Pitchers are constantly looking for the best way to recover after a long outing. Walk into any training room, and you will hear the hum of massage guns and see guys strapped to ice machines. We’re seeing newer things too, like ESTIM machines and even BFR after an outing. We know pitching causes microtrauma and neuromuscular fatigue. The debate over how to properly manage that fatigue never seems to stop.
A recent study finally put percussive massage and traditional ice therapy head to head. Researchers had collegiate pitchers throw 75 pitches and then gave them either a targeted massage gun session or 15 minutes of isolated icing. They tracked exactly what happened to the shoulder over the next 48 hours.
The results might force you to change how you handle your athletes post-game. One of these popular methods actually restored shoulder external rotation strength and proprioception. The other completely fell flat after two days. Check out this week’s podcast episode to hear my breakdown of the data and find out exactly what you should be doing to keep your pitchers healthy and performing at their best.
To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 392: Does Icing Your Shoulder Still Work for Baseball Pitchers?
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Show Notes
• Champion Baseball Rehabilitation Specialist
Transcript
Mike Reinold:
Welcome back, everybody, to the latest episode of the Ask Mike Reinold Show. We’re up in Boston, Champion PT and Performance, answering your questions. Actually, we have another journal article review, which we’re getting some great feedback on this kind of mix between some journal article reviews and some of our questions. Again, just trying to break down some of the articles that we’re finding, we’re talking about at Champion ourselves because if they’re changing our practice, then I’m sure they can change your practice as well. So we’re going to start covering those as well. But with me today, we have Brendan Gates, Dave Tilley, Mike Scaduto, Lenny Macrina, Kevin Coughlin, and Anthony Videtto.
We are back with a journal article review today and we have an article from the Journal of Strength and Conditioning Research, and the name of the article is The Acute and Delayed Recovery Effects of Percussive and Ice Therapies on Shoulder Strength and Sensory Motor Function After Baseball Pitching. And I got to say, I was excited when I saw this title kind of come across my screen to read this a little bit, but this was a cool study. So what do we have? This is what they did basically in their study, and this was a study that I think did a good job. Let me see. All right, so we have basically 16 male college age pitchers with a mean age of 22 years old.
So in Asia, this is from Taiwan, baseball is very popular. So this is what I would consider some fairly high level athletes, 22-year-old high level athletes for baseball. And what they had them do is they had them pitch a simulated game of five innings and 75 pitches with max effort. And what they tried to do is they tried to break it down into two groups, a group that did some vibration massage with a Hypervolt vibration gun after they pitched, and another group that iced for 15 minutes with a Game Ready system. So they compared two groups, the vibration gun and the ice. And what they did is they evaluated how they felt after pitching, after that treatment, and then more importantly, 48 hours later, which I think was an excellent thing to look at because that’s when you’re starting to recover from your outing and you’re starting to get prepared to maybe even throw a bullpen or something like that in your next outing.
So that’s what they looked at. I would say, just right off the bat with the methodology, I don’t love a lack of a control group that did neither, but okay, no big deal. I mean, we can still kind of compare it between the two. But again, what they essentially showed was that after pitching, your strength went down, your external rotation strength went down and your internal rotation strength. But that, to me, we’ve known. We’ve shown that in past studies that it goes down. But I think what was really cool for me was that if you iced and not vibration gun, your strength significantly returned back to basically 100% external rotation by 48 hours. In the vibration group, it was still down 11% 48 hours afterwards. Now, internal rotation was similar, and it got restored to about 95% of where it was, but we showed that there was a decrease in strength and it came back into the group that iced.
And same thing with proprioception, it was improved and same thing with subjective pain scales, that also improved. So gosh, this is such a cool study for me because this is one of the clinical things we deal with pitchers all the time. One of the big trends we’ve seen in Major League Baseball on a five-day pitching cycle, and I think this is throughout though, is that a lot of guys are saying that they’re too sore or maybe they don’t feel quite right on day two, so 48 hours after, when I would love for them to throw a bullpen. So a lot of them are pushing their bullpens back to day three, which was only two days out of their next game that they need to pitch. So we know that pitching reduces your strength, doesn’t make you feel great. Why would you want to throw your bullpen so close to your outing?
That’s kind of been my thing. And I think, again, this study proves that you should have as much time as possible. But more importantly, ice, that’s right, the nemesis of social media, ice, was shown to actually be effective. And that’s really, really interesting with people because I don’t really care about theoretical things about inflammation and how that can help somebody or not help somebody. Yes, I think if you go sit in a cave and just let your body heal, it’s probably best to let inflammation ride its course and do a good job. But if you’re getting paid or if you need to compete just several days later, I think we finally have a study now that’s going to change my practice. And I’ll say this, I’ll add this… We sent a group text out to all of our pro guys that we have a group thread about and shared this article with them and talked to them about them.
I would say over the course of my career, I’ve always said, “I’m pro ice. I like ice.” But I’ve worked with so many players that do and don’t ice that I do not have a strong opinion to say that you need to ice. I have so many successful pitchers that don’t ice, so I haven’t said that. But now for the first time in my career, I officially have changed my opinion to be a little bit more stern with this and say, “Ice is the way to go.” Again, you don’t have to, but if you want to have less pain and you want your strength to return for your bullpen on day two or whatever, your next outing, if you’re a reliever, that sort of thing, ice has been shown to finally do that. So I love the study. We sent it out to everybody. I want to hear your guys’ thoughts.
What do you guys think about it? Has this changed what you guys think? If you started talking to people about this, what do you guys think? Maybe Mike, you want to jump in? I know you’ve been thinking about this article. What do you got?
Mike Scaduto:
Yeah, I think my key takeaway in terms of clinical practice is I think it’s a no-brainer. It’s such an easy modality to use. It’s an ice pack. In the study, they use the Game Ready. And I don’t know if they specified the amount of compression that they use with the Game Ready or not in the actual study…
Mike Reinold:
No compression. Yeah. Intentionally no compression. So that way it would just be the cold.
Mike Scaduto:
Right. Yeah. And that’s what I thought. So I mean, it’s an ice pack. It’s easy. Icing is not the most pleasant thing, but it’s not painful by any means. Some people are more sensitive, but I think it’s such an easy thing that we can implement. Everyone has the ability to get an ice pack. The findings in this study are pretty clear about the benefits, and those are things that we’re really trying to achieve. I think we’re trying to get that strength back to be more prepared for their next bullpen and their midweek throwing. So I think, yes, to answer that question, I think it’s a no-brainer decision. There’s really… In my mind, I know there’s maybe some people out there that say there are some negative side effects of ice, which maybe is a limiting factor of this study where they didn’t do any blood work to take the inflammatory biomarkers and compare that.
But I think that’s not really the goal of this study. The goal was to see whether the strength returned and the perceived soreness was down. So in my opinion, I think those two things are more applicable to how the athlete’s going to feel the next time they pick up a baseball than exactly the specifics of the biomarkers in their blood. So I think, definitely, we’re going to push people to ice specifically their shoulder. And I think the study was interesting. We dived a little deeper into the methods. It was 16 people, maybe I would like to see a slightly bigger study. The subjects, they served as their own control, meaning they did both. So they did the icing protocol and then they did the percussion protocol, and then they compared the difference within the same person. So I don’t mind that. I think the inclusion-exclusion criteria… The inclusion criteria was a healthy baseball pitcher.
We know those are tough to find, maybe. So I don’t have any problem with that. What else are you supposed to do? They excluded people with significant injuries to their shoulder. So overall, I think it was a well-done study. Would love to see future research looking at this with maybe a slightly bigger study size, but I understand the intent of this study, and I think it was well done overall.
Mike Reinold:
Awesome. Yeah. And Mike, I don’t think I could agree any more. The whole concept of what ice does on the cellular level and slowing down or speeding up healing, you have a study that showed less pain, better proprioception, and a return to your strength. I really don’t care what their biomarkers on the inside or their inflammatory process really say. It’s about the outcome. And this is where, again, I think the debate online with ice that’s like, my lord, has gone so far about the anti-ice movement with some things and the push to do some other things. I think this is a really great example of maybe the pendulum swinging and maybe it went a little too far with one concept. And some of the other outcomes other than just inflammatory markers, I think, obviously, are more important. What else? Anybody want to jump in on this one? What would you say to somebody that talks about the ice or the inflammatory process? Does it matter? What would you say to somebody who said that, “Well, doesn’t it slow down healing”? What would you say?
Lenny Macrina:
I mean, if you guys are okay with me saying something, I… And my connection’s okay. I think you kind of alluded to it: the pendulum was swinging too far. And I think pitching 75 throws, I think your inflammation in your shoulder and your body is different than having a traumatic surgery or a car accident, where your inflammatory markers are going to be different. So I think this study kind of matches my biases, where I’ve never bought into the anti-ice world, where I still think ice is important because it depends on the situation. And so I think icing after throwing, no injury, just throwing… Now throwing does injure locally, but you’re not having this big blowout surgery injury, like I said. So I think that’s one thing. Another thing is they used massage guns for a prolonged period of time.
And five minutes of massage gun… I love the massage gun. I use it myself. We love… We have them in our clinic, but I think a five-minute session could have some inhibitory effects on the muscles. And I think there’s a bunch of research that shows vibration therapy, if you do it excessively, can be inhibitory. And so you got to be careful with an AMI and an ACL knee where you may want to do some vibration therapy to the quads after you do some icing to the capsule, which has been shown to help improve quad recovery and quad activation. You got to be careful. So I think maybe they did too much massaging with the massage gun, and that could have been inhibitory. So there’s a couple things from this study that were interesting to me, that it met my biases that ice is not bad, and that maybe we need to be careful with using massage guns excessively.
Mike Reinold:
It’s an interesting slant to that, maybe, on the massage. The good part for me is at least they did a vibration gun and then two days later they retested them. So to me, I don’t think they were still inhibited by that. But I love your point, though. It’s a very valid point. And maybe if they had a control group that did nothing, they would’ve done better, which is good. But still, I mean, if you were to tell me that after you throw, your external rotation strength is down 22%, I believe that. We’ve seen that in other studies. But if you ice, then it goes back to 100% by the second day, that’s awesome. I mean, like, are you kidding? I mean, that’s a study right there. So what else? Anybody else have anything they want to throw in on that? Dave, what do you got?
Dave Tilley:
Yeah, I think I also was growing up in the, “Ice is bad, never use it ever. It’s the demon,” kind of thing. And I think this study is a perfect example of how you have to read research critically, and then not to be crude, but you have to use your brain to apply stuff. And so there was this era when I was starting to get into more sports PT where the wave was like that brand new study came out and it inhibits healing. And so people were like, “No ice ever. And if you use ice, I’m never going to send you a patient again because you’re malpracticed.” And it’s like… All right, there’s very different context specific uses of modalities. And an ice in an acute ankle fracture, from a humane point of view, because someone’s screaming and it’s really painful, is different than ice AMI post-op knee, like Lenny just said, when it’s very helpful to get the quad going, versus 75 outing throw.
It’s completely different, like the tool can be applied in different ways. And I think the fear that a lot of people have, if you’re not reading critical research and using the application base, is like you start to get like, “Okay, this study says it’s bad, I’m never using it again. Where this study said it’s good, so I’m using it on every person.” Like needling. Needling came out. Everybody got needled all the time. And it was like, “Well, the number one outcome of if somebody wants needling to be effective is if they believe it’s going to work.” So I’m not going to needle somebody if they’re afraid of needles, even though the study said it was really helpful.
And I think as I read through the study, it’s like, “Oh, it sounds like a great application,” and I’m not, obviously, a huge baseball between innings kind of guy. You guys are doing all that work at Champion. If I was reading this as a young grad, I’d be like, “Oh, this is actually a good idea. Maybe I should think about using this critically, not just ‘never ice anybody ever no matter what.’”
Mike Reinold:
Yeah. So look, you have two options right now. I think this is the way like, “Listen to this podcast episode, we broke down a very positive thing on ice,” or go on social media, feel bad about yourself because somebody with a lot of followers shamed you into thinking you’re a bad PT because you iced somebody once. And that’s what we’re dealing with right now with some of the education that we see online, is very strong opinions that, like to Dave’s point, there’s a time and a place for most things, and I think hopefully we just found a time and a place for this. So yeah, I changed my opinion based on this study, and it still happens. We change our opinions all the time. But if somebody asked me, I say, “Definitely ice” now. Again, I’m not going to be mad at you if you don’t. It’s your body.
And then the first thing somebody said in our group text with all our pro guys was like, “Do you think this also applies to the elbow?” In my mind I was like, “Yeah, absolutely. I mean, we don’t have proof it does, but I can’t imagine that it would be much different.” So that’s where you’re not always going to have evidence, but you take the best evidence you can and apply it the best you can. So yeah, shoulder, elbow, ice after a pitching outing is back on my plate for what I think a pitcher should do if they want to prepare. And again, if you’re that pitcher that is pretty sore for a few days after and it’s limiting your ability to get ready for your next start, this is even more of a no-brainer for you. Because on a five-day cycle, I do not want people throwing a bullpen on day three. I just think that is the wrong approach.
So anything we can do to get that earlier. Seven-day cycle, same concept, but the more recovery you can have from your bullpen to your outing, the better. And if this helps you get ready, this would be great. And yes, I would ice after your bullpen too, by the way, based on this. Somebody else in the pro group asked that same question. Somebody said, “Should I do this after my side?” Yeah, absolutely. I think this study shows it. So, awesome. Hope you guys enjoyed that. Please rate, review us online so we can actually improve this podcast. We do read those, and we do try to improve them based on your feedback, and be sure to subscribe, and you can get more updates when we release these podcast episodes. Thanks so much.
