One of my closest friends, fellow ballplayer and trainer, and occasion contributor to this site, Andrew Sacks, just underwent PCL surgery on his right knee. He is chronicling his recovery, which I think is a great idea – one that I wish I had done myself with my elbow. Unfortunately, Andrew has an even longer road than most, as his left knee needs at least one ligament replaced as well, so two or three months into rehab on his right, he is going to be on the surgeon’s table again to get his left knee repaired. For a lifetime athlete, he is in for a long battle with inactivity and rehab.

Apparently Andrew bruises easier than grandma.

So, check out his blog entitled Life After Knee Surgery. Andrew writes well, and if you’ve ever laughed at one of my random thoughts or jokes, then you’ll enjoy his brand of humor as well (we basically share that brand). And if you further find yourself wondering about the difficulties of going to the bathroom while in a straight-legged knee brace, look no further.

But in the professional season, off-days are few and far between, and the rotation gives each starter 4 days to prepare for his next outing. Everyone is different in what he needs to prepare, but I’ll share my own preparation schedule that I feel gives me the best chance to succeed and stay strong throughout the season.

Day 0: Pitch (hopefully well)

I do very little on this day.  I stretch everything out, warm up really well, and go out and give em my best on the mound. Afterward I ice my elbow If I think I need it, but I generally am not a big icer.

Day 1: Repair Thyself

I do not lift weights on this day, nor do I do any shoulder or elbow prehab. I usually do not throw, either. My rationale for this is that throwing 100+ pitches is very destructive on the body, and a full day of rest is necessary to keep me healthy. If I do prehab, even without throwing, I’m still not allowing those tired and inflamed tissues in my arm to fully rest. So, I leave my arm alone – completely. I once asked my surgeon what he thought a pitcher should do after a start. His reply? “sit on the couch and eat potato chips.”

I keep off my arm as completely as I can, but my legs are a different story. Day 1 is my big run day, and I like an interval type workout with slightly longer distances. 10-12 “Bows” is one of my favorite workouts on Day 1. A “bow” consists of a very light jog on the warning track, and then an all-out sprint from foul-poul to foul-pole. A short rest is OK in between each bow, as keeping the sprint a sprint is a goal, and too little rest will reduce it to a fast run.

A crude drawing of a Bow

After getting my running done, I do hip work with a mini-band around my ankles, and I get a whole-body stretch in. After that, it’s bucket duty during BP and sitting through the ballgame.

Day 2: The Busy Day

Day 2 is hectic. No rest on this day.

First priority is a full-body lift, which will consist usually just of big, compound lifts like deadlifts, squats, chin-ups, floor pull-ups, and one pushing exercise like DB bench press. In-season I use heavier weights for low reps, with usually one higher-rep set thrown in to maintain my muscle mass. The low rep stuff keeps my max strength up without depleting all my energy, and I’ll typically use sets and reps such as 4×2, 4×3, 2×2 and 3×1, etc., done at 80-85% of my 1rm. Keeping max strength up is crucial, or else you end up a weakling by the all-star break, and all your offseason work becomes for nothing.

After lifting it is time to take care of my arm, which means my complete shoulder circuit of 2-3 sets, and all my elbow prehab. I also like to do some grip work holding heavy weights, (in addition to the deadlifts) like farmers walks or blob holds, if I can, because they make my elbow feel really good. I’m not sure why holding heavy things makes my elbow feel great, but it does.

Holding heavy things is fun!

After all the strength and prehab stuff, hopefully I have few hours break before going to the field. I’ll throw at the park, stretching it out a bit if my arm feels up to it, but basically the goal on this day is to get the arm moving again and prepare for my bullpen the next day.

After throwing, it’s time for al little more running. Short sprints, maybe 12x40yd is about par for this day, but I play it by ear depending on how I feel.

Day 3: Back to Work

Day 3 is highlighted by my heavier bullpen of the week, usually in the 5-10 minute range depending on what I need to work on and how I feel. This pen is thrown at maybe 70-80%, but I might pump it up higher if I feel I need a little higher intensity work, as your pitches and they way they feel change the harder you throw.

I do another set or two of shoulder and elbow prehab, this time with lighter weights. Usually 2lb is all I touch after Day 2 for my shoulders, and I like doing some table scapula stability exercises on Day 3 as well. Elbow work is very light. The workload starts to taper down on Day 3, as I have to be fully recovered by Day 5.

This is the last day I run hard. The other day I did 20x40yd sprints, but I mix it up depending on how I feel. Pick-ups, maybe 3 sets of 20 is something else that I might do on this day, to get some lateral leg work.

Day 4: Tapering Down

On Day 4 I play catch, usually ending with a flat ground or maybe a short, light mound bullpen of just a few minutes. The goal is to keep the arm moving while still working on the feel of my pitches. I feel better on game day when I have played catch the day before, rather than taking day 4 off.

I jog a little bit, just to get the blood flowing. I stretch really well and don’t do any other physical stuff with my arm.

Day 5: Pitch (hopefully well)

Hopefully I maintain my place in the rotation and give the fans something to cheer about. Then the preparation starts back up again!

Again, everyone is different, and this is so far what I have found works for me. Making sure you’re recovered for the next start is key, and if fatigue sets in you have to adjust your workload to compensate, ensuring that you’re at your best every time you take the mound. I enjoy training hard, but being a hero in the weightroom or on the track isn’t worth a damn if it leaves you tired for that next outing.

As I was in there, it suddenly dawned on me: Pitchers are just unlike everyone else in the sense that what they do is so physically violent, that they have to do what is called “prehab” just to reduce the likelihood (or in reality, delay) injury.  

Its pretty much a fact that if a pitcher doesn’t do regular rotator cuff, scapula, and forearm work (basically the whole pitching arm), he is doomed to inevitable, catastrophic arm injury.  Doing prehab doesn’t guarantee health by any means, as tons of diligent pitchers still injure themselves regularly, but its our insurance policy, and at the very least gives us a better chance of not being injured.Other athletes don’t do this.  Soccer players play soccer, and when they get hurt, they do rehab and return to action.  Lacrosse, football, tennis, you name it, these sports all allow their athletes to play, with nothing intrinsic in the sport that injures them.  Sure, football and martial arts are violent and injurious, but the injuries are general and not caused by any specific physical act.

Baseball position players are also allowed to play.  Sure, they come down with the occasional arm problem, but with not nearly the regularity as the pitchers. 

No, pitchers are the only athletes that aren’t just allowed to just play their sport.  They simply can’t show up at the ballpark and leave when they are done.  They have to spend extra time strengthening and stretching their throwing arm just so it’s less likely to rip itself out of the socket.  Ever seen a pitcher’s arm lay back, parallel to the ground in external rotation?  Try replicating that in your living room, and you’ll start to understand…

The pitching motion is just ungodly stressful and unnatural for the human body.  Its  interesting how in the entire athletic community, this one position in one sport is so different from the rest.  Sure, all athletes have to strengthen their bodies to compete at a high level, but none but the pitcher are at such an injury risk where they must go above and beyond just to have a chance at longevity, and even then it’s often a losing battle.  

The only other trends like this are in knees of female athletes and football linemen.  Women are predisposed to ACL injury due to their natural body shape and unique biomechanics, and have an ACL injury rate something like 10x that of men.  A good friend of mine just tore hers for the second time.  Football linemen are so heavy and get pushed around so much that they suffer a similar fate.  

I, for one, am ready for titanium ligament replacements.  Maybe one day that will be possible.  I’ll gladly call myself a cyborg if it allows me 20 more good years.  

These exercises can be done with dumbbells or a flat or tubular Thera-band (Flat is preferred). You can find Thera-Bands here: Thera-Bands 6 Yard Box (6 in. wide)

Pronation, supination and ulnar deviation are best done with a ban, mini-sledge hammer or baseball bat (though they are shown below with a dumbbell).

Forearm Flexion

With palms facing up, curl the weight toward you using your wrist.

Forearm Extension

With palms down grip, curl wrist straight up

Radial Deviation

With a thumbs up grip, curl wrist straight up

Ulnar Deviation

Stand with palm facing the thigh (neutral grip), curl wrist straight back, as if taking your pinky to your elbow

Forearm Pronation & Supination

Start with palms up, raise to neutral; lower on other side until palm faces floor, then raise back to neutral

Sets, Reps and Tempo

It is important to do all six of these exercises 3-4 times per week to ward of elbow problems, but you may have to adjust your volume during the season depending on how well your arm recovers.

Pick a weight or band thickness to allow 12-15 reps with a controlled tempo of 2 sec concentric (up) and 4 second eccentric (down).  Going slow with these makes a big difference.

Using a 12-15 rep range isn’t going to fatigue your forearms too much after the initial first two weeks, so it’s okay to perform 2-3 sets of these regularly, even close to your next game outing.

Shoulder pops and clicks when you move it? Those  are a result of weak stabilizers. Good thing is, the following shoulder circuit is going to make those a thing of the past, and add a few MPHs in the process.

This shoulder circuit is done for 2-3 complete cycles of 12-15 reps per exercise.  For beginners, this is going to probably require only 2lb dumbells, and the goal is to build up to using 3, and then 4lb dumbbells with perfect form for 3 sets of 12-15. The circuit is performed straight through, but I have grouped the exercises according to the body position (prone or standing).

Prone Segment

This segment is performed on a tall bench, training table, or bent over with a flat back. Notice it consists of the LYT circuit plus prone skiers and scapula pushups.

L-Raise

Start with back flat. Pinch shoulder blades and raise arms. Finish by externally rotating

Y-Raise

Keep shoulder blades tight and reach out with hands

T-Raise

Tightly pinch shoulder blades together

Prone Skiier

With arms straight, extend arms back toward your butt and up to the sky

Scapula Push Up

In pushup position with arms locked, let shoulderblades slump together, then press up fully keeping arms straight

Standing Segment

Front Raise (thumbs up)

Thumbs up front raise

60° Scaption (thumbs up)

60 degree raise on the scaption plane

30° Scaption (thumbs up)

30 degree scaption plane

Abduction (palms down)

Side raise with palms down

Open Palm Rotation Raise

Start with arm at opposite side, palms down; Raise and gradually rotate to finish with palms up

Sword Raise

Start with arm on opposite side, raise up as if unsheathing a sword. Be careful to not go behind the body, which would stress the elbow.

Side Lying External Rotation

Pictured with left fist propping the right arm up. Use fist or a towel to keep the arm off the torso

Internal Rotation (pictured with band)

Starting position

Ending position. Note fist under the arm to bring humerus forward

Yes, the circuit is 13 exercises long and takes the better part of an hour,  but it is worth it.  Being diligent with this circuit 2-3 times per week is going to bombproof the shoulder and rotator cuff and make you a stronger, more durable, and more than likely, harder throwing pitcher.

I want to thank Michelle Daniels, who was my athletic trainer at UMBC.  She taught me these exercises and brought me back to life following my surgery.

How do I know this? Because I have an unexceptional arm, and I’ve done a lot of squeezing.  I learned how to get the absolute best out of it, and for me, I believe the best is yet to come.  

As a high school senior I pitched at 78-81.  As a college sophomore I pitched at 85-89.  By Junior year (before my elbow went) I was sitting at 89-92.  

Thing is, I’m not special.  I just had good coaching, a great strength and conditioning coach, and a terrible, desperate desire to throw harder and develop into a good pitcher, one worthy of a chance at pro ball.  

The following are the 9 things that I credit with making a big jump in velocity, and which will continue to provide me with gains.  The bottom line is no matter how hard you throw, you can throw harder if you are willing to put all your effort into the list below.

1. Total Body Strength

      • This means just getting in the weight room, and increasing your strength and size as a whole.  This is the first step, the foundation for creating tremendous strength in more pitching specific areas.  Many youngsters simply haven’t the general strength to throw a ball in the 80s or 90s, and while some areas are more important to throwing than others, the body works as a whole.

2. Excellent Conditioning

     • Again, this is fundamental and adds to general body strength, but in a different way.  I can’t say exactly why being in great, great shape makes a pitcher throw harder, but I think it has something to do with creating a body that is fatigue resistant, because every part of you gets tired when you’re running and pushing yourself past your previous limits.

3.  Excellent Mechanics

       • This is often not accomplished until the previous two points are covered, because general body strength is needed to create the body control which is the basis for good mechanics.  Throwing with excellent mechanics maximizes your body’s muscular potential.  Thing is, getting to the point of having pro-quality mechanics takes tremendous repetition and the ability to make subtle changes, which a person of poor body-control simply cannot do.

4. Long Toss

      • Long toss stretches the arm out and teaches you to really get out in front with the ball.  Reaching out and extending your body is a big factor in throwing hard. Long toss also allows your body to find it’s own maximum mechanical efficiency, in that you are trying to throw the ball as far as you can; your body figures out with each throw how it best accomplishes that.  

5. Prehab (specific attention to shoulder/elbow)

     • I talked about prehab in a previous post, saying how it is the only thing keeping pitchers in the game and off the DL.  While it does prevent injury, it also strengthens the areas that are chief in throwing a baseball, i.e. the rotator cuff and forearm.  Pitchers who have extraordinary shoulder and forearm strength are almost certainly going to throw harder than those who don’t.

6. Core Strength with Emphasis on Rotation

    • Throwing is both linear and rotational, with the legs driving toward the plate and the core/hips rotating the torso to deliver the ball.  Again, total body strength is key, but a pitcher should take his core a step further, and aim to have the midsection of a gymnast.  

7. Strong Legs

     • Most people know this one.  Your legs carry and drive you toward the plate.  The more drive you can get out of them, the harder you should be able to deliver a pitch.  

8. Flexibility and Joint Mobility

      • You’ve see the beanpoles and the Tim Lincecums throwing gas.  They do this because they can move in any way they choose, and their joints and muscles don’t impede each other’s movements.  Have tight hips?  You won’t throw as hard,  I promise.  Tight shoulder capsule? You’re losing MPHs and increasing the likelihood of injury.  I know because I’ve been there.  

9.  High Repetition

       • Throw more.  Make sure you rest enough, but throw more.  

More Information to Come

Keep tuning in, because I am going to make a detailed individual post on each of the 9 items listed above.  As always, I’m open to comments, as this blog is a way for me to share the things that have helped me become a better ballplayer, though I still have a long way to go.

Keep in mind that I’m not a doctor or physical therapist, and my intention with this post is to create some body awareness and help people understand how their body may be feeling, and whether or not their expression of those feelings are in tune.

Call it Pain

Pain is typified by, and this probably is not news to anyone, sharp, short and sudden sensations that accompany a certain activity.  Pain draws our attention strongly and immediately to certain areas of the body.  

Now, pain is different in type and intensity for everyone, and being in tune with one’s body is important for reading into it.  I know which pains, when throwing or pitching, are incidental and aren’t telling me anything about the health of my arm or body.  These I largely ignore, because experience has taught me that they never manifest into anything pathological.  Pitchers commonly have little pains here and there that are just a natural part of the violent act of throwing.  Listening to one’s body and having experience with it is important, because one cannot become consumed with every little ache or pain that crops up.  It’s too stressful.

But some pain is an indicator of present injury or developing injury, and these need to be attended to.  These are usually stronger and don’t go away in a day or two, and may not respond to pain medication, therapy, ice, or other treatments.  If they do respond, then they will probably work themselves out with therapy, but they should not be ignored, and the activity should be backed off.  

During my rehab I have had little pains appear at different times and in different places.  Some of them I ignore, and they go away, and others I have had to back off my throwing or training until my arm could catch up and recover.  The key is understanding your body, and listening to it, and always being prudent about things.  Hammering away is not going to solve things when your body needs rest.

Call it Soreness

Soreness is present usually after a hard workout following a long period of inactivity, or an unusually stressful workout.  Its not the same as pain, though some people will claim that a part of their body “hurts” and they need to rest.  Soreness can indicate a developing injury, but more often it is probably the result of a new and taxing physical stimulus.  Soreness is typified by that burning feeling that encompasses larger areas of the body, and is usually very general and not pinpoint in nature.  

I have found that the best cure for my soreness is to keep the exercise regular.  If I am sore after a hard workout I won’t take off until it fades away, which could be up to a week, but rather will continue my regimen.  The soreness seems to get flushed out by this and usually recedes much faster than if I were to rest it.

After a start early in the season I will be sore, but will still lightly throw the next day and then increase my workload the subsequent days.  Rest is probably indicated when one can barely move from it, but other than that I have found that getting some exercise, or throwing a little for pitchers, is usually beneficial.

Call it Fatigue

Fatigue isn’t like the other two, because there isn’t usually a concrete sensation to go with it, other than aches and deadness.  Sharp or burning sensations aren’t there, but rather the muscles just don’t want to go.  

For pitchers this is a situation that calls for rest, because the arm is depleted and it just needs to recharge.  The hazard with throwing hard when fatigued is that mechanics get sloppy, and biomechanical laxity can cause more stress on all of your soft tissues.  You always want to be strong enough, when throwing hard, to maintain the highest quality mechanics possible.  Throw through fatigue too hard and too often, and some pain and soreness are going to appear, making things worse.

Call it Correctly

The important message here is to understand what your body is telling you, and to know it well enough to take the appropriate action.  All too often young pitchers will say their arms hurt when they are sore, or are sore when they are hurt, and the indicated paths to recovery for both are quite different.  Little pains and big pains are different, and should always be monitored, but may or may not lead to injury.  

When rehabbing from an injury there is often accompanying pains and tightnesses and sorenesses, and they, like all others, have to be analyzed to see if they are part of the healing process (which they often are) or a sign that progression is beyond the limits of the body.  But overall, people usually have an intuitive sense of when something is wrong, but over-analyzation of every pain can make for one neurotic and sleepless athlete.  The key is learning to know thyself.

…Standard MRIs are garbage.  When I felt my elbow go in the game, I was fairly sure that I was going to need surgery.  When I got my MRI a week later, however, my doctor could get a very accurate picture of my ligament on the films.  The regular MRI was just not clear enough in showing my ligament, and as such he recommended rehab and flexibility work, which had worked for me in the past.   Teammates of mine had had MRIs with a dye injection, which makes diagnoses much easier.  After 8 weeks of rest and rehab, I tried to pitch but couldn’t do it without pain.  My elbow felt loose when releasing the pitch, as if my ulna really wasn’t attached to my humerus.

So I went back and got an MRI with a dye injection, and it was clear as day that my ligament was torn.  My recommendation for others is to get a dye-injected MRI the FIRST time.  Ask for it and see if the doctor will prescribe it.

Your Elbow is What You Eat

So under the knife we went.  Surgery took only 70 minutes, and I was on my way home before I knew it.  It felt very surreal to have had the surgery that I so dreaded, but I was now on my way to having a clean, fresh elbow and career.  

Diet was the first thing I could control, and I’m a huge believer in good nutrition.  I believe the American diet is terrible and compromises the body’s ability to heal itself.  That said, I made it my quest to stuff as many vegetables and fruits down my throat as I could.  If the average person healed in 9 months, then I felt I could heal in 8 just because my body had every nutrient it needed to heal itself.  My rehab went very smoothly, and while I can’t say for sure that my diet helped, I know that I am organically healthier for the way I ate, and currently eat.  I took calcium supplements and a multivitamin, and always had tons of omega-3s from fish and flax oil in my system.  It is said that post-surgery energy needs are increased as well, so I made sure I was eating enough (although that has never been a problem for me).  

Some Like it Hot

Another thing I did that was out of the box for most was Bikram Yoga.  I had done Bikram Yoga, which is a 90 yoga minute class performed in a 105 degree room, in the past and enjoyed the increased flexibility that it afforded me.  So much heat is generated in the classes that bloodflow is through the roof, and it seems to speed healing and promote good health.  So I went twice a week for about 10 weeks after my incision was closed and I was cleared to sweat and exercise. The green light to exercise was given to me after 2 weeks, so I was happy to get back out running and into the Yoga studio.  Another goal of my rehab was to reinvent myself mechanically and make myself physically stronger and more athletic.  I had very tight hips and quads, and the Bikram Yoga helped so much to loosen me up and get me on track to maintain my flexibility outside of the yoga studio.  After about 10 weeks I had had it, and couldn’t invest the time anymore to make it to yoga.  On top of my running, rehab and lifting, it was too much to fit it in anymore.  My friends Eddie and Emily at Bikram Yoga Baltimore were wonderful in helping me recover.

[youtube=http://www.youtube.com/watch?v=chuNZAcagCE]

Pump That Off-Arm

There is a human phenomenon known as bilateral transfer, which is the body’s desire to keep paired muscles balanced in size and strength.  When one side is worked more than the other, the less-used side will still get the same growth hormones and bloodflow as the worked side, which will result in similarity bilaterally.

In rehab this is useful because you can work out your non-surgical side and still get the benefits in your surgical side.  As long as the incision is close and sweat and infection is not an issue, working out the non-surgical side can be very useful in preventing atrophy and weakness in your surgically repaired arm.  

So with these three tactics of excellent nutrition, Bikram Yoga and bilateral transfer, I felt I was able to get ahead in my rehabilitation and heal to the best of my body’s ability.  I never had any tricep tightness, a common symptom of the surgery, and my flexibility was excellent all through my recovery, both of which I attribute to working hard and doing the extras early on.

My next installment will cover the doctor-prescribed rehab protocol up to the throwing stage