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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.

Discipline

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?

Nope.

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.

Consistency

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 Baseball-Reference.com.

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 healthy and injured players from Little League to Major League Baseball.

 

Injuries Are Higher in the First Month of Season

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

baseball injury rates

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

 

Preparation for the Season

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

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

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

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

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

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

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

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

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

 

Velocities are Increasing

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

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

Average MLB Fastball Velocity

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

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

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

 

What Goes Around Comes Around

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

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

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

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

 

Pushing Past Our Physiological Limits

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

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

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

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

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

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

 

 

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

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

 

8 Keys to Tommy John Rehabilitation

Tommy John Surgery

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

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

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

 

Avoid Loss of Elbow Motion

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

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

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

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

 

Work on Imbalances During the Early Phases

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

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

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

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

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

 

Focus on the Shoulder and Scapula

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

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

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

 

Integrate Core and Lower Body Training

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

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

 

It’s Not Just About Strength

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

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

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

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

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

 

Don’t Skip or Rush Steps in the Progression

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

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

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

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

 

Use Your Throwing Program to Work on Your Mechanics

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

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

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

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

 

Follow a Slow and Gradual Throwing Progression

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

There are going to be bumps in the road.

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

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

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

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

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

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

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

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

 

5 Myths of Tommy John Surgery

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

Dr. James Andrews and Dr. Frank Jobe

Dr. James Andrews and Dr. Frank Jobe

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

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

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

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

And get ready for the most shocking one:

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

That is absolutely crazy!

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

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

 

Everyone Returns From Tommy John Surgery

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

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

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

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

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

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

 

There are No Complications with Tommy John Surgery

Tommy John Surgery

Tommy John Surgery

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

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

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

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

 

Recovery From Tommy John Surgery is Quick and Easy

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

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

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

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

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

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

 

Velocity Improves After Tommy John Surgery

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

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

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

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

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

 

All Tommy John Rehabilitation is the Same

Tommy John Rehabilitation

Tommy John Rehabilitation

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

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

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

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

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

 

Summary

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

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

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

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

 

 

How Baseball Players Can Enhance Performance While Reducing Injuries

The best part about January and a new year, at least in my mind, is the fact that baseball season is right around the corner!  Although spring training is only a month away and the start of college and high school baseball is close by, it is never too late to start preparing for the season.  I do sincerely hope you have already started preparing and have already had a great offseason of training.  If so, great!  Use this last part of the offseason to assure you have hit all the important aspects of a proper baseball offseason program and haven’t missed any critical components.

For those that haven’t started preparing, it’s time to get going!  It may not be optimal to start this late, but it is still possible to make a big difference.  I have seen many players improve with just 4-6 weeks of training.

 

Injuries in Baseball are Highest in the First Month of the Season

Two recent research reports have been published that analyzed the occurrence of baseball injuries in Major League Baseball and High School Baseball.  In both studies, the researchers found that the baseball injuries are highest in the first month of the season.

baseball injury rates

Do you know what this tells me?

I interpret this as the fact that preparation for the season is extremely important, and those that do not prepare well have a higher chance of injury. [Click to Tweet]

 

The Key to Avoid Injuries is Proper Preparation

How do you best prepare?  I have 5 areas that I think everyone should focus on to best prepare for the upcoming season.  Many people put the effort into one or maybe two of these components, but the key to unlocking your full potential is including all 5 components.

Baseball Training Program

They all build off one another:

  • Restore and maintain soft tissue and joint mobility lost from adaptations
  • Maximize total body gains from strength and conditioning
  • Incorporate arm care programs designed to maximize strength and dynamic stability
  • Integrate proper function and balance of the entire body
  • Enhance pitching mechanics through proper coaching with a throwing program

 

How Baseball Players Can Enhance Performance While Reducing Injuries

I’m pretty excited to have a new free webinar for everyone to enjoy and learn from, entitle “How Baseball Players Can Safely Enhance Performance While Reducing Injuries.”  In this 45-minute webinar I discuss the why injuries occur in overhead athletes and the 5 components above on how to best prepare to put yourself in the best position to succeed.  While designed around baseball, the information is definitely applicable to all overhead throwing athletes.

These are the same 5 principles that I follow to build my programs to safely enhance performance while reducing injuries.

To access the webinar, 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.






The Minimum Viable Exercise

I was having a conversation recently with one of the big league baseball pitchers that I work with in the offseason that I thought would be worth sharing.  As we were working on his arm care program and laying out the start of his long toss program, we started to discuss how far he should attempt to throw.  In the past, he had only thrown to somewhere in the 120-180 foot range (kids, take note of this, you can make it to the big leagues by only throwing to 180 feet in the offseason…), but he had been hearing about all the trendy long toss programs that have you throw to 300+ feet.

My reply was a less than convincing, “it depends,” as I strongly feel the need to individualize each pitcher’s programs.  However, I casually reminded him that he threw pretty hard and was already in Major League Baseball.  Not just professional baseball, but he is actually a big leaguer.

“Sure, I throw hard, but what if I could throw harder,” was his response!  I agreed, but stated “OK, but at what consequence.”

 

The Minimum Viable Product

This led us to the concept of the “minimum viable product.”

Those in the business world have surely heard of the concept of the “minimum viable product.”  A minimum viable product is a product with the least amount of features that can be released.  Think of it as a bare bones product.  In the lean manufacturing business model, this minimum viable product approach has numerous advantages that center around the concept of assessing the product and making adjustments along the way rather than making a huge gamble and finding out you were off base. If you put all your eggs in one basket and the product fails, you are in trouble as you have put considerable time, energy, and money into this product.

minimum viable exercise

Wow, what a parallel between the business world and the rehab and performance world!  We both thrive on assessing and adjusting!  How many times have I said that before (many)!

In the business world this could be the difference between succeeding and going out of business.

In our world, this could be the difference between enhancing performance and creating an injury.

 

The Minimum Viable Exercise

This is where the “minimum viable exercise” comes into play.  A minimum viable exercises is an exercises that is the least intensive that still elicits the desired effect.  Ok, yes, I just made that up, but that is how I would define minimum viable exercise.

To enhance performance and minimize injury, select an exercise that is the least intensive that still elicits the desired training effect. [Click to Tweet]

Using long toss as the “exercise” example and velocity as our desired “effect,” I would want you to throw as far as you need to increase velocity, and no more.  It isn’t always a “more is better” approach.  I can’t help but think of the classic Jerry Seinfeld joke about maximum strength medications where he states “Give me the maximum strength.  Figure out what will kill me and then back it off a little bit.”

YouTube Preview Image

This concept also applies to throwing with weighted balls, but I would say applies even more to throwing all year round.  Many baseball coaches feel that taking time off from throwing in the offseason is a missed opportunity to improve, despite statistical research showing that injuries increased 5x by pitching for more than 8 months out of the year!  We are often times too far along towards the “maximum strength exercise” rather than the “minimum viable exercise.”

When it comes to our original discussion about long toss distance, there are two ways of implementing.  One would be to simply jump into a long toss program to 300+ feet with the hope of increasing velocity (and not getting injured).  The minimal viable exercise approach would slowly and gradually extend the distance and then reassess.

Did velocity go up?  Could you perform long tossing at that distance with proper mechanics?  Are there any signs that your body can not handle the stress observed at that distance?  Based on this information you can make an accurate adjustment before it is too late, either continue to progress, back down, or be content with your progress and maintain.

The flip side of this is the young athlete that I commonly see that broke down from jumping too fast and performing for the “maximum strength” exercise.  The fine line between risk and reward is razor thin at this point.

You can apply the minimum viable exercise to any aspect of rehabilitation, fitness, and performance training, not just baseball.  I’m just using this in the context of our conversation.  However, I think this minimum viable exercise concept is already being perform more than we may realize.  Imagine you are trying to increase your deadlift, you wouldn’t make a huge jump in weight and risk performing your lift with bad form or getting injured.  Rather, you would make smaller and more gradual gains, then assess and adjust.

Don’t get me wrong, I am not saying don’t push yourself.  Rather, push yourself but in an intelligent and systematic way.

Don’t get greedy and jump to the maximum strength exercise.  Build intelligent programs that assess and adjust on the way.  This is the minimum viable exercise.

When Should Baseball Players Start Their Offseason Throwing Programs?

It’s that time of the baseball offseason when we start planning the start of players’ offseason throwing programs, and inevitably every year I get some sort of variation of the same question – “When should I begin my offseason throwing program?

There are a lot of opinions on when to start throwing, and you may have heard many arbitrary dates like January 1st, December 15th, after Thanksgiving, November 1st, or even “what do you mean start throwing, I never stop!”

 

When to Start an Offseason Throwing Program

baseball offseason throwing program

Often times it seems the initiation of offseason throwing programs is based purely on time and not on your own personal situation, goals, or physical status.  It is always my goal to try to individualize every aspect of my programs for baseball pitchers.  Not everyone starts throwing on the same day.  There are many factors, but generally it tends to come down to two questions:

  1. Is your body ready?
  2. What are your goals?

 

Is Your Body Ready?

Throwing a baseball takes a toll on your body, especially after a long professional season, or spring and summer of school and travel baseball.  I can’t tell you how many baseball pitchers I see at the start of the offseason that look really bad.  They are tight, sore, and weak.  Not all of them had an “injury” during the season, but let’s be honest, baseball pitchers have a micro-injury every time they pitch.

Taking care of your body is the first and likely most important part of your offseason.  Skip this step and you start the offseason behind.

While strength and conditioning has been popularized over the last decade, manual therapy and arm care programs to get your body in shape PRIOR to beginning strength and condition may be even more important.  This of it this way, take care of your body, work on your imbalances, clean up any lingering issues of tightness or soreness, and then get your body strong and ready to throw.

baseball pitcher throwing programThe analogy I often use with my athletes is the rock in the shoe.  For example, maybe you have some shoulder pain towards the end of the season.  Your shoulder pain when throwing is like a rock in your shoe.  It was creating a bruise and hurting your foot every time you walked.  You followed the suggestion to take some time off of your feet and let your bruised foot heal.  Now it is 4 weeks later and your foot feels great, so you take that first step.  What do you think is going to happen?  Yup, you hurt your foot again because you never took the rock out of your shoe.  (photo by Oakley Originals)

You have to address your underlying issues and not just rest and hope you feel better.  Get that rock out of your shoe before you start throwing.

Taking a couple of months off at the start of the offseason but ignoring getting your body back to neutral and ready to throw again is like the rock in the show analogy.  This applies for both injured and healthy baseball players.  If you care anything about your baseball career, you really have to get your body assessed and get on a program to set the foundation for a great offseason.  I talked about this in detail in my past article on how to get the most out of the start of the baseball offseason.

How do you know when your body is ready?  You have full mobility, strength, and stability.  You have no discomfort, even mild.  You have gone through an appropriate strength, conditioning, and arm care program to prepare body to throw.

Don’t guess, put the effort into getting your body ready and know you put yourself in the best position to succeed on day 1 when you pick up a ball.

 

What Are Your Goals?

Once we get your body prepared and you are confident your body is ready to throw, it is now time to discuss your situation and specific goals.  There is a big difference between the baseball pitcher that is preparing to pitch for the local Little League team, a D1 college, Minor League Baseball, or even the Boston Red Sox.

For veteran MLB pitchers, they have the luxury of knowing they have a roster spot and can take their time getting ready for the season.  They start with the end in mind and the end is game 7 of the World Series.  These guys can start throwing in late December and January and have plenty of time.

Unfortunately, not everyone is this lucky.  Most younger professional baseball players want to show up to spring training ready to dominate and impress their team.  This could have implications on making a big league roster, which minor league level you start at, and even preventing getting cut.  Minor league camp isn’t as long as big league camp, so you need to be at your best on day 1.  This may mean that you have to start throwing a month or so earlier to have enough time to get your long toss and mound work up to full speed.  Collegiate athletes are often in a similar situation.

For the younger athletes, the winter is often spent working on coaching to enhance your biomechanics and development.  I think it is great to work with a pitching coach during the winter, however, you have to be cautious to avoid overuse.  If you had a long summer and maybe even fall ball, you need time off from pitching.  I’ve said this before but I can’t say it enough – If you throw more than 100 innings or pitch more than 10 months out of the year, you are over 3x more likely to get injured.

That is a scientific fact that has been researched.

Take the winter to work on your strength and athleticism.  If you haven’t pitched that much, great, by all means get great coaching and work on repeating your delivery, but be smart about your volume, you don’t need to be throwing 3 bullpens a week all winter (I’ve seen it…).

What about if you are a position player?  In my mind, position players do not need to be stretched out as far and for as long, but throwing programs are important to follow to prepare for the season.  I usually start my position players throwing around January 1.  That still gives them plenty of time to stretch out their long toss and then work on position specific throwing.  Many young position players are just as tired at the end of the season and need to rest and regen their body.

I wish it were simple to say that there is an exact “best” day for baseball pitchers to start their offseason throwing programs, but there really isn’t.  Each player should be assessed and treated uniquely based on their body, situation, and goals.

Ready to get started?  Learn more about what we do for baseball offseason performance training at Champion Physical Therapy and Performance.

Champion Physical Therapy and Performance

 

 

 

 

What You Need to Know About GIRD: What It Is and What it Isn’t

GIRD Mike ReinoldGlenohumeral internal rotation deficit, or GIRD, continues to be one of the most polarizing topics in baseball sports medicine.  It has become so popular that even athletes and the general public know about GIRD, often exhibiting fear and anxiety with just the mention of GIRD.

How many times has a baseball player come back from the doctor with their head down saying, “I have GIRD,” as if the world has just ended?

I do not feel that everyone truly understands GIRD, how to assess GIRD, or how to treat GIRD.  There are a lot of theories and assumptions out there that may or may not be true.

Here is my take on GIRD, and it is not exactly how everyone would describe GIRD.

 

What is normal range of motion in an overhead athlete?

Before we can have any discussion on what is considered abnormal range of motion in the thrower’s shoulder, we should make sure we understand what is considered “normal” in overhead athletes.

Throwers have very unique adaptations from the demands of throwing. Numerous articles over the past 15 years have consistently shown that the dominant shoulder in overhead athletes exhibits an increase of external rotation and a subsequent decrease in internal rotation.  However, if you take the total rotation motion and combine ER and IR measurements the numbers are almost identical.

I remember when we first started discovering this phenomenon many years ago and it is uncanny how you find essentially the exact same total motion arc on both sides.

Here is an illustration of what this looks like.  In this figure.  You see the nondominant shoulder on the left and the dominant shoulder on the right.  You see the shift in the arc of total rotational motion, however if you break down the components of ER and IR, you see that both sides total 180 degrees.

GIRD glenohumeral internal rotation deficit

This adaptation has been shown in too many publications to list here, but I’ll add a few:

GIRD total rotational motion

This is a brief list but you can see that the total rotation motion on both the dominant and nondominant shoulders is almost identical in every study.  Statistical analysis revealed no significant differences in range of motion side to side.

 

Why the Adaptation in Shoulder Range of Motion?

Since the first discovery of this loss of internal rotation on the throwing arm, there have been several theories as to the specific reason for the adaptation.

The first theory centered around the fact that since there was a loss of internal rotation, there must be a subsequent tightness of the posterior capsule.  In actuality, this is really a long shot of being the isolated reason for the loss of IR, assuming a very specific cause for GIRD.

With so many potential factors contributing to the altered range of motion, it is surprising to me how popular this theory became.  If IR is less on the thrower shoulder, we now jump straight to recommending aggressive internal rotation and posterior capsular stretching.  I guess whatever theory comes out first gets the most traction and popularity!

The major flaw of the posterior capsule tightness theory is that it does not take into consideration the very specific increase in ER that is also seen in overhead athletes, let alone the fact that total rotational motion is still the same side-to-side.  If the posterior capsule was the cause of the loss of IR, would we then assume that the anterior capsule has loosened precisely the exact same amount to allow the exact same increase in ER as the posterior capsule does to restrict IR?

That sounds pretty unrealistic to me.

Shortly after the posterior capsule tightness theory was presented, many researchers took a more scientific look at what could be causing this very precise shift in the arc of motion in baseball pitchers and other overhead athletes. Several studies have now been published that have assessed boney changes that could be associated with GIRD.  Using both MRI and CT scans, it is now well documented that the humerus of the throwing arm is more retroverted than the nondominant arm.

What this means is that the actual bone of your upper arm torques and adapts.

Imagine twisting and wringing out a towel.  This is exactly what happens to the humerus during throwing while your growth plates are open.  The body, bones especially, do a great job of adapting to stress.  Essentially, the humerus bone of your upper arm twists at the growth plate and causes permanent adaptations to your bones.  Newer research is also now showing that the other end of the socket, the glenoid, also shows retroversion.

Based on these studies, the exact amount of retroversion observed appears to be approximately 10 degrees on average.  Now go back up and look at the table above.  Notice how the loss of IR is approximately 10 degrees and the gain of ER is approximately 10 degrees?  This boney adaptation makes the very specific shift in range of motion make more sense.  I have shown a simple and fairly effective way of measuring humeral retroversion in the clinic.  Try it in your throwers and you’ll see.

Pretty cool, right?  Still think the posterior capsule is the cause of loss of IR?

I was also a part of two studies that looked at glenohumeral translation in the baseball pitcher that both showed that posterior translation was twice that of anterior translation.  This was even present in baseball pitchers with as little as 10 degrees of IR.  They still had a large amount of posterior translation, not posterior capsular tightness.

Taking all of this into consideration, if there is one thing you take away from this article, it should be:

[quote]The thrower’s shoulder is supposed to have less IR on the dominant side.  This is normal.[/quote]

 

Determining What is Clinically Significant GIRD

A threshold to determine what can be considered a clinically significant loss of IR is vitally important to the implementation of programs designed to prevent and treat GIRD.  As previously discussed, a loss of IR itself can be considered a normal anatomical variation observed in overhead athletes.

Despite this finding, the term GIRD has continued to have a negative connotation, implying that any side-to-side loss of IR may be pathological.  This has resulted in a trend towards assuming many of the hypothesized theories of why loss of IR occurs are present in each person.

This unfortunately leads to a standardized prescription of stretches and exercises based on assumption and not a thorough assessment.

After reviewing the literature, it appears that most authors have been arbitrarily defining GIRD as a loss of IR greater than 15-20 degrees in comparison to the nonthrowing arm.  Some authors have even published studies showing that your chance of getting injured is increased if you have GIRD of more than 15-20 degrees.

Correlating GIRD to injury is too simplistic at best and again has too many flaws to consider this valid.

You can not accurately state why an increase in injury was observed.  Was it the loss of 17 degrees of IR?  Or perhaps the subsequent gain of 17 degrees of ER?  You can’t make a definitive conclusion either way.

[quote]Perhaps the increase of injuries in baseball pitchers is due to the gain in shoulder ER, not GIRD and the loss of IR?[/quote]

I am thinking this more and more everyday.

Another major flaw with defining GIRD using an arbitrary number is that the published amounts of range of motion have a very large standard deviation.  If you look through the published studies on GIRD, you’ll see that the standard deviation of measurements is large, ranging from 8 degrees to over 15 degrees.  That means the “normal” amount of internal rotation on a shoulder is approximately 50 degrees, but plus or minus 15 degrees.  Thus both 35 degrees and 65 degrees of internal rotation should be considered “normal.”

I can say that I have observed this first hand in professional baseball pitchers.  I have seen just as many players with 140 degrees of total rotational motion than I have with 200 degrees of total rotational motion.  Sure, this averages out to 170 degrees.  But not all baseball pitchers have 170 degrees of total rotational motion.

With such a large standard deviation and variability in measurements, assigning an arbitrary number to define GIRD is too simplistic.

 

A New Definition of GIRD

These findings have caused me to alter the way I define GIRD and stimulated me to propose a new definition of GIRD based on total rotational motion.

Previous definitions of GIRD based on arbitrary numbers have resulted in generalized treatment programs that are not specific or individualized enough to be utilized in clinical practice.

I propose that a loss of side-to-side IR is actually a normal anatomical variation in overhead athletes and should not be considered pathological GIRD unless there is a subsequent loss of total rotational motion in the dominant arm as well.  

This definition essentially takes the large variability in ROM that has been observed in athletes into consideration and allows for a more individualized approach to treating GIRD. So:

[quote]GIRD is a loss of internal rotation range of motion in the presence of a loss of total rotational motion.[/quote]

In this new definition of GIRD, a pathological condition of GIRD is defined as a loss of IR in the presence of loss of total rotational motion.

Lets looks at this as both an illustration and an equation.  In the figure below, you see the normal arc of motion in an overhead athlete, and to the right, an altered total rotational range of motion due to a loss of IR.

a new definition of GIRD

You can observe this yourself by assessing the specific range of motion measurements.  To calculate GIRD, use this equation:

GIRD = (Side-to-side difference in ER) + (Side-to-side difference in IR)

Here is an example of two baseball pitchers with a loss of IR:

  • Player 1 = (D ER 120 deg – ND ER 100 deg = +20 deg ER) + (D IR 60 deg – ND IR 80 deg = -20 deg IR) = 0 deg – Despite a loss of 20 degrees this is not pathological GIRD because total motion is the same bilaterally
  • Player 2 = (D ER 120 deg – ND ER 100 deg = +20 deg ER) + (D IR 35  deg – ND IR 80 deg = -45 deg IR) = -25 deg GIRD – This represents a pathological GIRD because both IR and total rotational motion are limited

I would suggest that the first player above should not be considered or even called GIRD, despite the fact that there is 20 degrees less IR on the throwing shoulder.  Because the total motion is the same, this is a normal adaptation in this athlete.

In fact, I would comfortably say in my experience that if you tried to reduce that 20 degrees loss of IR when total motion is symmetrical, you would essentially be increasing the total rotation motion and creating instability in an already vulnerable joint.

I believe this causes more injuries than it helps.

Because of the negative association that we have established with the word GIRD, I would propose that we stop calling everything GIRD and reserve GIRD for when it is truly pathological.  This helps clear up confusion.

I strongly feel that this new definition of GIRD takes the individual variability of range of motion as well as the total rotation motion into consideration and is a much more accurate calculation to base treatment recommendations.

 

Why is this important?

The goal of this article is to share my experience treating baseball pitchers.  I have rehabilitated 1000’s of injured baseball pitchers and managed 1000’s of healthy baseball pitchers.  This unique experience really opened my eyes to what is “normal” in baseball players.

When I first started working in Major League Baseball, I quickly found out that much of what I believe to be “facts” were not always accurate.  I’ll be the first to admit this.  If you only treat injured baseball pitchers, you start to assume that some normal adaptations may be pathological.

While my experience has been with baseball pitchers, this information can be extrapolated to all overhead athletes as these findings have all been established in other sports, such as tennis and handball.

There are far too many people who see a loss of IR and immediately label it GIRD.  Furthermore, there are far too many people who label any loss of IR as GIRD and blindly treat the posterior capsule.  I’m not saying that posterior capsular tightness does not exist, I am just saying it exists far less than we are diagnosing it and there are many other reasons that we need to consider before we start challenging the integrity of the stabilizing structures of the thrower’s shoulder.  I even dedicated an entire webinar to showing you 5 ways to gain IR without stretching the posterior capsule.

Blindly assuming GIRD is pathological, stretching the heck out of IR, and treating the posterior capsule is harmful.

 

Assess, Don’t Assume

Even with a pathological GIRD using the above equation, you can not assume you know why they have a loss of IR.

I have previously published a study showing that there is an immediate loss of IR after pitching.  We theorized that this was too acute to represent any changes in the capsule and most likely represented muscular stiffness from the eccentric trauma associated with pitching.  This was even more apparent when we also noticed that there was a loss of elbow extension, which is also subject to extreme eccentric forces during throwing.

You can’t assume they need to be stretched to gain more IR or that the posterior capsule is tight.  Maybe it is.  Maybe it isn’t.  Regardless:

Assess, don’t assume.

There is a specific way to assess the posterior capsule, which I will share in an upcoming post.  In fact I am going to write a series on how to more accurately assess GIRD, internal rotation, and the posterior capsule.

By changing the way we assess and define GIRD, we can start to more accurately understand what is happening to these overhead athletes and provide the best care possible.