Tag Archives: injury prevention

2 Risk Factors For Tommy John Surgery: A Concerning Trend

20 Major League Baseball pitchers have had Tommy John surgery (i.e. Ulnar Collateral Ligament (UCL) Reconstruction) since the end of the 2013 season, and all are under age 30 (thanks for info @mjfensom).  As a healthcare professional, I find that very disturbing.  What may be worse , there are likely tons more pitchers who are continuing to throw through chronic UCL damage, even as early as in middle school and high school.  I was listening to sports medicine/elbow guru Dr. James Andrews discuss this topic in an interview with Sirius/XM Power Alley’tommy-john-surgeryMike Ferrin and Jim Duquett.  This, along with an NJ.com article by Michael Fensom on the same topic, lead me to want to blog on this topic.  I care tons about the health and performance level of those ballplayers I come in contact with, and I feel this “trend” needs to be a key topic of discussion with all youth baseball players, parents, and coaches.   Some background on my perspective:  I played 18 years of competitive baseball (little league through sophomore year of college into beer-league fast pitch softball) and I’ve worked with a great number of middle school through college baseball players in the last 10 years of my sports medicine and performance-training career.  In listening to Dr. Andrews, he was spot-on with a number of concerning issues I’ve come across as an athletic trainer.  I agree with Dr. Andrews that this is “a trend” due to significant changes which have seemed to take place in the world of baseball, especially over the last decade.  A significant number of young ballplayers play baseball year-round, specializing in the sport at earlier ages.  Additionally, many players participate on multiple teams during the same season.  In the past, UCL tears were typically seen only in the highest levels of baseball into adulthood.  Nowadays, Dr. Andrews finds the significant amount of high school-aged Tommy John surgeries he performs alarming.  Let’s take a closer look at these two risk factors:

Early specialization vs. multi-sport athlete

It seems that a lotTommy John Surgery Overspecialization more ballplayers are playing baseball year-round these days, even as early as in middle school.  This is a significant reason why more high school athletes (in all sports) are being treated for overuse/chronic injuries that used to only typically occur in older athletes.  This repetitive strain from the same sports motion 12 months a year leads to increased risk of injury to bones, ligaments, muscles, and tendons.  I recognize that it can be difficult combating the “everybody’s doing it” peer and coach/instructor pressure.  We have to ask ourself: is it really the player who wants to play baseball year-round, or are they being pressured into it for the benefit of others? Experts have found that early sport specialization does not correlate positively with future professional athletic success.  Simply put – the earlier you specialize, the earlier you tend to peak.  In addition to a physical toll, early sport specialization can lead to mental burn out.  Think of it this way: what is your favorite food?  I personally love chicken wings.  But what would happen if I ate chicken wings 5 or 6 days a week for 12 months?  Besides gut girth likely increasing, I would probably (and sadly) never want to eat chicken wings again! Taking a different approach, multi-sport athletes develop greater athleticism due to cross-training. Playing multiple sports is a great route to overall athletic and personal development.  More and more college coaches are going on the record stating that they want multi-sport athletes as opposed to ones who only play their sport.  They don’t want players who are bored, burned out, and oft-injured.  Additionally, these days college coaches generally find division 1-caliber players regardless of where they are.  In other words, playing year-round for an expensive club is not always necessary to “make it big”.  Now, I fully recognize the great benefits to playing on a travel baseball club – it’s a great opportunity for players.  The point I’m making is, wherever they do play, we have to watch the overall toll that their throwing arm is taking.  This takes accountability from the athlete, parents, and coaches, all working together cooperatively.  To avoid this year-long training breakdown, I recommend taking 1 season a year to play a different sport from your “primary” sport, ideally choosing a sport that stresses the body in a completely different manor (i.e. contact vs non-contact, upper extremity-focused vs lower extremity-focused, or high volume vs low volume running).

Playing for multiple teams during the same season

Let me paint a picture for you of the extreme (yet too common): Nolan just finished his middle school baseball game (Let’s call them Team A).  Mom picks him up, and in a rush he scarfs down two Taco Bell chalupas and a Gatorade on the way to another game for his travel baseball team (Team B)  He pitched 5 innings in his middle school game, and now he’s been told by his other coach he is going to play outfield in his travel team’s game tonight.  I forgot to mention: Nolan is late to the game because mom drove to the wrong field, assuming he was playing for team C today (but that’s on Saturday!) instead of team B.  Nolan jumps right out of the van and into the game, assisting in 8 plays during the course of the game and throwing an average of 10 long-toss balls between each inning.  65 + 8 + 60 = 133 throws, not counting pre-Team A game warm ups.  Two days later, Team C is short handed, and it’s a “must win game”, so coach puts Nolan in to pitch the final 3 innings of the game… Maybe I don’t have to write anything else.  You get the picture.  It is situations like this where pitch counts and total throwing volume get “lost in translation” between multiple coaches and parents, rest periods are way inadequate, and nagging injuries occur.  This is not only isolated to baseball and softball – the same thing occurs in soccer, lacrosse, and basketball.  However, the significant strain to the elbow and shoulder is what makes baseball and softball players even more likely to fall victim to this preventable situation. Outside of these two areas, other risk factors for elbow and shoulder problems in ballplayers include (which I plan to cover in more depth in a future blog):

  • Improper pre-season/early season acclimation (going 0-60mph in 0.5 months?)
  • Improper off-season training program (is core, rotator cuff, hip strength, endurance conditioning, and functional mobility being addressed properly?)
  • Improper In-season maintenance program (are you avoiding GIRD and hamstring/posterior chain restriction, while maintaining core conditioning and staving off arm decelerating-muscle fatigue?)
  • Delayed management of throwing-related pains (are you putting things off that should have been addressed yesterday?)

Bottom line: Athletes, parents, and coaches need to maintain open lines of honest communication between all involved parties, and we health and athletic performance professionals need to promote safe training habits with the focus on long-term health and success.

Be well,

RS

Ryan Stevens, MPS, LAT/ATC, CSCS

RStevensATC@gmail.com

5 essential components for developing agility

Are you quick?  I’m not talking 100 meter dash time.  I’m talking “5-10-5” time.  That person who fears nobody 1 on 1, and who nobody wants to defend.  You create separation on offense and close the gap on defense.  Do you want to be that athlete (or develop that athlete)?  He are 5 essential components you must include in your training program if you wish to develop your agility.

*Addendum: This blog was written with the intention of these being ideas for someone who has no major imbalances/deficits/asymmetries needing correction – I.E. they have a good functional movement and mobility assessment with solid movement patterns.

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1) Core Stability

Amazing agility takes great control of your center of gravity.  You have to be able to resist motion and momentum in order to change direction quickly.  Core stability is the foundation for deceleration (which is the foundation for change of direction).   For the following exercises, I like to aim for 30 reps in a set done well before increasing difficulty.  As you improve, you can increase speed of movements with the side plank and bridge (as long as your trunk is stable).  Here are some things I use:

    • Side plank with extremity movements (1:16 mark on the video).  Get creative with your extremity movements to up challenge.
    • Bird dogs (video).  Also try these ipsilaterally!single leg bridge marching
    • Single-leg bridge with marching: Perform these slow and controlled – keep your trunk in one place while flexing one hip as in the picture.  Work up to 2 sets of 30 reps each side.  Unlike the picture, with these place your arms like you are “under arrest” (since you’ll soon be breaking the speed limit).
    • Anti-rotation exercises (video thanks to Martin Norum).  Slow and controlled is the key here.

2) Strength (Glutes, Quads, Adductors, Calves)

Strength is the foundation of power (see below).  By improving your lower body and hip strength, you’ll be able to produce more power into the ground, thus propelling you the opposite direction while making your opponent look foolish.  Periodize your strength program properly, with rep # appropriate for the phase you are in.  Here are some exercises I use:

      • Deadlift: 2 versions to work on.  Traditional (video thanks to Eric Cressey) and Single leg RDL (video thanks to Angel Stone).  When doing traditional deadlifts, if you have bumper plates focus on a strong lift, then drop from tall.
      • Goblet lunges (multi-direction): “Goblet”-style hold increases posture muscle stress, challenging core.  Forward, lateral (like in the video – thanks Eric Cressey), diagonal (forward AND backward), and retro should all be performed.  Work on the “push back” version in place like in the video to develop eccentric strength, and the walking versions for strengthening the concentric component of cutting.lateral band walk
      • Mini-band lateral walking:  Band around the knees = easy, around ankles = harder.  Avoid knees buckling towards each other while you step.  Great exercise to use in superset on an upper body day.
      • Calf raises: Off of a step to increase stretch reflex.  Do lots of them.

3) Lateral/Rotational Power (Plyometrics)

You have to use your core stability and strength in an explosive manner.  Here are some ideas from what I use:

      1. Medicine ball throws: Rotational, “punches”, “Granny toss” or underhand overhead, and overhead forward with follow-through to RDL (see above).  Perform sets of 6-8.
      2. Single-leg bounding (multidirection): First work on doing these in place (off of one foot and landing in the same spot on the other). Imagine hoping over a low fence. These can also be performed forward, lateral, diagonally, and backwards. Perform sets of 6 on each leg.
      3. Broad jumps (multidirection):  In addition to jumping forward, also try lateral and diagonal.  Sets of 6.  (thanks to Nike Training)
      4. Quick hops:  Channel your inner MC Hammer.  Less foot contact time on the ground is better! Perform in place, or moving back and forth forward, lateral, or diag (2- or 1-legged). Two versions: Standing tall or perform while staying in “athletic position”.  15-30″ sets, depending on your training phase.

4) Acceleration and Deceleration (planned)

Simple fact: in order to change direction, you have to be able to slow down and stop (temporarily).  Too often athletes only focus on developing speed and power, but neglect to spend much time on deceleration training.  Stop faster than your opponent, and you’ll be changing direction faster than your opponent.  After you decelerate and stop, you have to move quickly in a new direction.   Gain speed quickly.  BOOM! Like being shot out of a cannon.  Here are some drills I use:

      • Lateral step Med ball fake throw I learned this from Lee Taft (thanks Lee!)
      • Lateral/diagonal bounds with med ball (video thanks to Nike Training).  The next level up from Med ball fake throws, now you cover more ground with your bounds
      • Med ball catches: Perform the above drills, but instead of holding the med ball, have some one toss it to you so that you catch it just before you land in your “cut” position.
      • Push Shuffle and Carioca: Perform for footwork and for speed. To push shuffle, a) do not cross shoes, and b) move laterally by pushing the ground away from you through your back shoe. When doing carioca with or without ladder, focus on a good hip turn and pump arms “athletic” rather than “dance-style”. (Thanks to King Sports Training for video) 
      • Low box shuffle/crossover: check out these two great videos on low box training that I use for agility.  Shuffle (thanks Lee Taft) and crossover (Thanks RPI Strength)
      • Spider drill (video thanks to QuickBoard).  Use both a “shuffle only” version as well as a natural crossover version
Chicago Bulls v Utah Jazz

Poor defender had no chance…

5) Reaction (unplanned)

Making a planned change of direction is one thing.  Reacting and making an unplanned change of direction is true agility.  The final crucial component to developing your agility is to work on your reaction skills.  Here are some drills I use:

    • Tennis ball catch reaction(Thanks to Joe Hos for video)
    • Reaction cuts (variable cues): Work on performing quick starts and 45/90/180 degree change of direction skills while reacting to variable cues. Visual instruction (coach points), verbal (clap/whistle), or movement (go after tossed ball).
    • Partner Mirror Drill:  Get creative with rules.  “Use only shuffle”, “Can use crossover”, “Anything goes”.  Can also be performed using forward, backward and lateral movements in 4 planes of motion. (Thanks RPI Strength for video)

5 components to work on, all important in developing agility.  Ready to become a human highlight reel?  Now go dominate.

RS

Questions or additional recommendations? Leave a comment.

Ryan Stevens, MPS, LAT/ATC, CSCS
RStevensATC@gmail.com