Strength in Numbers - 46

From: Jan-31-2022 09:47:am

The Return to Throwing: What To Do & What Not To Do

Last week we talked about the issue of pain and getting athletes out of pain when they throw. In this newsletter, we will talk more about throwing programming considerations that can help reduce pain and how to break the pain cycle.

A LITTLE MORE ON KINESIOPHOBIA

I continued some discussion with my go-to return-to-throw mentor, Mike Killian, about what pain does and how it functions.

Mike and I are alike because we like to create schematics and heuristics, visuals and sayings that resonate with people in executing an approach to enhancing performance and advancing athlete wellness.

For example, he came up with this model :

What he's showing, is that for every physical injury, there’s a psychological response. The athlete could go in two directions. Pain catastrophizing needs a form of cognitive behavior therapy in my opinion, as it starts the onset of kinesiophobia, the fear of movement as there is FEAR of re-injury.

The first part of attacking cognitive barriers to recovery is understanding the acronym itself. FEAR stands for False Evidence Appearing as Real.

Athletes need facts, so people in the rehabilitation setting need to be up to date to give athlete’s an accurate dose of reality. Depending on the injury in baseball, return to performance outcomes are pretty strong.

For example, let’s take TJ surgery, 85-90% return to sport, with 65-75% returning to the same level or better. Reassure the athlete that they will go on the attack concerning their injury and fortify their body and movement patterns to avoid any future risks.

Provide the athlete examples of athletes who have had a similar injury and how well they performed afterward—there are many of them in MLB.

Essentially every athlete needs some form of legitimization that they will succeed.

If kinesiophobia is avoided, you can see that on the right side, the cycle leads to a head-on approach to accelerating the recovery process and leads to outcomes faster.

WHAT TO DO ABOUT PAINFUL THROWING

In this week’s podcast with Mike, we talk about the specific throwing approaches to training where he puts his focus.

His method is to increase the deceleration of the posterior cuff and improve hand break and arm position at foot contact.

He accomplishes this with a throwing sock and connection ball, both important constraints that create boundaries for movement and muscle contraction to benefit the athlete and avoid pain.

There’s a great video below of Kyle Gibson explaining his process using both items simultaneously.

WHAT TO DO TO REDUCE THE RISK OF SHOULDER AND ELBOW INJURY DURING RETURN TO PERFORMANCE TRAINING

One thing to keep in mind is that Mike uses the ArmCare platform to scale training and examine any inconsistencies in strength.

For external rotation strength deficient athletes, the posterior deceleration training will boost their performance. However, suppose they are already imbalanced with greater external rotation (ER) strength versus internal rotation strength. In that case, programs have to be tailored to balance the deceleration work for the posterior shoulder with the internal rotator (IR) cuff, as the reversed ratio (greater ER strength versus IR strength) could lead to future elbow problems.

Again, be data-led in your approach to avoid secondary injuries from strength deficits and imbalances.

WHAT TO AVOID ALTOGETHER

I do not mean to step on anyone’s toes here, but I am still trying to figure out why throwing athletes do reverse throws?

I will give you a biomechanical reason why I am against them.

Take the two graphs below:

(Graph of internal rotation torque in the delivery at various time points)

(Graph of varus torque during various time points in the delivery, which is the force needed to stabilize the inner elbow and protect the ulnar collateral ligament from damage.)

These graphs show the varus torque during various time points in the delivery. Varus torque is the force needed to stabilize the inner elbow and protect the ulnar collateral ligament from damage.

Okay – now that you have studied the graphs, you should be able to see that the red dots are almost stacked on each other and that the peaks for eccentric internal rotation torque and varus torque happen almost at the same time before the maximal layback of the arm.

What should occur to you is that these two rotational loads are almost perfectly correlated. Therefore, as eccentric internal rotation torque goes up, so does the efforts of the medial elbow stabilizers to reduce the stretching on the ulnar collateral ligament.

Now that we have shown this connection let’s go back to the reverse throws.

The athlete is in a half-kneeling position and tries to whip the ball as fast as possible behind them. What is known in research is that 90% of all throwing arm injuries are related to moving the arm behind the body rather than accelerating the arm forward.

This type of throwing is largely CONCENTRIC for the external rotator cuff, which is completely opposite to the methods used by Mike which are ECCENTRIC.

So, given the graphs, you are most definitely increasing the speed of layback, and when it comes to torque, you are taking that forearm mass and accelerating it faster behind the body to jack up the varus torque to resist stretching of the ulnar collateral ligament.

This does not make sense to me.

Here’s an example of reverse throwing:

In this week’s podcast, we get into more of these drill interactions and ways to communicate the biomechanical and physiologic relevance when regaining the throwing motion and arm strength.

Not all drills are created equally and not all drills are beneficial. The way to execute is to individualize everything by understanding athletes’ strength and range of motion responses.

If you want to dive deep into biomechanical aspects related to injury and performance, check out our ArmCare IQ on YouTube, which are free mini-lectures on various topics.

We also go real deep in our Certified ArmCare Specialist Course—join our community of experts, be proactive and reduce the amount of painful and injured throwing arms out there.

Until Next Time!

Ryan

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