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An Easy Way for Baseball Pitchers to Maintain Mobility: The 2-Out Drill

I have a saying that I always used when I discuss how and why baseball pitchers sustain injuries:

Baseball pitchers get injured when they’re tight or they’re tired.

I know, it’s not that profound of a statement, but I really do think it’s that simple.  We often try to overcomplicate the reason for baseball pitching injuries.  Over the years we have researched this quite a bit and found that:

  1. The act of throwing is stressful on the body
  2. Throwing makes you lose mobility and strength
  3. A loss of mobility or strength is correlated to injuries

I originally published the first study to look at range of motion of the throwing arm before and after pitching.  We were looking to determine what happened to the arm immediately after throwing.

We reported that after throwing a 40-50 pitch bullpen session, that shoulder internal rotation decreased by 10 degrees, shoulder total rotational motion also decreased by 10 degrees, and elbow extension decreased by over 3 degrees.

 

 

What do these 3 motions all have in common?  These are the muscle groups that all eccentrically contract to slow down and decelerate the arm while throwing.

We found that the act of throwing causes an immediate loss of range of motion of both the shoulder and the elbow.  Anecdotally, I have found that this loss of motion can easily be cumulative and result in a steady loss of motion over a season.

However, with a simple mobility routine performed over the course of a season, we reported that we were able to restore and maintain mobility in pitchers, which is one of the primary reasons I believe our pitching injuries were so low and we handled our pitchers so well when I was with the Boston Red Sox.

Since publishing this original research report on loss of mobility from pitching, others have also correlated the loss of mobility to injury rates.  This is why I also have another saying that I often use:

I want you to be “you” every time you pick up a ball.

What I mean by this is, if we know you loose motion from pitching, and we know that this loss of motion is cumulative over the course of the season, and we know that this loss of motion can potentially lead to injuries, then we should do whatever we can to restore and maintain your mobility BEFORE you pick up a ball.

This is why we recommend a good warm-up routine prior to throwing.  I also believe this is why our arm care programs at my facility, Champion PT and Performance, are so successful.  We not only build up the arm strength and dynamic stability in our athletes, we also help restore and maintain their mobility.

The impact is huge.  Players almost immediately notice the difference in how they feel and that it is so much easier to get loose.  We offered a peek into our Arm Care programs at Champion in one of our past episodes of our Champion TV video series:

 

While our arm care programs are effective in managing the baseball pitcher during the season, don’t forget that we have also noted that you lose mobility fairly quickly while pitching, after only 40 pitches.  

You probably lose motion slowly over the course of a game as your pitch count rises.  I am sure any pitcher that plays on a team with a strong offense knows that they feel like they tighten up while on the bench during a long inning while their team puts up a few runs.

So while arm care programs are necessary in season, what if there was something we could do during the game to maintain mobility?

 

The 2-Out Drill

This was the exact question my friends and colleagues Rafael Escamilla and Kyle Yamashiro sought to answer.  Working with the Oakland Athletics, they developed what they called the “2-Out Drill.”  

Essentially what this means is that you should perform the drill between innings, perhaps when your offense records the 2nd out of the inning and your know you’re close to getting back on the mound.

The 2-Out Drill contains a series of mobility, activation, and movement prep drills specific to the act of pitching.  

I wanted to share a video of the 2-Out Drill so you can see it in action.  I have modified the original version slightly based on what I have found to be effective, but here is how I teach people to perform:

 

An Easy Way for Baseball Pitchers to Maintain Mobility

Rafael and Kyle recently published a study in the American Journal of Sports Medicine documenting the effectiveness of the 2-Out Drill.

The reported that after throwing a 40 pitch bullpen, that range of motion was limited, similar to our past study.  However, the group of pitchers that performed the 2-Out Drill were able to restore their mobility back to the pre-pitching levels.

These results are amazing and important.  In talking to Kyle, some of the things that he told me that aren’t in the research study were that the pitchers felt so much better, felt like it was easier to get loose, and felt that they were able to pitch better after performing the drill.  My athletes said the same thing.\

To me, this is a no-brainer.  The 2-Out Drill is quick, simple, and effective at maintaining mobility during the game.  I recommend all baseball pitchers use the 2-Out Drill between innings, but also prior to throwing each day.  It’s also a great way for relievers to get ready in the pen before they starting throwing.

Give the 2-Out Drill a try and let me know how you feel.

 

Want our FREE Arm Care Program?


EBP Reinold Throwers Arm Care ProgramOur mission at EBP is to provide the best and most trustworthy information. That’s why we now are offering Mike Reinold’s recommended arm care protocol for absolutely FREE.  A proper arm care program should be one of the foundations of injury prevention and performance enhancement programs.  The EBP Arm Care program is the perfect program to set the foundation for success that EVERY baseball player should perform.

 

The Biggest Mistake Baseball Players Make When Playing Catch

Over my career, I’ve been fortunate to work with a wide variety of baseball players.  I’ve worked with everyone from youth to MLB Cy Young winners, and I’ve also worked with hundreds of healthy and injured baseball players.

I have found that many baseball players make the same mistake when playing catch, and I think this mistake can cause a lot of soreness, decreased performance, and maybe even injury down the road.

But more importantly, I’ve found that most big leaguers do NOT make this mistake and most injured players DO make this mistake.

The Biggest Mistake Baseball Players Make When Playing Catch

The mistake is simply that they start throwing too hard too early.

I can’t tell you how many times I’ve started a throwing program with someone coming back from an injury and their first few throws are near max effort at my knees from 45 feet!

Throwing a baseball is such a dynamic activity, it’s very stressful on the arm when this happens.  It’s the equivalent of waking up, getting out of bed, and then immediately running sprints.  You’d never do that, you’d maybe stretch out, go for a jog, then start sprinting.

I’ve always used this simple phrase when starting to teach players this concept:

Let distance dictate your intensity.

This is very similar to Alan Jaeger’s concept of stretching out and compressing on the way back in when long tossing, but something I apply to any throwing situation.  The arm needs to get ready for the upcoming demand.

Luckily, this mistake is easy to fix.

Watch my video below to learn how.  I discuss this common mistake and how I teach baseball players to warm up their arm.

EBP Reinold Throwers Arm Care ProgramWant our FREE Arm Care Program?

Our mission at EBP is to provide the best and most trustworthy information. That’s why we now are offering Mike Reinold’s recommended arm care protocol for absolutely FREE.  A proper arm care program should be one of the foundations of injury prevention and performance enhancement programs.  The EBP Arm Care program is the perfect program to set the foundation for success that EVERY baseball player should perform.

Lat Injuries in Baseball Pitchers

It seems like we are starting to see more and more injuries to the latissimus dorsi, or lat, in baseball pitchers than ever before.

20 years ago, lat injuries in baseball pitchers were fairly rare.  You always had the one or two you’d come across, but they certainly weren’t something I would call a common injury.

In this article, I’m going to discuss the anatomy, role of the lat during pitching, and reasons why I believe lat injuries are increasing.  Then, based on this information, I’ll outline several key factors to considering when trying to prevent, diagnose, and rehabilitate lat injuries in baseball pitchers.

 

Anatomy of the Latissimus Dorsi

The latissimus dorsi muscle is a large flat muscle of the back.  It has several attachment points on the back of the body, which can vary for each person.  The muscle blends with the thoracolumbar fascia of the lower back and spans out to attach to the iliac crest of the hip, the lower ribs, and the spinous processes of lower thoracic vertebrae.

Some studies have even shown that up to 80% of people will also have some attachment to the scapula as well.  This attachment point is very close to the teres major muscle, a muscle that is intimately related to the lat in both anatomy and function.  Please note: I am note referring to the teres minor muscle, which is one of the rotator cuff muscles, but rather the teres major.

In the below illustration, you can see the large lat muscle on the left and the smaller teres major on the right.  The left side also shows the intimate relationship between the lat and teres:

latissimus dorsi teres major baseball pitching injuries

At the point of the scapula, the lat runs parallel with the teres major muscle.  In many people, the lat and the teres major may actually even blend together.  In fact, baseball pitchers can injure either or both of these muscles from pitching, but you rarely hear about teres major injuries.  Often times these will just be grouped together and labeled a “lat injury.”  Of the 16 subjects in a recent study by Nagda in AJSM, only 3 had an isolated injury to the latissimus.  Similarly, in another recent review by Schickendantz from AJSM, only 5 out of 10 subjects had isolated lat injuries.

Both the lat and the teres major run through the back of the armpit to the front of the shoulder and attach near the bicipital groove.  In the below illustration, you can see the close relationship between the attachment points of the lat, teres major, and pectoralis major and the biciptial groove, which I shaded in red:

latissimus dorsi teres major baseball pitching

 

The lat actually attaches to the floor of the biciptal groove while the teres attached just next to it.  However, there many fascial connections between the lat, teres major, pectoralis major, coracobrachialis, subscapularis, biceps, triceps and others.

So…

Do you still think that anterior shoulder pain in pitchers is always “biceps tendonitis?”

As you can see, the lat and teres major (and others), attach along near the biceps tendon.  I have never been a big believer in biceps pain in baseball pitchers.  I just don’t think it happens as common as it is diagnosed.  It has never been something that I have focused on with my athletes.  Many people often just assume anterior shoulder pain is biceps pain and use that as a junk diagnosis.  But doing so is careless and leads to less specific rehabilitation programs.

 

The Function of the Lats in Baseball Pitching

Both the lat and teres major function to perform shoulder extension, adduction, cross body adduction, and internal rotation.  As you can see, from the point of full layback in the throwing motion, these are the exact motions that are performed when throwing.

If you’re not convinced that the lats are important in baseball pitchers, take a look at your athletes with their shirts off.  The asymmetrical hypertrophy of the lat on the throwing side is amazing.  The volume of throwing in baseball pitchers causes a significant growth in the size of the lat.

The lat actually has three roles during baseball pitching:

  1. Controlling the arm going into layback with an eccentric contraction
  2. Transition from layback into acceleration transitioning from an eccentric into a concentric contraction
  3. Accelerating the arm concentrically into internal rotation as well as down and across the body

As you can see, the layback position when the arm transitions from moving into external rotation and into accelerating into internal rotation is an extremely vulnerable position of many injuries.

kinetics of baseball pitching

In their classic research studies looking at the EMG of muscles during baseball pitching, Jobe and Gowan have shown that the lat becomes active during late cocking as the arm comes into full external rotation in the layback position.  This is the period where the arm transitions from moving into external rotation to moving into internal rotation.

EMG during this phase has shown that the lat is significantly active in this phase, at 168% of a maximal manual muscle test.  This means that the lat contracts nearly 2x more aggressively during throwing than when pushing as hard as they can on a manual muscle test during your clinical exam.

This makes sense, as Fleisig and colleagues at ASMI have shown that the arm has a significant amount of stress in this position and accelerates at over 7000 degrees per second, which is the fastest recorded human motion in sports.

The lat has a significant role in slowing down the arm flying into layback and then transitioning into internal rotation through the arm acceleration phase of throwing.

 

Why Do Lat Injuries Occur in Baseball Pitchers?

The anatomy and function of the lat has not changed, so why are we seeing an increase in the amount of lat strains in baseball pitchers?

I think there are a few reasons.

 

More Layback and Retroversion

We know a few things are evolving in baseball.  Just over my short career, I have seen the physical characteristics of baseball pitchers evolve.

Back in 2008, I published a research study that looked at the range of motion of professional baseball pitchers and noted that their throwing shoulders had 137 degrees of external rotation.  When we measure players now, it’s not uncommon to have 140-155 degrees of external rotation.

We know that external rotation in the throwing shoulder is due to boney adaptations from throwing while the growth plates are open.  Youth baseball players are throwing so much, that the volume of throwing is likely leading to more boney changes, and more layback.

So that lat will need to produce tension to eccentrically control the arm into layback and switch to concentric acceleration from a more biomechanically disadvantageous position.  The lat is needing to produce more force at further amounts of end range of motion.

 

More Cumulative Stress

So, take your increased shoulder external rotation and add more throwing and you are pushing both volume and intensity.  Each time you throw, I believe you have a micro-injury of the muscles of the arm, including the lat.  We know that the arm gets tight right after throwing, likely due to this stress.

What we are seeing more and more at Champion, are baseball players with a loss of overhead shoulder elevation and cross body abduction.

lat tightness in baseball pitcher

To me, this is a sign of excessive workload, poor recovery, or most likely both.  This slowly worsens over the course of a season if not addressed.

When we evaluate the shoulder, it’s clear that tightness of the lat and teres major are the contributing factors to this tightness.

If the lat is tight during the throwing motion, that is going to cause more stress at the full layback position each and every throw.

 

Bigger, Stronger, Faster Baseball Players

So, now we have more external rotation of the shoulder, putting the lat in a biomechanical disadvantage, plus cumulative tightness of the lat from the stress of throwing, which causes increased tension at end range.  Add more strength and power in the modern day baseball player and we are just adding fuel to the fire.

Baseball strength and conditioning has evolved over the years and has done an amazing job building strong powerful athletes.   Well designed baseball strength and conditioning programs are different from those of other sports.

However, it is very common to have high school, collegiate, and even professional baseball players perform the same type of strength and conditioning program as other sports, such as football and hockey.

You have to start questioning if focusing on developing maximum strength and power is the best approach for baseball pitchers.  Are we starting to put too much focus on always trying to add strength and power?  Are we focusing too much on strength and not athleticism?

I know in my time in Major League Baseball, very few baseball pitchers had overdeveloped upper body strength.  They all had strong legs, but most professional baseball pitchers looked quite average with their shirts off.  Who am I kidding, many were well below average!

But these were MLB All-Stars and Cy Young winners that threw in the upper 90’s.

These days, baseball pitchers are starting to look like body builders, with the notion that more is always better.

Just like everything else, there is likely a diminishing reward to strength training when your job is to throw a ball, and proper strength and conditioning programs must periodize the stress involved on the body.  I can’t tell you how many times I shake my head when I watch videos on social media of players trying to hit a max effort lift in the weight room in the spring.  If you are still trying to maximize your strength in the spring and not focusing your stress on pitching, you are missing the boat on what makes a great pitcher.

 

Pushing Past Our Physiological Limits

As you can see from the first three reasons I believe lat injuries in baseball pitchers are increasing, we are increasing the stress applied to the lat in many ways from increasing shoulder joint mobility, to decreasing lat mobility, to increasing lat strength and power.

The final reason I believe we are seeing so many more injuries takes all these into consideration, however, may be the final straw that broke the camel’s back.  In addition to the above, the culture of baseball now is pushing velocity at all costs.

The current state of baseball believes that velocity is king.

So we are seeing throwing programs that include things like aggressive long toss and weighted ball programs being pushed throughout baseball in an attempt to maximize velocity.

There is a time and a place for these programs, however, many if not most athletes performing these programs are not prepared for these programs.  I’ve said it hundreds of times before, but performing a velocity enhancement throwing program without skeletal maturity, a solid foundation of total body strength, and a proper baseline of arm strength is like frosting the cake before you ever baked it.

In our recent research projects with ASMI and Motus Global, we have identified that the likely reason that weighted ball programs are effective at gaining velocity is due to the increased amount of shoulder external rotation that occurs over the course of a weighted ball program.  Our study has shown an average of 5 degrees of external rotation of the shoulder is gained over the course of a moderated 6-week weighted ball program.

Over time, pitching with this increased range of motion and velocity can overload muscles like the lat and lead to injuries.

We are pushing past our physiological limits.

 

Preventing Lat Injuries in Baseball Pitchers

To prevent lat injuries, you first need to understand the 4 concepts that I discuss above.  Without an understand of why lat injuries are occurring, we’ll never be able to prevent them.

Taking the above factors into consideration, we can reverse engineer how to potentially reduce lat injuries.

  1. Since we are developing greater amounts of external rotation of the shoulder, we must emphasize proper strength and dynamic stability of the shoulder.  Essentially, if we are decreasing our static stability, we need to enhance our dynamic stability.
  2. We must perform soft tissue techniques, both manually and through self myofascial release, to maintain proper lat and teres mobility.
  3. Strength and conditioning programs must emphasizing complete athleticism and not just maximum strength and power.  These programs must be periodized to decrease the emphasize on strength as baseball pitchers start to get closer to the season and pitching off the mound.
  4. We should avoid pushing past our physiological limits with weighted ball and long toss programs without an adequate foundation of physical maturity, strength and conditioning, and arm strength.

 

Diagnosing Lat Injuries in Baseball Pitchers

Realistically, despite the above information, we are going to continue to see lat injuries in baseball players.   I’ve heard many people say that lat injuries are often overlooked and difficult to diagnose.

I completely disagree.

I just think we aren’t looking hard enough.  It seems like anyone with anterior shoulder pain is diagnosed with “biceps tendonitis,” which I hope you will carefully scrutinize in the future after reading this article.

Next time someone has anterior shoulder pain, don’t jump to the conclusion that it’s from the biceps.  Look at overhead and cross body mobility. Test the lat function with manual muscle testing including straight arm pulldowns, arm abduction, and shoulder internal rotation and see if it is weak or produces symptoms.

lat strength test baseball

lat muscle test shoulder internal rotation at 90

Also keep in mind that lat injuries can present with either anterior or posterior shoulder pain.  Strains at the muscle tendinous junction tend to have posterior shoulder pain, in the back lower armpit area.

latissimus dorsi teres major injuries in baseball pitchers

But these are the easier types of lat injuries to diagnose.  It’s the anterior pain that I think we are missing.

 

Rehabilitating Lat Injuries Baseball Pitchers

Lastly, I want to share a few clinical pearls when rehabilitation injuries to the latissimus dorsi or teres major muscle.  These come with experience.  I have seen many players struggle with this rehab, so learn from my mistakes:

  1. Lat injuries need to be shut down from throwing for longer than you think.  On average, I tend to shut players down for 4-6 weeks, but now that we are identifying these injuries sooner before they become huge injuries, I sometimes consider as soon as 2 weeks.
  2. The chance of reinjury is high.  I have seen many players reinjure their lats from trying to come back too soon, or progressing too fast.
  3. It’s hard to stress the lat appropriately in the clinically setting.  The act of pitching places a tremendous amount of stress on the lat.  Players will have a satisfactory clinical examination before the lat is ready to throw.  As a general rule of thumb with lats, I tend to say that you must pass my clinical examination, then wait an additional week before you can start throwing.  Seriously.
  4. Go slower than usual with a throwing program.  Again, it’s easy to reinjure the lat.  You need to perform a gradual intensity long toss program without max intent.  Once you get a decent base of long toss under your belt, you can increase intensity.  I see too many players focus on intensity before distance in their throwing program.  I always say, “let distance dictate your intensity.”

 

Lat Injuries in Baseball Pitchers

There is no doubt about it, lat injuries in baseball pitchers are becoming more common, and probably will continue to do so as we continue to push out limits of throwing velocity.  To prevent, diagnose, and rehabilitate lat injuries, you have to understand the anatomy, function during pitching, and pathomechanics of lat injuries.

 

 

Arm Care Starts with the Scaps

The two most commonly reported areas of pain in baseball players are the shoulder and elbow.

However, the area in pain may not actually be causing the pain itself.

The body is a chain and weakness in one link of that chain can cause pain in another area. This is certainly the case when it comes to arm pain. Often when pain is felt in the arm it is due to a lack of mobility elsewhere in the body. That “elsewhere” is often from the scapulothoracic joint.

In order to understand the importance of the scapulothoracic joint, which is comprised of the scapula (shoulder blade) and the rib cage, we have to appreciate the functional. The shoulder joint is made up of the head of the humerus and the glenoid cavity of the scapula. The humeral head sits right on top of the glenoid cavity like a golf ball on a tee. As the shoulder joint goes through various motions, the scapula has to move with it. It does this by gliding on top of the rib cage. For every two degrees that the shoulder moves, the scapula should move one degree (2:1 ratio).

Here’s a great video showing the anatomy of this movement:

If the scapula is unable to move close to a 2:1 ratio with the shoulder, then we are going to be limited with how far we can move our arm. This limit, when trying to throw a baseball, is problematic, as the thrower will place undue pressure on the shoulder and elbow in an attempt to reach the proper range of motion.

Scapula Exercises for Baseball Pitchers

As you can see, it’s pretty important to not just focus on the arm, but also the scapula.  Below are my four favorite correctional exercises to develop scapulothoracic movement.

Side Lying Half Moon Thoracic Stretch

In addition to mobilizing the thoracic spine, the lying half moon stretch is exceptional at promoting scapulothoracic range of motion.

Have the athlete flex their top knee at 90° and sit it on top of either a medball or a foam roller. This will keep their spine aligned properly. The athlete should try to drag their fingers along the ground as they progress throughout the motion. It is important to note that athletes who lack ST mobility will not be able to get their hand all the way to the ground initially.

As the athlete moves their arm through the motion the scapula will go through all of its movement patterns.

 

Back to Wall Shoulder Flexion

For baseball players it is critical that the scapula is able to elevate and upwardly rotate as the arm extends forward towards ball release. This drill is an example of how an assessment test can also be used as a corrective exercise.

Have the athlete stand with their feet 4-6 inches away from the wall and cue them to keep their back completely flat against the wall. With the amount of lumber extension we see across the population this may be very challenging for some athletes. If the athletes cannot keep their lower back flat on the wall, instruct them to bend their knees and active their core.

Forearm Wall Slides

As the athlete slides their hands up the wall they are getting more elevation and upward rotation of the scapula; but as they pull their hands off of the wall, they’re going to retract the scapula and get some slight posterior tilt as well.

Make sure that athlete engages their core and doesn’t fall into lumbar extension as they bring their hands off of the wall as this should be an exclusively scapulothoracic movement.

Prone 1-Arm Trap Raise

The last exercise in my scapulothoracic joint mobilization series is very similar to the classic Blackburn’s exercises.

I prefer to have athletes do these exercises unilaterally and on a table because when done bilaterally and on the floor we often see more spine movement than actual ST movement. This is another good exercise for developing posterior tilt of the scapula by allowing the lower trap to get involved.

The beautiful thing about all of these exercises is that they require very little to no equipment at all. This means that athletes can do these exercises in the gym, on the field, or at home.

Give these scapular exercises for baseball pitchers a try and keep that arm healthy this season!

 

Want EBP’s FREE Arm Care Program?

EBP Reinold Throwers Arm Care ProgramOur mission at EBP is to provide the best and most trustworthy information.  That’s why we now are offering Mike Reinold’s recommended arm care protocol for absolutely FREE.  A proper arm care program should be one of the foundations of injury prevention and performance enhancement programs.  The EBP Arm Care program is the perfect program to set the foundation for success that EVERY baseball player should perform.

 

 

 

Defining Long Toss

A recent study out of Wake Forest in the Orthopedic Journal of Sports Medicine looked at the perceived definition of a long toss program by pitchers, pitching coaches and athletic trainers associated with Major League Baseball. The ultimate goal was to see the differences, if any, in how players and teams incorporate these programs into daily programs, including rehabilitation.

The study showed that long toss distances were longer if utilized by the pitcher or pitching coach compared to when an Athletic Trainer employed the program. Also, there was considerable variation in throwing mechanics when throwing on a line and when the athlete would utilize a crow hop.

One possible explanation between these differences may be that players performing a long toss program designed by an athletic trainer were likely rehabilitating back from a pitching injury, while pitching coaches were just performing daily long toss between outings.

The results of this study show that there is considerable variation in the use and rationale behind a long toss program. Players, coaches and athletic trainers need to understand the implications  and demands of a long toss program in order to maximize their use between starts and in the rehabilitation setting. It may be most beneficial to use multiple variations of long toss programs that best suit the athlete and the goals of the throwing program, such as one form for rehabilitation and another for healthy players.

 


 

Defining the Long-Toss: A Professional Baseball Epidemiological Study

Austin V. Stone, MD, PhD, Sandeep Mannava, MD, PhD, Anita Patel, Alejandro Marquez-Lara, MD, and Michael T. Freehill, MD

Background: Despite widespread use of long-toss throwing in baseball as a component of arm conditioning, interval throwing programs, and rehabilitation, long-toss distance and throwing mechanics remain controversial.

Purpose: To ascertain the perceived definition of long-toss throwing through a survey of professional pitchers, pitching coaches (PCs), and certified athletic trainers (ATCs) associated with Major League Baseball.

Study Design: Descriptive epidemiology study.

Methods: Pitchers, PCs, and ATCs associated with 5 Major League Baseball organizations completed an anonymous survey that collected demographic data, personal use of long-toss throwing, and their perception of the distance and throwing mechanics that comprised long-toss.

Results: A total of 321 surveys were completed by 271 pitchers, 19 PCs, and 31 ATCs. For all respondents, the mean distance considered as long-toss was 175 ft (95% CI, 170-181 ft). Respondents categorized the throwing mechanics of long-toss, with 36% reporting throwing “on a line” and 70% reporting long-toss as “not on a line.” Of those throwing “on a line,” 28% reported using crow-hop footwork while 60% used crow-hop footwork when throwing “not on a line.” Interpretation of long-toss distance significantly varied by position: pitchers, 177 ft (95% CI, 171-183 ft); PCs, 177 ft (95% CI, 155-200 ft); and ATCs, 157 ft (95% CI, 144-169 ft) (P = .048). When asked when long-toss throwing is used, pitchers reported using it more frequently in preseason (P = .007), during the season (P = .015), and in the off-season (P = .002) compared with that by ATCs. Functional goals for long-toss throwing demonstrated that pitchers and PCs use long-toss for shoulder stretching more frequently than ATCs (P < .001 and P = .026, respectively). ATCs used long-toss more than pitchers for interval throwing programs (P < .001).

Conclusion: The definition varies for long-toss throwing distance and throwing mechanics. Pitchers and PCs believe that long-toss comprised longer distances than ATCs and employed long-toss differently for strength conditioning, training, stretching, and rehabilitation. This discrepancy highlights a potential lost opportunity for protecting the shoulder. While long-toss is an important tool, a more scientific definition is warranted to better elucidate its role in enhancing throwing performance and rehabilitation.

 

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5315237/

Is Rotator Cuff Strength the Key to Preventing Tommy John Injuries?

I like simple studies that answer complex answers.  A recent report in the International Journal of Sports Physical Therapy has shown the baseball pitchers with Tommy John injuries have weaker rotator cuff strength than healthy players.

This has long been studied and shown previously but the I really liked how the authors conducted this study.  Two things stand out to me from these results that have considerable implications.  Baseball players with Tommy John injuries had:

  1.  7% deficit in ER rotator cuff strength compared to their non-throwing arm.  Healthy players had no deficit between their shoulders.
  2. 30% deficit in ER rotator cuff strength compared to the throwing arm of healthy players.

So, players with Tommy John injuries were weaker in general and showed specific throwing arm weakness.  I’ve always said that shoulder strength and mobility is the key to reducing these Tommy John injuries, these results completely support the need for rotator cuff strength.

 

EBP Reinold Throwers Arm Care ProgramDownload Our Free Throwers Arm Care Program

So it’s pretty obvious that we should be performing a shoulder program.  I’ve recently put together a free arm care program for EBP that you can perform to get your shoulder and forearm strong, and hopefully prevent some of these Tommy John injuries.

 

 


Baseball Players With Ulnar Collateral Ligament Tears Demonstrate Decreased Rotator Cuff Strength Compared To Healthy Controls

Background: Ulnar Collateral Ligament (UCL) tears are common in baseball players. Alterations in rotator cuff strength are believed to be associated with injury to the shoulder and/or elbow in baseball players.

Hypothesis/Purpose: Baseball players diagnosed with a UCL tear will demonstrate decreased internal (IR) and external rotation (ER) force as an indication of isometric muscular strength in the throwing arm compared to IR and ER force of the throwing arm in healthy baseball players. The purpose of this study was to examine isometric IR and ER strength of the shoulder in baseball players with UCL tears at the time of injury compared to healthy baseball players.

Study Design: Case‐control study design

Methods: Thirty‐three of the participants were diagnosed with a UCL tear and thirty‐three were healthy, age‐ and positioned‐matched controls. All of the participants played baseball at either the high school or collegiate level and volunteered for the study. Isometric rotator cuff strength measurements for internal (IR) and external rotation (ER) were performed with the arm held to the side at 0 ° of shoulder abduction. All measurements were taken bilaterally and the means of the throwing and non‐throwing arms for IR and ER in the UCL group were compared to the means of the throwing and non‐throwing arms in the healthy group. One‐way ANOVAs were used to calculate differences between groups (p < 0.05).

Results: Baseball players with UCL tears demonstrated significant rotator cuff strength deficits on their throwing arm IR (p < .001) and ER (p < .001) compared to throwing arm IR and ER in the Healthy (UCL IR = 131.3 ± 31.6 N; Healthy IR = 174.9 ± 20.7 N) (UCL ER = 86.4 ± 18.3 N; Healthy ER = 122.3 ± 18.3 N). On the non‐throwing arm, the UCL group was weaker in both IR (135.0 ± 31.1 N; p < .001) and ER (93.4 ± 22.8 N; p < .001) than IR (172.1 ± 24.1 N) and ER (122.3 ± 19.1 N) in the Healthy group.

Conclusion: Participants with a UCL tear exhibit lower force values as an indication of isometric rotator cuff strength in both the throwing and non‐throwing arms than a healthy cohort.

Int J Sports Phys Ther . 2015 Aug; 10(4): 476–481. BASEBALL PLAYERS WITH ULNAR COLLATERAL LIGAMENT TEARS DEMONSTRATE DECREASED ROTATOR CUFF STRENGTH COMPARED TO HEALTHY CONTROLS Copyright © 2015 by the Sports Physical Therapy Section Abstract Background Ulnar Collateral Ligament (UCL) tears are common in baseball players.

Source: Baseball Players With Ulnar Collateral Ligament Tears Demonstrate Decreased Rotator Cuff Strength Compared To Healthy Controls