I recently had a run-in during a game, in which I threw behind (I missed) a batter who had gotten a hit off of me earlier and then ran his mouth about how easy I was to hit. A brawl nearly ensued, but he didn’t feel safe coming all the way out to me. Understandable.
Most good things in life can arise from something bad. So is the case with Tommy John surgery. TJ is unique among major arm surgeries in that it potentially provides a greater than 100% recovery. Getting to 100% or above, however, is a matter of capitalizing on the time off, and making the most of a bad situation.
So here I’ve compiled a list of the top 5 good things one can get out of a little elbow-slicing action…
I’ve been familiar with foam rolling and myofascial release for a few years now, starting when I was told I had a lot of inflexibility that needed to go away. If you’re unfamiliar with myofascial release, check out this article. It’s from wikipedia, but it gives a pretty thorough overview. Basically, though, you maneuver yourself over a foam roller, which compresses the tissues beneath, allowing for connective tissue (fascia) restrictions to loosen. This includes trigger points, which gives a lot of people chronic pain.
I hadn’t done much of it recently, but felt motivated to get back into it. And having experienced good things with it in the past, I made some time after a workout.
I figured I would write a post of milestones of post-surgical activities, as that is a pretty common question people have. I asked other guys all the time when they could do this or that, so here you go. Some of these I can’t remember exactly, so bear with me.
Out of sling: 2 days
Stopped taking painkillers: 1 day
Started forearm rehab: 1 week
Full Range of motion: 3 weeks
Pitchers and baseball players in general have an interesting sport to prepare for. Team sports like soccer, lacrosse (if you consider it a real sport), hockey, basketball all require a good amount of stamina, as they require nearly constant motion. The needs in those sports is somewhere in between anaerobic and aerobic. Baseball and football are different from the others, and similar to each other as both are played in short, high-intensity bursts followed by rest intervals between plays.
Interesting thing is, though, that pitchers have historically been part-time distance runners, doing tremendous amounts of sustained running between outings. The validation for this practice was that pitchers needed strong and enduring legs to go deep into games.
While it’s true that during a 7-inning outing a pitcher will be pitching over the better portion of two hours, he isn’t doing it in one sustained effort.
Rather, any pitching performance is broken down into half-inning intervals of pitching and rest, which is further broken down into shorter intervals between each batter, and then even shorter intervals between each pitch.
Training is supposed to make the athlete better prepared for game situations. If we want a pitcher to best prepare himself for his act of pitching, then it doesn’t make sense to perform sustained cardio work between starts. Rather, pitchers should be condition like they play: by working in intervals.
Are you a chronic sufferer of hip external rotator tightness. You are not alone. The good news? There is help.
Pitching is a rotational activity, and the hips and core are the chief couplers of power to the arm. As the stride foot lands the internal rotators of the hips, along with the core, rotate the midsection to face the plate. The hip external rotators, if tight and inflexible, will impede this rotation. (Remember that the hip internal and external rotators are antagonist muscles, which means they oppose each other and that one must stretch while the other contracts.)
So while the internal rotators fire, the external rotators relax and stretch. If the external rotators are tight and do not stretch to their full and normal range of motion, the whole kinetic sequence is impeded. This, in turn, makes the arm bear an extra burden by being in the valgus position longer while trying to catch up and get in the proper position to deliver the pitch. Dr. Morgan and others told me that they believe this leads to elbow problems, including UCL tears.
So at week 12 it was time to start throwing. Because I was pain free and swelling free I was given the go-ahead.
That first throw was pretty scary, but I knew I was ready for it, and it went fine. It felt just like it used to. I started out at 30 feet, progressing to 40 feet x 60 throws by the month’s end. Month two moved me back to 50 feet, and month three to 60. Midway through month three, however, I switched to a different throwing program because I was progressing faster than my throwing program would allow.
I talked earlier about falling on my arm when I was running and how important that was in trusting my arm. The first day I let a ball go on a line was another such moment. After every single throw was on a soft arc, letting one go on a line was one of the first tests of my new ligaments. I can remember that first throw, and how liberated I felt when I did it without pain. I only uncorked a few of these per session, but they always provided me with a release from the tension of wondering if my elbow was really strong enough to get me back to where I once was.
Pitchers are weird people, mostly because of the physical act of throwing. The motion is so violent and powerful that it throws a pitcher’s body out of whack and causes major asymmetries in strength, size, flexibility and range of motion, bone structure, etc.
One major adaptation of the pitcher is in shoulder range of motion (ROM). Pitchers have incredible, otherworldly external rotation. The average person couldn’t dream of contorting his arm in such a way.
My buddy Andrew Germuth showing off his external rotation
And what price do we pitchers pay for enjoying such lavish external rotation? You guessed it! A tight rotator cuff and a subsequent deficiency of internal rotation. (there is always a catch!)
So what? Does it matter if a pitcher has poor shoulder range of motion internally?
The answer to this question is unequivocally “yes.” Any trainer or physical therapist will tell you that a lack of ROM in any joint is pathological and indicative of underlying problems. Normal ROM should exist in all one’s joints, and if not, there is a probably a problem as to why. In many populations these imbalances in flexibility might not impair day-to-day functioning, but for athletes and especially pitchers, inflexibility poses major problems.
Dr. Craig Morgan and colleagues are researching the link between elbow pain (up to and including full blown ligament tears requiring Tommy John surgery) and internal rotation. What he is finding (as he found in me) is that a huge amount of pitchers coming to him have significant GIRD (glenohumeral internal rotation deficiency), and once that GIRD is reduced to an amount within 20 degrees of the internal rotation of the non-throwing shoulder, the pitchers very often return to throwing without pain. Internal rotation deficits are caused by posterior shoulder capsule tightness, which can be alleviated using the sleeper stretch. Restore your internal rotation ROM and you will be throwing healthier and harder.
Getting surgery sucks. It is, however, usually the only option for someone who tears a tendon, ligament, or muscle while playing a sport and wants to play competitively again. So it’s a situation where one needs to suck it up and take some solace in the fact that they are on the road back to the top. Especially with TJ surgery, the prognosis is great and with proper attention to rehab there’s a good chance of making velocity gains on top of having the elbow of a superhero and time off to improve mechanics.
The first 3 months post-op were exciting in the sense that everything was new and changes were dramatic. Things returned to normal rather quickly, and it was all building up to that fateful day when I would chuck that pill again, even if it was only for 30 feet at first.
As previously mentioned, I spent a fairly good amount of time in the studio of Bikram Yoga Baltimore both before and after my elbow surgery. Eddie and Emily, the owners, are wonderful people are were super supportive of me. The other instructors as well were terrific and I felt at home there.
Bikram Yoga makes a lot of health claims, some of which may or may not be true, but overall I think it’s a great practice and will improve the health, flexibility, and recovery time of those who might bring a chronic injury into the studio.
My sister wrote a nice piece for school explaining the Bikram phenomenon, and it’s a good read. But the class is relatively straight-forward : 90 minutes in a 105 degree, 40% humidity room which consists of 26 postures, each repeated twice. If it sounds difficult, that’s because it is. However, nothing worthwhile is easy and Bikram is no exception.
To class one brings a large jug of water, a yoga mat and towel to cover the mat, and a scant outfit to allow ease of movement and a cooling effect. One class costs about 14-20 dollars depending on the studio, which is actually pretty reasonable considering the length of the class (most yoga classes are an hour) and the intensity of the workout. Buying class cards brings down the cost per class down even more.