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PN: How does a pitcher improve internal arm strength and endurance? Primarily, meaning those muscles which give endurance and stability to the shoulder and elbow.
Former pro Steven Ellis: As a starter, there are two things I always refer to. First, be sure that the shoulder always works properly and there is good muscle balance and flexibility around the shoulder. Part of that can be done via conditioning programs. On the other hand an enormous part of that comes from good coaching. If you just let pitchers loose, they develop bad habits and it reinforces poor mechanics. You can do all the conditioning you want- if they have poor mechanics it’s for naught. Basically, it’s a combination of the two.
Frequently I am asked "How many pitches per week and how many games per season should my boy pitch." In trying to answer those questions I refer to ‘It’s not how much you throw, its how well you throw.’ I think it’s important to reinforce having good videos of pitchers who have had success with good mechanics and to show them that. We have hours of high speed films to help study this. When I deal with the major league guys, I often sit with the pitching coach and look at films to see what is going on mechanically that might be causing the problem. How do we improve it? Bring the Doctor and coach together.
Conditioning the shoulder. The shoulder is linked to the trunk primarily by muscle and ligaments. The only bony connection is your clavicle and it’s not much. You are asking the muscles to do a lot. The program for conditioning muscles must be directed to all the muscles involved with throwing. So specific exercises are important. Specific exercises in part, have to be directed by pattern but also by weight.
If you try to go to a heavy weight then you overwhelm some muscles and you don’t condition them all. I don’t know any pitchers I deal with, who, during the season, lift more then five or six pounds. It’s the pattern of exercises. In the off season they will lift a little heavier, but not in-season. The exercises have to be done properly and monitored so that the athlete is not substituting as he goes along.
Strengthen the Scapula
So, the initial exam starts with an assessment of proper shoulder function. Secondly, start identifying 7-10 different exercises. I tend to prescribe more exercises in the position they are going to throw as opposed to lower down exercises. I focus a lot on the scapula because it controls the socket. If the socket is misdirected, then they (the pitcher) get into trouble with how the humerus works and it gets out of sync (with the rest of the motion). It’s important to have strength in the cuff, but it’s important to have the function of the different muscles in the scapula. Those little guys are very important (teres major and minor, supra and infra spinatus)
When people talk about endurance, they usually mean the heart. I’d like to talk about endurance of specific muscles. Some of that you get from exercise and some through throwing. That’s the only way you get endurance- to simulate the activity you want. That endurance is very important. Not every shoulder is born the same way. They might have the same anatomy but the way it all works is quite different. Sometimes you have to look at the individual and work at it that way.
There are some pitchers who go out and throw 100-130 pitches. They are tired and they are sore, but 5 days later they are ready to do it again. Then there are those who throw 40 and they are dead. The anatomy just doesn’t hold up. Part of that is their conditioning and part of that is the genetics of how they are put together. You don’t have to be huge either to be a power pitcher: Ron Guidry (former NY Yankee star pitcher) the Perez brothers, and Randy Johnson are players like that.
Complete range of motion is very important. Without it, a pitcher will not be effective because something is going to change. Either they are going to fatigue their muscles, or they are going to, in some way, end up with an injury acquired by the limited ROM.
If you do not have a normal shoulder pattern you will put more stress on your elbow. When kids get tired, they start dropping down and get in trouble with their elbow. The shoulder has a lot to do with the elbow. There are some elbow things that are independent of that, but a bad shoulder will cause elbow problems.
PN: Are there specific kinds of pain and locations that indicate a certain injury or condition?:
Former pro Steven Ellis: Where and when the player perceives pain is very helpful in starting to focus on where the problem is. If they are feeling discomfort on the top of their shoulder it is usually more a direct rotator cuff injury. Whereas if the pain is in the front of the shoulder, that is more likely to be some tendonitis. But the likely cause is that the front of the shoulder is taking more stress and is stretched out a little bit.
The back of the shoulder is usually not well conditioned and pain in that areas means they are having trouble with deceleration. Or they recoil, partially throw, and that puts a little more pressure on the back of the shoulder or cuff. Those locations are important.
Little League Elbow
Inner elbow problems are determined specifically by where they are on the inner elbow and the youth’s age. If they are right on the bone and they are still growing, then that’s more the little league elbow. Traditionally, the kids are growing and the pull they put on the particular bone causes the trouble. If they are having pain in the muscle belly down below the elbow, then that is more muscle soreness and pain. If they have pain that’s sort of behind the elbow or comes down into their forearm and hand then that’s more likely the ulna nerve and on the inside. Usually it’s an inflammatory problem or it can be they have a little congenital difference and the nerve takes more stress on the "The Funny Bone."
Some youngsters, in the age you are dealing with (12-17), usually don’t stretch out the ligament on the inside of their elbow, that’s something we usually see tearing out in a little older group.
The back of the elbow is a rare pain, usually an older group would experience this. If they do experience this pain it’s what we call "Tennis Elbow" and is due to poor mechanics where they put more stress on the outside of the joint.
PN: Can you describe the difference between pain, discomfort and soreness and what they mean to the young ball player?
Former pro Steven Ellis: Everyone is going to be sore the day after they throw. If you talk to major leaguers the day after they throw and ask how they feel- they usually say "I have the usual soreness." It means they are sore, there is some swelling but they don’t mean it as if they are hurt. Anytime you throw in a repetitive activity, there is a certain amount of muscle breakdown, tissue breakdown and that’s what the soreness is. Sometimes this tissue breakdown can be a little bit more then you would like and you start to worry about it if it is more then the normal day 2 or day 3 soreness
When doctors do MRI’s (Magnetic Resonance Imaging) today they can pick up more of this then they could ten years ago. So its not uncommon to see a different MRI picture when comparing muscle soreness vs. when someone has torn a muscle. There is more damage and more bleeding etc.
When someone is having pain that increases with a particular performance, mainly a pitch, then you start to worry a little more. If they have pain with performance or if their performance is changing and painful then you have to be careful. If ever a kid comes up and has had the normal 4 or 5 days rest and says, gee I just can’t pitch, then you have to pay attention to that.
PN: What should a young pitcher do for arm care after he pitches and what are your age suggestions for starting to throw breaking ball?
Former pro Steven Ellis: What do you do after pitching? Traditionally we have them ice it down for about 20 minutes and that helps the metabolism, increases oxygen to the area etc. The other thing that can be helpful is to go through your light exercises, have someone perform gentle massage just to get things moving and even play some light catch to increase the blood throw.
Thoughts On The Curveball
Breaking balls. At some point kids have to learn how to throw a breaking ball. I don’t know when it is effective for them to throw one. At one point there was the opinion that breaking balls caused elbow problems and I am not sure that this is truly the case. As people are trying to use this theory when training young pitchers, I guess it possibly gets down to the number you are throwing. In a game, I think more pitchers will work on location and velocity then they will on breaking balls. They use the breaking ball 15-20 % of the time. The other 80% is movement and velocity.
If your shoulder is not good to start with and you are not throwing well ... that’s going to hurt you. Too often we focus on "THE BREAKING BALL" as a problem and that’s not necessarily true.
PN: What is Little League Elbow?
Former pro Steven Ellis: LL Elbow happens to growing kids, is on the inner side of the elbow, and is mostly related to a certain stage of development. At that particular stage the pitcher is throwing too frequently and there can be pain. Parents and coaches have to decided what is more important, losing a year of development vs. losing a career.
If the player is complaining of pain you have to listen to them. Its either pain for anatomical reasons or pain for whatever reason he doesn’t want to play. Once the pain is evaluated and someone tells you that you can’t find any cause then you have to sit back and have a heart to heart talk.
On the other hand if there are anatomical things, and it is not looked into, and people continue to force the kid to go out there, then you might be into something much worse that will threaten a career.
Playing Too Much
There are a number of kids who I see at 14 or 15 that have good skills and potential but are blown out because they were forced into it. They were kids who were very good in Little League. However, in LL there was control over pitches and innings. They get above that, and there are so many options to play, if they are good everybody wants them, and they end up playing on two or three different teams. Unfortunately no one puts the whole package together. Everyone thinks the more he plays the better he will be, the better he is the more people will want him. But you might be doing more damage then good in terms of development.
PN: How much should a player throw. For example, if an athlete pitches from April - August and then plays QB for the HS until November, he is throwing for eight months. Any danger?
Former pro Steven Ellis: Generally I advise people that once they get out of LL they really shouldn’t change the number of pitches they throw for the next year or two. They should stay at the same number and the same frequency because, frequently they are going to a bigger distance and a whole bunch of other things that change about the game. And so they better adapt their body to the other changes and gradually come along in terms of pitching. Specific pitch counts should stay around the Little League counts for a while.
Arm Development Schedule
The philosophy in the pro camps is that the first year a drafted pitcher comes into camp they spend the next two to three months making sure their arms are strong and that they pitch effectively, with good mechanics. Don’t worry about competition. And then each year, monitor the competition because they are all a little different. Because while Carl Pavano (top Red Sox pitching prospect recently traded to Montreal) is a big strong individual he became stronger recently. A lot of these guys are 18 yrs old and still maturing. So you want to be careful to let that go through its normal sequence. We have a couple other pitchers who have been with us for three years who for the next season we are keeping them on a very limited schedule. It varies quite a bit by their maturation level, but also development during that time is important.
PN: How does an injury such as the one which occurred to Red Sox prospect Chris Reitsma occur? Can it be prevented? (Broken arm suffered during a pitch)
Former pro Steven Ellis: The Reitsma thing was a freak injury. Who knows! He is a very well conditioned athlete and has done everything he has been told. So sometimes things happen. He’s doing well and will be pitching again.
An overall conditioning program is important. Starting with nutrition, ideal weight, body fat, etc that are important to watch. Flexibility and cardio-vascular conditioning stuff is important. Strength training : the everyday players are on a standardized program. We send out a booklet taking them week by week from October to Feb/March. Pitchers are very different in that they do. All the things for running and weights from the rib cage down are similiar to everyday players. Above the rib cage it is a very different program. We keep them away from heavier weights and have them more in a throwing, not a pitching program, more of a long toss program to work on mechanics, really get the arm back and decelerate, and learn how to use the muscles around their shoulder. And then in January we take them to the mound and start working them a little bit.
Long toss and mechanics should be worked on first for around a month just to get them to be ready to go to the mound and throw. Strength training for the upper arm/shoulder is mostly done with hand weights and rubber tubes. That’s all they need, Bio-dex and Cybex are fine, but they are expensive and you can do the same with hand weights and tubing.
Dual Sport Athletes
Frequently there is such an emphasis on strength and conditioning for each team that football could be bad for baseball in that conditioning for strength and bulk is not the best for baseball. Going from football requires significantly more transition time to play baseball then a sport like basketball. On the good side they are most probably more of a natural athlete any ways, that’s why they are able to do it. On the bad side they can get into trouble from the different philosophy’s of preparation.
PN: When should a parent take their son to a doctor for an evaluation.
Former pro Steven Ellis: Repetitive pain, pain that lasts from one outing to the next, performance pain that deteriorates your ability, localized pain that persists. Those are all things that parents want to pay attention to.
PN: As a consumer what’s the best way to shop for the right physician.
Former pro Steven Ellis: You would like to see someone who understands pitching (or whatever your sport is) . The title or background information does not necessarily tell you what they know about pitching. You really want someone who deals with teams and players and who was a player themselves. There are some outstanding physical therapists and excellent athletic trainers. But then there are some of these individuals that operate sports medicine clinics and they deal with football players. They are not going to be quite as effective dealing with a baseball player.
PN: What are your feelings about ice and heat?
Former pro Steven Ellis: Ice them down for 15-20 min. No longer then that. To a certain extent it’s correlated with how much they pitched. An inning or two is not such a big deal. It’s done as routine- maybe more tradition then routine. Once the swelling is down then you go to heat to increase blood flow and get things going which permits the muscle to work more efficiently during that period of time (throwing).
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