Baseball Article Archives

Check out all my articles on baseball injuries, rehabilitation, and performance.  Explore the archives below or click the button to subscribe and never miss another post.


The Effect of a 6-Week Weighted Ball Training Program on Baseball Pitchers

I’m very proud to say that our first research project on the effect of baseball pitchers training with weighted balls has finally been published!  Big thanks for my coauthors Lenny Macrina, Dr. Glenn Fleisig, Kyle Aune, and Dr. James Andrews.

By now, many people have seen the results of the study.  I’ve presented the data at APTA, ASMI, PBATS, Sabermetrics Seminar, and many more as we went through the publication process.  We felt this study was very important for the game of baseball as we have seen such a large growth of interest in weighted ball programs, without a complete understand of what happens to the body.

I believe we have found the mechanism behind why throwing weighted balls enhances velocity.  It’s not a change in biomechanics, arm speed, or strength.  It’s a gain in layback.  This likely also explains why these programs are more stressful and show higher injury rates.  I’ve written a summary below, but I urge you to read the full study for all the details:

 

The Effect of a 6-Week Weighted Ball Training Program on Baseball Pitchers

The Effect of Weighted Ball Training on Baseball Pitchers

We performed a 6-week weighted ball training program with high school baseball pitchers.

Players gradually ramped up over the 6-weeks to include kneeling, rocker, and run-and-gun throws with balls ranging from 2oz to 32 oz.  All participants had been throwing and weight training prior to prepare for the program.  We modeled this off very commonly performed programs.  We feel that this program, if anything, is more conservative than many of the programs we have seen.  Many other programs are longer, have less of a ramp up, and include balls that are even heavier.  Also realize that throwing a heavier ball with less intensity over a longer period of time is likely more stressful on the body, it’s just physics.

The max weight, 32oz, was used for a total of 18 full effort run and gun throws.  This represents only 3% of the total balls thrown over a 6-week period.

A control group was used that did not perform the weighted ball program.

After 6 weeks, the weighted ball group did increase velocity by 3.3%.  It should be noted, though, that 8% showed no change, and 12% showed a decrease in pitch velocity. Furthermore, 67% of the control group also showed an increase in pitch velocity.

Arm speed and arm strength did not increase, and biomechanics did not change, meaning the gain in velocity was not from any of these commonly theorized reasons.  In fact, arm strength was up in the control group, suggesting that a weighted ball program may actually inhibit strength gains.

The weighted ball group showed almost a 5 degree increase in shoulder external rotation, or layback.  This has been correlated in previous studies to both velocity and stress on the arm.

The weighted ball group had a 24% injury rate.  Half of these did not occur during the study, they occurred the next season, which is an important finding.  There were no injuries in the control group.

 

The Road to Publication

Many people don’t know what happens in the background when conducting studies with sound methodology and peer review with a prestigious journal.  So I thought I’d share that process.

It takes weeks to months to go through a credible IRB to assure the project is designed well.  It then takes months to conduct the trials to actually acquire the data.  This has to be planned well to assure consistency and valid data.  It takes weeks to analyze the data, going back and forth with the statisticians to sort through the results to pull out the clinical implications.  It then takes months to write the manuscript, remember we are clinical researchers, mean we actually work with clients in the day!  We write these in our spare time at night and on weekends.  The manuscript is then submitted to a journal, which takes months to get back to you, they likely have hundreds on manuscripts submitted per month.  You then work with 3 peer reviewers that take a hard look and criticize the paper.  Their goal is to assure the results are reliable, valid, and without bias.  You then go back a forth a few times over several months.  At this point in time >90% of articles have been rejected, so if you’ve made it this far, congrats!  The editor now takes over and we have another back and forth to assure the results are clear and everything is in order.  The publisher then reaches out with page proofs for you to approve.  Then, magically one day, you get an email with a PDF attached and a link to the publication!

Exhausted just reading that?  Yup, me too.

It’s a LOT easier to just type away and hit publish on a blog, but so many questions are unanswered when that happens.  Was the study designed properly?  Did the procedure follow sound methodology to assure the results are valid?  Were the methods reliable?  Was there no bias from the authors?

That’s why we felt it was so important to get this data out to the scientific community in a medical journal.  Doctors, physical therapists, athletic trainers, and strength coaches need to understand the effects of weighted balls when designed injury prevent, performance enhancement, and rehabilitation programs.

 

Should You Use Weighted Balls?

Weighted balls are not evil.  They are not the cause of injuries.

Throwing itself is the cause.  Weighted balls just change the stress to the body.

They can be used strategically if you understand this and build a program that takes the science into account.  However, remember there’s more than velocity when it comes to pitching.  And science also tells us that there are MANY other ways to enhance velocity that are much less stressful.

Weighted balls are just another tool for us to be used with the right person, at the right time.  But that is probably less often than you think.  If you are a coach using these programs, you must understand this.  There are so many teams now just starting a generic templated program for all players.  There is a better way.

 

The Future of Weighted Ball Research

This study was phase one.  We wanted to look at the results of a 6-week program that is commonly performed in high school players.  This study has shown us a few very important things and has brought to attention what I believe is the primary reasons weighted balls increase velocity (and injury risk).

We have already finished phase two and phase three.  Phase two will look at the effect of different positions and ball weights on the arm, mechanics and velocity.  This study will help us understand which positions and balls to use.  Phase three will look at the immediate effect of different ball weights on the arm.

Together these three studies will shed a lot of needed light on the use of weighted balls.

Once these papers are finalized, the important part starts.  We’ll then work on a clinical commentary paper that summarizes all of our past studies and the science of weight balls.  This will be extremely valuable, and an import resource for baseball coaches, parents, and players to read.

There are still many questions to be asked.  It’s almost impossible to answer them all, but we are lot closer to understand the true science behind baseball pitchers training with weighted balls.

 

Help Spread the Word

Want to help?  I hope so.  Trust me, we are very busy at Champion PT and Performance with baseball injuries.  But nothing would please me more than reducing injuries and helping baseball players take it to the next level.  How’s that for sincerity.

This info needs to get to the baseball coaches, players, and parents.  Please share and spread the word.  Thank you!

 

 

Understanding Tommy John Surgery and How to Avoid It

Note from Mike: Today’s post is an excellent article from New York Yankees team physician, Dr. Chris Ahmad, and Frank Alexander, ATC.  We know that Tommy John injuries continue to rise. Chris and Frank have written a new book to help educate your baseball players, parents, and coaches about Tommy John injuries, and more importantly, how to avoid them.

We have an epidemic on our hands in youth baseball.  With nearly half a million participants, baseball is one of the most popular high school sports in the United States.1 Injuries to the throwing arm continue to grow every year and there is no slowing down in sight.

While there are a number of injuries that a baseball player can succumb to, the most well-known are Tommy John injuries, also known as ulnar collateral ligament (UCL) tears. Once considered a career ending injury, Dr. Frank Jobe revolutionized baseball and all of sports medicine in 1974. That summer, he performed the first UCL reconstruction on the most famous recipient – and namesake – of the surgery, Tommy John.  

UCL injuries are the most studied condition in all of orthopedic surgery and its popularity in the media has made it a preeminent sports injury.

It is estimated that 1 in 4 Major League pitchers will need Tommy John Surgery in their career. In 2000, 13 MLB pitchers had UCL reconstructions. Over a decade later, in 2012, that number had increased nearly three-fold to 32 pitchers requiring the season ending surgery.2

Unfortunately, the increasing numbers of players falling victim to UCL injuries translate to the younger levels of baseball as well.

Evidence suggests the trend has impacted adolescent athletes with a 50% increase in UCL reconstructions in high school baseball players aged 15 to 19 years old.3 In New York State alone, the volume of UCL reconstructions increased by 193% over a 10-year period.3  These younger players may feel pressures within the competitive culture in youth baseball. This may lead players to play through pain and more talented players may be told they have to throw more frequently and with greater intensity.

While there are several reasons why there are so many Tommy John injuries, research has described overuse to be the main cause of player injury.

There is a 500% increase in risk for surgery for those players that pitch more than 8 months per year and a 400% increase in risk is observed for those that throw more than 80 pitches per game.3

Not only are younger athletes enduring this big-league problem, their understanding of the injury leads many of them to want the surgery even in the absence of injury.  There are still many myths about Tommy John Surgery.

Many players see their idols in Major League Baseball have surgery and return to the field throwing harder. What the younger athletes don’t see is the painstakingly long hours that the pros put into their rehab. Mike Reinold recently had a podcast episode with several Tommy John patients to describe their experiences.

There is a common belief among players, parents, and coaches that the rehab program post-Tommy John was shorter than 1 year and allowed for a quick return to throwing.4 We are now seeing players at the higher levels of competition returning to sport around 14-16 months and the average at the Major League level is 15 months post-operatively.

The popularity of Tommy John Surgery in addition to the perceived glamor players receive upon their return is what leads the younger players to think surgery is necessary. Research from our office has shown that 51% of high school baseball players believe that they need Tommy John surgery in order to enhance their performance.4  This is in the absence of an injury – meaning, players that are healthy think they need surgery just to get better at the game of baseball.

Players should have surgery for UCL insufficiency (i.e. tear), not to improve their performance. While we want to celebrate the return of our favorite athletes to the playing field, we only hear about the successes and not much about the players that are unable to make it back. The success rates of Tommy John Surgery range between 80 – 90% and even though players make it back to the field, pitchers throw fewer innings post-operatively.2,4 Having surgery places an enormous burden on the player mentally, physically and emotionally.

As the numbers of youth athletics participants continues to rise, it may seem that elbow injuries have become a part of America’s pastime.  Leaders in the field have established guidelines for our younger players in hopes that they will remain injury free and continue a long, healthy career.

 

A Guide for Young Baseball Players

Even with the implementation of these guidelines we continue to see a rise in throwing arm injuries leading us to write our book Understanding Tommy John Surgery and How to avoid it: A Guide for Young Baseball Players.

 

Understanding Tommy John Surgery and How to Avoid It

 

Our vision for Understanding Tommy John Surgery is to help younger players better understand elbow injuries and that it is not okay to play through pain. Some warning signs may include decreased velocity, elbow tightness, and difficulty warming up.  We also discuss a number of different ways for youth baseball players to stay healthy such as keeping a log of the number of innings or pitches thrown, proper warm-ups, and sport diversification.

By allowing our players to understand their elbow and know that playing through pain is not a good idea, we may finally see a reverse in the trend of Little Leaguers being diagnosed with Big League problems.

If you’d like to learn more and join in our efforts you can visit Dr. Ahmad’s website and get your own copy of Understanding Tommy John Surgery and How to avoid it. If you or a family member has a baseball related elbow injury, Dr. Ahmad will happily review the images with you as a free service and is available to all baseball players across the nation. You can learn more at his website!

 

References

 

  1. Saper, MG, Pierpoint, LA, Liu, W., et al. (2018). Epidemiology of shoulder and elbow injuries among United States high school players. American Journal of Sports Medicine, 46(1), 37-43.
  2. Erickson, BJ (2015) The epidemic of Tommy John Surgery: the role of the orthopedic surgeon. American Journal of Orthopedics, 44(1), E36-E37.
  3. Hodgins, JL, Vitale, M, Arons, RR, & Ahmad, CS. (2016). Epidemiology of medial ulnar collateral ligament reconstruction A 10-year study in New York State. American Journal of Sports Medicine, 44(3), 729-734.
  4. Ahmad, CS, Grantham, WJ & Griewe, RM (2012) Public perceptions of Tommy John Surgery, The Physician and Sportsmedicine, 40(2), 64-72.

3 Things Baseball Players Need to Develop Elite Pitching Performance

There is no magical answer to the question, “what are the best pitching mechanics?”  Take a look around Major League Baseball and you’ll see an endless amount of mechanical variations.

There’s definitely not just one way to throw a baseball.

However, some key moments in the delivery do tend to be more consistent in elite baseball pitchers than many think.

I’ve always considered the wind up more of the dramatical part of the delivery, often times allowing some unique “flare” for each pitcher.  It’s almost like a peacock showing their feathers.  The windup sets the stage for what is to come but doesn’t really have much force or stress seen.

However, everything changes when the foot hits the ground.

Take a look at the moment of foot contact between these three pitchers (photo credit is from Rob Friedman and his amazing collection of pitching gifs):

How to Develop Elite Pitching Performance

And these three at the moment of ball release:How to Develop Elite Pitching Performance

All of a sudden, we start to see very similar mechanics, even though how they got to these positions differed dramatically.

Sure, you are always going to find anomalies, that’s why they are Major League Baseball pitchers.  But I don’t think it’s in anyone’s best interest to try to emulate the mechanics of that one goofy big leaguer.

To truly understand how to best train youth baseball pitchers, we must understand 3 things:

  1. What do elite level baseball pitching mechanics look like?
  2. What are the mechanical faults most common in youth baseball pitchers?
  3. How does youth pitching mechanics change as they age?

Once we understand these factors, we can then develop programs to help facilitate their natural development.  It is extremely important to base our pitching instruction on the science of baseball pitching mechanics.

We sat down last year with my team at Champion PT and Performance and The Farm Baseball Academy to discuss these exact 3 questions to help develop our Elite Pitching Performance Program.

Our youth and high school baseball pitchers should strive to develop sound pitching mechanics at an early age.  Then, once the master the basics, we can start focusing on their long term development based on the above 3 points.

 

Youth Baseball Pitching Mechanics

A recent research study performed by Dr. Glenn Fleisig and the team at ASMI did an amazing job of following several youth baseball pitchers to see how their pitching mechanics changed as they aged, and how this compared to elite baseball pitchers.  The authors followed a group of youth pitchers and assessed their mechanics yearly from age 9 to age 15.

For first time, we now have a more clear pitcher of how youth baseball pitchers slowly develop into elite pitchers.

Using this information, we can build not only better training programs for baseball pitchers to perform, but also a several year curriculum to develop elite pitching performance as they age and mature.

The researchers discussed a few main findings:

  • Stride length – Youth baseball pitchers had a shorter stride length than elite pitchers
  • Open landing – Youth baseball pitchers landed in a more open position than elite pitchers
  • Land with too much Shoulder ER – Youth baseball pitchers shoulder was too far into layback early in their delivery when foot plant occurred than elite pitchers
  • Trunk separation – Youth baseball has less separation of their hip and shoulder than elite pitchers

How to Develop Elite Pitching Performance

Interestingly, pitching velocity has been correlated to both trunk separation and stride length in youth pitchers, so these findings are even more important.  These appear to be two very important things that youth pitchers do with their mechanics that may be holding them back from being elite.

 

The 3 Keys to Enhancing Pitching Performance

Based on the two reports above, we identified three big keys to enhancing pitching performance that we wanted to assure we built our programs around:

  1. Develop hip and shoulder separation
  2. Develop linear and rotation power
  3. Develop lower body drive and intent

We considered this the foundation of our pitching performance programs.  Anything else, like working on long toss or weighted ball programs prior to developing this foundation would be focusing on the wrong things in my mind.

I always say that in baseball pitchers, the lower body develops the power, the core transfers the power, and the upper body dissipates the power.

 

Develop Hip and Shoulder Separation

The first key is developing the ability to separate the hip and shoulder.  This will help land in a more closed position and develop the ability to transfer the force from the legs to the arm and eventually the ball.

While mobility of the hips and spine is a huge factor in developing separation, core stability is also important to control the mobility.  In youth, I see many that don’t have any issue with the mobility to achieve separation, they simply don’t have the core control.

 

Develop Linear and Rotational Power

The next key is to train baseball pitchers to develop linear and rotational power towards the plate.  The body is inherently strong moving forward and back, and less so moving sideways and rotation.

Linear and rotation power is something that needs to be developed.

 

Develop Lower Body Drive and Intent

Once proper trunk separation is established, and linear and rotational power of the lower half and core is developed, then we can focus on developing lower body drive and intent down the mound.

This would inherently increase stride length and help land in a more closed position.

It’s amazing to me how many kids essentially throw with their arms, and not their lower half.  Take a look at our three pitchers here slowly developing drive with their lower half:

How to Develop Elite Pitching Performance

I do believe that intent is something that needs to be taught to many youth baseball pitchers, but many simply just don’t have the mobility, strength, and stability to drive down the mound.

 

How You Can Develop Elite Pitching Performance

Champion online baseball performance training programThe above information is what I consider to be some of the most important things to focus on when developing pitchers.  As I previously mentioned, this has become the core of our Elite Pitching Performance Program at Champion.  We have so many athletes, from Little League to Big Leagues, using our programs to maximize their performance.

But I know not everyone can train with us.  That’s why we wanted to build a program anyone can follow online.

We are really excited to now offer online versions or our training programs!  I teamed up with Champion Strength Coach Nick Esposito to take our acclaimed programing and build an online version anyone can follow so we can help more people all over the world.

We have our advanced program for high school, college, and pro athletes looking to maximize their performance, as well as a youth version for those younger athletes looking to start building an amazing base.  The programs build complete athleticism, including baseball-specific strength, power, mobility, agility, and even an integrated arm care program.

 

 

 

The Science of Weighted Baseball Training Programs

Weighted baseball training programs to enhance pitching velocity are becoming more popular each year.  However, there are so many questions regarding the proper use of  weighted baseballs:

  • Are weighted baseball training programs effective at improving pitching velocity?
  • If so, why do weighted baseball velocity programs work?
  • Does everyone gain velocity with weighted ball programs?
  • Are weighted baseball programs safe for everyone to perform?
  • Do we know the long term implications of these programs?

We still do not know many of these answers.  There are a bunch of great facilities around the country that are pushing the limits with not only training with weighted baseballs, but also attempting to collecting data to help answer some of these questions.

We are getting better everyday, but there is still a great need for more information.  Like anything else, the pendulum is swinging towards the side of pushing the limits.  I’ve discussed this in a past article on baseball velocity programs and essentially noted that I felt we have not found out the most appropriate dose, and are simply are overdosing.  We need to fully understand the science of these programs before we let this swing too far.

 

The Science of Weighted Baseball Training Programs

We have just recently finished a 2-year study looking at the safety and effectiveness of weighted baseball training programs at Champion.  Lenny Macrina and I conducted the study in collaboration with ASMI, Dr. Glenn Fleisig, and Dr. James Andrews.

This is the first real research study looking at the way a 6-week weighted baseball training program effects pitching velocity, arm stress, range of motion, strength, and most importantly, injury rates.

The results are eye-opening for sure.

As many of you know, planning, conducting, and publishing a real research project takes time, often years from the beginning to the eventual publication.  It must go through a strict review to assure safe methodology and a lengthy peer-review process to assure there is no methodological flaws or bias that may be skewing the data.

It’s great that many people around the internet are discussing the data that they collect at their facilities.  This is a great first step in becoming better as a group of professionals.  but without careful scrutiny of their research design, methodology, statistical analysis, and results, it’s tough to call that data “research.”  There are so many variables that could skew the data, it’s hard to draw accurate conclusions.

Our project has been presented at numerous scientific meetings and is currently submitted for publication.  It’s actually been nominated for the Sports Physical Therapy Excellence in Research Award.

Are Weighted Baseball Velocity Programs Safe and Effective?But because it takes so long to get to publication, I wanted to write a summary of our findings.  I recently published this on EliteBaseballPerformance.com, an amazing website I have started dedicated to providing trust worthy information to advance the game of baseball.

Click below to read my summary of our research project on EBP, and please be sure to share this with any baseball player, parent, coach, rehab, or fitness specialist that may work with baseball players:

 

 

5 Reasons Why I Don’t Use the Sleeper Stretch and Why You Shouldn’t Either

Ah, the sleeper stretch.  Pretty popular right now, huh, especially in baseball players?  Seems like a ton of people are preaching the use of the sleeper stretch and why everyone needs to use it.  It’s so popular now that physicians are asking for it specifically.

I don’t like the sleeper stretch and I rarely use it, in fact I haven’t used it in years.  I don’t think you should use it either.

There, I said it, I felt like I really had the get that off my chest!

Every meeting I go to, I see more and more people talking like the sleeper stretch is the next great king of all exercises.  Then I get up there and say I don’t use it and everyone looks at me like I have two heads!  Call me crazy, but I think we probably shouldn’t be using it as much as we do.

In fact, I actually think it causes more harm than good.

 

5 Reasons Why Shouldn’t Use the Sleeper Stretch

I haven’t used the sleeper stretch in over a decade and have no issues restoring and maintaining shoulder internal rotation in my athletes with safer and more effective techniques.

If you have followed me for some time, you know that I rarely talk in definitive terms, as I always strive to continue to learn and grow.  I know my opinions will change and things aren’t black and white.  However, over the years my stance on NOT using the sleeper stretch has only strengthening.  As I learn more and grow, I actually feel more strongly that we shouldn’t be using this common stretch.

So why don’t I use the sleeper stretch?  There are actually several reasons.

 

It’s Often Performed for the Wrong Reason

The sleeper stretch is most often recommended for people with a loss of shoulder internal rotation.  When a person has a loss of internal rotation, it can be from several reasons, including:

  1. Soft tissue / muscular tightness
  2. Joint capsular tightness
  3. Joint and boney alignment of the glenohumeral joint and scapulothoracic joint
  4. Boney adaptations to repetitive tasks, such as throwing a baseball and other overhead sports

You must assess the true cause of loss of shoulder motion and treat accordingly.

Of the above reasons, you could argue that only joint capsular tightness would be an indication to perform the posterior capsule.  But see my next point below…

Performing the sleeper stretch for the other reasons could lead to more issues, especially in the case of boney adaptations.  The whole concept of glenohumeral internal rotation deficit (GIRD), is often flawed due to a lack of understanding of the normal boney adaptations in overhead athletes.

I can’t tell you how many people think they have GIRD that I evaluate and that they in fact do NOT have GIRD.  Click here to learn more about how I define GIRD.

 

It Stretches the Posterior Capsule

If you have heard me speak at any of my live or online courses, you know that I am not a believer in posterior capsule tightness in overhead athletes.  Maybe it happens, but I have to admit I rarely (if ever) see it.  In fact, I see way more issues with posterior instability.  Please keep in mind I am talking about athletes.  Not older individuals and not people postoperative.  They can absolutely have a tight posterior capsule.

But for athletes, the last thing I want to do is make an already loose athlete looser by stretching a structure that is so thin and weak, yet so important in shoulder stability.

Urayama et al in JSES have shown that stretching the shoulder into internal rotation at 90 degrees of abduction in the scapular plane does not strain the posterior capsule.  However, by performing internal rotation at 90 degrees of abduction in the sagittal plane, like the sleeper stretch position, places significantly more strain on the posterior capsule.

Based on the first two points I’ve made so far, if you have a loss of shoulder internal rotation, you should never blindly assume you have a tight posterior capsule.

Assess, don’t assume.

But be sure you know how to accurately assess the posterior capsule.  Many people perform it incorrectly.  Click here to read how to assess for a tight posterior capsule.

 

It is an Impingement Position

This one cracks me, check out the photos below, if you rotate a photo of the Hawkins-Kennedy impingement test 90 degrees it looks just like a sleeper stretch.  I personally try to avoid recreating provocative special tests as exercises.

sleeper stretch impingement reinold

 

This is a provocative test for a reason, by performing internal rotation in this position, you impinge the rotator cuff and biceps tendon along the coracoacromial arch.  If you actually had a tight posterior capsule, you’d get subsequent translation anteriorly during this stretch and further impingement the structures.

So based on this, even if you have a tight posterior capsule, I wouldn’t use the sleeper stretch.  I would just perform joint mobilizations in a neutral plane.

 

People Often Perform with Poor Technique

So far we’ve essentially said that people often perform the sleeper stretch for the wrong reasons and can end up torquing the wrong structure (the posterior capsule) and irritating more structures (the rotator cuff and biceps tendon).

Even if you have the right person with the right indication, the sleeper stretch is also often performed with poor technique, which can be equally as disadvantageous.

People often roll too far over onto their shoulder or start in the wrong position.  If you are going to perform the sleeper stretch, at least follow my recommendations on the correct way to perform the sleeper stretch.

 

People Get WAY too Aggressive

Despite the above reasons, this may actually be the biggest reason that I don’t use the sleeper stretch – people just get way too aggressive with the stretch.  The whole “more is better” thought process.  Being too aggressive is only going to cause more strain on the posterior capsule and more impingement.  You may actually flare up the shoulder instead of make it better.

I always say, if you have a loss of joint mobility, torquing into that loss of mobility aggressively is only going to make it worse.

 

When the Sleeper Stretch is Appropriate

There are times when the sleeper stretch is probably appropriate.  But it’s not as often as you think and it’s most often not in athletes.  The older individual with adhesive capsulitis or a postoperative stiff shoulder may be good candidates for the sleeper stretch.  But I honestly still don’t use it in these populations.  There are better things to do.

But of course, there are good ways to perform the sleeper stretch and there are bad ways, technique is important.

For more information on some alternatives to the sleeper stretch, check out my article on sleeper stretch alternatives.

 

Keys to Effectively Stretching the Forearm

Sometimes you do something and don’t even realize what it means when you do it.

I’ve always been complimented by my athletes and patients about how I stretch their forearms.  They tend to gravitate to me for a stretch.  Perhaps it’s because I’ve worked with so many baseball players with stiff forearms, but apparently my technique feels more effective to people.

As with everything else, I do put a lot of thought into my technique to stretch the forearm.  The issue I think I see with people is that they are solely focused on wrist flexion and extension, and miss the majority of the stretch this way.

I wanted to share a quick video demonstrating how I stretch stretch the forearm.  Not rocket science, but paying attention to the little details will surely help you stretch the forearm more effectively.

These same concepts can be applied if you are performed a forearm stretch on yourself.

 

Keys to Effectively Stretching the Forearm

Essentially what it comes down to is assuring you:

  • Lock out the elbow
  • Bring the wrist into flexion or extension
  • Also include pronation or supination
  • Assure that you are including all the fingers
  • Assure that the finger joints are not flexing, extend them too

Hope this helps you more effectively stretch the forearm!  Let me know what you think and if you do something different.

 

 

Are Baseball Velocity Programs to Blame for the Rise in Pitching Injuries?

do velocity programs cause pitching injuries

One thing is certain when it comes to baseball pitching injuries, they are rising.  Another thing is also certain, baseball velocity programs are ridiculously popular to enhance pitching velocity.

This winter I was honored to be a speaker at both the Professional Baseball Athletic Trainers Society Medical Meeting and the American Sports Medicine Institute Injuries in Baseball Conference.  In both meetings we spent countless hours discussing the rise in injuries and what we can do to help reduce these alarming rates.

I believe the biggest thing we can do is educate, and that is the intent of this article.

Recent reviews of Major League Baseball data have shown that 25% of all pitchers in MLB have had Tommy John surgery.  I’ve written in the past about why Tommy John injuries are rising in Major League Baseball.  While this is amazing to begin with, a scarier trend is also emerging.  86% of MLB pitchers had their Tommy John surgery while playing professional baseball.  However, 61% of all minor league baseball players had their Tommy John surgery during high school or college.

Pitching injuries are occurring at an earlier age.

A recent study in The Physician and Sports Medicine showed that 30% of youth baseball players up to the age of 12 reported episodes of shoulder or elbow pain.  Another report in the Journal of Arthroscopy noted 31% of pitchers up to the age of 22 have experience an arm injury.

Dr. Ahmad of the New York Yankees reported in the American Journal of Sports Medicine on the rise in Tommy John surgery over a 10-year period in the state of New York.  The volume of surgeries increased 193% between 2002 and 2011.  Plus, there was a statistically significant trend towards the age of surgery going down, meaning that more and more kids are having Tommy John surgery at an earlier age.

Dr. James Andrews, who has done more Tommy John surgeries than anyone else, has been discussing how he is seeing a rise in Tommy John surgery in youth baseball pitchers.  At meetings, he tells the story of how he used to see just a few kids a year, but now over a third of Tommy John procedures he performs are in youth pitchers.  Here is a graph showing the rise in Tommy John surgeries performed each year by Dr. Andrews:

tommy john surgery youth

 

Why Do Baseball Pitching Injuries Occur?

Over the years, we have hypothesized many potential causes of the rise in injuries in baseball but the research keeps coming back to two primary causes of pitching injuries:

  • Overuse
  • Increased velocity

Pitchers that throw more innings, more pitches per game, more games per week, play for multiple teams, and participated in more showcases have all been shown to have higher injury rates.  But it’s not just overuse during the season, it’s overuse throughout the year.  In a landmark study by ASMI, pitching for more than 8 months out of the year resulted in a 5x greater chance of sustaining an injury.  This is significant.

Combining all the great research now available to us, here is how the chance of youth baseball injuries increase due to overuse:

  • Pitching > 100 innings in one year = 3x greater risk of injury
  • Averaging > 80 pitches per game = 4x greater risk of injury
  • Pitching > 8 months per year = 5x greater risk of injury
  • Regularly pitching with arm fatigue = 36x greater risk of injury

Our trend towards emphasizing velocity more than any other pitching attribute is not helping either.  Two studies, one in the American Journal of Sports Medicine and the other in Sports Health, have shown a correlation between velocity and elbow stress in high school and professional baseball pitchers.

While increased stress on the Tommy John ligament does not necessarily mean they will get injured, ASMI has also noted that velocity correlated to injuries and that pitchers that threw harder had a 2.6x greater chance of getting injured.  In the previously mentioned article in Arthroscopy, an increase in velocity was associated with a 12% greater injury risk.

So it makes sense that we are seeing a rise in both the average pitch velocity in Major League Baseball and the number of players undergoing Tommy John surgery:

tommy john surgery correlates to pitching velocity

Essentially, the harder and more often you throw, the higher your chance of injury.  

Many people are perfectly OK with accepting this risk, and I am too.  But, the fact that throwing a baseball is not good for your body is very apparent and the first thing that we must all understand when designing baseball training programs.

 

The Evolution of Baseball Training and Velocity Programs

I believe we are in what I would call the “velocity program” era of baseball training.  The primary focus of every kid in America is on performing a “velocity program” that they saw on the internet and essentially guarantees a huge increase in velocity.

The internet is filled with a lot of information.  This is a great thing and allows us all to learn at a rapid pace.  However, it’s difficult to determine who we should actually be listening to and trusting.  Often times the most articulate writers with the most impressive videos will get the most exposure.  What we are seeing is a blind trust and faith in these recommendations based on anecdotal information and limited science.

This is a huge problem to me.  The science is not adding up.

The two biggest offenders I see right now are weighted ball and long toss programs.  These programs have become popular.

Below are the Google search term trends for “weighted baseballs” and “increase baseball velocity” from 2004 to February 2016.  You can see a trend upward as well as the rise in popularity of weighted baseballs over the last few years:

increase pitching velocity

Let me be clear and get this out of the way.  I am a believer of performing weighted baseball and long toss programs.  I incorporate them into my programs and think you should too.  (No one will remember those last two sentences, by the way).

It’s not the program that is the problem, it’s how these programs are being implemented.

It all comes down to “dosage.”  We all know that medicine is effective.  But there are side effects to all drugs and, more importantly, you can overdose and cause more harm than good.

I believe we are overdosing on velocity programs.

We are putting a lot of faith into programs being marketed on the internet that have not been validated scientifically to be safe or effective.  Again, just to be clear, there are many smart coaches on the internet with great programs.  I follow many great minds and really respect what they do.  But realize that:

  • People are trying to implement these programs on their own without thought or a clear understanding on what is safe and effective.  They are not selecting the appropriate dose.
  • People are implementing the same velocity program for everyone, often on a team-wide basis, not individualizing the dose for each individual.
  • People are getting greedy.  Many people think if a 1 lb ball can help them gain 3 MPH, than a 2 lb ball can help them gain 6 MPH!  They are overdosing.

We have a very limited understanding of the science weighted baseball, long toss, and other baseball training and velocity programs, but research is starting to come out.  Below is what we currently know regarding weighted ball and long toss programs.

If you are going to start a pitching velocity training program yourself of with athletes, you MUST understand the science.

 

The Science of Weighted Ball Velocity Programs

Weighted ball training programs work.  We have enough evidence to know that weighted ball training helps to increase pitching velocity.  We’ve known this for decades.  But at what cost?

I can tell you from my experience as the person on the other side of the equation, I hear this comment all the time from injured baseball players: “I started a weighted ball training program this winter, gained 3-5 MPH on my fastball, and then hurt my arm for the first time during the season.”  I can’t tell you how common that is at Champion every day.  This is all I do every day.

How about this conversation I recently had:

  • Pitcher: “I hurt my shoulder two weeks ago and can’t throw without pain.”
  • Me: “Have you ever hurt your arm before?”
  • Pitcher: “Never.”
  • Me: “Did you do anything different this offseason?”
  • Pitcher: “I started an aggressive long toss program to 300+ feet and weighted ball program.”
  • Me: “How did it go?”
  • Pitcher: “This is the best my arm has ever felt.”
  • Me: “Wait, you just said you can’t throw because of pain for the first time, sounds like this is the worst your arm has ever felt.”
  • Pitcher:  [blank stare…]

As you can see, his perception may be the biggest part of the problem.

**Update – since the writing of this article, I have been working with this same athlete.  We toned down his program completely, building up his body and strengthened his arm.  After that, and only after that, did we start a much milder version of a velocity program with long toss and low dose/frequency weighted balls.  His velocity is up even MORE this year and his arm feels great, but I really wanted to share the message I got from him: “Hit 92 MPH the other day, I guess less is more!”  

We still don’t know how safe these programs are and, more importantly, what the effective “dose” should be to increase pitching velocity.  What I mean by this is, how heavy, how light, how many throws, how often per week, and how much during the year among other questions.  Selecting the right dose is important, and it should start with the minimum viable dose to achieve a training effect.

We still do not know the safest and most effective “dose” for pitching velocity programs, just like medicine, more is not better. [Click to Tweet]

The first study to look at the biomechanics of weighted ball programs has been submitted for publication by Dr. Glenn Fleisig and ASMI.  Dr. Fleisig presented the results of their study at the ASMI Injuries in Baseball Course.  Their study looked at mound vs. flat ground throwing of 4, 5, 6, and 7 oz balls.  Although limited in what was evaluated, they showed that throwing balls less than a 5 oz regulation ball increased the amount of stress on the arm.

What tends to happen with overload balls is less stress but over a longer period of time, and for underload balls it’s more stress over a shorter period of time, which is a bad combo.  Sorry for my crude drawing but here is a graphic visualization of this concept:

weighted ball velocity training stress curves

The 7 oz throws were less stressful than a regulation ball, however, we still don’t know if this changes as the balls get heavier or if they change with more intense run-and-gun or turn-and-burn style throws.  These were not studied.  I think they do.

We have recently finished up a big study at Champion PT and Performance where we have teamed up with ASMI, Dr. James Andrews, Dr. Glenn Fleisig, and Motus Global to research weighted ball programs.  In the first phase of the study we are using knee throws, rocker throws, and run-and-gun throws using between 2oz and 2lb balls.

I’ve recently published the whole summary on this study, which you should definitely ready:

 

We found that weighted baseball programs can be effective at enhancing velocity, but at what cost?  We have a 24% injury rate, which we feel was due to significant increase in shoulder external rotation range of motion.  That’s not good.  Furthermore, performing a weighted baseball training program did not increase arm strength, arm speed, or mechanical changes.

Unfortunately, this is was my hypothesis.  Weighted ball programs using weights more than 5oz are effective at enhancing velocity.  I believe this may be because it causes such a quick and dramatic increase in external rotation, or layback.  Increasing this layback correlates to greater velocity.

Weighted baseball training programs may be changing out anatomy.

Scientifically, this gain in external rotation is not from a muscle stretching or the bone adapting.  It wouldn’t happen that fast.  What is likely happening is that the static stabilizers that are supposed to prevent excessive external rotation are being damaged.  This could be the capsule, labrum, or even rotator cuff.  These are not injuries that you want.  Plus, as layback increases, so does stress on the Tommy John ligament.

This is why many people do not get hurt during a weighted ball program, but end up getting hurt down the road.  They’ve pushed past their normal anatomy to increase pitching velocity.

So weighted ball programs have two potential concerns:

  1. Overweight balls may be causing damage to the tissue of the shoulder to allow more layback.  This gain in layback may also increase the strain on the Tommy John ligament (among other things).
  2. Underweight balls increase the amount of peak strain on the arm.

 

The Science of Long Toss Velocity Programs

In addition to weighted ball programs, we have also seen an increase in baseball long toss programs designed to improve pitching velocity.  Long toss is nothing new, but throwing maximum distance and trying to extend this distance over time has become more popular.

Similar to weighted ball programs, we are starting to see studies published quantifying the stress observed on the throwing arm during long toss throwing.  You have to take the science of long toss into consideration.

Dr. Fleisig and ASMI evaluated the stress observed during long toss programs in past studies.  One of these studies, published in the American Journal of Sports Medicine, studied the difference between pitching off a mound and long tossing at 120 feet, 180 feet, and at maximum distance.  Long tossing to 120 feet had similar stress on the arm as pitching on the mound.  Throwing to 180 feet had greater stress.

However the most alarming finding of the study involved throwing maximum distance.  When subjects were asked to use a crow hop and throw as far as they could, the stress on their arm increased by 10% more than pitching off the mound (and their mechanics changed too…)!  It should be noted that the mean distance thrown was 264 feet, less than what many people throw.

Another recent study publish in the American Journal of Sports Medicine by Dr Elattrache of the Los Angeles Dodgers showed no significant difference between pitching off the mound and long toss throwing between 60 and 180 feet.  Let’s be really clear on this one, the amount of stress on the shoulder and elbow were the same as pitching off the mound AND throwing flat ground from even as short as 60 feet, despite a significantly lower velocity during the throw.  Perhaps throwing flat ground is less biomechanically efficient.

It is apparent that the longer you throw, the more stressful it is on the arm, even more so that pitching off the mound.

Long toss is important.  But again perhaps we are using the wrong dose.

I for one have worked with many players that love long toss and many players that hate long toss.  I’ve worked with MLB All-Stars and Cy Young winners on both sides.  I have worked with some that can easily throw 250+ feet without any sign of altered mechanics, while others labor at 180 feet.

Perhaps our issue is more related to the fact that one magical long toss program doesn’t exist.

Trying to say that a certain distance is recommend for everyone is very disadvantageous.  Everyone is different.  Think about it this way, should a 5’8″ tall pitcher and 6’6″ tall pitcher throw the same distance?  Should a sidearm pitcher throw the same distance as someone more over the top?  Should a 15 year old skeletally immature kid throw as far as a 30 year old big leaguer?

Long toss programs need to individualized for each person.  Similar to weighted ball programs, we now know that the stress on the arm exceeds pitching off the mound.

 

Do We Want to Expose the Throwing Arm to Increased Stress?

I think we do.  The body is a really amazing thing.  It’s really good at adapting to applied demands.  We’ve shown scientifically that:

  1. If you throw too MUCH when your growth plates are open, you place too much stress on the arm and greatly increase your chance of injury
  2. If you throw too LITTLE when your growth platers are open, you don’t apply enough stress to develop the physical ability to throw hard when you are older

Exposing the body to increased stress is a good thing.  This is how it adapts.  But just like a rubber band, if apply put too much stress or too many repetitive stresses, it will snap.

We need to expose the throwing arm to increased stress.  I don’t think the real problem is that these weighted ball and long toss velocity programs apply more stress on the arm.  That may be advantageous to an extent to build load tolerance by exposing the body to this extra stress.  It again just comes back to dosage.

These imposed demands need to be applied scientifically with the appropriate intensity, volume, frequency, and timing during the year.  This is not happening.

 

Are Velocity Programs to Blame for the Rise in Baseball Pitching Injuries?

I don’t think velocity programs directly to blame for the rise in baseball pitching injuries.  It’s not the program, it’s the dose.

So what we know right now is that both weighted ball and long toss programs produce more stress on the arm than pitching off a mound.  Again, this is acceptable if applied appropriately, and in fact this may be desired.

But let me ask you a couple of big questions:

  • Would you throw a bullpen 6x per week?
  • Would you throw bullpens all year around?

I hope you said “no” to both of those questions.  If not, you have a lot of reading to do.  Remember, pitching for more than 8 months per year has been shown to result in a 5x greater chance of injury.  A staggering number.

Most coaches know this and have started to throw less bullpens with their pitchers over the offseason.  However, bullpens are being replaced with weighted ball and long toss velocity programs.  Some are even doing this all offseason, while others continue to do this during the season.

So if the science is showing that both weighted balls and long toss place MORE stress on the arm than pitching off a mound, why would you do this 6x per week and why would you do it all year round?

We aren’t resting enough.  Remember what we said before, throwing a baseball is bad for your body.  You need to build in proper rest for recovery.

Your body does not care what or how you are throwing.  It just cares about the stress that is being applied to the tissue.

There is a place for weighted ball and long toss velocity programs, our programs we have built at Champion PT and Performance include these training techniques.  But these should be individualized and applied appropriately using what we know scientifically about these programs.

I believe many are overdosing on these velocity programs and this is one of the main reasons that despite all our advancements in baseball training programs, injury rates in baseball continue to rise.

I wrote this article because I work with injured baseball players all day, and it pains me to do so.  I sincerely want to be put out of business.  I am worried that we are hurting our youth and I see this trend only getting worse.

 

Elite Baseball Performance

As we continue to learn and develop our programs, I am going to share them.  I actually have a lot of baseball content coming and a couple of surprises on the way.  I have recently launched a new website dedicated to advancing the game of baseball at EliteBaseballPerformance.com.  I have put together an amazing group of advisory board members and contributors, including people like Dr. James Andrews, Dr. Glenn Fleisig of ASMI, MLB players like Josh Beckett and Craig Breslow, and several baseball coaches, athletic trainers, strength coaches.

My goal is simple, to provide cutting edge and TRUSTWORTHY information to advance the game of baseball.

Photo by Joel Dinda

How to Assess for a Tight Posterior Capsule of the Shoulder

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

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

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

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

 

 

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

 

Learn Exactly How I Evaluate and Treat the Shoulder

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

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

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

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

Click below to learn more:

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