Read part one of this article, Exploring Arm Injuries – What Hasn’t Worked.
ASMI is considered the leading researcher on UCL injuries in Baseball pitchers. No one has done more research than they have although Driveline Baseball is making some HUGE strides on the development side. If you haven’t seen it already, here are some of the major risk factors they present in their positional statement on UCL injuries.
- Pitching on multiple teams
- Pitching year round
- Poor pitching mechanics
- Poor physical condition
Here is ASMI’s recommendation for professional players and teams looking to reduce Tommy John surgery.
- Optimize pitching mechanics to ensure using the whole body in a coordinated sequence (kinetic chain). A biomechanical analysis is recommended, as it provides objective data to the pitching coach, strength coach, and pitcher. A biomechanical analysis can also serve as a baseline for re-evaluation later in the pitcher’s career, after performance improvement or after return from injury.
- Vary speeds for each of your pitch types. This will not only reduce the overuse on the elbow, but also can be an effective strategy. The best professional pitchers pitch with a range of ball velocity, good ball movement, good control, and consistent mechanics among their pitches. The professional pitcher’s objectives are to prevent baserunners and runs, not to light up the radar gun.
- Open communication between a pitcher and his professional coaching and medical staff is paramount. The pitcher’s elbow and body are living tissue. Pitching and training create small tears in the tissue; rest, nutrition, and hydration repair the tears. A pitcher and his team should have a plan, but that plan needs to be monitored and sometimes adjusted depending on how the pitcher feels. Specifically, the pitcher should keep his trainer or coach up to date about any soreness, stiffness, and pain. That way when there is an issue, the player and team can consider rest, modified activity, or examination from the team physician to allow the elbow to heal and avert serious injury.
- The pitching coach needs to watch for signs of fatigue on the mound. This could be seen in-game as well as in bullpen sessions.
- The team trainers, coaches, medical staff, and front office must share knowledge in a holistic approach to minimize the risk of injury.
- Flat-ground throwing drills and bullpen sessions should not always be at maximum effort. Reduced effort will allow for physical fitness and technique without adding undue stress to the UCL.
- Take off at least two consecutive months each year from all throwing. During this “active rest” period, you can do other physical activities and exercises, as well as continue proper nutrition. The UCL and body need time to recover and build strength, so the concept of annual periodization should include adequate rest from pitching.
- Exercise, rest, and nutrition are vital for a pitcher’s health. Pitchers with high ball velocity are at increased risk of injury. The higher the ball velocity, the more important to follow the guidelines above.
Now we must interpret the information and apply it to amateur players. Obviously optimizing pitching mechanics is important but that’s a topic for a different time. The most important information we can take from this article is opening a line of communication with our players for starters. After that, look for signs of fatigue on the mound. Are they struggling to find the zone? Did they throw 25 last inning and they are already 20 deep in this one with less than two outs? Let’s try to remember that the health and development of our player is more important than some plastic trophy. Number 7 and 8 are without a doubt the 2 most important things to apy attention to. TAKE OFF AT LEAST TWO CONSECTUTIVE MONTHS EACH YEAR FROM THROWING! It’s over, done, nothing more to say! All of the research indicates that in those two months it will give the arm an opportunity to heal and LOSE some external rotation which is a great thing. Essentially tightening up the spring. If you talk to any ortho, in about 2 seconds they know if your son is a pitcher. Amateur pitchers have extremely poor internal rotation due to excessive rotation caused by repeated throwing. Don’t believe me, call the Doctor. During this period of time you don’t stop Baseball activity all together, just throwing a Baseball. Contrary to popular opinion I love year round Baseball players. At 7 years old I knew I wanted to play professional Baseball. No one pushed me to train, no one forced me to collect Baseball cards, play Baseball video games or watch Baseball tonight. I did those things every day because I absolutely loved it. All my parents did was support that dream. Kids these days are a bit different, sometimes they need to be prodded a little bit, but if it’s in their heart let em go for it. Don’t force them to play another sport just because Joe Shmoe says it’s a good idea. However, get them in other forms of TRAINING to increase strength and skill levels across multiple areas. This leads into the next topic. EXERCISE, REST and NUTRITION ARE VITAL FOR A PITCHERS HEALTH!!! If you don’t train outside of regular Baseball activity, have poor sleeping habits and worst of all, eat empty calories all the time you run a considerably higher risk of getting injured. If you are interested in learning more about the nutritional aspect, we will go into it in great detail later in the book.
Now let’s discuss how we can improve the health and performance of pitchers everywhere. Conventional Baseball training emphasizes an adequate training of muscle fibres, of cardiovascular conditioning and neuromuscular coordination. However, most Baseball related injuries are due to overload that occurs within elements of the bodies wide fascial net, which are then loaded beyond their prepared capacity. UCL injuries are a prime example of this very thing. This tensional network of fibrous tissue includes ligaments and tendons. Fibroblasts continually but slowly adapt the morphology of these tissues to repeatedly applied challenging loading stimulations. Principles of a fascia oriented training approach MUST be introduced to Baseball. This includes utilization of elastic recoil, preparatory counter movement, slow and dynamic stretching, as well as rehydration practices and proprioceptive refinement. This method of training should be introduced on a regular basis to Baseball players in order to develop a more resilient fascial body.
Whenever a football player is unable to take the field because of recurrent knee pain, a tennis star gives up early in a match due to shoulder problems, or a sprinter limps across the finish line with a torn Achilles tendon, the problem is most often neither in the musculature nor the skeleton. Instead, it is the structure of the connective tissue – ligaments, tendons, joint capsules, etc. – that have been loaded beyond their prepared capacity. (Renstrom and Johnson, 1985; Hyman and Rodeo, 2000; Counsel and Breidahl, 2010). The same exact thing is occurring in the UCL of Baseball pitchers and as a result, Tommy John surgeries continue to rise. According to ASMI and all the leading researchers in the game, we know that UCL injuries happen over time as opposed to one isolated throw. The UCL stretches repeatedly like a rubber band and develops micro tears that ultimately lead to the partial or full tear of the ligament. Due to the repetitive nature of pitching a baseball and the stress levels placed on the UCL during the process, it is paramount that the Baseball community begins to understand the importance of training protocols that build the connective and fascial strength necessary to handle the workload they experience. The only way to prevent these injuries from occurring is the continued education of coaches and players. Especially at the amateur level, pitchers MUST throw more, pitch less and MUST build up the connective strength to handle the workload they are going to experience. Here is a deeper look into the fascia we are attempting to train.
Fascia has been described as a body of wide tensional network, which consists of all fibrous collagenous soft connective tissues, whose fibrous architecture is dominantly shaped by tensional strain rather than compression. This continuous network envelops and connects all muscles and organs. Think of a spider web that surrounds the entire body. It is important to understand, that the local architecture of this network adapts to the specific history of previous strain loading demands (Blechschmidt, 1978: Chaitow, 1988). According to the widely accepted SAID principle the body will Specifically Adapt to Imposed Demands. We are simply not asking our pitchers to prepare properly.
Focusing on training the fascial network should become a necessary protocol in the development of Baseball pitchers. If the fascial body is well trained to become optimally elastic and resilient, then it may be relied upon to perform effectively and at the same time offer a CONSIDERABLY higher degree of injury prevention to the UCL in pitchers. Baseball training at all levels is generally focused on the classic triad of muscular strength, cardiovascular conditioning and neuromuscular coordination. Most Baseball pitchers lift weights, run poles and do conditioning work based on plyometrics. Alternative physical training activities like Pilates and yoga take the connective tissue work into account, but that certainly isn’t enough when specifically looking to build connective strength in one problematic ligament.
Connective tissue is amazing in its adaptability. When regularly put under increasing yet physiological strain, the inherent fibroblasts adjust their matrix remodeling activity such that the tissue architecture better meets demand. Recent studies have confirmed (Arampatzis et al., 2010) that in order to yield adaptation effects in human tendons, the strain magnitude applied should exceed the value that occurs during habitual activities. These studies provide evidence of the existence of a threshold or set point at the applied strain magnitude at which the transduction of the mechanical stimulus influences tensional homeostasis of the tendons.