VELO BUFFET

ARM CARE &

RECOVERY PROGRAM

DAN CABULING Throwing Coordinator - BRX Performance

Thisprogramwascreatedprovideafoundationforgoingintoathrowingprogram,velocityprogram,or your season.The commonbelief in the throwingworld rightnow is thatyoumust throwmore, throwharder,and throw further todevelopingyour arm. This thought process has lead to an injury rate of about 50%. Thedefinitionof insanity isdoing the same thingoverandoveragainbut expectingadifferentoutcome.Thatiswhythisprogramwascreated.Therehastobestructure,education,andtoolsgiventoyoutohelpkeepyourarmhealthy.Aperfectprogramthat isn't consistently implemented is useless. The perfect exercise that isn'tperformedcorrectlyisalsouseless.Thisprogramusesevidence-basedpracticesandevidence led techniques to fill in thewidening gap that is arm injuries.With thatbeingsaid,thisprogramcanserveseveraldifferentpurposes.

1. Arm Strength and Conditioning 2. Pre-habilitation 3. Performance Enhancement

This program isn't limited to these purposes. How and the time of yearwill helpdetermineitspurpose.Therewillbeafewdifferentcalendaroptionsthatwillgiveinsight intohowyoushouldusethisprogram.Butrememberthatconsistencyandproperexecutionofdrillswillputyouinthebestpositiontostayhealthyandreadyforwhateverlaysaheadforyourarm.

BuyIn

Purpose,Justifications,andExplanations

Manyathletesonlyperformprogramsbecause the teamorprogram theyplay forrequires them to. This leads to athletes questioning why they should do theprogram;why is it important, andwill it help them. Ultimately,many athletes gothrough themotions, skip portions that they deem unnecessary, and/or not careabouthowtheyaredoingtheprescribedexercises.Ifyoufindyourselffeelingthatway, keep on reading. Each drillwill have a purpose so youwon't have toworryaboutwastingyourtime.

Purpose

ArmStrengthandConditioning

There is a common belief of throwing more is what develops arm strength andconditions your arm. If this principle was taken and applied to another skill,sprinting,itwouldresultinathletessprintingworkoutstoconsistofonlyrunningashardandasfaraspossible.Theonlyvariablethatchangeswouldbedistance.Yes,youmightgetfasteratthestartbutovertimeyouwillrunintoseveralissuesthatcanbegroupedintooveruseinjuries.Thisisexactlywhatishappeningtoarms.Tostrengthen the armwemust increase either the intensity (weight) of an exerciseand difficulty of an exercise. To condition the arm we must also increase thedifficulty of the exercises that we use but also increase the volume (repetitions)performed. This program takes this into account in each respect and provides aholisticapproachtoarmcare.Thisprogramwillservetoprovidethefoundationforyoutostartathrowingprogram,weightedballprogram,orvelocityprogram.

Pre-habilitation

Pre-habilitation is the idea that you should perform exercises that help preventinjury, rather thanwaiting for an injury to happen and perform them. The latterconcept is rehabilitation. If you are returning from an injury, you should consultyourDoctorandPhysicalTherapistonwhatyoushouldbedoingtoreturntoplay.Onceyouhavemadeyourway through the appropriate rehabilitationprocess foryour injury and performed a throwing program, provided by your Doctor orPhysical Therapist. This could be a good option to follow after. There are threemajorreasonswhy.Thefirstismanyrehabilitationprogramsonlyprepareyouforafractionofwhatyouneedtobeabletodoonthefield.Thesecondisafteryourfirstinjury, your chances of re-injury exponentially increase. Injured athletes shouldfocus onmore pre-habilitationwork than the average non-injured athlete. Lastly,whenyouthrowyouareactivelyinjuringyourarm.Ourshoulderswerentmeantforoverhead throwing andwemust take that into accountwhenwe are in betweengamesandseasons.

PerformanceEnhancementTothrowaballconsistentlyhard,accurate,andpreciseyoumusttrainyourarmtoperformthepropersequencingofmovements,muscleactivations,andhaveenoughstamina to do it several dozen times a game. If you use a Bank analogy tounderstandperformanceenhancement,thinkofrecoveryworkasmakingdepositsinto your account and throwing as takingwithdrawals from your account. If youcontinuously take withdrawals you will soon go bankrupt. That is what leads toinjury.Anotherway this program addresses performance enhancement is that ismimicsthepositionsthatyoumustbeinwhileactivatingthemusclesthathelpstabilizetheshoulderandelbowasyouthrow.Mostexerciseshaveyouholdaballduringeachexercisetoreinforcethesamemovementsthatyoudoasyouthrow.Mostarmcareprogramshaveyouholdahandle,dumbbell,oraplateforexercises.Thatisn'tthemosteffectivewaytostrengththestabilizersoftheshoulder.Havingyougripaballduring the exercises will increase rotator cuff activation. This will also helpstrengthenthemusclesthathelpprotecttheelbowduringthrowing.

Justifications

Totrulycreateathletebuyinyoumustbeabletoanswerthequestion"WHY?"Thisquestionissomethingthatcanbeaskedforseveraldifferentreasonsbutthemostcommonreason is theywant to learnwhy theyaredoingsomething to justify theamountoftimetheyarededicatingtotheprogram.Thiscanstartwiththeprogrambeingusedbyotherathletes.Iwanttobelike"FILLINTHEBLANK"soIwilldothesameprogramas them. It canbe resultsdriven, I amdoing thisprogrambecause"FILLINTHEBLANK"gotresultsfromitandIwantthesameresults.Thelastandwhat Ibelievethestandardshouldbe is thescientific justificationof theprogram.Wit that inmind; thisprogramwill start there. Iwillmake statementsbelowandattachthestudiesthatsupportmystatements.

Statements1. Sport-specificmovementshelptrainmusclesthatyouuseinyoursport.2. Grippingincreasesrotatorcuffactivation.3. Eccentricstrengthoftherotatorcuffisessentialforarmhealth.4. Isometricgripstrengthisamajorcontributortoelbowhealth.

Support

Antony,N.T.,&Keir,P.J.(2010).Effectsofposture,movementandhandloadonshouldermuscleactivity.JournalofElectromyographyandKinesiology,20(2),191-198.Beardsley,C.(2017,June08).Whyarestrengthgainsspecific?(andwhydoesitmatter?).RetrievedJune14,2017,fromhttps://www.strengthandconditioningresearch.com/perspectives/just-get-strong-is-wrong/Byram,I.R.,Bushnell,B.D.,Dugger,K.,Charron,K.,Harrell,F.E.,&Noonan,T.J.(2010).PreseasonShoulderStrengthMeasurementsinProfessionalBaseballPitchers.TheAmericanJournalofSportsMedicine,38(7),1375-1382.doi:10.1177/0363546509360404Cools,A.M.,Johansson,F.R.,Borms,D.,&Maenhout,A.(2015).Preventionofshoulderinjuriesinoverheadathletes:ascience-basedapproach.BrazilianJournalofPhysicalTherapy,19(5),331-339.doi:10.1590/bjpt-rbf.2014.0109Escamilla,R.F.,Yamashiro,K.,Paulos,L.,&Andrews,J.R.(2009).ShoulderMuscleActivityandFunctioninCommonShoulderRehabilitationExercises.SportsMedicine,39(8),663-685.doi:10.2165/00007256-200939080-00004Lin,F.,Kohli,N.,Perlmutter,S.,Lim,D.,Nuber,G.W.,&Makhsous,M.(2007).Musclecontributiontoelbowjointvalgusstability.JournalofShoulderandElbowSurgery,16(6),795-802.doi:10.1016/j.jse.2007.03.024Park,M.C.,&Ahmad,C.S.(2004).DynamicContributionsOfTheFlexor-PronatorMassToElbowValgusStability.TheJournalofBoneandJointSurgery-AmericanVolume,86(10),2268-2274.doi:10.2106/00004623-200410000-00020

SafetyMeasuresIsmeasuredandtrackedforseveralreasons.Themostimportantisreadiness.Gripstrengthwillgiveyousomeinsightintohowreadyyourarmisforthethrowingthatday. If you take care of your arm, perform your properwarmup and cool down,yourgripstrengthshouldn'tfluctuatemuch.Withthatbeingsaidtherewillbedayswhen your grip strength will drop. Those days will be after higher intensitythrowingdays.Ifyourgripdropsby10%ormoreatanytime,makenoteandswitchtoaPalateCleanserday. If youhavea lotof throwing,weeks4-6 in the throwingprogram,skipyourlongtossthrowing.Ifyourgripdoesn'treturntonormalwithin1-2daysseekoutprofessionalhelp.

SignatureSystem

Thepurposeofthesignaturesystemistoallowacoachtocheckinwithyouastohowyourarmisfeeling,ifthisprogramisn'tbeingimplementedbyacoachandyouaredoingitonyourown,haveyourparentcheckinwithyou.Thisisamomentforyou to truly check in and see how your arm is progressing through the program.Remember,"LessisMore"whenitcomestothrowing.Onedayoffofthrowingthatenablesyoutokeepmakingyourwaythroughtheprogramisinvaluablecomparedto pushing through soreness or pain that could result in several weeks off fromthrowing.

SorenessScaleorRateofPerceivedExertionRateofPerceivedExertionand theSorenessScaleare interchangeable.Theyhavebeen placed throughout this program as anotherway for you or a coach to trackhowhardyouareworking.Itwillrangefromworkouttoworkoutbutifthereisalargedifferencebetweentheleveltheprogramsaysyoushouldbeworkingatyoushoulddroptheintensityyouarethrowingorstopthrowingandallowyourbodytorecover.

*ArmHealthRoadMapformoreonunderstandingthedifferencebetweenpainandsoreness.

ArmHealthGuide

Firstandforemost,themaingoalofourtrainingistokeepathleteshealthy.Ourcomprehensiveapproachtothisincludesabaseball-specificstrengthandconditioningprogram,shoulderandelbowcare,andanin-deptheducationalprocess.Oursystemteachesathleteshowtotakecareoftheirarmsinourgymandonthefield.Althoughweprovidethetoolsneededtomaintainahealthybodyandarm,youastheplayeraretheoneultimatelyresponsibleforconsistentlyputtinginthedetailedworkthatleadstoitsmanifestation.Togiveyouinsightintotheeducationalcomponenttoourprogram,I’llfirstdiscussthefunctionalanatomyofthemostimportantjoints,ligaments,musclesandnervesinvolvedwithmaintainingarmhealth.I’llalsodefinewhataninjuryisandthecommonmisconceptionsrelatedtoinjury.Finally,I’llprovidetheframeworkofmy“ArmHealthGuide,”howtouseit,andhowtogiveyouthebestchanceofkeepingyourarmhealthy.

Firstwewillstartwiththeelbowjointitself.Bonesareconnectedtoeachotherbyligaments.ThemostimportantoneattheelbowistheUlnarCollateralligament,notoriousforbeingtheligamentthatrequiresa“TommyJohn”surgerytofixwhenittears.Thisligament’smainjobistoresistthestresscreatedbythrowing.Overtime,itcanbreakdown,partiallytear,orcompletelytear.Goodmechanics,strength

training,andproperarmcareallhelptopreventanyunwantedwearandtearofthisligament.

ThemusclesthathelpprotecttheelbowduringthrowingareagroupcalledtheFlexorPronatorMass.Theyarethemusclesthathelpyouflickyourwrist.Lastly,theulnarnerveisthenervethatrunsthelengthofyourarm.Whenyouhityour“FunnyBone,”youarehittingyourulnarnerve.Itstartsattheshoulder,runsdownthroughthelittlegroovenexttothetipofyour

elbow,andendsatthetipofyourpinkyandringfingers.Thenextjointwe’lldiscussattheshouldergirdle.Theshouldergirdlehasthreebones:theshoulderblade(scapula),thecollarbone(clavicle),andtheupperarmbone(humerus).Yourshoulderbladeislocatedonyourback,yourcollarboneisself-explanatory,andthehumerusistheupperarmbone.Duringthethrowingmotion,yourarmwillfirstlaybackintoexternalrotationawayfromyourtarget.Afterithasfinishedexternallyrotating,internalrotationforwardstowardsthetargetoccurs.Whenthrowing,themostimportantpartiskeepingtheballinthesocket.Thereareseveralpartsoftheshoulderthatareresponsibleforthis.Thefirstisasmallpieceoftissuecalledtheshoulderlabrum.Itsincreasesthesizeoftheshouldersocketbyconnectingtheshoulderbladetotheballofhumerus.Nextinlineisasetofmusclescalledtherotatorcuff.Therotatorcuffiscomprisedof4musclesthathelpkeeptheballonthetee.Twoofthesemusclesaretheonesthatgetsoreonthebackofyourshoulderafterthrowing.Lastly,thebicepsmuscle(notpictured)alsohelpskeeptheballinthesocket. Allofthesemuscles,tendons,ligaments,andbonesserveapurposeduringthethrowingmotion.Thethrowingmotionisthefastestmovementperformedinanysport.“Withgreatpower,comesgreatresponsibility!”Youasabaseballplayerareresponsibleforyourarmhealth.I’llsayitagain:YOUareresponsibleforyourarmhealth.Thepartslistedabovearecommonareasforinjuryduringthrowing.AprofessorIhadduringmyMaster’sprogramdescribedinjuryinawaythatmadealotofsensetome.“Injuryisthedisruptionoftissue,thatmayormaynotleadtoadeclineinperformance.”Adisruptionoftissueisanychange,goodorbad,ofthemuscles,tendons,ligamentsorbonesthatwerelistedabove.Thekeytothisdefinitionisthatinjurydoesn’talwaysleadtoadeclineinperformance.Putanotherway,althoughyoumightbeabletocontinuetoplay,throwhard,gettinghittersout,orcommandyouroffspeed,youmightstillbedoingdamage.Thisisbecauseinjurieshappenovertime.Aninjuryexperiencedatage21israrelyarandom,independenttraumaticexperience;theballprobablygotrollingatage13or14.Thefirstpicturebelowwillprovidea“legend”thatisneededtokeepyourarmhealthy.Thefollowinggraphicwillgiveyouastep-by-stepguideonhowtokeepyourarmhealthy.The“ArmHealthGuide”shouldbereferencedeverytimeyouthrowabaseball.Why?AccordingtotheAmericanSportsMedicineInstitute,“The2014NationalElectronicInjurySurveillanceSystemreported130,376emergencyroomvisitsduetobaseballrelatedshoulder,elbow,trunk,lowerarm,head,neck,ankleandfacialinjuries.”Moreover,yourchancesofre-injurydramaticallyincreaseafteryourfirstone.

Takeamomentandthinkabouthowyourarmfeelsduringorafteryouthrow.Doesthespotthatgetssoreorbotheryoueverchange?Isityourelbow?Isityourshoulder?

Arethereanyspotslistedabovethatgetsoreorpainfulwhilethrowingorafterwards?Ifso,Ihaveputtogetheraguideforeachofthosespotsthatdiscusseswhatcouldpotentiallybecausingpain/soreness,howtoprevent/stopit,andwhenyoushouldconsultadoctor.

ARMHEALTHGUIDE

Howtouse:

1. Chooseareafrombodydiagramabove.2. InsertintoArmHealthGuide3. Sorenessvs.Pain

a. Sorenessgoesawayin1-2daysanddoesn’taffectthewayyouthrow

b. Paincanbeduringthrowingorallthetimeandispainful/tendertothetouch.

4. Payattentionifsorenesssticksaroundformorethan2days.5. Ifyoutransitiontopain

a. Thinkabouti. Stopthrowing–2weeksii. Considerastrengthtrainingprogramiii. Seeahealthprofessionalordoctor

Chooseanareafromthebodydiagramshownabove.InsertitintotheArmHealthGuideandfollowthechart.Thesecondstepisdecipheringbetweensorenessandpain.Manycoachesbelievethatthesearethesameortheyshrugthemoffandtellyouto“Suckitup!”Ibelievethatthisisonereasonwhyamajorityofbaseballplayers,especiallypitchers,willhavesometypeofinjuryrelatedtothrowingduringtheircareers.

INSERTAREALISTEDIN

PHOTOABOVE

Soreness

Duringthrowing REST/RECOVER

Immediatelyafterthrowing REST/RECOVER

Sorefor2+days REST/RECOVER

Pain

Everytimeyouthrow

REST/STOPTHROWING

Painfulfor2-3daysafterthrowing

STOPTHROWING

Painfulanytimeyoumoveit SEEADOCTOR

HealthyArm

INJURY

FATIGUE

Theeasiestwaytodecipherbetweenthetwoissorenessgoesawayafter1-2daysofrestanditdoesn’taffectthewayyouthrow.Painisjusttheopposite!Itcanbewhenyouthrow,afteryouthrow,orallthetime.Itwillaffectthewayyouthrow,perform,andeveninyourdailylife.Ifthat’sthecaseandyoucontinuetothrow,youareputtingyourselfatthehighestriskforinjury,ifyoudon’thaveonealready.

Onceyouhavedecidedbetweensorenessorpain,followthechartanddeterminethebestrouteforkeepingyourarmhealthy.Restandrecoverycanmeanalotofthingsbuttokeepitsimple,itwouldbewaitinguntilyourarmsorenessgoesawayandresumethrowing.Thereareseveralwaystospeeduptherecoveryprocess,(keepaneyeoutformynextpost!)butinmanycasesit’sstrengthtrainingorconditioning.

Ifyougettothepointofexperiencingsorenessthatlastsmorethan2days,youshouldseriouslyconsidertakinganextendedtimeofffromthrowing,lookingatyourmechanics,orastrengthtrainingprogram.Assorenesslingersforlongerandlongeritcantransitiontopain.Thesooneryoucanrecognizethis,thebetteroffyouareatstayinghealthy.Ifyougettothepointofpainlastingmorethat2-3days,youshouldstopthrowingfor2weeks.Aftertwoweeks,resumethrowingandseehowitfeels.Ifthepainisthesame,whetheryouareplayinglightcatchorthrowingoffthemound,youshouldseeadoctor.

IhavebeenthroughthisprocessandinthepastIignoredeachstep,whichultimatelyendedmycareerwithatearofmyulnarcollateralligament.Thiswasn’tfromonethrow,butratherfromhundredsofthrows,andmanyofthemverypainful.Ilostsightofmylong-termgoalsandonlythoughtaboutthegameinfrontofme.Ifyourgoalistoplayhighschoolbaseball,collegebaseball,orprofessionalbaseball,thenstayinginjury-freeshouldbeatthetopofyourprioritylist.Beinginjury-freenotonlyallowsyoutoplayatthebestofyourability;italsoallowsyoutostayonthefieldtokeepdevelopingandimprovingyourbaseballskills.Thesecondsorenessorpainsetsin,yourabilitytoperformislimited.Seeingahealthprofessionalaboutanarminjurymightputaholdonyourabilitytoplayintheshort-term,butitwillultimatelyputyouinthebestpositiontoplaythesportyouloveforaslongaspossible.

Phases&Explanations

Eachphasehasaspecificfocus,phase1isfocusingonconcentricmuscleactionsoractivating the propermuscles that stabilize the shoulder. Phase 2 focuses on theeccentricmuscle actions, so focusingon themuscles that control thedecelerationportion of throwing. Phase 3 focuses on force coupling or activating all musclessurroundingtheshoulderandelbowatthesametime.Moreexplanationsarebelow.DURINGALLPHASESPROPERFORMISKEYANDBESURETOSQUEEZETHEBALLDURINGEACHEXERCISETOINCREASETHEACTIVATIONOFTHEMUSCLESBEINGEXERCISED.

Phase1

Thefirstphaseofthisprogramisfocusedondevelopingconcentricstrengthofthedifferentmusclesthathelpprotecttheshoulderandelbowduringthrowing.Therearetwokeystomakingthisphaseeffective,firstisproperform.Byperformingtheexercisesthecorrectwayyouwillensurethatthecorrectmusclesareactivatingandactivatinginthecorrectorder.Thesecondisholdingthetopportionoftheexercisefor 1 second for each repetition. This will increase activation and help increasemuscularendurance.

Phase2

The second phase will focus on developing eccentric strength of the differentmuscles that help protect the shoulder and elbow during throwing. Once again,properformisthefirstkeytothisphase.Thesecondisthat foreachexerciseyoumust take 3-5 seconds during the lowering phase of each exercise. Buildingeccentricstrengthofthemusclesthatprotecttheshoulderandelbowisessentialtolong-termarmhealth.

Phase3

Thefinalphasefocusondevelopingisometricstrengthofthedifferentmusclesthathelps protect the shoulder and elbow during throwing. Isometric strength isrequired toenhance the force couplingeffect thatprotectsour joints.Musclesarepairedtogetherandco-contracttohelpprovidestabilitytoajoint.Youhavetobuildenduranceforallthemusclesthatarerequiredtostabilizetheshoulderandelbow.Due to the nature of throwing, certain groups for example the flexor-pronatorgroup, are overworked and their opposing group, the supinators, aren't able toeffectivelystabilizetheelbow.