BOWFLEX

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Elbow Pain in Pitchers

To: No one person but to every one

Reference: Elbow pain in the pitcher

This presentation is born out of frustration. But it is not meant to offend anyone.

As a certified athletic trainer (ATC) I see too many young baseball players with medial elbow pain. These young athletes come to me after it is too late – they have been practicing/implementing inefficient (and incorrect) mechanics.

I was once told in graduate school “common things happen commonly and uncommon things happened uncommonly.” This has never been more true than it is today with youth baseball. I am seeing more and more eight, nine and 10-year-olds (and older) that present with the same description. The script hardly ever changes. The mother usually brings the patient to the clinic because her son is in pain. After an evaluation of the athlete, it is explained to the mother that her son has a tight shoulder and it is expected that her son's mechanics may be contributing to his elbow pain. A video analysis of her son's mechanics is recommended. The mother usually states that she would like to have her husband present. The video analysis is scheduled for another visit.

At this next visit the father begins the session by saying that his son has taken pitching lessons and he is quite sure his son’s mechanics are not flawed. The father continues by saying that his son’s pitching coach instructs him by using any combination of the following statements/mantras:

· Get into a tall balance point
· Break the hands quickly to get on top of the ball
· Fall toward the plate
· Land with the front foot closed
· Extend the arm out in front of the body so the release point is closer to the batter
· Snap the wrist down hard and fast

At this point, many of you who are reading this are saying to yourselves “yeah, those sayings/mantras seem right” because you or your own son have been taught these same things.

A good friend and colleague of mine has a saying, “people don’t know what they don’t know”. Being taught only one way of doing a task doesn’t mean that one way you were taught is the only way or even the best way of doing that task. You don’t realize/know that there is another way. Therefore you don’t know what you don’t know.

Much of (if not most of) the pitching instruction that I am encountering today is what has been called by some “belief based”. Belief based revolves around the basic concept of “that was the way I was taught so that is the way I teach.” Does anyone see a flaw with that thinking? What if what is being taught isn’t the only way or the BEST way of instructing our young players? What if what is being taught is hurting our young players? What if the next “great pitcher” never realizes his potential because he was instructed based on someone’s “belief”?

On the contrary, there is a concept of instruction that has been labeled “evidence based”. Evidence based instruction comes from the practical application of research. What does the research say? Without getting technical, the research tells us that if a pitcher has a decreased ability to rotate their arm/shoulder down by a certain number of degrees, then that pitcher’s mechanics change placing unnecessary and excessive strain on the elbow. Therefore, that pitcher experiences elbow pain.

Without this fundamental biomechanical understanding and detection, a pitcher and his parents are placed in what appears to be a never-ending cycle. It goes something like this:

· The pitcher experiences either shoulder or elbow pain
· The pitcher is told to take an over-the-counter anti-inflammatory medicine
· The pitcher temporarily feels better but the pain returns
· The pitcher’s parents take him to a physician asking for a steroid injection (after all that is what the big leaguers do, right?)
· The pitcher is instructed to stop pitching for 2, 3, or 4 weeks and is given a prescription strength anti-inflammatory medicine by the physician
· The pitcher plays another position (usually 1st base – because there is not much throwing, right? When in all actuality throwing from 1st base, in my opinion, is one of, if not the most, arm-dominant throwing positions.)
· The arm feels “better” after a couple of weeks
· The pitcher resumes pitching
· The pitcher throws 1, 2 or maybe even 3 innings and the pain returns (often times more intensely than the original bout of pain)
· The parents take the athlete back to the physician or perhaps to a “sports specialist” for a second opinion
· Rest and anti-inflammatory medicines are again prescribed
· An MRI may be ordered
· An injection may follow
· Rehabilitation is recommended
· The season is 1/3 to 1/2 over with at this point and frustrations from the pitcher, parent and coach are really getting high
· The season is “pieced together”
· The parent and pitcher vow to get instruction in the “off-season” (this is an oxymoron – baseball is a year-round sport now-a-days)
· The pitcher receives instruction based on someone’s “belief”
· The next season begins
· The cycle starts all over again

Have you been there? Do you know someone who has? I see it every spring. Is there anyone to blame? I don’t think any one person is to blame. Because “people don’t know what they don’t know.”

Analogy time: Have you ever been walking and you suddenly feel something in your shoe? Sure you have. What is your reaction? Often times you try wrinkling your toes to redistribute the object that has found its way into your shoe. You begin walking on a different part of your foot than you normally do. You may even limp for a while. But what would be the logical thing to do? That’s right – take the object out of your shoe!

This pebble in the shoe analogy is so applicable to the pitcher and elbow pain cycle mentioned above. The pitcher begins to experience some type of discomfort. He consciously or subconsciously (because the body is a remarkably created machine) makes a change to his pitching mechanics. He “limps” around for a few outings (or even seasons). When in all actuality to break that cycle, one only has to stop long enough to identify and take out the “pebble” that is in the pitcher’s mechanics.

There are other causes of elbow pain in pitchers besides the tight shoulder issue. Belief based instruction puts emphasis on the pitcher’s arm being the prime mover/accelerator of the ball. The elbow leads the body through the acceleration phase of pitching vs. the body pulling the arm through. These pitchers are labeled as arm throwers.

Arm throwers have many things in common but a few of them include:

· Slow/robot-like side steps as their first move from the rubber
· A pause or hesitation at the top (i.e. balance point)
· A short stride length
· Minimal/No back side follow through
· (There are a multitude of things to look for between the first side step and back side follow through)

On the contrary, evidence-based instruction places the emphasis on using the whole body in an efficient manner of creating, storing, and ultimately releasing kinetic energy. Tim Lincecum, 2008 NL Cy Young Award Winner, and his dad understand this concept. My understanding is that Tim is around 5’10” or 5’11” tall but can throw 98 mph and higher.

How did Tim Lincecum become that good? According to the 2008 Sports Illustrated article, Tim’s dad videotaped and analyzed nearly every pitch Tim threw growing up. I realize that many parents (and some pitching coaches) videotape their son pitching. When you view the video, what are you looking for? What checkpoints do you have? What objective measurements are you taking? What degree of hip rotation does your son have? What is the relationship of your son’s trunk lean to his front foot? What ball path does your son have from hand break to front foot plant? Tim’s dad looked at these things and many more. Are you looking for these? If you are, what are you (or your son’s pitching coach) doing with the information once you find it? How are you implementing these findings into your son’s pitching mechanics?
The previous paragraphs most likely caused you to have one of two reactions:

1. You were offended because you believe you can identify mechanical flaws just by watching a pitcher with your eyes. You may very well be able to. But I would have to say you have some very good eyes. For you see, a pitcher’s shoulder can rotate up to 7000 degrees/second (and beyond in elite pitchers). That is the equivalent of a shoulder going in a complete circle (like an airplane propeller) 20 times in one second (thanks C.K. for the numbers.) You don’t know what you don’t know.
2. You realized your son may very well have been taught to be an arm thrower and all kinds of light bulbs went off in your head.

If you are the latter and feel your son or one (or more) of your players could benefit from a professional, evidence-based video analysis of his pitching mechanics, visit…

http://www.athletictrainingandconditioning.com/P.I.T.C.H.html

Thank you for taking the time to read this article.

Wishing you health and success,

Joe

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Coordination and Movement Skill Development

Brian Grasso is the CEO of the International Youth Conditioning Association and is considered one of the premier authorities on youth athletic development in the world. Access Brian's free database of articles and exercises at DevelopingAthletics.com.



The key ingredient to working with pre-adolescent and early adolescent athletes is providing global stimulation from a movement perspective. Younger athletes must experience and eventually perfect a variety of motor skills in order to ensure both future athletic success and injury prevention. Developing basic coordination through movement stimulus is a must, with the eventual goal of developing sport-specific coordination in the teenage years. Coordination itself, however, is a global system made up of several synergistic elements and not necessarily a singularly defined ability.


Balance, rhythm, spatial orientation and the ability to react to both auditory and visual stimulus have all been identified as elements of coordination. In fact, the development of good coordination is a multi-tiered sequence that progresses from skills performed with good spatial awareness but without speed to skills performed at increased speeds and in a constantly changing environment. As Joseph Drabik points out, coordination is best developed between the ages of 7 – 14, with the most crucial period being between 10 – 13 years of age.


As with anything else, an important issue with respect to coordination development is to provide stimulus that is specific (and therefore appropriate) for the individual. Prescribing drills that are either too easy or too difficult for the young athlete will have a less than optimal result.


An interesting note, as I have suggested in past articles, is that there appears to be a cap with respect to coordination development and ability. Younger athletes who learn to master the elements associated with good coordination (balance, rhythm, spatial awareness, reaction etc), are far better off then athletes who are not exposed to this kind of exercise stimulation until advanced ages. The ability to optimally develop coordination ends at around the age of 16. This validates the claim that global, early exposure is the key from an athletic development standpoint. Again, global coordination will serve as the basis to develop specific coordination in the teenage years.


Once again, it is important to mention that coordination development is a process that encompasses years of exposure and is based on DIVERSITY and VERSATILITY. Young athletes cannot be pigeonholed into sport specific stimulus at a young age and expected to vault into the ranks of elite athletics. As the motto of my company says, ‘You Can’t Become a Champion Until You Become An Athlete’.


Furthermore, it is important to understand that coordination-based exercises must be introduced during the preadolescent ages. Adolescence is not an appropriate time during which to begin elements of coordination training. As strength, speed, height and body mass change significantly during these years, it is much more prudent to reinforce already known movements rather than teach new ones. Herein lies the art and understanding of developing a young athlete. Coaches, trainers and parents must accept the fact that developing a healthy and successful athlete is a journey or process that encompasses several varying degrees of stimulus, all of which build on top of the other.


Coordination training, for example, is introduced during the pre-adolescent ages while nervous system plasticity is high and movement habits have not yet been ingrained as permanent. The scope of coordination training changes during the adolescent ages, during which physical growth alters the young athlete’s previously mastered movement habits. At this time, refinement of movement should take precedent over learning new movement-based skills. In post-adolescence, coordination training can once again be taken to new heights.


One point to consider about coordination is that genetic pre-disposition plays a significant role. Less coordinated children will likely never exhibit the tendencies of naturally coordinated children regardless of training. That is not to say that improvements cannot be made, however – quite the opposite.


Here are three basic principals of coordination training –

1. Start young – coordination improves as a result of learning and mastering new movements. Start young athletes off early with coordination-based exercises that challenge their abilities (within reason). The more coordination a young athlete has, the more ability he or she will display at any perspective sport.


2. Challenge young athletes on an individual and appropriate level – Some youngsters have good balance while others display good rhythm. The key to successful coaching is to undercover what elements of coordination each athlete requires and develop drills/exercises that most suitably target the weaknesses.


3. Change exercises frequently – young athletes learn quickly in most cases. Be sure to challenge them physically and intellectually with new exercises often.


The following list provides some basic exercises that you can use with your young athletes to help develop elements of coordination –


Multi-directional forms of running, jumping and skipping


Single leg balancing games


Mirror games (mirroring each other’s movements)


Known exercises starting or finishing in new positions (start sprints from belly or one knee; end with hands up or on all fours)


Opposite arm circles (right hand circles forward, left backwards)


Simultaneous arm and leg circles


Jump in place with 180 or 360 turns while in flight


Balance exercises on a low balance beam


Cross step-over running or carioca


Somersault to balance (somersault to standing one legged balance)


Skipping A, B and C’s


Obstacle running (place hurdles directly on floor and have athlete run over them)


Remember, coordination includes elements of balance, spatial orientation, rhythm and various other traits. This list reflects exercises to improve several of those elements.

Learn more about Brian's complete system of developing young athletes -

Complete Athlete Development Home

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