Facing the Reality About "The Arm" Injury

(Note: this was a post I wrote in August 2018 for True Grind Systems, a sports performance training facility in Austin, TX. Some media that True Grind owns and included in the original post has been omitted. You can find the original blog post here.)

Before I begin this rant, allow me to give you some background information about myself and how this topic came about. Since 2015, I’ve been a pitcher at an NAIA school in Texas. Before I set foot on a college campus, I had already gone through two elbow surgeries: an ulnar nerve transposition in February of 2013 during my senior year of high school, and an ulnar collateral ligament reconstruction – commonly referred to as Tommy John – later that September. After those two surgeries, I took a gap year to rehab and then pitched two full seasons at the NAIA level. During the summer after my second full season, I sustained a shoulder injury that ultimately led to a shoulder debridement surgery in May of 2017.

Then, at some point between February and April this spring, I re-tore my UCL. I was less than a year out from my most recent surgery. Suffice it to say, I’m one thoracic outlet syndrome diagnosis away from experiencing every common pitching injury that exists today. Not that that’s anything to brag about.

I have no formal strength and conditioning education. I have no formal education in dealing with anatomy, physiology, training, kinesiology, or any other subjects of that nature. I am a business administration major with a sports management specialization.

However, I’ve learned quite a bit through my five-plus years of experience with injury and rehab. I have met dozens of different doctors, dozens of different physical therapists, and dozens of different strength coaches. All of these people have different outlooks, methodologies, and opinions on how to help their athletes not only fully recover from injury, but come back healthier and performing better than before. Many of these people changed my life and I credit them with adding years to my baseball career. I’ve seen everyone from my local physical therapists and orthopedic doctors in my small Texas panhandle hometown, to strength coaches with multiple Cy Young Award-winning clients, to a doctor who had previous clientele consisting of all the players in a Major League Baseball organization.

That being said, as I was sitting in the doctor’s office a couple weeks ago, assuming I was going to be released to start a return-to-throwing program, I started going over the usual spiel in my head about what the doctor was going to say. This doctor has done all three of my surgeries. Between the visits for the initial injuries, the surgeries, the post-ops, and the check-ups, I estimate that I’ve seen this doctor between 20-30 times the last six years, meaning I have a pretty good idea for what he’s going to tell me given the current situation or where I am in my injury process. On this particular day, I was four months out from a PRP injection I had been given to see if it could help heal the partial tear in my UCL. The pain I had experienced during my first check-up after the PRP injection was now gone, so in my thoughts, I had already moved past the fact that he was going to release me to throw, and continued on to the specifics of the protocol he would give me moving forward.

It took me until this appointment to be conscious of one thing he always says, which then sparked thoughts about all other things entailed in the protocol for rehabilitating an injured pitcher. The thing that stuck out to me was that every single time I had been
released to throw again after an injury or setback, I had been advised to find a coach, trainer, or someone knowledgeable to watch me throw as I progress through the return-to-throwing program. I would need a person literally watching every throw I make, monitoring and critiquing my mechanics, arm action, and overall performance level through each phase of the program. If possible, this person should be helping me re-map and re-pattern the way I throw if it is deemed necessary. This person is included in the protocol to help find any flaws in my delivery that might have led to my injury in the first place or could potentially lead to new injury.

The first several times I heard this, it went in one ear and out the other. I disregarded it. Neglected the fact that this could be an opportunity to help me. It wasn’t because I didn’t care or was too lazy. In my mind, it took me about a third of a second to realize that I wasn’t going to be able to find someone to do this for me. That this was just a part of the protocol that was going to have to be left out because I didn’t have someone in my life with the means to hold my hand while I throw every single day for the next 8-12 months. At least not someone that could find a flaw and know how to fix it. It just wasn’t plausible. So, I would always forget about that part of the program and leave it at that.

I came to the realization that there are many things asked of pitchers in the general population during their rehab process that are absolutely absurd. I’m not talking about the months and months of strength training, throwing to increase arm fitness, physical therapy, etc. Though that side of rehab is hell, it can definitely be accomplished if you want it bad enough. I’m referring to the accessory parts of a protocol that get overlooked, like I overlooked someone who could monitor my throwing, because the athlete does not have the resources to complete that part of the protocol.

Let’s use another example. My throwing program actually includes a section titled “3D Biomechanical Motion Analysis” that is mentioned as a possible useful tool in re-mapping and re-patterning a pitcher’s mechanics. Through consultation with someone knowledgeable, this could allow a pitcher to find flaws in his delivery that led to injury in the first place, correct them, and continue as a pitcher with more efficiency throughout the kinetic chain.

These are fantastic things to include in a return-to-throwing program. I have no qualms with either, and nor should anyone else. It is completely logical. They are innovative. They could help me return injury free, perform better than I was before injury, and limit my risk of being injured again.

But, dude, I’m a college student that plays baseball at an NAIA school. How the hell am I supposed to have access to 3D biomechanical analysis? To put it bluntly, how should anyone have access to that if they’re not already at the Major League level? I don’t know of any Division I programs that have a complete biomechanics lab, let alone any program at a lower level. The training facilities that have their own lab are sparse across the country, and it’s not cheap to utilize their tools.

When this doctor did my first elbow surgery five years ago, I was in high school. Neither then nor now will I be able to find my own personal biomechanics expert/pitching coach/trainer to watch me when I throw. Even if I could, the trainers at my school don’t know what to look for. This fall semester, we will have about 110 baseball players in our program. We have four coaches and two graduate assistants. How will one of those guys hold my hand throughout my throwing program? The player to coach ratio is almost 20 to 1. And, depending on the coach or assistant that might be available to consistently watch me, they may not even know what to look for or how to critique my movements. There’s just not a significant chance that I will be able to have someone watch me progress through the program while also being able to make any mechanical improvements. And I sure as hell don’t have the resources to use a biomechanics lab.

Is it absolutely necessary to use a biomechanics lab or something similar in your rehab process? To be honest: no. However, I will say that I’ve never used one, and I’ve been injured four different times. I blame much of that on the fact that I have never moved well on a functional level. Putting markers on my body and throwing bullpens in front of Edgertronic cameras could have definitely helped me in the past. Hell, it could help me now. Just take that for what it’s worth.

One part of the rehab process that you could argue is necessary, though, is consistent manual therapy. Getting soft-tissue work and manipulation can do wonders for a thrower, assuming you can find someone certified who knows what they’re doing.

Our athletic program has over 10 sports. You can count the number of trainers in our athletic training department on one hand. Let me just say that going to the training room to receive any type of soft-tissue work is a tall order when you’re dealing with an undermanned staff. What adds to the complexity is going to the training room if your sport is not in-season. You and your teammates are not priorities for half of the school year, and that’s fine. It makes sense. Some days you just have to go to practice and skip it. At no fault of our training staff, catering to every athlete’s needs on a daily basis is just not feasible.

It might sound like I’m complaining about all the things asked of me, an injured athlete, to complete. I can assure you that is not the point. Some people might even think, “So you have to leave out biomechanical analysis and going to the training room every day. So what? You can still come back healthy.” That is true. I’m not debating that. I’m just outlining examples of a comprehensive rehabilitation protocol that athletes are expected to adhere to in order to ensure that they return without injury, performing better than they were before, and at lower risk for re-injury.

There’s a key word there I added there for a reason. “Comprehensive.” If the athlete does indeed find a way to complete every part of their rehab protocol, theoretically, there should be no problem. There’s a solid chance they will never have another injury that is related to their current injury because aspects of that protocol will become part of their daily life as their career extends past the rehabilitation stages. However, most athletes – most pitchers – do not have the resources to complete anything other than their throwing program, standard physical therapy, and basic strength training. That is not comprehensive. And I think it’s safe to say, because I know from experience, that trifecta alone has a less than perfect track record when you get a few years down the road from an injury.

There are so many things that are asked of athletes that we simply cannot find the resources for unless we are already professional athletes at an elite level where everything is in reach, or we have an unlikely network of relationships with professionals and a chunk of money to throw at them. Most high school, college, and low-level professional players are not in that boat.

I think we fail massively as a baseball collective in expecting every athlete to have the ability to find success in rehab programs when they don’t have access to everything it’s supposed to include. I think that’s a huge reason why the number one pre-cursor to injury is having already been injured at least once in a career. Doctors, trainers, coaches, and even athletes are simply passive about this. This is a serious flaw in the baseball world, where arm injuries are an inevitable epidemic. We just sit back and if a second or third injury happens… it happens. And we do the same thing all over again. It’s practically delusional.

The solution is not simply completing every step of a rehab program. I’m not saying that at all. But there is something to be said about the knowledge that can be gained and tools that can be utilized moving forward in a career that are learned in the rehab process. A pitcher that develops a routine involving mobility work where he is deficient, the opportunity to seek out a reliable manual therapist, and the ability to point out basic movement flaws in his own delivery can set himself up for health and longevity for a very long time in his career if he is able to learn these things the first time he gets hurt. Why should any pitcher not be able to achieve this? Why should players have to go through multiple surgeries or even retire due to injury in order to learn these lessons and pass them on to others?

I was three surgeries deep before I started learning any of these lessons. By the time I tore my UCL the second time, it was too late. I wish I had the knowledge five years ago that I have now. We need to do a better job in the baseball world of educating players. We need to increase the availability of helpful and necessary resources. We need to understand the limitations on players in lower levels of baseball. We are doing a great job and are on the right track in dealing with injuries in baseball, but on some level, it almost feels contradictory to sit back and accept injury (more specifically, re-injury) as inevitable while claiming to prevent the exact same thing.