In The News: A complete game shut out with 15 K's to start the season! Read about it Here!
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As a high school and collegiate baseball player who dedicated every waking minute to trying to improve my baseball abilities, I can relate to the passion and work ethic required to succeed. Fast forward 20 plus years and the dynamics on how today's players approach their baseball development is drastically different. The rising pressure from parents, coaches and travel teams has contributed to increased physical stress on young arms leading to an array of overuse injuries.
Let's take a closer look at the alarming injury statistics that our youth baseball players are up against:
In 2001 the Journal ofMedicine, Science, Sports & Exercise reported that athletes who pitched with a tired arm were 6 times more likely to suffer from elbow pain and 4 more times likely to have shoulder pain than those who did not have a tired arm.
A similar study, in 2002, in the American Journal of Sports Medicine reveled the following:
Throwing more than 600 pitches per season yielded a 3.5 times greater chance for elbow pain
Throwing more than 75 pitches in a game yielded a 2.5 times greater chance for shoulder pain
Pitchers who reported they were tired while pitching had a 6 times greater chance for elbow pain and shoulder pain increased by four-fold.
Nearly 50% of the 476 youth pitchers studied, reported elbow or shoulder pain during the season
In 2006 the American Journal of Sports Medicine reported that overuse was the predominant factor leading to the development of arm pain in youth baseball pitchers. This was a follow-up study to the 2002 research. Nearly the same results were evident . The 5 risk factors that were identified for reporting pain were as follows:
The 50 pitch count: For every 25 pitches, after the 50 pitch count, the percentage of throwers who reported pain increased.
The 75 pitch count: Throwing over 75 pitches yielded a 2.5 times greater risk for shoulder pain
The 600 pitch count: Throwingmore than 600 pitches in a season yielded a 3.5 times greater risk of elbow.
Pitching while fatigued: Pitchers who reported they were tired while pitching had a 6 times greater chance for elbow pain and shoulder pain increased by four-fold.
Curves & Sliders: Pitchers who threw these breaking pitches were at an increased risk for shoulder and elbow pain.
Pitchers experiencing elbow pain had these characteristics in common:
they were the "older" youth pitchers
Shorter in height
increased body mass index (BMI)
throwing with a fatigued arm
decreased perceived self-performance
participating in multiple baseball leagues
Pitchers experiencing shoulder pain had these characteristics in common:
increased # of pitches thrown in games
increased cumulative pitch counts over the season
throwing with a fatigued arm
decreased perceived self-performance
In a 2010 study the American Sports Medicine Institute reported the following:
Pitching more then 100 innings in a calendar year had a 3.5 times higher "serious injury" rate that required elbow or shoulder surgery.
Serious injury rates tripled for pitchers who also played catcher. This was a small sample size, so it was not sufficient to establish that this was statistically significant. However, it bears concern to monitor the volume of throwing on "non-pitching" days.
An increase in Tommy John Surgeries are proof that the overuse injuries are having a profound impact on youth baseball players.
According to surgical statistics performed by Dr. James Andrews at ASMI, the number of the ulnar ligament-transplant operation, commonly known as Tommy John Surgery reveals some disturbing trends:
1995 - 1998: 9 Tommy John elbow operations
Over the next 4 years....65 operations
2003-2008....244 operations
THE BIG 3
Researchers at ASMI and other national institutions conclude that there are 3 primary risk factors that contribute to injuries in youth baseball pitchers:
Total number of pitches during a game, season, and a year.
Injuries are the result of the cumulative stress (microtraumatic trauma) of the repetitive act of throwing. This stress accumulates over multiple games, seasons and years in young players
2. Poor pitching mechanics
A statistical link has yet to be determined, however biomechanical and clinical studies are continually being reviewed to find inefficiencies in throwing mechanics that lead to increased stress on the arm
3. Poor physical conditioning (more on this topic in the next post)
Closing Out The Overuse Injuries
The baseball experts seem to agree that of theBig Three, the total number of pitches thrown combined with the lack of rest (in between starts and total through out the season) are the biggest contributors to the increase of arm injuries.
We've closed out this post on the alarming rates of overuse injuries. In part 2 we will discuss how to combat these injuries with a smarter approach to throwing and how to properly condition the body to handle the increased volume.
1. Lyman S, Fleisig GS, Waterbor JW, et al. Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc.2001;33(11):1803-1810.
2. Lyman S, Fleisig GS, Andrews JR, Osinski ED. Effect of pitchtype, pitch count, and pitching mechanics on risk of elbow and shoulderpain in youth baseball pitchers. Am J. Sports Med 2002;30(4):463-468.
3. Olsen SJ 2nd, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors forshoulder and elbow injuries in adolescent baseball pitchers. Am. J Sports Med. 2006;34(6):905-912.
4. Valovich McLeod TC, Decoster LC, Loud KJ, Micheli LJ, Parker JT, SandreyMA, White C. National Athletic Trainers' Association Position Statement: Prevention of Pediatric Overuse Injuries. J Ath. Tr. 2011;46(2):206-220.
5. Fleisig G, Andrews J, Cutter G, Weber A, Loftice J, McMichael C, Hassel N, Lyman S. Risk of Serious Injury for Young Baseball Pitchers: A 10-Year Prospective Study. Am. J. Sports Med. 2010;20(10): 1-5.
6. Kaplan KM, Jobe FW, Morrey BF, Kaufman KR, Hurd WJ. Comparison of Shoulder Range of Motion, Strength, and Playing Time in Uninjured High School Baseball Pitchers Who Reside in Warm- and Cold-Weather Climates.Am.J Sports Med. 2011; 39(2): 320-328.
7. Dun S, et. al., A Biomechanical Comparison of Youth Baseball Pitches: Is the Curveball Potentially Harmful? Am.J. Sports Med. 2008;36(4):686-692.
9. Fortenbaugh D, Fleiseg G, Andrews J. Baseball Pitching Biomechanics in Relation to Injury Risk and Performance. Sports Health: A Multidisciplinary Approach 2009;1:314-320.
11. Davis, J.T., et. al. The Effect of Pitching Biomechanics on the Upper Extremity in Youth and Adolescent Baseball Pitchers. Am. J. Sports Med. 2009;37(8):1484-1491.
13. Fazalare J, Magnussen R, Pedroza A, Kaeding C. Knowledge of and Compliance With Pitch Count Recommendations: A Survey of Youth Baseball Coaches. Sports Health: A Multidisciplinary Approach. published online February 6, 2012. DOI:10.1177/1941738111435632 (accessed February 7, 2012).
14. American Academy of Pediatrics Council on Sports Medicine and Fitness, Baseball and Softball Policy Statement (doi 10.1542/peds 2011-3593)(www.pediatrics.org/cgi/doi/10.1542/peds2011-3593 (accessed February 27, 2012).
Dr. Michael M. Reinold, PT, DPT, SCS, ATC, CSCS is considered a leader in the field of sports medicine and orthopedic rehabilitation. As a physical therapist, athletic trainer, and certified strength and conditioning specialist, Michael specializes in all aspects of care of shoulder, elbow, and knee disorders. He has worked extensively with a variety of professional athletes with emphasis on the care of throwing injuries in baseball players. In addition to his clinical work, he has made significant academic contributions in the form of laboratory research, biomechanical research, and clinical outcome studies.
Michael is currently the Head Physical Therapist of the Boston Red Sox Baseball Club. He had previously spent the last 6 years in various roles including Head Athletic Trainer and Rehabilitation Coordinator. Prior to the Red Sox, Michael was formerly the Facility Director of Champion Sports Medicine and the Coordinator of Rehabilitative Research & Clinical Education at the American Sports Medicine Institute in Birmingham, AL.
This article that you are about to read is really disappointing. Pitching injuries in young athletes continue to rise despite research and effort designed to reduce these injuries, this is a problem.
To quickly summarize what we have learned about youth pitching injuries, we know that approximately one-third of youth baseball pitchers will experience shoulder or elbow pain during a season. We also know that youth pitching injuries increased sixfold in the early 2000′s with Dr. James Andrewsat his center in Alabama.
This number is probably even higher now. (Photo byEdwin Martinez)
After years of speculation regarding exactly why these injuries occur. There is only one factor that continuosly correlates to these pitching injuries. I’ve discussed the Little League curveballdebate in the past. It isn’t throwing a curveball, it isn’t pitching at an early age, and it isn’t long tossing. The reason is simple:
Youth pitching injuries are due to overuse
But I think we are being polite be saying “overuse.” I would imagine we can even say “abuse” or maybe even “neglect.” Let me explain why.
After years of research showing that high pitch counts, pitching too frequently, throwing for multiple teams, pitching in showcases, and pitching while fatigued are significant factors in the rise of your pitching injuries, Little League Baseball and USA Baseball did the right thing They consulted with many experts in the field of throwing injuries, including James Andrews, Glenn Fleisig, and the experts at the American Sports Medicine Institute, to develop pitch count rules to protect our youth from this overuse.
Kudos to them for stepping up and doing the right thing. But here is the problem….
A recent study publish in Sports Healthsurveyed 95 youth baseball coaches about their knowledge of the saftey guidelines established by the USA Baseball Medical and Safety Advisory Committee. The results are disapointing to say the least.
Overall, coaches answered 43% of questions correctly
27% of coaches admitted to not following the safety guidelines, however only 53% of coaches felt that other coaches in the league followed the safety guidelines
19% of coaches reported that they pitching a player while having a sore or fatigued shoulder or elbow
I’m sorry to say this, but…
Not understanding the safety guidelines is irresponsible and intentionally not following them is abuse.
The cause of youth pitching injuries are definitely multifactoral, however, overuse has been shown to be the most influential. Sadly, overuse also seems to be the easiest to address.
So what can you do? It probably starts with education. Share this article to help spread that word that overuse needs to end and safety guidelines need to be followed.
You can go back and read my article on Little League pitch count rules. USA Baseball also has some guidelines. To summarize them, in addition to monitoring pitch counts, players should not pitch with pain, should limit their throws from other positions (especially catching), limit their participation in our leagues, limit their participation in showcases, and not progress to more demanding pitches until their bodies start to mature.
All coaches need to be aware of these recommendations. Injury prevention begins with the understanding of how injuries occur and what the specific safety recommendations entail.
The next step is getting on a proper injury prevention program. I’ve discussed some of these topics in my article on preventing Little League pitching injuriesand have shared with you my Little League injury prevention exercisesthat I prepared for MGH several years ago. I probably need to update these but it serves as a good basis to begin.
It really is a shame that all these youth pitching injuries are occurring, let’s do our best to spread this education and help reduce these Little League injuries as much as we can!
You can find more great information on injury prevention at Mike's Site. www.mikereinold.com
Within the past decade, baseball progress has come a long, long way. The progress has lead to such things as baseball-specific skills and training systems to develop. In laymen’s terms, this means that players who are willing to do what it takes, more than before, have the ability to reach elite status.
These baseball players, in the video below, are striving for elite status as they prepare for upcoming season in our Conca Performance Baseball Strength and Conditioning program.
Though elite status is more attainable then it was in previous years, the term attainable is not to be confused with effortless. In fact, that is the underlying theme of Mathew Syed’s book entitled,Bounce. Syed, a British journalist, broadcaster and author sums up the science of success in his book, that any and everyone can fulfill their dreams if they keep at it and find people who’ll help steer them in the proper direction.
In one of his passages in Bounce, Syed writes,
“Purposeful practice is about striving for what is just out of reach and not quite making it; it is about grappling with tasks beyond current limitations and falling short again and again. Excellence is about stepping outside the comfort zone, training with a spirit of endeavor, and accepting the inevitability of trials and tribulations. Progress is built, in effect, upon the foundations of necessary failure. That is the essential paradox of expert performance.”
Syed’s advice should not fall upon deaf ears. In fact, his point is furthered by arguably one of the greatest hockey players/athletes in the history of sports, Wayne Gretzky. Gretzky has admitted, “I wasn’t naturally gifted in terms of size and speed; everything I did in hockey I worked for. The highest compliment that you can pay me is to say that I worked hard every day….That’s how I came to know where the puck was going before it even got there.”
When discussing athletic ability in any level or sport, the one topic that always seems to arise is genetics. It would be foolish to think that genetic make-up does not play a pivotal role in determining an athletes’ true peak performance, because it is does. This is so because genetic make-up is responsible for the functional make-up of the musculoskeletal system. The musculoskeletal system is responsible for things such as bony make-up, muscle fiber type distribution and tendinous insertion locations. All of these components can and will play a role in an athlete’s ability to develop key skills, such as high levels of force production/speed or endurance capacity. Ironically, only a sparce minority of athletes actually come near their true genetic limitation.
A prominent reason for most athletes never hitting their genetic limitations is due to the fact that they do not work hard or smart enough to reach this limitation. Although the peak limitation is tough to measure because it can vary immensely, the best way athletes seem to measure it is by the term of “making it.’ The idea of “making it” can mean differ things to different people. Sticking with hockey, one player’s goal may be to reach the NHL, while another player’s dream is to be able to play at the top-tier of the collegiate level. This idea holds true in all sports, especially in baseball where it isn’t uncommon to see a player drafted straight out of high school. For some that may be the ultimate goal, however, other players may wish to play in college. Regardless of the sport or the endpoint, numerous steps and short-term goals need to be set and obtained in order for an athlete to reach his or her ultimate potential.
When such steps aren’t taken, it can be detrimental to an athlete’s progress. While there are athletes everywhere who are enthusiastic, willing and determined, they do not make up the majority of athletes. Unfortunately, the most common situation involves an athlete setting intermediate goals. These goals do not really challenge or push the athlete to truly hit his or her peak potential. When this occurs, complacency starts to take place. Complacency is a slippery-slope, often leading to plateaus, failed dreams, and the most damaging- self-excusing internal dialogue.
In order to avoid the slippery-slope, one easy step to take is to pursue the role of the underdog. Before you go thinking that you want no part of being an underdog because it is stigmatized as cowardly and undesirable, you should comprehend what kind of mentality an underdog possesses, and how successful an underdog can be.
Despite popular belief, an underdog does enter a contest/fight with confidence. In addition, knowing they have nothing to lose, the underdog is relieved of the high stress levels that accompany fearing failure. A prime example of this mentality was put on display for the world to see during 2007-08, when the New York Giants upset the heavily favored New England Patriots in the Super Bowl (and agin in 2012!). More importantly, the underdog knows that he or she will never, ever be outworked. They may not be the most naturally gifted, or blessed with perfect genetics, but the underdog will outwork any opponent that dares to stand in their way. This doesn’t just take place during events, but also before in preparation.
That is where we at Conca Sports and Fitness come into play. Over the years we have helped, trained and pushed athletes of all sports, genders, shapes, sizes, skill levels, and genetics. It does not matter what your true genetic limitation or goals are, we will help you reach them. All you need to do is be willing to work, sacrifice and push yourself and what you can accomplish may amaze you.
In Part 1 or our two part series we discussed some of the top 5 components you need to be a successful player. In Part 2 we will focus in on some of the solutions to get your body game ready.
Part 2:
The Benefits of Off-season Baseball Training - Fixing your Asymmetries and Stiffness
Once the season comes to an end, players will notice certain areas of their body feeling stiff, sore, loose and even painful. Recognizing and screening these specific areas will be the first step is finding movement patterns that have become asymmetrical and or stiff. Addressing these areas should be a priority before they lead to injury.
Thoracic extension and rotation
Without these two areas of mobility, the velocity of the ball with not only be less then it was in the beginning of the season, but a greater risk of (stress) injury is placed on the cuff and elbow. Having enough extension and rotation through the upper back not only results in a healthier shoulder, but will also increase performance. The thoracic spine keeps the shoulder from over reaching and allows a longer and greater cocking phase when throwing the ball, resulting in higher arm velocity speeds and a more efficient throwing motion. If these forms of mobility become limited, the stress on the shoulder and elbow increases.
Below are some clips on how to gain thoracic extension and rotational mobility.
Gaining thoracic extension can be done just as easily. Using a foam roller, begin laying it across the middle of your back. Clasp you hands behind your neck in a neutral position, arch your upper back over the roll trying to touch the top of your shoulder blades to the ground, then return to a neutral spine. Be sure to maintain a flat lumbar spine. The upper back extends, while the low back remains flat the entire times. Repeat for five repetitions, move the foam roller up one inch on the back towards the shoulders and repeat the exercise. Continue rolling the foam roller towards the top of your shoulders to ensure mobilization of the entire thoracic spine. Remember to deeply exhale as you extend your back over the roll.
Ankle Mobility
Many of the athletes we see come to us with poor mobility in the foot and ankle, baseball players are not the exception. A quick way of checking an athlete’s ankle range of motion is to simply look at how he/she stands. If the athlete’s toes are pointing outward, and the arch of the foot is relatively flat can be an indicator of a lack of ankle dorsiflexion (how far the foot can pull up). Deep body weight squatting is another way to assessment how a lack of ankle mobility can effect gross movement patterns as seen here. Poor mobility around the ankle joint can contribute to poor running mechanics, poor body positioning and overall mobility in the field and can even effect throwing mechanics.
All movement and ground reaction forces begin with your feet, so paying close attention to taking care of your feet (ankles) will give you a big advantage on the field and in the Gym.
One of the ways to keep the ankle mobile is starting in a half kneeling position and performing the following movements: Keeping the front heel completely flat and toes remaining forward, drive the knee as far as possible straight ahead before the heel lifts off the ground, then return to starting position. Repeat this move five times, and then drive your knee to the right and left of the dowel to turn this exercise multi-planar.
Glenohumeral Internal Rotation Deficit
This can be one of the biggest issues players, especially pitchers, run into during the season. Glenohumeral internal rotation deficit (GIRD) is known as having a measurement of 19 degrees or more of internal rotation deficit between the dominant throwing arm and non dominant arm. When being assessed, coaches and trainers must find the total range of motion (ROM) of each shoulder. The total range of motion is found by measuring the external and internal rotation of the shoulder, then adding the two numbers together. A calculation of a total range of motion of approximately 170 degrees on both shoulders is ideal.
When comparing shoulder ROM, we are looking at the differences between internal and external rotation of the two shoulders. In the throwing arm, there will be a greater degree of external rotation and a lesser degree of internal rotation of the non-dominant shoulder. Since we can predict the asymmetries that are going to occur, look at the difference between internal rotation between the two shoulders. Ideally we would like it to be between 12-17 degrees as this has shown many players to have no symptomatic issues. However, when numbers reach around 19 degrees and above, these have turned into symptomatic and injured shoulders. Soft tissue work across the posterior capsule along with mobility exercises and light cross body stretches will be the prescription for decreasing GIRD. Remember a proper evaluation must preceded any corrective exercises. Here is a sample of a cross body stretch to gain some internal rotation (if needed).
DO NOT overlook the low intensity exercises during training. A strong cuff is needed to decelerate the arm when going into internal rotation. The cuff is made up of four muscles, infraspinatus, supraspinatus, subscapularis and teres minor.
The main function of these four muscles is not only to externally and internally rotate the shoulder, but more importantly to stabilize the glenohumeral joint. Strengthening the subscapularis may be one of the most important as it depresses the humeral head during overhead movement and will prevent the head from superior migration (head of the humerus sliding upward into the acromion). When the head rises, the athlete would typically feel discomfort or pain as the head crunches tissue into the acromion (another reason why overhead mobility work is a must!!). Below are a few exercises that should be a part of every players program. Not only should these exercises be done during the offseason, but during in-season training as well.
DO THIS:
Dynamic stabilizations – These exercises can be done either with a partner or by yourself. Perturbation can be one of the lowest technical exercises with the biggest outcome. Since the main function of the cuff is to stabilize that joint why train it in any other way? Having the trainee stabilize their shoulder in the packed position (down and back) while partners or coaches perform perturbations at different ranges of motion gives the shoulder the functional training it needs to stabilize the glenohumeral joint.
NOT THAT:
Don’t be that guy -
Do not go find some tubing and have your players crank out a bunch of repetitions and think that will be fine. There are exercises that may work, but there are also ones that give much better results.
Below is the T exercise which mainly hits the posterior deltoid, supraspinatus and lower traps. Begin with the arm at shoulder height and slowly drop the arm back down towards the floor and repeat.
Next is the Y which is used for the mid and low traps while also hitting some of the upper trap. The body position will remain exactly the same as the T, except the arm will now be raised in the position of a Y.
DO NOT OVERWORK THE CUFF!!!
The rotator cuff is not meant to become fatigued! When it does, the muscles cannot function properly and the risk of injury is increased. Think about running long distance. When you reach that maximum threshold you feel like your legs are about to give out and your body will collapse. The same will happen with your shoulder if these small muscles are worked to failure. Programming rotator cuff exercises can be done at any point during the workout. If they are done in the beginning, those muscles are now prepared for the pushing and pulling that is done in a workout. On the other hand, if the exercises are done during the workout, the athlete and coach much look at the number of repetitions between cuff exercises as well as the intensity of the pushing and pulling done on that day. Also, whether you’re an athlete or a coach, remain in contact with one another and always ensure the safety of how the athlete feels to determine if his shoulder may be overtraining.
Recovery
Going to the gym is only 1/3 of the battle during the offseason. Working your butt off 3-4x a week at the gym is an excellent start, but what are you doing during the other 165 hours out of your week? This is where adequate sleep and proper nutrition come into action. Sleep as much as you can! This is where your body allows itself to shutdown and focuses on increasing recovery more than any other part of your day. Stalking on facebook late night or attempting to win the Super Bowl on your Xbox is not going to aid in reaching your goals. There have been multiple studies shown that the hours you get before midnight are more important than the hours you have afterward. Set a schedule for yourself to finish everything you planned for the day, and aim for a time where you can get the 8+ hours of sleep you need.
Nutrition is the final piece to the puzzle. Beginning with a diet log 3-4x a week can help you assess how well you are nourishing your body. Once you see that cereal, bagels and pizza aren’t going to cut it, begin with going back to what your parents told you when you were a kid...
Breakfast is the most important meal of the day (and no it's not PopTarts or Cereals!)
We'll save the more detailed nutrition information for a separate post, so for now remember these quick tips for every time you eat.
Eat protein at every meal
Eat fruits and vegetables at every meal
Eat fiber at every meal
Make sure you have enough omega-6 and omega-3 everyday (Krill Oil)
There are no secrets in the recovery process or becoming a better athlete. Work hard, eat right, get enough sleep and you will become a much improved player from last season.
If you want to be a successful baseball player you need:
1. ACCELERATION when sprinting to first base or getting a jump on a ball in the gap
2. STRENGTH when swinging the bat, throwing "gas," or firing a ball from deep in the hole
3. POWER when driving a ball in the gap and exploding off the mound in the late innings
4. STABILITY to control ALL of these movements
** You need even more STABILITY in the shoulder if you’re a pitcher.
A long season can have a negative impact on each of these components that make up an athlete’s profile. The greatest concern to the athlete is not merely a decline in their physical performance, but a decline in their body's dynamics over the course of the season. The chances for stress (injury) on key areas such as the SHOULDER, ELBOW, HIPS and BACK are magnified.
Aside from the obvious ones I stated above, listed below are my top five reasons why it is a necessity that baseball players become involved with an off-season strength training program.
1. Weaknesses
"What’s your bench bro???" This is probably one of the most frequently asked questions with athletes when they step into a "gym" or training facility. Sad to say, how much someone can bench press has very little carry over to sport performance other than powerlifting. Walk into any gym in town and watch who spends the most time on their back pressing weight. You guessed it! The middle and high school boys!
Take a step back and identify your weaknesses or areas that need improvement. Is it your bat speed? Is it the time it takes you to sprint to first base? Or is it that you have been dealing with specific painful areas such as the shoulder, elbow or hip while in season?
Figuring out where you can make the biggest improvement for next season will only make you that much better and keep you off the injured reserved list. Remember, you’re only as strong as your weakest link. Having an intervention with yourself, your coach and/or your strength coach is one of the most important first steps before beginning an offseason program.
2. Your Core
When you hear everyone talk about training your core, what’s the first exercise that comes to mind? A million sit-ups? That’s typically the #1 answer received. Unless you’re looking for increased disc pressure and zero improvement in rotational core strength and stability, then go ahead and do your million sit-ups.
Believe it or not, your core muscles are built to transfer energy from your lower body to your upper body. Coming up in a future post we will go into greater detail on the importance your core development has on throwing and hitting power.Understand this concept for now. When looking at baseball players, their entire sport is built around generating power through rotation. Hitting and throwing are both major repetitive rotational movements. All the energy generated in these motions begins at the ground. The more stable your core the more energy gets transferred to the upper extremities, which equals more power (velocity in arm and bat speed).
The key when looking at the best baseball players is that they are all in sync from the ground through their legs, their core and all the way to their upper extremities.
Picture this, if you have a really strong lower body and strong upper body but no stability through your midsection you’re going to have a huge disconnection and lose power in transition from your legs to your arms!
Plank and bridge variations along with anti-rotation holds and presses are among the top core activation exercises.
3. Strengthening and Maintaining a Healthy Rotator Cuff
The words baseball throwing and rotator cuff (RC) go hand in hand. However, many players and coaches lack understanding of RC function let alone how to optimally train it. We will cover this topic in greater detail in another post but for now here are the basics:
Envision this: A pitcher begins his wind up and starts his controlled fall to the mound. As the front foot hits the ground, the throwing arm makes it's approach to the release point and in a fraction of a second a 98mph fast ball explodes out of his hand. The arm didn't create the power. It was simply the end of the bull-whip. As a result the shoulder has to internally rotate at approximately 7,000°/s during the acceleration phase (just prior to ball release). This is not only one of the most biomechanicaly dangerous movements in sports, it's the fastest motion in all of sports.
The rotator cuff muscles are too small to be responsible to decelerate the arm (slowing down the arm after ball release) by themselves. Other physical components such as hip internal rotation thoracic rotation play a roll in assisting the deceleration phase. Aside from these other components, keeping the rotator cuff strong, stable and maintaing consistent ranges of internal and external rotation throughout a season can be very complex. We will discuss what to look for and how to manage this in an upcoming post.
4. Soft Tissue Restoration
Soft tissue is recognized as tissue that connects, supports or surrounds other structures and organs of the body. These tissues include muscle, fascia, tendons and ligaments. When a muscle becomes damaged it also becomes dense or thick with inflammation. To relieve the density of these damaged tissues, certain forms of self-myofascial release are necessary including foam rolling and massage. Performing these techniques daily will help players recover faster, maintain better overall muscle tissue quality and decrease the risk of injury.
Some soft tissue restoration techniques we use at CSF are below:
5. Be A Better Athlete
With the days of youth sport specialization upon us, younger athletes are focusing on just one sport at too early of an age. The result is a decrease in overall athleticism and overuse injuries. The danger with baseball is that it's primarily a static sport. With the focus on repetitive, single-direction, rotational patterns that involve throwing and hitting, asymmetrical muscular imbalances can develop. Several other athletic attributes such as foot speed and agility can be suppressed.
If you look at the rosters of most collegiate and pro teams, many of the players were multi-sport athletes throughout high school. Don't kid your self, college and pro-scouts are looking for good baseball talent. But what they're really focusing on is your overall athleticism. They want athletes!! Can you run fast, be agile, can you move, are you strong, etc. If you can do all the above and bring some baseball talent, you will be a complete player, reduce your chances for injury and attract some attention.
Start your preparation now and get involved in a structured and supervised off-season strength and conditioning program. Combine this with continued refinement of your baseball skills and this will not only help you with your baseball development but with your overall athletic development as well. This could be one of the most important decisions you will make in your career.
We can do all the strength training, mobility work, and soft tissue treatments in the world and it won’t matter if they’re overused – because I’m just not smart enough to have figured out how to go back in time and change history. Worried about whether they’re throwing curveballs, or if their mechanics are perfect? It won’t matter if they’ve already accumulated too many innings.
While athletes might be playing with fire each time they throw, the pain presentation pattern is different. You burn your hand, and you know instantly. Pitching injuries take time to come about. Maybe you do microscopic damage to your ulnar collateral ligament each time you throw – and then come back and pitch again before it’s had time to fully regenerate. Or, maybe you ignore the shoulder internal rotation deficit and scapular dyskinesis you’ve got and it gets worse and worse for years – until you’re finally on the surgeon’s table for a labral and/or rotator cuff repair. These issues might be managed conservatively if painful during the teenage years (or go undetected if no pain is present) – but once a kid hits age 18 or 19, it seems to automatically become “socially acceptable” to do an elbow or shoulder surgery.
Sure enough, just yesterday, reader Paul Vajdic sent me this article from the Shreveport Times. The author interviews world-renowned orthopedic surgeon Dr. James Andrews about the crazy increase in the number of Tommy John surgeries he’d performed over the past decade.
A comment he made really jumped out at me, in light of my point from above:
“”I had a kid come in, a 15-year-old from Boca Raton, (Fla.), who tore his ligament completely in two,’ Andrews said. ‘The interesting thing is when I X-rayed his elbow with good magnification, he has a little calcification right where the ligament attaches to the bone. We’re seeing more of that now. He actually got hurt with a minor pull of the ligament when he was 10, 11, 12 years of age. That little calcification gets bigger and, initially, it won’t look like anything but a sore elbow. As that matures, it becomes more prominent. It turns into an English pea-size bone piece and pulls part of the ligament off when they’re young.’”
In other words, it takes repeated bouts of microtrauma over the course of many years to bring an athlete to threshold – even if they have little to no symptoms along the way. Injury prevention starts at the youngest ages; otherwise, you’re just playing from behind the 8-ball when you start training high school and college players.
In addition to walking away with the perspective that young kids need to be strictly managed with their pitch counts, I hope this makes you appreciate the value of strength and conditioning programs at young ages, too. For more information, check out my post, The Truth About Strength Training for Kids.
We can’t prevent them all, but I do think that initiatives like the IYCA High School Strength Coach Certification in conjunction with pitch count implementation and coaching education are a step in the right direction.
Eric Cressey, MA, CSCS is the President of Cressey Performance, just west of Boston, MA. He publishes a free daily blog and weekly newsletter at www.EricCressey.com.
Over the years we have adopted the same philosophies that Eric uses with his baseball clients. Baseball players in the Pioneer Valley who are looking to take your game to the next level, while reducing your chances of developing a shoulder or elbow problem, give us a call at 413-304-2350. Let the Conca Strength and Conditioning team provide you with a comprehensive plan to make this your best season yet.
At Conca Sport and Fitness we have seen an influx of shoulder and elbow injuries this summer. In a effort to provide our baseball clients with the most current trends in injury prevention and performance enhancement, Eric Cressey has been kind enough to provide a 2 part guest post on our blog which will hopefully provide some insight to the problem.
We have a great working relationship with our athlete's parents, their AAU coaches and the medical community. Eric's article may seem controversial, but in no way are we attempting to single out any particular individuals. We are attempting to shed some light on a growing trend in youth baseball. I really believe you will enjoy this 2 part series.
If something is going to be controversial and potentially elicit a negative response from my readers, I “sit” on the topic for 24 hours. During that time, I weigh the decision of whether me publicly writing about something is for the better good – meaning that it’ll help people in the long-term even if it makes them recognize that they’ve been goofing up in the short-term.
I did some thinking on that front last night (actually, for the past several nights), and decided to go through with this blog, as I feel like it’s something that every single baseball player, parent, and especially coach ought to read. So, if you’re in one of those categories – or are just a baseball fan who loves the game – please spread the word on what you’re about to read, whether it’s with a Facebook “recommend,” “Tweet,” or just a friendly email with the link to this article.
If you’ve perused my Baseball Content page much in the past, you’ll know that I don’t try to hide the fact that throwing a baseball is an incredibly unnatural and flat-out dangerous motion. It’s the single-fastest motion in all of sports, and every day, physically unprepared athletes go out and essentially play with fire every single time they try to light up a radar gun – or even just play catch.
Not surprisingly, when you mix physically unprepared bodies with arguably the most dangerous sporting challenge on the planet (the folks in Pamplona, Spain might argue with me, but that’s a blog for another day), athletes get hurt. Arm injuries (like all youth sports injuries) are rising exponentially thanks to not “less athletic athletes” taking part in high-risk sports, but also this participation taking place at all-time high rates thanks to the proliferation of little league all-star teams, AAU teams, fall ball, private pitching instruction, and the baseball showcase industry. A fantastic study by Olsen et al. in 2006 (must-read for anyone involved in baseball development) clearly demonstrated strong associations between injuries requiring surgery and pitching “more months per year, games per year, innings per game, pitches per game, pitches per year, and warm-up pitches before a game” as well as showcase appearances during adolescence. The message was very clear: throw too much – especially at a young age – and you’re going to wind up hurt.
Unfortunately, though, many people glaze over numbers in studies (if they ever read them), and while they may walk away with the “overuse is bad” message, they don’t appreciate what true overuse really is – especially since it’s age-dependent. Fortunately, a February 2011 study from Fleisig et al. showed in no uncertain terms that, in ages 9-14, throwing more than 100 innings per year was associated with a 3.5 times higher risk of elbow or shoulder surgery – orretirement altogether.
To put this into context, I’ll first ask you: do you realize how challenging it is to throw 100 innings in a little league season? Let’s say you start baseball the first week of April (little league) and even manage to play on a summer team that runs through the end of July. That’s a four month season: exactly what I was accustomed to growing up – at the absolute most.
Conveniently right now, we are almost exactly through a month of the major league season – and Jon Lester leads my team of choice, the Boston Red Sox, with 31.1 innings pitched. In other words, at this point in time, a high-performance, skeletally mature pitcher (with no history of arm troubles) in the most elite baseball league in the world is on pace for roughly 130 innings pitched over the first four months of the year. However, there are parents and coaches out there that actually think it’s okay to send an 11-year old out there for a comparable number of innings? It’s especially troublesome when you realize that younger kids always throw more pitches per inning than their older counterparts, as they don’t have good command and insist on trying to strike everyone out instead of pitching to contact here and there.
Just think about how hard that is to do. Lester throws on a five-day rotation, and Little league games are, at most, twice a week. If a kid pitches once a week for four months, even if he throws complete games every time out (not something I’d advise, for the record), he’d still struggle to hit 100 innings (16 starts x 7 inning games =112 innings). Rats! It’s actually tough to overuse kids when the season is kept in check.
So, instead, they add seasons. Join an AAU team (or seven of them). Play fall ball so that you can rack up another seven innings every weekend. Be sure to hit up a few college camps on Saturdays and throw as hard as you can so that your Sunday outing in 25-degree weather is extra miserable. Make sure you see your pitching coach for bullpens as soon as fall ball ends. Get your registration in early for that showcase that’s taking place the first week in January. Just do some band work and a couple of half-ass stretches and you’ll be fine. Riiiight….good thinking.
At risk of sounding arrogant, I’m good at what I do. I’ve devoted my life to keeping baseball players healthy. They comprise 85% of our clientele at Cressey Performance, and I work with millions of dollars of arms every off-season and see players from ages 9 to 50+. I do my best to surround myself with the smartest people in strength and conditioning, rehabilitation, and skill-specific training in and outside of the game. I managed the first subpectoral biceps tenodesis in major league history. I can talk mechanics with the best pitching coaches around, write strength and conditioning and throwing programs, manually stretch guys, you name it. I’ve got two fantastic therapists in my office to do massage, ART, Graston, chiropractic adjustments, and a host of other manual therapy approaches – not to mention a great physical therapist nearby who can handle all our complex cases. You know the only things I, we, or anybody on this planet can’t control?
Poor judgment by athletes and their parents and coaches.
And that – no doubt about it – is the primary reason that kids get hurt. We can do all the strength training, mobility work, and soft tissue treatments in the world and it won’t matter if they’re overused – because I’m just not smart enough to have figured out how to go back in time and change history. Worried about whether they’re throwing curveballs, or if their mechanics are perfect? It won’t matter if they’ve already accumulated too many innings.
While athletes might be playing with fire each time they throw, the pain presentation pattern is different. You burn your hand, and you know instantly. Pitching injuries take time to come about. Maybe you do microscopic damage to your ulnar collateral ligament each time you throw – and then come back and pitch again before it’s had time to fully regenerate. Or, maybe you ignore the shoulder internal rotation deficit and scapular dyskinesis you’ve got and it gets worse and worse for years – until you’re finally on the surgeon’s table for a labral and/or rotator cuff repair. These issues might be managed conservatively if painful during the teenage years (or go undetected if no pain is present) – but once a kid hits age 18 or 19, it seems to automatically become “socially acceptable” to do an elbow or shoulder surgery.
Of course, this isn’t just applicable to coaches in the 9-14 age group. You see “criminal” pitch counts in the high school and collegiate ranks as well, and while they may be more physically mature than the 9-14 year-olds, that doesn’t mean that they’re exempt from the short- and long-term consequences.
This is why we need the best coaches at the youngest levels. It’s also why we need pitching coaches that understand “managing pitchers” as much as – if not more than – teaching pitching mechanics. And, it’s why coaches need to understand the big picture in terms of what different kids can do at different ages, at different times in the year.
It’s also while parents need to be proactive with their young pitchers. If a coach isn’t going to track his innings – and a 9-year-old kid certainly can’t be expected to do so – the parent needs to step up and do so. I’ve met a lot of parents of kids who have been injured at ages 17-21, and most of them look back with a lot of anger toward coaches at younger levels for overusing their sons. Hindsight is always 20/20, but foresight is what saves an arm. Don’t be afraid to step up and say something, as you aren’t telling a coach how to do his job; you’re protecting your kid, just as you would be locking the door at night or making sure he brushes his teeth.
In terms of planning the competitive year, I have no problem with a 9-14 year-old kid playing baseball 4-5 months of the year, as the other 7-8 months per year should be devoted to at least two other sports. It’s basically the “rule of thirds” for long-term athletic development: three sports, four months apiece. Kids can strength-train year round.
At ages 15-16, I’m fine with kids changing things up and going to only two sports. Baseball might occupy 7-8 months, but a big chunk of that should be focused on preparation. So, a kid might start playing catch in November, start his high school season in March, and then play summer ball through the end of July. August through November would be devoted to a fall sport and fall ball would be altogether omitted, as it was the only idea worse than making Rocky V. Kids would, of course, strength-train year-round.
At ages 17 and up, it’s fine with me if you want to specialize in baseball, but that doesn’t mean you should play year-round. I actually advocate kids only throw for 8-9 months of the year (at most) – which is right on par with what most professional players do. The only thing that’d be different is that the season would be shifted up a bit in the year, as the high school season usually starts a few weeks before the professional season. Pro guys get half of October, then all November and December off from throwing. “Specialized” high school players get August, September, and October off (again, because fall ball is as useful as a trap door in a lifeboat). Strength training is year-round.
You’ll notice that there isn’t a single penny spent on off-season baseball showcases. That wasn’t an accidental omission (read here why I don’t like them). If you insist on going to one, pick one between June and early August.
I’m convinced that the next big thing in Major League Baseball’s “scouting revolution” is meticulously analyzing what players did when they were younger. If they are going to draft kids, they want to know that they haven’t been overworked for years prior to entering professional baseball. You’re already seeing this taking place in collegiate baseball based more on an assumption: pitchers from the North are getting more and more opportunities to play down South because coaches recruit them (beyond just talent) under the assumption that they’ve accumulated less wear and tear on their arms.
This piece might have ruffled some feathers. Kids want to play year-round. Parents want to make kids happy – and they enjoy watching them play. You know what else? Kids love chocolate, and parents want to see kids happy – but that doesn’t mean that kids should get a limitless amount of chocolate to consume, right? You put away the Easter candy this week to stress moderation and look out for their long-term well-being.
Coaches enjoy coaching and want to win – and they may take a commentary like this personally because they’re the ones who sent a 9-year-old out for 120 innings one year – and now he’s the one having the elbow surgery. Or, maybe it’s the college coach who let a kid throw 160 pitches in a game and killed his draft status because teams know he’ll have a shoulder surgery in three years. Admitting you’re wrong is hard enough, but admitting you’re wrong and learning from that mistake to help future kids is even harder – but all the more rewarding.
This post wasn’t intended to make anyone feel bad, but bring to light an issue (throwing volume) that I think is the absolute most important consideration when taking care of arms. We can do everything right in terms of physical preparation, but if you throw too much – especially at vulnerable ages – none of it matters.
Again, if you could help spread the word on this, I’d really appreciate it. And, feel free to comment below; I’m here to help.
Eric Cressey, MA, CSCS is the President of Cressey Performance, just west of Boston, MA. He publishes a free daily blog and weekly newsletter atwww.EricCressey.com.
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Over the years we have adopted the same philosophies that Eric uses with his baseball clients. Baseball players in the Pioneer Valley who are looking to take your game to the next level, while reducing your chances of developing a shoulder or elbow problem, give us a call at 413-304-2350.
We also have the privilege of working with the staff at Extra Innings. Together, our baseball clients get the best in instruction and athletic development. Let the Conca Strength and Conditioning team provide you with a comprehensive plan to make this your best season yet.
