Mechanics That May Prevent Medial (Inner) Elbow Pain
It's March of 2006 and in just the past week I've talked
to 5 or 6 guys or their parents who are having pain on the medial
(or in plain English "inner") portion of their Pitching
Arm Side (aka PAS) elbow. While this
is probably due to the weather warming up in some parts of the
country, it still bothers me.
Because there are limits to the positive impact that
conditioning programs can have on pitchers who are younger than 16
years old (biologically, and not necessarily calendrically,
speaking), let me suggest a few mechanical tweaks that pitchers
can make that may reduce the medial (inner) elbow pain that you or
are experiencing and may reduce the likelihood that they will
experience this pain in the future.
Of course, when reading this you should keep in mind
that in some cases the root cause of the problem is overuse,
which means throwing too much while too young, and the only way to
fix the problem (at least until the pitcher gets older) is to not
throw so often and/or so hard.
1.A. Don't Show The Ball To
The simplest thing that pitchers can do is to not follow the
common advice to show the ball to Center Field as they pass
through what is variously referred to as the High Cocked Position,
the High Guard Position, or the Power Position. The problem with
doing this is that it forces you to pronate your forearm too early
and then requires that you then supinate your forearm to get your
palm around to facing the target. This then focuses the load on
the UCL and may irritate it and/or the bones to which it attaches.
1.B. Do Show The Ball To 3B
A better thing to do is for a RHP to show the ball to 3B as you pass through the High Cocked Position, the High Guard
Position, or the Power Position. For a LHP, this means that they
would show the ball to 1B. The reason to do
this is that it supinates your forearm at this moment which then
requires you to pronate your forearm in order to get your palm to
face the target when you release the ball. This activates the
Pronator Teres muscle and takes some of the load off of the UCL.
If you were wondering, very few major league pitchers actually
show the ball to Center Field. Instead, most show the ball to 3B
or at most SS.
Do Break Your Hands Early
If you are interested in going a little farther down this road,
then another thing you can do is break your hands early. This has
three benefits. First, it virtually eliminates the problem of
rushing. Second, it reduces the risk that you will experience
elbow pain. Third, it reduces the risk that you will experience
shoulder pain. If you were wondering, there are a number of major
league pitchers who break their hands, and get their pitching arms
up, much earlier than most.
Try To Keep Your Fingers
On Top Of The Ball
A related piece of advice that I think contributes to elbow
problems is the advice to always keep the fingers on top of the
ball. While well-intentioned (I believe the idea is to keep you
from throwing under the ball), I believe this advice causes more
problems than it solves.
Break Your Hands With Your Palm
If, after breaking your hands, you keep your palm facing 3B, or
then you will have by definition turned your pitching arm side
forearm over early. At a minimum, this will put you in a better
position to powerfully pronate your forearm as you accelerate your
arm toward the plate.
3.B.2. Do Go "Thumbs Up" After
Breaking Your Hands
One fairly common piece of advice is that pitchers should keep
their thumbs down as they break their hands. I think this is bad
advice and can lead to both elbow and shoulder problems. What I
teach my guys is to go "thumbs up" after they break their hands.
This means that they show the ball to 3B as they raise their PAS
arms up into the High Cocked position.
Some people will say that the above advice will hurt your velocity. I'm not convinced that that is
the case. For one thing, Freddy Garcia (and others) does what I
advocate in point 2 and his velocity is just fine (and he seems
more injury-free than others). Also, even
if following this advice does cost you some velocity, I think that
Greg Maddux proves that this isn't an insurmountable problem and
protecting your elbow (and thus your career) is worth it.
MEDICAL AND SCIENTIFIC BASIS
FOR THIS ADVICE
The above advice is based on my general knowledge of the
physiology of pitching, which I gained from studying the work of
Dr. Mike Marshall, and is backed up by articles like "Effect of
Pitch Type, Pitch Count, and Pitching Mechanics on Risk of Elbow
and Shoulder Pain in Youth Baseball Pitchers" by Stephen Lyman
PhD, Glenn S. Fleisig PhD, James R. Andrews MD, and E. David
Osinski MA. On page 465 of this article, the authors make the
"In fact, two mechanical flaws,
backward lean in the balance position and early hand
separation, correlated with a decreased risk of elbow pain.
Two other flaws, a long arm swing and arm ahead of the
body at the time of ball release, correlated with a
decreased risk of shoulder pain."
When the authors talk about the
"arm ahead of the body at the time of ball release" they are
talking about pronation (and more importantly something that I
call Early Pronation). The only way to have the arm in this
position at the Release Point is to be actively pronating at (and
more importantly well before) that moment.
One thing to keep in mind when
reading this paragraph (and article) is that the use of the term
"mechanical flaw" is unfortunate (if not a bit misleading). I believe
that the authors do not mean that doing these four things will
hurt your velocity or control. Instead, I believe that they are
just saying that these four things differ from what they believe
are ideal mechanics.
Of course, that makes me wonder
about the veracity of their model of the ideal pitching motion.
This article may be located via
Google or may be downloaded from here.
GENERAL CONDITIONING PLANS FOR
I am often asked to
recommend a conditioning routine for pitchers. I like several. One
is a program called
(.pdf) that is designed to condition a pitcher's
entire arm. A second resource is a new book that
Steven Ellis just
published that is called Tuff Cuff. Third, Tom Seaver's book
describes his conditioning routine. Finally,
Dr. Mike Marshall has
an extensive conditioning program as part of his overall package.
I am neither a doctor nor a medical professional. Instead, I
am just a guy who knows a few things about pitching. As a result,
before following this, or any of the advice that I give out, you
should first run it by your physician.