Protecting Against Tommy John Surgery: 3 Training Methods
Elbow injuries have been on the rise for decades, and medical professionals have yet to find a way to curb them. The most notable of these being the famous Tommy John Surgery. Other injuries to the region include Ulnar Neuritis, Muscle Strains of the Flexor Pronator Mass, and Tendon injuries the Common Flexor Tendon, also known as Golfers Elbow.
In 2022, 28 MLB players underwent TJ Surgery, and as of right now, 40 MLB players are on the Injury List with Tommy John. One of the main questions here is, why are elbow injuries rising so much? It seems to be a combination of things. For one, pitchers are throwing harder than ever. The average fastball in 2015 was 93.1mph, now it is 93.9mph. Also, kids are throwing harder at a young age. When I played high school ball, it was almost unheard of to face a kid throwing over 90mph. Now I routinely have 2-3 high school players a year who can eclipse this mark. The harder the throw, the more strain on the muscle, tendon, and ligaments along the elbow, thus increasing the odds of injury.
There is also the new pitch clock. It will be interesting to see the data once the 2023 season is over. Does making pitchers throw at a higher frequency increase their injury risk? This is a big question. Data over the next few seasons will start to shed light on this topic, but for now, it is hard to say for sure. It is unlikely that the pitch clock goes anywhere given that baseball viewership is up 7%. Therefore players must adjust to the faster game.
Glenn Fleisig, a researcher for the American Sports Institute and pioneer of pitching biomechanics, recently went on Mike Reinolds' Podcast and talked pitching mechanics. He placed a large emphasis on elbow injuries and their rise. In his opinion, pitchers should train their elbows to be resilient to UCL issues. This makes sense, for an area that is so susceptible to injury, players should focus on strengthening it. So how do we go about this process? Like a lot of things in sports medicine, let's use anatomy and good research as a guide.
*The UCL is the white angular tissue on the bottom right.
Basic Elbow Anatomy
The inside of the elbow is most frequently injured in the Late Cocking and Early Acceleration Phase of throwing. During this phase, the inside of the elbow gaps. This gapping separates the ulna from the humerus. It is up to the UCL and Flexor Pronator Mass muscles to limit this gapping. If this complex fails, one of the aforementioned injuries occurs, including UCL Tears.
Training the Flexor Pronator Muscles seems to be the best way to directly stabilize the elbow. A research study in 2020 looked at what muscles close the gap the best. A full contraction of the full Flexor Pronator Mass was best, but from an individual standpoint, the Flexor Digitorum Superficialis (FDS) outperformed the rest. I think there are some clever ways to incorporate this muscle into a pitcher's arm care.
3 Ways to Train the FDS.
1. Finger Kettlebell Hold - This one is a favorite of time. The player holds the kettlebell with there tips of their 4 fingers. Do not worry if the pinky seems like it is not doing much, the 2020 study showed that the middle and index were most important. I like to start players off with 3 round of 30 seconds at around 30-35lbs. Two variables can be adjusted here, weight and time. Increase both over time, but never both at the same time.
2. Banded Finger Flexion - This one focuses on the battle tested method of time under tension with progressive overload. I like to start players off with a medium band (green), and perform 3-4 sets of 12 reps.
3. Wrist Flexion at 90/90 - This one works off the part of the research that showed how a full contraction closed the gap the best. I make the exercise more specific to the throw motion by bringing the arm into the 90/90 position. Here they flex the wrist against banded or weighted resistance. Similar to the last exercise players perform 3-4 sets of 12 reps.
Conclusion
Athletes will continue to redefine what is possible in sport, as I think the average speed of the fastball will continue to climb. The increase in injuries points towards a need for intervention. I believe this intervention should be giving more attention towards the athletes' vulnerable areas, such as the elbow. This is why all Arm Care and Strength and Conditioning Programs should start including elbow strengthening. It will better protect you as a player, give you better outcomes as a Physical Therapist, and make everyone more successful.
