Share   Subscribe to RSS feed

Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Archive for 'elbow'

If you follow my blog, then you already know I have a 16 y/o left-handed son who pitches. As a sophomore, he is in the early stages of recruiting and has been to 3-4 showcase camps. He has good size at 6’3″ tall and 184 pounds. He has been up to 82 mph.

We have been told he projects at the D1 level, but he just needs to throw a little harder. Baseball is all about bigger, faster and stronger these days. Analytics and numbers rule the day. Coaches have told us that once he consistently throws 85 plus, the offers will start to roll in.

So, the big push for many pitchers today is gaining velo. There are lots of programs and “experts” on the subject offering online programs, weighted balls, velocity training tools, throwing programs, etc. The two questions I always have are:

  1. What is safe for throwing athletes?
  2. What is effective?

As a physical therapist, I only want to pursue things that satisfy both questions above. Personally, I do not believe there is a quick fix, or any one program that will deliver the goods.


Continue reading…

I just returned from the Sports Physical Therapy Section’s annual conference in Las Vegas. There were plenty of great presentations from various industry leaders. I thought I would take a moment and summarize a few key points from the conference that may be helpful to clinicians and consumers alike.

The conference theme was the power of innovation. Hot topics covered were blood flow restriction therapy, cupping, dry needling, eccentric loading for tendiopathy, weighted ball training, and kinesiotaping and laser therapy to name a few. Below are some takeaways worth mentioning:

  • Blood flow restriction (BFR) training can be used to help reduce muscle atrophy after surgery, improve muscle protein synthesis and provide a way to increase strength with loads as low as 20-30% of 1RM for clients unable to tolerate heavy loading
  • BFR is not superior to nor a substitute for high intensity training (need to push weight to see best strength gains), but it can be used as an adjunct to training. It also produces an increase in IGHF1 after exercise.
  • BFR should not be used before higher intensity activities such as HIT, plyometrics, SAQ, etc.
  • Clinicians and strength coaches should consider Olympic lifting derivatives as an alternative to traditional lifts if there is concern with catch phases or biomehcanical/physical concerns. Examples include high pulls/snatch pulls instead of traditional cleans and snatches.
    Continue reading…

In my previous post, I outlined the history and findings related to my son’s medial elbow pain. Since publication of that blog post, I have since been given the results of his MR arthrogram and have further updates. If you did not read the prior post, you can click here to read it.

Initially, my concern was tendinitis or more of a flexor/pronator strain given his mild yet persistent soreness and response to rest. The imaging revealed that his UCL was pristine, the radiocapitellar joint liked good, no osteophyte formation or really any inflammation in the soft tissue. The surge told me he had to look closely, but there was evidence of mild fluid around the apophysis. So, in essence, there was some overload/strain being placed on the growth plate.

Given that my son’s growth plates are still open at age 15, he was experiencing some overload (apophysitis) rather than strain on the UCL itself. Had he been skeletally mature, there likely would have been more stress being placed directly on the ligament itself. So, this was good news for all of us.

We received the results on Tuesday October 31. With clearance to pitch last weekend as tolerated by the MD, I elected to have my son throw a bullpen last week. He threw 25 pitches on Wednesday night (one week ago) and was at 100% and pain free. As such, I let him throw 40 pitches in our showcase game last Saturday. He again threw pain free. Now that Fall baseball has ended, we will shut him down for some extended rest and focus on arm care and overall strength and conditioning as he continues his HS workouts.

Some key takeaway points for players, parents and coaches:

  • Never dismiss pain that occurs with throwing
  • Educate players about throwing related soreness/tightness (such as lactic acid build up that would be typical after a start on the mound) so they can differentiate that from true pain
  • If velocity, mechanics or performance in a player suddenly drops, be suspicious of a potential injury knowing that most players will try to throw through it (look for shaking/rubbing of the arm, grimacing or other body language that is outside the player’s normal routine)
  • If you suspect an injury, seek out an immediate assessment from a knowledgeable physical therapist and/or MD who treats baseball players as they will do a more comprehensive evaluation and uncover the root cause of dysfunction faster
  • Getting imaging in a higher level player will provide peace of mind for the athlete, parent and coach allowing for proper care and progression back to pitching as evidenced in this situation
  • Managing pitch counts, innings pitched and recovery between appearances will be instrumental in preventing or reducing injuries

In the end, we must rely on the athletes to communicate what they re feeling. Often, pitcher push through fatigue and pain in the spirit of competition. It is imperative that we advise against this in order to promote long term health and prevent more serious injuries. I know I feel fortunate that my son’s injury was not serious at all.

Moving forward, I will adjust his off season and in-season throwing to ensure he actually conditions his arm with more frequent throwing (not pitching) to ensure his endurance is better, as I feel this may have been a factor in his overuse scenario. While he threw a weekly bullpen this summer, he only threw on average 2 days per week on top of that. He threw daily in middle school ball last year and never had any arm related issues on the mound.

Each player is different in terms of their build, pitching capacity, arm talent, etc. With that said, I think it is important to analyze their performance over the year based on innings pitched, pitch counts, rest between outings, strength program, throwing programs and perceived fatigue to evaluate what works bets for the player. Educating players and parents about arm care and health management strategies will reduce injuries and facilitate long term success for pitchers that have a chance to play in college and beyond.

I have a steady flow of baseball players who come to see me for shoulder and elbow rehab. As a former pitcher whose playing career was altered by an arm injury at age 14, I have a particular interest in throwing injuries. My son is a 6’2″ left-handed pitcher that plays showcase baseball. He will be the subject matter of this post moving forward.

img_9958

Many of the players I see for shoulder and elbow pain suffer from pathological GIRD (glenohumeral internal rotation deficit). While it is common to see throwers with less internal rotation on their dominant side, it is important to assess total shoulder motion to make sure their mobility is within 5 degrees of their non-dominant side. Asymmetry in total shoulder motion and shoulder flexion increase the odds of elbow injuries. Click here to see the correlation in professional pitchers. Additionally, insufficient external rotation gain on the throwing arm increases injury risk. Click here to read an abstract summarizing data within the same group of professional pitchers.

Given this information and my background, I have preached arm care for years to my son. For some background, my son has pitched since he was 9 years old. Since I have been a coach for his team in one capacity or another since he was 10, I have closely monitored and controlled his pitch counts, innings per outing and total innings per year. He has always been able to throw hard, but he had a big growth spurt in middle school and his velocity grew with that.

He now throws between 75-77 mph as a HS freshman. He is projected to be 6’5″ tall and weighs 170 pounds at this time. His showcase coach pitched in MLB, and we have two other organizational pitching instructors with big league experience who supervise his weekly bullpens. His total innings pitched for 2017 = 43. Research indicates anything over 100 significantly increases injury risk. With all that said, he has developed some medial elbow pain over the past 4 months. He has no history of arm trouble to date. My intention is for this post to serve as useful diagnostic and proactive intervention for those who may see and experience similar cases.


Continue reading…

Spring training has begun, and youth baseball players all over the country are starting to practice and prepare for their upcoming seasons. My very own 14 y/o son has started his 8th grade season, while having been working with his travel team on the weekends since mid December.

cole-ncdb-pitching3

As a physical therapist, former player, father, and assistant coach on his 14U team, my first concern is always the health of a player. I see several baseball players in my sports medicine practice ranging in age from 9 year olds to MLB platers. Diagnoses include internal impingement, SLAP tears, little league elbow/shoulder, OCD, UCL sprains, rotator cuff tendinitis, instability, fractures and scapular dyskinesia.

One of the hardest things to do in my profession is get inside the head of a young athlete. Many will refrain from mentioning pain for fear of letting down a parent or coach, or out of concern for losing playing time. Society has become too focused on early specialization and winning from an early age. In addition, “travel baseball” has been somewhat diluted and water down by lots of dads who want their sons to play year-round. I often see kids being abused on terms of too little rest or improper recovery after they pitch and catch.

The biggest, most athletic and hardest throwing kids undergo the most strain as they are asked to shoulder the load at pitcher, catcher and shortstop early on. Many coaches are counting innings in tourneys and not pitches based on tournament guidelines. Too many kids are pitching on consecutive days without proper rest all in an attempt to win meaning less tournaments at a young age. Fortunately, we are making progress in the sports medicine world thanks to the efforts of Dr. James Andrews and others.

High schools are adopting pitch count regulations this year, and MLB along with Dr. Andrews has developed their site, www.pitchsmart.org, to spread education about injury prevention in youth pitchers. Dr. Christopher Ahmad is on the advisory committee for PitchSmart.org, and he is also the lead author on a new paper detailing an injury assessment tool for young baseball players, The Youth Throwing Score.


Continue reading…