FIXING PITCHER’S ELBOW – FROM THE GROUND UP
Dom Cadden, Commonwealth Champion Powerlifter – @DomCadden
For the athlete, a vital part of recovery is about identifying why an injury occurred in the first place, and figuring out what can be done to prevent or at least reduce the risk of it reoccurring. That’s why research from the University of Florida suggesting that that a pitcher’s elbow injury could be linked to movement in the hips has us pretty excited!
Dr Kevin W. Farmer, an assistant professor in the University of Florida department of orthopaedics and rehabilitation, led research that shows a limited range of motion in a pitcher’s hips could be a risk factor in injury to his elbow.
Let’s break down the motion:
- 1 Weight shifts to the leg shifts to the back leg
- 2 Knee of front leg lifts so thigh is parallel with the ground. This is one of the few differences with other sports involving throwing, e.g. fielding in cricket, where the cost of the time added by this action is often not worth the additional speed it will add to the ball when thrown.
- 3 At the same time as the front leg lifts, the pitcher brings the ball behind his shoulder and begins the pitch.
- 4 The throwing hand comes over his shoulder at the same time his raised knee comes down. The lead foot should contact the ground with the toes pointed roughly towards the target. For this to happen, both hips must rotate – the rear leg internally, the front leg externally.[i]
If a pitcher doesn’t have the hip internal rotation range of motion to square his body towards the plate, then he may end up throwing across his body, which would reduce the transfer of power from lower body to the upper body.[ii]
The science behind this transfer of load or power through the body and is known as Proximal to Distal Sequencing. In sports involving throwing (football, baseball, discuss, shot-put) and striking (golf, baseball, hockey, punching, etc.) we develop a load from the ground and transfer that energy / force through our bodies to the final lever (punch, bat, club, stick, ball). The hips are considered to be a POTENTIAL ROTATIONAL SPEED MULTIPLIER.Hip and pelvic rotation begins with firing of the gluteus muscles (specifically the gluteus medius muscles) as well as lower back lumbar rotator muscles, which is why exercises such as deadlifts and front squats can be good for such sports.
EXAMINING THE STRESS
Much of the stress of the pitch is concentrated on a single ligament – the ulnar collateral ligament of the elbow joint. Farmer explained that about 1000 pounds of pressure per square inch can be placed on that ligament. Farmer and his colleagues called this pressure during the pitch the “elbow valgus torque”.
To test how a pitcher’s hip range of motion affected his elbow, Farmer and his team tested athletes in a biomechanical throwing analysis in a lab that had a pitching mound surrounded by high-speed cameras. The researchers placed motion-detecting markers on the pitchers’ joints.
HIPS VS OTHER RISK FACTORS
Other factors that increase the risk of ‘torquing’ the ulnar collateral ligament of the elbow include the pitcher:
- hyperextending his arm when he throws
- having his shoulder is too far back when he throws
- opening his body towards home plate too soon
The University of Florida researchers correlated the hip range of motion to what they already knew could risk injury and found that the less range of motion pitchers had through their hips, the higher the risk to their arms. The conclusion was that pitchers unknowingly compensate for limited range of motion in their hips, and this could then place more torque on their elbows.
WHAT YOU CAN DO
There are some big take-home messages from this study for baseball pitchers or indeed anyone involved in a sport for that involves throwing.
CHECK YOUR FLEXIBILITY
Identifying limited hip internal and external rotation early could save a lot of pain. Lie on your stomach with a 90° bend at the knees. Rotate your knees outwards as far as you can. Have someone take a photo, then measure the angle between each lower leg and the vertical. Ideally, this should be a minimum of 60° for pitching. Now lie on your side and raise your top leg (straight) to create as large an angle as you can to the other leg. This should be a minimum of 100°.
SIDE-LYING HIP ABDUCTION
Lie on your side as above. Use a theraband, cable weight or ankle weight as you raise your top leg away from your bottom leg. Electromyographic data have shown that this movement produces the most activity in the gluteus medius and potentially produces the largest gains in strength there.[iii]
DO PIRIFORMIS STRETCHES (such as this and this), where the hip is in flexion and hip flexion and external rotation.
Pick exercises that require the development of potential energy in the lower body to be transferred to the upper extremities via trunk rotation. Examples would include:
SINGLE-LEG DEADLIFT, which involves a good imitation of the pitcher’s follow-through
TORSION BAR TWISTS – with straight arms, start with the end of the bar next to the rear of your hip. Twist and raise the up in front of you to eye level, pause, then lower to your other hip. Repeat. You can also do this holding a weight plate
rotational medicine ball throws– standfacing wall, with feet shoulder-width apart. With the med ball in both hands, swing ball to right side of your body, then rotate your torso and throw ball into the wall. Catch the ball off wall and repeat to opposite side.
AB ROTATION + ADDUCTION
Russian twists are a classic core exercise for increasing strength in the transverse abdominis muscles. Double up and work your adductor muscles as well by holding an object between your feet –e.g. a ball or a small. Lie on your back with legs up vertically – the straighter at the knees, the harder the exercise. Spread your arms out, palms flat on the floor. Lower legs (held together), touching the feet to the ground as high up your body as you can – level with your hips is ideal. Breathe out as you raise your legs up vertical again. Breathe out as you go down to the other side.
[i] Tippett SR. Lower extremity strength and active range of motion in college baseball pitchers: a comparison between stance leg and kick leg. J Orthop Sports Phys Ther 1986;8(1):10-14.
[ii] Wilk KE, Meister K, Fleisig G, Andrews JR. Biomechanics of the overhead throwing motion. Sports Med Arthrosc 2000;8(2):124-134.
Dillman CJ, Fleisig GS, Andrews JR. Biomechanics of pitching with emphasis upon shoulder kinematics. J Orthop Sports Phys Ther 1993;18(2):402-408.
[iii] Distefano LJ, Blackburn JT, Marshall SW, Padua DA. Gluteal muscle activation during common therapeutic exercises. J Orthop Sports Phys Ther 2009;39(7):532-540.