressive to be that consistent over 20 years and 2700 games. 

Consistency breads dependability and trust.  We are developing a systemized approach to our model of integrated physical therapy, fitness, and sports performance at Champion Physical Therapy and Performance.  Why?  So we can build a reliable service to our clients with repeatable and predictable results.

Want to get ahead in life?  Focus on consistency.

Lead By Example (Positively)

There are many different kinds of leaders in this world.  There are the loud and vocal leaders, the motivators, the “pump up the crowd” kind of people.  The ones that want the attention and lead to gain the spotlight.  The manic-depressive crowd.

There are also the quite and consistent leaders that lead by example.

Leading isn’t necessarily a good thing, there are many examples of “negative” leaders.  People that are captivating and engaging and actually set the WRONG example!  Like it or not, these are leaders. 

But luckily there are also the “positive” leaders.  The leaders that set the example, that push others just by being so disciplined and consistent. 

In the long run, I’ll take the type of leaders like Jeter, the positive leaders that consistently lead by example.  To me, this is as much educating and motivating, as it is leading.  This is what young professionals need to learn.

And don’t forget, this applies to anyone.  You can lead others in any direction, meaning you do not have to be in a position of authority to be a leader.  John Maxwell has an excellent book on this call The 360 Degree Leader

Don’t Rock the Boat

One of the most interesting things about Jeter to me is how neutral he has stayed on everything throughout his career.  While I’m sure he had plenty of opinions, it’s usually not in anyone’s best interest to blurt them out every night on SportsCenter.

Many of the “guru’s” on the internet should really take this one to heart.  Unfortunately controversy sells.  However, realize we are all probably going to change our opinions and adjust our thought process based on past experiences and knowledge gained.

Don’t be that person that is so definitive in their thought process AND doesn’t mind telling the world about it!  Have an open mind and try to avoid rocking the boat, it always comes back to haunt you!

When you are so vocal about something, you start to focus on defending your stance instead of keeping an open mind.

Treat Everyone the Right Way

One of the sentiments within baseball is that Jeter is a “good guy.”  I’ve had the opportunity to meet Jeter several times.  I’ve seen him walk into the training room of an All-Star game just to introduce himself and say hello to the staff.  Not everyone does that, in fact most don’t.

Baseball has a funny way of changing people.  The players have everything in the world given to them and are treated as rock stars at all times.  Imagine arriving at a hotel at 4:00 AM and having a line of people asking for your autograph as you get off the bus!  It’s hard to stay grounded.

Treating people the right way is the corner stone of any relationship.  You are not a better human or person in this world because you can hit a fastball, or because you have accumulated $275 million dollars over your baseball career.  These may be extreme examples, but it applies to us all.


As we move on today as the first official day in the last 20 years that Derek Jeter is not a professional baseball player, keep these 5 principles in mind.  Yankee fan or not, there are plenty of things we can all learn from Jeter’s amazing career.

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.


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