Jan 29, 2015Call to Arms
At all levels of baseball, preventing pitching injuries is a hot topic. This author keeps his players at East Carolina University healthy through a collaborative and comprehensive approach.
By Zac Womack
Zac Womack, ATC, LAT, is Head Athletic Trainer at East Carolina University, where he has provided coverage for the baseball team since 2008. He spent the seven previous years working in the New York Yankees’s minor league system. He can be reached at: [email protected].
From orthopedic surgeons and athletic trainers to baseball coaches and moms in minivans, there is a lot of discussion right now about pitching injuries. Parent pressure has pushed governing bodies in athletics to implement pitch counts. Dr. James Andrews has developed an app to help players avoid overuse. And in a position statement this past summer, the American Sports Medicine Institute called the increase in Tommy John surgeries an epidemic.
Here at East Carolina University, we’ve been working hard to keep the injury bug from infiltrating our team. We find that many freshman pitchers arrive on campus with little knowledge about how to keep their arms healthy–“I always ice after games” is often their sole strategy–and their time in the weightroom is focused more on sculpting a beach body than developing strength to protect their elbow and shoulder.
To break these bad habits and keep our pitchers healthy throughout their careers, we rely on a comprehensive program built around two principles. The first is that we treat each pitcher as an individual. When a hurler joins our team, we recognize that he comes to us with a unique background. Some have poor mechanics. Others have muscle imbalances. And there are always a few with preexisting overuse issues.
Instead of lumping them all together, we assess and construct a plan for each pitcher. This takes more time, but it’s well worth the effort. We’d all rather spend time preventing an injury than treating or rehabilitating one.
The second important ingredient is the total cooperation and fine-tuned coordination we have among the baseball coaches, strength coaches, and athletic trainers. We understand each others’ expertise and work together to achieve our shared goals of keeping the pitchers healthy and effective.
Our program has helped our pitchers stay off of the injury report and allowed them to develop and succeed on the mound. Many have gone on to pitch professionally. For instance, former ECU pitcher Seth Maness was drafted by the St. Louis Cardinals in 2011 and made his major league debut in 2013. We also had three pitchers drafted in 2014 and look forward to following their careers.
One of the biggest challenges of working with college pitchers is that many believe they are invincible. Typically, they have not given much thought to what goes into preventing an arm injury because they don’t think it will ever happen to them.
Many freshman pitchers arrive at ECU after having thrown all spring and summer with their high school and travel teams–and have been doing this for years. They have taken numerous pitching lessons and attended multiple camps in the hopes of adding a little speed to their fastball. Dreaming of being recruited or maybe even drafted, they have thrown as hard as they can for as many coaches and scouts as would watch. There is no telling how much damage this accumulated wear and tear has caused.
Therefore, one of the first things we do with every new pitcher is find out their history. When they first arrive on campus in the fall, I meet individually with each of them. Not only does this allow us to get to know each other, it gives me a chance to understand who they are as a pitcher, their throwing history, and what we can do to help them.
Establishing a good working relationship with our pitchers from the beginning is the key to building their trust in me and opening the lines of clear communication. During this meeting, I ask them the following questions:
– How long have you been pitching? – How many pitches did you average per outing, and what types of pitches did you throw? – How much rest did you get between outings? – How sound are your mechanics, and how have they changed since you started pitching? – When did you start throwing breaking balls? – Did you have an offseason to rest your arm each year? If so, how long? – When not pitching, did you play another position that required throwing? – Did you play any other sports? If so, what sports and what position? – What kinds of injuries have you suffered?
In addition to compiling a complete history for each new pitcher, we visually and physically evaluate them. A big focus is range of motion, which we measure from head to toe, not just the player’s throwing arm. Specifically, we look at bilateral range of motion in a hurler’s ankles (dorsiflexion and plantarflexion), hamstrings, hips (internal and external rotation), elbows (extension), and shoulders (flexion, internal, and external rotation).
To further hone in on a pitcher’s arm, we determine their glenoid humeral internal rotation and external rotation “total arc” and compare the degrees bilaterally. We continue to record this measurement monthly throughout their college career, as it gives us a quantitative, long-term view of their range of motion and helps us spot subtle, yet revealing, changes that otherwise could go unnoticed.
Every Pirate pitcher is also evaluated through an orthopedic and functional screening exam to identify any flexibility or strength limitations on either side of their body. We particularly look at their ankles/feet, knees, hips, lower back, shoulders, neck, elbows, wrists, and hands.
What are some of the things we have found? We have seen pitchers arrive with poor dorsiflexion in one or both ankles due to ankle sprains in high school and discovered others had unbalanced hip flexibility or strength. Some pitchers report to us with poor posture and a lack of flexibility in their thoracic spine or inadequate strength in their posterior scapular muscles. And numerous throwers have come in with weakness in their lower body or core, which translates to poor stability on the mound.
A final key area in our assessment is pitching mechanics, and I lean heavily on the knowledge and experience of ECU Pitching Coach Dan Roszel in this area. First, we watch each player throw live. Analyzing their mechanics up close and in real time helps us identify characteristics for peak pitching performance and the “red flags” that hinder it or could lead to an arm injury. When evaluating pitching mechanics, there are several common warning signs Coach Roszel and I look for:
– A violent delivery that could increase a player’s chances of hurting his arm – Throwing across the body, which puts added stress on the medial elbow – An overreliance on the upper body – An incomplete follow-through – Failure to get good hip flexion/trunk extension during delivery, which forces a player’s arm to take on excessive tension or torque and increases the risk of injury.
Besides watching pitchers live, Coach Roszel and I also film bullpen sessions, scrimmages, and games so we can break down a player’s form in greater detail. Having film is beneficial for the players, as well, because we can show them what we see in their mechanics. In addition, we can look back and compare their pitching mechanics from throughout their time at ECU.
FINDING A SOLUTION
Anytime our assessments reveal physical limitations in pitchers, we put together a detailed, individualized plan to correct the issue. We might modify their daily workouts, adjust their throwing programs, or even shut their throwing down to prevent them from hurting themselves, and we use a combination of corrective exercises, stretching, yoga, and manual therapy to fix any imbalances. The following are some examples of common problems we’ve encountered and solutions we have come up with to correct them.
Weakness or physical limitation: We have had a lot of success correcting poor posture in our pitchers. Posture can have a direct impact on a pitcher’s velocity, pitch control, and ability to reduce throwing stress. When we have a pitcher who displays poor posture, we work to correct any weaknesses in his scapular stabilizers, retractors, and depressors through a combination of rotator cuff exercises, retractions, and rows. We also use soft-tissue mobilization to relieve tight pectoral muscles, which can pull or rotate the shoulder forward if not addressed.
Poor pitching mechanics: Correcting flawed mechanics can require a variety of tweaks, such as having a pitcher keep his head over his pivot foot through his delivery, adjusting the direction or length of his stride, or making sure he is not opening his hips too early. Cleaning up mechanical issues like these has allowed our pitchers to develop better command of their throws, increase velocity, and reduce stress on their arms.
However, pitchers who have had success with their current mechanics can be resistant to making changes. Adjusting to altered mechanics can take some time and may even lower the effectiveness of their pitches at first, which can impede a player’s initial acceptance of the changes.
Therefore, education is a vital part of the process. If we encounter resistance, we explain to the player how ignoring key fundamental pitching mechanics can negatively affect pitch velocity potential and reduce their ability to command pitches, all while adding unhealthy forces to their arm. We continually work to provide players with information they can understand and utilize. When pitchers understand how and why mechanical changes will enhance their performance and reduce their risk of injury, they are generally much more open to implementing them.
As pitchers work on new mechanics, we tell them it is important for them to be honest when describing how their arm is feeling, so we can adjust their throwing, treatment, and workout schedules accordingly. Even the smallest alterations can result in changes to the tension or torque in their elbow and shoulder.
If a pitcher is stiff or sore after tweaking their mechanics, we give them extra time off between throwing sessions and slowly build them up as they start to feel better. We pay close attention to their arm and bodies through daily communication, evaluation, and manual therapy. We also implement more flexibility/stability-based exercises in the weightroom and eliminate lifts that aggravate the affected body part or cause discomfort.
Fatigue or over-use: We once had an incoming freshman pitcher who arrived underweight and fatigued from pitching all spring and summer. He was obviously in need of a break and a plan.
We shut him down from throwing for two months and specifically worked on building his strength and flexibility. From there, we allowed him to gradually move back into a progressive throwing program. In the end, he was able to get some much-needed recovery time for his arm, put on weight, and gain strength without losing flexibility.
Range-of-motion problems: Handling range-of-motion issues requires thorough–and multiple–evaluations. Assessing a pitcher’s shoulder range of motion bilaterally and comparing it to his previously recorded measurements provides us with quantifiable proof of any changes.
Range-of-motion problems early in the season are frequently a result of muscle tightness, so our pitchers regularly come into the athletic training room for soft-tissue work on their pectoralis minor, posterior rotator cuff, latissimus dorsi, and medial elbow. Manual therapy has served our pitchers well in reducing their symptoms and quickly improving their range of motion.
IN THE WEIGHTROOM
Along with crafting individualized plans to address limitations, we make sure our pitchers create and maintain a strong musculoskeletal foundation with the help of ECU Assistant Strength and Conditioning Coach Blaine Kinsley. All of our pitchers work in the weightroom multiple times each week, and the main emphasis is to develop overall strength, explosive power, flexibility, and physical endurance.
To help build their core and increase both strength and range of motion through multiple planes and angles, we use front barbell squats, goblet squats, front and side lunges, front and side step-ups, pistol squats, single-leg squats, and kettlebell swings. Regardless of the specific activity being performed in the weightroom, a coach, strength coach, or athletic trainer is on hand to observe that all of the exercises are performed correctly and with good posture.
Our upper-body workouts tend to focus on unilateral movements, such as single-arm retractions and rows. The main goal is adding upper-body strength while ensuring pitchers don’t hurt their arms or leave so stiff and sore that the session negatively impacts their throwing. We allow our pitchers to bench with moderate weight dumbbells as long as they keep their elbows tucked in by their sides, which avoids putting added stress on the shoulder. In place of heavy bench-press loads, we do a lot of push-up variations. Medicine ball exercises are also a staple of our upper-body days to ensure our pitchers are training multiple angles through rotational work.
In addition, we include some type of rotator cuff exercise during every lifting session. Here are a few examples of some of the movements we do: – Side-lying dumbbell horizontal abduction – Side-lying dumbbell external rotation with elbows at 90 degrees flexion – Dumbbell Cuban presses – Back-to-wall shoulder flexion (no weight) – High rows – Low rows – Wall slide with overhead shrug – Athletes write out ABCs with elbows extended and two 2.5- to five-pound plates in between both hands – YTIWs with cuff weights or dumbbells.
Our conditioning program includes football stadium stair sprints, weighted vest lunges, and agility exercises to build both strength and endurance. Plyometric and footwork needs are met through a combination of ladder drills, box jumps, cone drills, hurdle jumps, and medicine ball exercises.
To ensure lower-body range of motion doesn’t suffer while we focus on the upper body, we incorporate yoga into our pitchers’ weekly workout routines. A pitcher with good flexibility is required to do yoga once a week, and those who need to improve their flexibility typically have two to three weekly sessions. Most of our young pitchers don’t realize how inflexible they are until they attempt a yoga program for the first time and have a truly eye-opening experience.
Yoga has also helped our pitchers’ body control, which has provided positive results in both the weightroom and on the mound. We have been able to help them develop stable shoulder girdles, core strength/low-back stability, hip mobility, functionally stable pelvic movements, and thoracic spine mobility. A properly functioning posterior chain helps provide the stability and balance needed to support a pitcher from the start of his delivery to the end of his follow-through.
SPRING IN THE AIR
Once the season begins in February, our primary goal is to ensure our pitchers have a regular routine to prepare them for their next start or relief appearance. This gives them confidence and a sense of control as well as maintaining their strength and range of motion throughout the season.
Our pre-throwing warm-up routine is the same for every player on our team. We start with a dynamic warm-up to get the blood flowing. From there, each player clips a light resistance tubing band to a fence with a carabiner and goes through a variety of arm exercises, such as front arm circles, side arm circles, high and low rows, backstrokes, external shoulder rotations with the shoulders at 90 degrees, front punches, and wrist flexions/extensions. All of these exercises are performed at a smooth, up-tempo pace with a focus on correct posture and proper form. Our goal is to have the entire body warmed up before the players pick up a baseball instead of throwing a baseball to warm-up.
After a start, relief appearance, or bullpen session, our pitchers go through a total body flexibility routine. This is where we incorporate more static stretching to help reduce the amount of tightness following a stint on the mound. (See “Staying Loose” below for a sample routine.)
During the season, we also focus a lot on recovery. Our pitchers regularly drop by the athletic training room the day after a start, relief outing, or bullpen session for a shoulder and elbow massage. Using a combination of deep-tissue massage, instrument-assisted soft-tissue mobilization, and self-myofascial release, my goal is to locate and break up adhesions throughout their body. In addition to their work with me, many pitchers come in multiple times each week on their own to use the foam roller, massage stick, or lacrosse ball for soft-tissue self-maintenance.
For several years, we’ve had a lot of success with our comprehensive plan to prevent pitching injuries. None of it would be possible, however, if the baseball coaches, strength coaches, and I weren’t on the same page. Everyone involved with our program speaks with one voice. The strength and conditioning coaches and baseball staff reinforce our messages on the importance of arm care, and we communicate daily about any issues that arise. Our combined years of collegiate and professional baseball-specific experience allow each of us to bring different strengths to the table, but we realize that no one has all of the answers when it comes to arm care. We are all students of the game who must continue to learn and grow.
SIDEBAR: STAYING LOOSE
After any appearance on the mound, it’s important that our pitchers focus on their flexibility. We use the following total body workout to help them stay limber between outings:
Jump rope: Single- and double-leg hops, 2×30 sec. each
Standing leg swings: Front to back and side to side, 10 to 15 per leg
Thera-tubing series: Front and side arm circles, backstrokes, external rotation, high rows, YTWs, 10 to 15 reps each
Bent elbow cross-arm body stretch: 3×10 sec. holds
Tricep stretch with side-trunk lean: 3×10 sec. holds
Forearm stretches: 3×10 sec. holds with palms together and elbows out
Bodyweight pry squats: 3×5 sec. holds
Bodyweight lateral lunges: 3×6 per side
Wide-leg reach downs: Toward the right foot, toward the left foot, and then toward the ground in the middle, 2×10 sec. in each direction
Supine internal hip rotation holds: 3×10 sec. holds