The Times They are a-Changin" (1964, Bob Dylan). Bob Dylan wasn't much of a baseball player, but his title of this 1964 hit was predictive of baseball today. Much of the way we think of baseball has changed recently, particularly for pitchers. Most of what coaches and players were using for pitching instruction, and even for injury rehab, was simply based on what was handed down from generation to generation, and from coach to player. But a newer way, based on actual baseball research studies, has proven that there are better ways to teach throwing and to prevent baseball injuries. A lot of what was accepted by coaches and players for many decades has been proven wrong. Simply put, if you're still doing it the old way, you're not getting the most benefit from proper training methods, and you're likely causing injuries rather than preventing them.
At Olympic Physical Therapy, based in Middletown, R.I., with offices in Wakefield, Tiverton and Bristol, a team of physical therapists has been studying the new science of proven baseball studies. The group is changing the way local teams prepare for performance pitching and for reducing injuries to pitchers.
Even the rehabilitation of throwers' injuries is different now than just several years ago. Working with pitchers from Salve Regina University, Middletown, Portsmouth and Narragansett High Schools, and even the University of Rhode Island, among others, the newer approach based on biomechanical scientific research has proven to be immediately valuable.
Most of Rhode Island's better baseball stars have been through the program at Olympic, including Matt Bouchard (New York Mets), Joe Mollicone (Tampa Bay Rays), Kyle Regnault (URI), Alex Briggs (University of Maine), and others.
"Knowing the biomechanics of pitching from the ground up is the difference," said Don Levine, DPT, co-owner of Olympic Physical Therapy. "We don't teach the kids how to throw; that is for their coaches. It's all different now than before. The kids need flexibility, strength and power. The new areas we target reduce the risk of injury at the same time it creates power."
Different Power Source
Take, for example, the simplest notion of how to add power to a throw. For decades it was taught to strengthen the shoulder (the ball and socket) with inward and outward resistive band exercises, and to do countless grip and forearm exercises. Would it surprise you that only 16% of the force of throwing comes from the shoulder joint? More than 50% of the power needed comes from the trunk and hips.
The shoulder and arm acts only as a whip in the chain of throwing. Since the coach's focus for decades has been on the shoulder, it is likely that they have been actually causing excessive shoulder strain. Their heart is in the right place, but their focus is in the wrong place. The muscles that support and stabilize the shoulder blade have far more to do with providing power for throwing than rotator cuff muscle strength does. In fact, a study on shoulder blade muscle strengthening, done in a functional (meaning "like-throwing") way, showed a 24% increase in rotator cuff strength - without even strengthening the rotator cuff muscles. The rotator cuff muscles, of which there are four, became functionally stronger once their "stable base" became more powerful. Furthermore, the trunk and hip muscles are vital in producing power and saving the shoulder and elbow from dangerous stress.
The words "opening early" are an example of when the pitcher rotates and opens his trunk too early and leaves the arm to do all the work of delivering the ball. The very ligament that supports the elbow during the pitch, the ulnar collateral, popularly known as the "Tommy John Ligament," can withstand 32 Nm (Newton-meters, a measure of torque) of force, and yet the fastball generates up to 64 Nm. How does the elbow not explode? Because the shoulder blade, trunk and hip muscles diffuse the forces - unless the pitcher opens up early. Opening the trunk too early in a throw produces less power and significantly adds to elbow stress.
The player or coach looking for more power in throwing a baseball shouldn't look at the shoulder joint. A 1999 study by Fleisig et al in the Journal of Biomechanics found that due to interactional torques the arm is nearly passive in creating force to throw the ball.
The New Science
Here are more topics studied that comprise the "new generation" of baseball science:
Which is more likely to cause an arm injury, the curveball or fastball? The research shows that too many of either can cause harm, but contrary to the old wives' tale, or perhaps the old coach's tale, the fastball is far more likely to hurt a young arm. The higher velocity of the arm during the fastball delivery creates more of a pulling force, or traction force, on the growth plates of the arm bones, near the ends.
It is that traction force that directly causes what is known as "Little League elbow" and "Little League shoulder." In fact, the nature of the curveball requires the pitcher to slow down his arm speed, and creates less traction force.
But the science behind the arm speed shows that too many of either pitch causes an acute irritation to the growth plate in the young thrower, just more so in the fastball. Many of these old wives' tales persist in the baseball world, where coaches are comfortable in their old ways. Here are some other newer paradigms of recent biomechanical baseball study:
1. There is no evidence, contrary to popular belief, that a sidearm motion is more stressful to the shoulder than a normal ¾ delivery. The body-lean makes up for providing the same shoulder angle during delivery.1
2. A strong predictor of rotator cuff overload can be viewed simply by observing the standing pitcher from a rear view of the shoulder blades. If the pitcher possesses a "peaking shoulder blade," or one in which the middle border is raised compared to its opposite, then the pitcher is far more likely to become injured. It is a sure sign that there is weakness of the stabilizer muscle of the shoulder blade.2,3
3. The return-to-throwing program after injury is now decided not by the old-fashioned "cookie cutter" method as it had been forever. There is now a player-age-role combination that reintroduces proper forces at a staged and proper time.4
4. If a pitcher has tight shoulder internal rotation, there is 50% more stress on the elbow.5 Previously, when the elbow hurt, physicians would look to solve the symptoms at the elbow when the cause of the problem was likely the lack of shoulder range of motion. In addition, the most reliable clinical test is the "milking test" for predicting a UCL tear.
5. If a player has tight shoulder internal rotation he is 2.1 times more likely to develop a labral tear.6 The labrum is the rim around the cup of the socket of the ball and socket joint. The stabilizing ligaments attach to the labrum. When failed or disrupted, the labrum causes a weak throw, a painful throw and an unstable shoulder. There has been an increase of diagnoses of these since 2000 by more than 200%.
6. Little Leaguers are more likely than older players to land with the lead leg toward first base rather than pointing toward home. This causes an open front side, a failure to "stay closed late" with the trunk, and a significant increase in shoulder and elbow strain.7
The next question becomes, "What do I do for treatment and then retraining of a thrower?" The PT would apply the functional litmus test. For more information, visit the Gray Institute at www.grayinstitute.com, go to Educational Products, select Comprehensive Functional Videos, and scroll to throwing. This video explains the kinetic chain biomechanics of the arm as a whip, with power and shoulder stability generated from the core and scapulothoracic complex. They coin the term "pel-trunk-ula," the interaction of the kinetic chain and core. It is both pioneering and fascinating for sport function.
By applying the functional litmus test, the PT designing a program simply uses creativity and common sense to train the proprioceptors. Job 1 on day 1 of rehab and training would be to analyze the sport or task. So, simplified for a pitcher, the rehab program would consist of a series of core and scapular exercises in: 1) the standing position to mimic the throw; 2) transverse plane motion of core and upper trunk; and 3) emphasize the loading (coiling aspect of the throw) and then the unloading (the delivery until follow-through).
You may have to mobilize each joint in three planes of motion manually, and then reapply the proprioceptive paradigms based upon your discrete manual therapy findings. But, even here, have the player in the pitching position while you mobilize the joint to move in the same way as needed. Again, just think, "retrain the proprioceptors" and position the athlete to mimic their sport. Once done, you can add resistance training with core balls, tubing, PRE and other devices.
1. Dun, et al. Journal of Biomechanics, 40, 265-270.
2. Kibler, et al. (2013). British Journal of Sports Medicine, 10, 1136.
3. Kibler, et al. Journal of Shoulder and Elbow Surgery, 11(6), 550.
4. Welker, E. (2008). Advanced Orthopedic Physical Therapy, AOPhysicaltherapy.com.
5. Marshall, R., et al. (2000). Journal of Sports Sciences, 18, 247-254.
6. Wilk, B., et al. (2011). American Journal of Sports Medicine, 39(2), 329-335.
7. Cosgarea, et al. (1993). Medical Science of Sports Exercise Journal.
Bert Reid is co-owner of Olympic Physical Therapy of Wakefield, R.I.