As a certified athletic trainer (ATC) I see too many young baseball players with medial (inside) elbow pain, posterior (back) elbow and shoulder pain, and anterior (front) shoulder pain.  These young athletes come to me after it is too late – they have been practicing/implementing inefficient (and incorrect) mechanics.

I was once told in graduate school “common things happen commonly and uncommon things happened uncommonly.”  This has never been more true than it is today with youth baseball.  I am seeing more and more eight, nine and 10-year-olds (and older) that present with the same description.  The script hardly ever changes.  The mother usually brings the patient to the clinic because her son is in pain.  After an evaluation of the athlete, it is explained to the mother that her son has a tight shoulder and it is expected that her son's mechanics may be contributing to his arm pain.  A video analysis of her son's mechanics is recommended.  The mother usually states that she would like to have her husband present.  The video analysis is scheduled for another visit.

At this next visit the father begins the session by saying that his son has taken pitching lessons and he is quite sure his son’s mechanics are not flawed.  The father continues by saying that his son’s pitching coach instructs him by using any combination of the following statements/mantras:

• Get into a tall balance point
• Break the hands quickly to get on top of the ball
• Fall toward the plate
• Land with the front foot closed
• Extend the arm out in front of the body so the release point is closer to the batter
• Snap the wrist down hard and fast

At this point, many of you who are reading this are saying to yourselves “yeah, those sayings/mantras seem right” because you or your own son have been taught these same things.

A good friend and colleague of mine has a saying, “people don’t know what they don’t know”.  Being taught only one way of doing a task doesn’t mean that one way you were taught is the only way or even the best way of doing that task.  You don’t realize/know that there is another way.  Therefore you don’t know what you don’t know.

Much of (if not most of) the pitching instruction that I am encountering today is what has been called by some “belief based”.  Belief based revolves around the basic concept of “that was the way I was taught so that is the way I teach.”  Does anyone see a flaw with that thinking?  What if what is being taught isn’t the only way or the BEST way of instructing our young players?  What if what is being taught is hurting our young players?  What if the next “great pitcher” never realizes his potential because he was instructed based on someone’s “belief”?

On the contrary, there is a concept of instruction that has been labeled “evidence based”.  Evidence based instruction comes from the practical application of research.  What does the research say?  Without getting technical, the research tells us that if a pitcher has a decreased ability to rotate their arm/shoulder down by a certain number of degrees, then that pitcher’s mechanics change placing unnecessary and excessive strain on other structures of the arm.  Therefore, that pitcher experiences some type of arm pain.  Additionally, research tells us that faulty lower body and trunk mechanics can transfer stress to the throwing arm.  This too can result in a pitcher experiencing some type of arm pain. 
 

Without these fundamental biomechanical understandings and detections, a pitcher and his parents are placed in what appears to be a never-ending cycle.  It goes something like this:

• The pitcher experiences either shoulder or elbow pain
• The pitcher is told to take an over-the-counter anti-inflammatory medicine
• The pitcher temporarily feels better but the pain returns
• The pitcher’s parents take him to a physician asking for a steroid injection (after all that is what the big leaguers do, right?)
• The pitcher is instructed to stop pitching for 2, 3, or 4 weeks and is given a prescription strength anti-inflammatory medicine by the physician
• The pitcher plays another position (usually 1^st base – because there is not much throwing, right?  When in all actuality throwing from 1^st base, in my opinion, is one of, if not the most, arm-dominant throwing positions)
• The arm feels “better” after a couple of weeks
• The pitcher resumes pitching
• The pitcher throws 1, 2 or maybe even 3 innings and the pain returns (often times more intensely than the original bout of pain)
• The parents take the athlete back to the physician or perhaps to a “sports specialist” for a second opinion
• Rest and anti-inflammatory medicines are again prescribed
• An MRI may be ordered
• An injection may follow
• Rehabilitation is recommended
• The season is 1/3 to 1/2 over with at this point and frustrations from the pitcher, parent and coach are really getting high
• The season is “pieced together”
• The parent and pitcher vow to get instruction in the “off-season” (this is an oxymoron – baseball is a year-round sport now-a-days)
• The pitcher receives instruction based on someone’s “belief”
• The next season begins
• The cycle starts all over again

Have you been there?  Do you know someone who has?  I see it every spring.  Is there anyone to blame?  I don’t think any one person is to blame.  Because “people don’t know what they don’t know.”

Analogy time:  Have you ever been walking and you suddenly feel something in your shoe?  Sure you have.  What is your reaction?  Often times you try wrinkling your toes to redistribute the object that has found its way into your shoe.  You begin walking on a different part of your foot than you normally do.  You may even limp for a while.  But what would be the logical thing to do?  That’s right – take the object out of your shoe!

This pebble in the shoe analogy is so applicable to the pitcher and arm pain cycle mentioned above.  The pitcher begins to experience some type of discomfort.  He consciously or subconsciously (because the body is a remarkably created machine) makes a change to his pitching mechanics.  He “limps” around for a few outings (or even seasons).  When in all actuality to break that cycle, one only has to stop long enough to identify and take out the “pebble” that is in the pitcher’s mechanics.

There are other causes of arm pain in pitchers besides the tight shoulder issue.  Belief based instruction puts emphasis on the pitcher’s arm being the prime mover/accelerator of the ball.  The elbow leads the body through the acceleration phase of pitching vs. the body pulling the arm through.  These pitchers are labeled as arm throwers.

Arm throwers have many things in common but a few of them include:

• Slow/robot-like side steps as their first move from the rubber
• A pause or hesitation at the top (i.e. balance point)
• A short stride length
• Minimal/No back side follow through
• (There are a multitude of things to look for between the first side step and back side follow through)

On the contrary, evidence-based instruction places the emphasis on using the whole body in an efficient manner of creating, storing, and ultimately releasing kinetic energy.  Tim Lincecum, 2008 NL Cy Young Award Winner, and his dad understand this concept.  My understanding is that Tim is around 5’10” or 5’11” tall but can throw 98 mph and higher.

How did Tim Lincecum become that good?  According to the 2008 Sports Illustrated article, Tim’s dad videotaped and analyzed nearly every pitch Tim threw growing up.  I realize that many parents (and some pitching coaches) videotape their son pitching.  When you view the video, what are you looking for?  What checkpoints do you have?  What objective measurements are you taking?  What degree of hip rotation does your son have?  What is the relationship of your son’s trunk lean to his front foot?  What ball path does your son have from hand break to front foot plant?  Tim’s dad looked at these things and many more.  Are you looking for these?  If you are, what are you (or your son’s pitching coach) doing with the information once you find it?  How are you implementing these findings into your son’s pitching mechanics?

The previous paragraphs most likely caused you to have one of two reactions:

• You realized your son may very well have been taught to be an arm thrower and all kinds of light bulbs went off in your head.

If you are the latter and feel your son or one (or more) of your players could benefit from a professional, evidence-based video analysis of his pitching mechanics, visit our P.I.T.C.H. Program.