Pitching and injury are two words that are commonly synonymous in today's game. Last year 275 pitchers had at some point in their career gone under the knife to repair their ulnar collateral ligament. The 3-4 inch incision on the inner arm has become somewhat of a right of passage. Once the MRI has confirmed the tear you're looking at anywhere from 9 -16 months before you're back on the mound depending on the type of surgery performed. The success rate for pitchers to return to the same level of performance or better is where the dilemma begins.
The one common denominator for success as a pitcher in professional baseball is velocity. At the very least, it gets you a look and a shot if nothing else is elite. If you tell a pitcher that they can do whatever they need to do to throw as hard as they can, even if it means breaking down, AND they'll still get to come back a year later as if nothing happened, they will take that chance 10/10 times. The only problem now is that we're seeing pitchers frequently go under the knife more than once. They're continuing to take the chance that they can keep doing what they're doing and keep coming back the same as ever, except it kind of doesn't work that way... (PICTURE OF HARD THROWER)
So let's go back to the cause of these injuries. Pitching injuries, regardless of region, are multifactorial and are impacted by many different things such as movement dysfunction, previous injury, developmental movement patterns, anthropometrics (individual body size), workload, pitch usage percentage, diet, sleep, training patterns, weather, time of day, mental fear avoidance, and honestly many more. I want you to think logically with me for a second, if we're moving a certain way and we get hurt but we don't change anything in the process of returning to throw can you really expect a different result?
The thought process typically goes something like this. "I was successful doing what I was doing, if I can get surgery and come back doing what I was doing then I'll absolutely do that." Or "I'm worried that if I change what made me good I won't be as dominant anymore." These are all valid thoughts, but there is more to this that isn't being discussed. I can't tell you how many times I've seen a pitcher go down with TJ and come back strong only to go down a few years later with the same problem. There has been this theory that a reconstructed elbow only has 5-7 years before it goes down again and I honestly think that's a ton crap. Maybe this applies IF nothing else changes, sure.
The body can only take that kind of damage and get surgically repaired so many times before it starts adapting to the damage and that return to form idealogy becomes a pipe dream. Now, let's discuss the bigger issue here that revolves around this way of thinking. What if it's not the elbow that goes down this time? Return to form from shoulder surgery is a much bigger gamble. Not only that, but the shoulder is a much more elaborate and less stable joint than the elbow. There are many movement possibilities around the shoulder and scapula that make it easy to cheat or compensate a movement and cause it to adapt into a more dysfunctionally moving region.
We're living/playing in a time where advanced tech is much more accessible. The possibility for an amateur pitcher to get a state-of-the-art motion capture analysis is greater than ever, let alone a professional baseball team. The majority of MLB teams have an advanced pitching lab where they can evaluate nearly every aspect of how a pitcher moves from their body movement to the way the ball leaves their hand to the force they create while driving into the ground and yet these injuries aren't being slowed down in the least bit. This begs the question "Are we looking in the right area?" Don't get me wrong, motion capture is an incredibly important piece of the puzzle, but it's probably not fixing your problem. The scapula alone has 17 muscles that attach to it which means 17 muscles have to work to some degree to allow it to move to complete the task of that specific movement.
No advanced tech or medical device has the ability to test which muscles fire, when they fire, the capacity of which they fire, and how they coordinate in relation to the other muscles around them. Surface EMG is like hieroglyphics to today's modern language with what they can tell us in terms of how an athlete uses certain muscles. Someone's mechanics may be pristine on the motion capture analysis but they complain of constant pain or soreness or even deal with chronic injury while another athlete may rate highly on an injury probability score from their motion capture analysis and they seem to be better off. There's just so much more going on that we can't see.
We could take this to an even deeper level and talk about the trigger point patterns and muscle tone around certain joints which can tell us how certain guys generate force and potentially why some areas wear down or fatigue quicker. Workload is important but can only go so far if you're putting greater chronic demand on a structure that's not built to take on that much stress over a long period of time. It could be 1 throw, 100 throws, 1 season, or 5 seasons, the body will adapt regardless and sometimes it's not what you were hoping for.
What about the rest of the body?
Maybe a reason for the elbow taking on so much load is that something in the lower half is inefficient. The body will find a way to compensate for the lack of use or energy transfer from the lower half to make up for it in the upper half. Or it could be that they're using the wrong grouping of muscles to create the force from the lower half as energy works its way up to the upper half. This will create some pretty nasty movement patterns, trigger point patterns, and injury along the way which will also potentially start to create more stress on the arm.
We can work to change movement patterns that dramatically reduce the stress being absorbed around the elbow and shoulder. It turns out that scapular function plays an important role in how the body uses the arm during a throw. If we work to improve the function and centration of the humerus to the scapula through dynamic movements like throwing a baseball then we can reduce the stress being put on both the shoulder and elbow.
I have been fortunate to help several big league pitchers improve how they use their scapula in conjunction with the rest of their body when they throw and it's not uncommon that after a year of working together, I hear something along the lines of "This is the best my arm has ever felt" or they'll report little soreness after a 100 pitch outing. This isn't magic, it's just teaching the body to share the forces it creates (don't come at me with Newton's 3rd law and force creation). I've also worked with several big league pitchers who have dealt with lower-half injuries in their career which has limited their availability but also caused an issue with command. As these issues were cleaned up with detailed work around changing their movement patterns their command and occasional arm pain improved as well. This isn't just theory, it's been put into practice with positive results. We'll save the topic of improving command for a later date.
Now let's get back to the topic at hand. Our dilemma is do we chase the velocity$$$ or do we address the health? The current collective believes you need to pick, I believe you can have both. You just need to address what got you in trouble in the first place otherwise your story will play out like a broken record. Is it a movement pattern, is it a timing issue, is it something with your command, is it an inefficiency in the lower half, is it over-training? Whatever it is, something got you there that needs to be addressed otherwise you might see yourself in the same injury boat or worse a different injury boat which is a boat that's sinking quickly. For some reason, this is the piece no one is talking about or addressing.
If you're curious about the finer details as to how all of this can be achieved or about the process that I use well, let's just say I'm working on something. Until then, you'll just have to reach out.
I'd hate to see any more careers not be lived up to their fullest. There's just too much at stake.
Tyler
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