The Corruptive Potential of The Current Return to Throwing Protocol
When I was 18 years old, I had Ulnar Collateral Ligament Reconstructive Surgery, or Tommy John, as it is more popularly known. A week later, I moved into my dorm at Spartanburg Methodist and began the hardest year of my baseball career. While there were several obstacles I had to overcome, without question, the most challenging was the standard return-to-throwing protocol.
I was relentless in my physical therapy work. I lost 30 pounds (I was fat. I needed it), and I became an absolute monster at doing non-specific, isolated strengthening exercises. The people that helped me through the first 5 months (I got an extra month before throwing because I was already redshirted) were terrific. I went to multiple check-ups, and my doctor told me how great I was doing. I was ready to start throwing and get back to doing what I loved.
I GET TO THROW AGAIN
I don’t know how many people have ever made a crow hop throw at 30 feet with an arc on the ball, but it wasn’t really something I was prepared to do. It felt similar to throwing with the wrong hand. It felt the exact opposite of normal. But it was day 1. “They cut me open.” I thought. “It will get better.”
My problems just got different.
On day 1, after a few short hops (damn disorganized tissue), I kept missing arm side and high. At 60 feet, I would periodically throw a 30-foot scud. At 90 feet, the ball started to straighten out. After a few weeks, I was out to 120 feet, but the protocol called for so many throws that I had to play catch with multiple different teammates. Some position players told me they hadn’t made that many throws at 120 all spring. Nonetheless, I was able to labor through my flat grounds and was ready to start throwing on the mound.
My first day on the mound consisted of 15 throws at 50% to be monitored by a radar gu. Fifty percent was like 43 mph. I don’t even know how someone can do that. You’re telling me a guy who’s touched a hundred is going to progress well by throwing 50 mph? A fifty percent throw looks nothing like a real throw. Two weeks into the mound phase, the protocol advanced rapidly. It wasn’t long before I was “cutting it loose” after about 60-70 pitches.
Looking back, a central problem with the whole program was that I made so many slow throws that my body had no idea what efficiency even was. When I asked my trainers and coaches for guidance, the only advice I got was, “Don’t overdo it.” Well, here’s the problem with “overdoing it”: You never know you overdid it until you overdid it. And another thing: how do you jump from 75% to 100%? Are you supposed to go by the radar gun? There were all these made-up numbers, and it was all on flat ground. It was mentally and kinesthetically confusing.
This confusion delayed my progress immeasurably. It took me two years to finally throw a baseball anywhere near the same speed I had thrown before surgery. It was even longer before I threw anything that even remotely resembled a breaking ball. During the entire process, I consulted with my trainers, therapists, and coaches, but we never once talked about how I was moving. Granted, this was before anyone had slow-motion video capability on their phones, but we never looked at video or made any assessment of how I was moving. There was no concern about how I was throwing. If I was doing any of the same things that might have contributed to my injury, it went unnoticed. The only direction I got was, “Ok, now go make all these throws, and as long as you don’t have pain, keep going.” Well, what the heck did that mean? When you go from doing next to nothing for 20 weeks to making 75 throws 3 days a week, what counts as pain? Many of the throws I made caused what I would now consider “overt pain”, and the ones that didn’t outright hurt certainly felt weird.
I came out of my rehab with what many would now call “the yips.” Having learned more about motor control and direct perception, it’s now clear to me that during my rehab, I acquired a movement disorder. And that disorder was brought on mainly by the corruptive nature of the one-size-fits-all return to throwing program.
As the Florida Baseball Ranch® Director of Player Development, one of my most essential taskings is to take a look at the way we manage post-injury throwing protocols. As you can imagine, it is one of my greatest passions, and I have some ideas.
So, what can we do? As you might anticipate, I have some ideas.
- Randy Sullivan wrote in his Rehab Revolution blog a few weeks ago that the first four months need to be handled very differently. While it needs to be done intelligently and deliberately, we need to work to align and manage scar tissue far more effectively while the athlete is not throwing.
- Once throwing begins, we need to build plans that guide the athlete toward more efficient and safe patterns. We need to use constraint-based throwing drills to correct biomechanical inefficiencies. A vast majority of athletes that I see that are fresh off return to throwing programs present with a disconnection we call “forearm play.” They typically have early trunk rotation at front foot strike. Their arm is up and ready to throw before their front foot lands, so prematurely external rotate their shoulder. This adds undue stress to his medial elbow and shoulder and can lead to a linear deceleration pattern. This pattern works fine for pushing a ball 60 feet as the intensity ramps up; it affects performance and health.
- We need to prepare their body to throw the ball hard again. Our athletes need to become more efficient movers, and no one lobbing a ball 45 feet moves efficiently. We need to steal throws from the generic return to throwing program very early on to begin to develop better patterns.
- Any physical restrictions or biomechanical anomalies that might have contributed to the injury need to be identified and eliminated during the return to throwing protocol.
- We must weave specificity into all aspects of training. Their warm-up, throwing routine, recovery work, and the weight room should address all possible contributors to arm pain and decreased performance.
- And, they need to move better on the mound. To do this, we must revisit our acceptance of the current dogma that suggests that the mound is more stressful that flat ground throwing. Initially, when we are trying to change how our athletes move, the flat ground makes throws make sense. They change the sensory information from the last time the injured athlete threw (on the mound). We’re not suggesting that on day 3, the athlete should do a “mound push day.” However, throughout the rehab process, drill throws need to be blended to the mound as much as possible. If the athlete is connected, the mound will facilitate the movement. If not, it might amplify the disconnection.
- We don’t need to try to build so much volume on the mound before we increase effort. In the 3 years following surgery, I never threw more than when I was on my return to throwing program.
- This process cannot be one-size-fits-all. To help our athletes optimize their recovery, we must build our rehab programs around the athlete’s individual movement disorders.
- The process will likely require frequent, subtle, and nuanced adjustments along the way.
- We need to stop looking at rehab as “getting back to full strength,” and instead, use the entire process to prepare athletes to perform better on the field. Because while the record shows that 85% make it back to the same level or better, that’s a decent chunk in which that the rehab process simply fails. And in many cases, that is 12-18 months of lost development time if we are just trying to get them back to the same as they were pre-surgery. We have taken so many steps forward in the medical process as well as player development, it is time the return to throwing program catches up.
Early rehab throws can be corruptive if the athlete is forced to overindulge in low effort throws and/or flat ground throws. So, our new, simplified guidelines for return-to-throwing are as follow:
- Don’t make it look or feel weird.
- Don’t let it hurt.
It is indeed time for a rehab revolution.