I was speaking at a sports symposium and I must have been more nervous than usual.  Maybe because it was a different crowd than who I usually speak to (they were sports med docs and orthopedic surgeons instead of strength coaches and trainers), or maybe because it was the chick on the front row that kept giving me mean looks (I was presenting a different viewpoint than traditional rehab and I don’t think she liked it).  Anyway, I was discussing how conventional rehab places all of it’s emphasis on the shoulder and elbow without an attempt to look at the biomechanics that leads to injuries.  Then I said it.  What a colossal mistake…..”It’s not the shoulder’s fault, It’s not the elbow’s ‘fart’……”  Fart instead of fault.  Just off the chain man.  But at least it got the crowd going and I had nothing to lose after that point.

If you have a shoulder or elbow injury, have had one, or are just doing the “pre-hab” exercises to prevent one, I want to show you a different approach, a better approach, a biomechanical approach, and simply, a throwing approach. Here are a few pics of thrower rehab exercises that spurred me to talk about the shoulder and elbow.  When I see this, it just pushes my buttons and I just can’t stand the thought of a pro athlete, or even a little leaguer, doing this stuff.  Warning: DO NOT DO THESE!

  

In the first picture I will give the guy the benefit of the doubt in that he could just be assessing what the scapula is doing while the athlete is………uh, well uh, what the heck is he doing?  It doesn’t look like a throw to me.  Definitely not a throw.  But this is not what I have seen in the clinic and training room.  Usually he is trying to get the scapula to “stabilize” or stay in a certain position during a “throw.”  Yet that’s not even close to a throw.  No legs, no wind up, it’s artificial and it’s neuromuscular nonsense because it is not a throw.  The second picture is even more ridiculous.  The shoulder external rotators do not even come close to resembling this in a throw.  Completely artificial and trains the proprioceptors to do something they DON’T do in a real pitch or throw.  The scapula is locked up and there is no trunk, hip, or leg motion to generate power for the throw.  Have you ever seen anyone move their arm like that, especially in a sport?  It can actually de-train the throw and decrease performance.

Let me illustrate with a study.  In a research study of pitchers, they did a strength test of the shoulder external rotators of the throwing arm compared to the non-throwing arm.¹ The presumption was that the external rotators of the throwing arm would be stronger than the external rotators of the non-throwing arm because the throwing arm has to decelerate all that force as it goes into internal rotation on the follow through.  Make sense?  Does it really?  If you are a pitching coach reading this, it makes NO sense.  If you understand the mechanics and biomechanics of the throw then you realize it is getting further off base.

What were the results of the study.  Exactly OPPOSITE of what they presumed.  The external rotators of the the non-throwing arm were stronger than the throwing arm.  The person with the traditional, conventional paradigm will be scratching their head.  It doesn’t make sense. But the pitching coach says, “Of course it makes sense!”  Why??

As a right handed pitcher follows through, there is transfer of weight to the left leg as the right arm goes across the body.  Who is the main player or pinch hitter for the right arm on the follow through?  Yes, the left hip and leg.  That left hip and hamstring decelerate hip flexion and rotation – which decelerates the trunk – which decelerates the scapula and the posterior shoulder.  They are a power player muscle group to decelerate and control that follow through motion and have influence all the way up to the shoulder.  Think about it, why would you want the small external rotators muscles to do it all by themselves when you can call on the big guys – the hip and hamstrings?  On the follow through, the throwing arm external rotators can sit back and relax because they know they are getting help from the guys downtown and they don’t have to do much.  Maybe sip on a Pina Colada and watch that knuckle ball go home.  The external rotators of the throwing arm have been trained to relax on the follow through because the big guys are doing their job.

However, on the non-throwing arm, it’s another story.  They haven’t been trained.  There’s no motor planning built into them.  There has been years of training, coaching, mechanics, technique training, sequence training and all that goes into the pitching arm.  The external rotators of the non-throwing arm don’t know what they are doing.  So they say to themselves, “We can do it, we don’t need any help!”  Guess what would happen if that continued?  Impingements, strains, sprains, posterior capsule problems, UCL tears, etc.  In fact, that is exactly what happens.  It’s not the shoulder’s fault because it was “weak.”  The tight and weak hamstring (in the transverse plane, not just the sagital plane) did not help control and decelerate the trunk to dissipate the extreme force of the throw and the shoulder had to compensate, leading to injury.  The scary thing about that study is that they concluded the throwing arm external rotators were “weak” and therefore needed to be strengthened to “prevent injury” so they developed an artificial training program for the shoulder doing sitting down external rotation exercises and a bunch of other completely irrelevant exercises for a thrower.  I submit that by having a pitcher do those exercises, they are predisposing him to further injury.

So, what happens in the training room or clinic?  They do just what the study did; exercises that train the external rotators to be stronger.  Exercises that have nothing to do with throwing.  Exercises that tell the muscles to do something that they shouldn’t be doing in a throw.  Essentially, exercises that mis-train the tissues and can even decrease performance.

What are just a couple of biomechanical glitches that can play into a shoulder or elbow problem?  Quick example:  The right handed pitcher (or thrower from about any position), has a tight right calf.  He flexes at the ankle and knee on the start of the wind up then he strides off of that leg. But he can’t flex through his ankle properly due to the tight calf, and that will cause him to not flex through his knee as well either.  So, he has to get that motion from somewhere else and goes up to the hip to get it.  So there’s increased flexion at the hip when there needs to be extension through that hip.  If he can’t extend through the hip then he can’t eccentrically load his trunk and core then the scapula musculature doesn’t get loaded (eccentrically lengthened or turned on) and the head of the humerus bumps the acromion and boom…….cuff impingement.  CAUSE – tight calf, COMPENSATION – flexed hip/trunk, SYMPTOM – shoulder impingement.  Just doing shoulder exercises with a towel under your arm pit won’t cut it and does not address the cause.

Let’s go even further and look at the foot. Let’s say the pitcher has a rearfoot varus (a bony deformity where the heel is turned inward) with a stiff subtalar joint.  In other words, the foot won’t allow proper motion to turn on all the muscles of the leg and hip, thus not allowing the power and energy transfer to the trunk and arm for the throw.  As the pitcher loads and pushes off of that right leg and the body starts moving FORWARD toward home plate.  Yet, the arm is still moving backward or externally rotating.  So what’s the ball doing at this point?  Is the ball going toward the plate or away from the plate?  The ball is moving forward, toward the plate, yet the arm is still moving backward. It’s because the trunk is moving forward to the plate and taking everything (including the arm and the ball) with it.  But if the foot shuts the leg down, then the hip down, then the trunk down; the chain of power is out of order and the arm takes up the slack for the diminished power from the legs and it wreaks havoc on the elbow.  Low and behold – strains or the UCL starts screamin’.  Not the elbow’s fart, fault, excuse me.  Make sense?

I recently watched Stan Lee’s Super Humans on the History Channel and he has some just amazing stories of superhuman acts.  One of them was called “Killer Punch” and it was about a martial arts expert from China that could generate incredible force in a one inch punch http://www.youtube.com/watch?v=UaqHT4TWHW8&NR=1.  They did a test of how much force he produced in 3 different punches on a test dummy used in car crash tests.  The first punch he generated over 700 lbs of force, which is off the charts. He has one punch he called “Explosive force.”  On the “explosive force” punch, he caused further displacement of the dummy than on the first punch.  He said that he generates the force for this punch starting in his BIG TOE, up through his leg and body and into his knuckles.  My point is that the force starts from the ground up and is not just in his punching arm.  Yes, same thing goes for a knuckle ball, it’s from the ground up.  Hey, maybe we should have him do some knuckle exercises to make his knuckles stronger.

I recall working with a pitcher who was 6 months out from a rotator cuff repair.  He had been getting therapy for 5 months then came to me.  His complaint was simple: he still couldn’t throw.  What?? You’re 6 months out man, you’ve gotta be kidding me.  Yes, he could do the shoulder exercises.  Yes, he could do the band exercises and that one in the pic above.  Yes, he could lift a fairly heavy dumbbell over head.  But he couldn’t throw.  I had him get on the floor in a push up position with all his weight on his non-surgical arm and do some reach throughs with his other arm to get him to rotate his body on that arm to assess his scapula strength.  He was awesome.  Had him do it on the throwing arm that had the surgery, couldn’t even do 1 rep.  Not one.  What the heck were they doing with him?  He couldn’t coordinate a one leg squat and a rotational arm movement similar to a throw.  He couldn’t do agility drills where I had him do reaches with his arm to load his hip then use his hip to drive his arm into rotation…..couldn’t do it.  Had him stand on his throwing leg and reach overhead to load his leg and arm concurrently as in a throw…..looked terrible.  His leg power was sorry.  No 3D power to generate a throw.  His legs, trunk, and arm were disassociated and not linked together as in a throw.  Yes, he had some shoulder strength, but he had no throw-ability.  We did so many 3D drills for the legs with the arm integrated into it that he could throw in a week.  He was one sore puppy though.

If all your training and rehab is just focused on the injured area, you may be missing the link that is causing that area to break down.  Traditional concepts won’t get to the cause to ultimately get the player to his optimum performance or prevent something else from breaking down in the future.

Michael Griffith

www.3dperformancesystems.com

¹ MULLIGAN, IVAN J.; BIDDINGTON, WILLIAM B.; BARNHART,
BRUCE D.; ELLENBECKER, TODD S.  Isokinetic Profile of Shoulder Internal and External Rotators of High School Aged Baseball Pitchers.
Journal of Strength and Conditioning Research. Nov 4, 2004. Vol ume 18:Issue 4.