Protecting the UCL (Tommy John Ligament)

By Nunzio Signore (BA, CSCS, CPT, NASM, FMS)

Elbow Image

A recent study in The Physician and Sports Medicine showed that 29% of youth baseball players up to the age of 12 reported episodes of shoulder or elbow pain.  Another report in the Journal of Arthroscopy noted 31% of pitchers up to the age of 22 have experienced an arm injury as well.  Over a third of Tommy John procedures performed are done on youth pitchers.  Here is a graph showing the rise in Tommy John surgeries performed on youth each year by Dr. Andrews:

UCL surgery chart

Today, I want to touch on three things we do here to help stabilize and protect the UCL (Tommy John Ligament):

  1. Strengthen the “Flexor / Pronator” Groups
  2. Improve Shoulder Mobility
  3. Controlling Excessive ROM During the Season

1. Strengthen the “Flexor / Pronator” Groups – These are some of the muscles that help stabilize and protect the elbow, especially in the “layback” position:

  • Flexor Digitorum Superficialis
  • Flexor Carpi Radialis
  • Flexor Carpi Ulnaris
  • Pronator Teres

The flexor digitorum superficialis is an extrinsic muscle that allows the four medial fingers of the hand to flex. These fingers include the index, middle, ring, and pinkie fingers.

flexor digitorum superficialis

The flexor carpi radialis muscle is a relatively thin muscle located on the anterior part of the forearm. It performs the function of providing flexion of the wrist and assists in abduction of the hand and wrist.

flexor carpi radialis

The flexor carpi ulnaris arises along with the other superficial muscles, from the medial epicondyle of the humerus. These muscles flex the wrist and adduct it (move it laterally in the direction of ulnar).

flexor carpi ulnaris

The pronator teres muscle is located on the palmar side of the forearm, below the elbow. its function is to rotate the forearm palm-down. This is also known as pronation.

pronator teres

Here are a few of the exercises we do to strengthen the flexor/pronator group.

  • Stretch – Wrist flexion/extension Stretch (x 20-30 sec/side)
  • Strengthening Exercises (1-2 sets ea / 2x per week)

(Isolated DB Wrist Curls – x10/side)

(Grip Strength – x3/ea way)

(Pronators – x8 reps)

2. Improve Shoulder Mobility – A lack of shoulder flexion has been shown to place stress on the medial elbow. Improving shoulder mobility will go a long way in helping to take extra torque /stress off the UCL.

(Band Res. Shoulder Flexion)

(Side Lying Windmill)

3. Controlling Excessive ROM During the Season – Gains in external rotation (ER) happen naturally from throwing during the season, but excessive gains in ER can create an unstable shoulder, forcing the elbow to have to take up the slack and placing added stress on the UCL. Monitoring throwing volume as well as participating in a good strength training program complete with shoulder stabilizations during the season can be a career saver.

See ya in the gym…
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Interview with Kinnelon’s RHP Paul Cannarella (coming off Tommy John Surgery)

FullSizeRenderWe are here with Kinnelon’s Paul Cannarella.  Paul came to us in the fall of his senior year and has been training with us for almost a year.  He graduated from Kinnelon High School this year and unfortunately during this spring season he hurt his elbow.  He had Tommy John surgery and he is now on his path to recovery.  I thought it could be a great interview and learning experience to hear Paul tell his story first hand.

[Read more…]

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Top 9 Reasons Pitchers Get Injured

By Nunzio Signore (BA, CSCS, CPT, NASM, FMS)

Leading Causes of Pitching Injuries

It’s no secret that the numbers of youth injuries in baseball are staggering. Even with the implementation of pitch counts, youth injuries not only continue to rise but account for many of the injuries ball players eventually suffer later in their careers.  Here we go we my Top 9 Reason Why I believe pitchers are getting injured… [Read more…]

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Top 9 Reasons Pitchers Get Injured – Part 3

By Nunzio Signore (BA, CSCS, CPT, NASM, FMS)

Top Injury 3 1

In the final piece of this three part series (click here for Part 2, here for Part 1) on injury and its mechanisms, we’ll look at shutting down, ramping-up and poor strength training programs. [Read more…]

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Top 9 Reasons Pitchers Get Injured – Part 2

By Nunzio Signore (BA, CSCS, CPT, NASM, FMS)

Top Injury 2 1

In Part 2 of this 3 Part series (click here of part 1), we’re continuing down the path of injuries and what I believe to be many of the main perpetrators…

[Read more…]

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Top 9 Reasons Pitchers Get Injured – Part 1

By Nunzio Signore (BA, CSCS, CPT, NASM, FMS)

Top 9 - Part 1 1

It’s no secret that the numbers of youth injuries in baseball are staggering. Even with the implementation of pitch counts, youth injuries not only continue to rise but account for many of the injuries ball players eventually suffer later in their careers. Below is a chart of my top 9 leading causes of pitching injuries:

Leading Causes of Pitching Injuries

In Part 1 of this 3 Part series we’ll start to look at what I believe to be some of the main reasons why. [Read more…]

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Losing Your Legs and Your Velocity Early in the Game

By Nunzio Signore (BA, CSCS, CPT, NASM, FMS)

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3 Reasons for Lower Back Pain (Pain Site vs. Pain Source) – Part 3

By Nunzio Signore (BA, CSCS, CPT, NASM, FMS)

Pain Lower Back Top 2

Unfortunately 90% of the pitcher population cannot handle the amount of lumbar extension Tim Lincecum puts his body through. It’s no mystery that low back pain can severely compromise velocity, as well as command, in pitchers.  In Part 3 of this series on Pain Site vs. Pain Source (click here for Part 1 and here for Part 2), we’ll look at low back pain and some possible “sites” further down the kinetic chain that could be causing it.  And some things we can do from both the strength and mechanics (pitching) side to help relieve unwanted stress in the area. [Read more…]

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5 Minutes of Manual Therapy for Pitchers… Priceless

By Nunzio Signore (BA, CSCS, CPT, NASM, FMS)

5 minutes Top 1Over the last 2 years, I’ve had the privilege of working with Robbie Aviles, a pitcher in the Cleveland Indians organization. One day while working on his arm, my business partner walked up, saw what I was doing and said to me “Nunz, isn’t there a blog in here somewhere? There’s seems to always be a waiting line at the treatment table for this.” So with the blizzard of ’17 behind us, this seemed as good a time as any to write about the importance of getting back the Internal rotation (IR) in order to keep shoulder range of motion in “top-notch” shape all year. [Read more…]

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Pain Site vs. Pain Source: 3 Ways the Lower Half Causes Medial Elbow Pain

By Nunzio Signore (BA, CSCS, CPT, NASM, FMS)

Elbow Pain Top

In Part 2 of this series on pain site vs. pain source (click here for Part 1), we’ll look at medial elbow pain, how it’s not always originating at the arm (or from the upper half for that matter). [Read more…]

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