What Happened to Noah?

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

On April 30th in the bottom of the 2nd inning, just 38 pitches into his fifth start of the year, Noah Syndergaard threw a 2-1 pitch to the National’s Bryce Harper then proceeded to clutch under his arm. Something was obviously not right. The latissimus dorsi (lat) is one of the major players for stability and throwing gas, and Syndergaard just tore his.

(Noah Syndergaard Injury)

Noah 2Although I am not a surgeon nor can I say what caused Syndergaard’s tear, I can speak with some certainty about a few possible issues, that I see on my side of the fence every day, that could lead to this injury. But first, let’s take a look at what this muscle does throwing-wise and why it can be so hard to diagnose.

The lat is the broadest muscle of the back and the biggest of the accelerator muscles. It originates from the posterior iliac crest, attaching to the lower t-spine and continuing up and around inserting at the medial aspect of the humerus.

It’s a major player in both creating stability at layback as well as creating the extreme rotational torque when switching into the accelerative phase of the throw.

(Layback to Acceleration)

In more layman’s terms the lat connects the lower body to the upper body and is responsible for transferring much of the force at foot strike up through the core and into the arm.

Hard to Diagnose

What generally makes a lat strain hard to diagnose is the fact that it’s thought of mostly as a back muscle. But if we look below, we can see that the top end of muscle attaches to the medial aspect of the humerus. This can cause it to be misdiagnosed as a biceps tendon or rotator cuff issue by physicians and PTs not familiar with dealing with overhead athletes.

Latissimus dorsi

Noah 3

Type of Tear

The type of tear must be taken into consideration when choosing a rehab plan:

Grade 1 and 2 Tears – Indicate that the muscle has not torn completely off of the bone. Surgery is generally not required or suggested as it can extend recovery time considerably. Most choose to let the tear recover on its own. If there has to be an upside to a bad situation, it’s that this is the grade tear that Syndergaard suffered.

Grade 3 Tear – This is the Mac Daddy of lat tears and is usually career ending.  Surgery is the only option. Much like the one White Sox’s Jake Peavy suffered in 2010.

(Jake Peavy Injury)

Recovery time

The lat is responsible for many things including core stability, breathing and even coughing. This means it never really gets to rest, making it difficult to rehab.  Recovery time can be anywhere from 3 to 5 months depending on the grade of tear and physical condition of the player. This would include:

  • 6-8 weeks of complete layoff followed by
  • Throwing program taking into account long toss, velocity enhancement and blending back to the mound.

Possible Causes

1. Improper Exercise Selection – First let me say that strengthening the lats can do wonders for:

  • Increasing your deadlift and bench press
  • Keeping the mid/lower back and hips healthy
  • Improve diaphragm function (breathing!!)

Due to the fact that we train over 100 pitchers in our facility a year, we are a bit more sensitive to the exercise selection and to what degree intensity-wise that we train the lats. This is why there is very little overhead work, Olympic lifts or “cross-fittish” types of training prescribed in our pitching programs. Pitchers spend a majority of time with their arms overhead which is a very unstable position to begin with, thus I see no reason to add weight to an already unstable position in the form of such exercises as pull ups, lat pull-downs and military presses. There are however many great exercises to hit the lats in a more “overhead friendly” manner.

2. No Mobility/Soft Tissue Work – Making sure that the lats are strong is paramount for velocity but not at the expense of losing flexibility. An easy test for lat length is “supine shoulder flexion”. Lie on your back and try to extend your arms overhead to the floor behind you without bending the elbows. If you succeed, you’re all good. If however you resemble the gentleman below, stay away from any overhead work or high volume throwing until we get some of the tension out of the lats!! Time would be better spent foam rolling the lats and incorporating some static and dynamic flexibility work.

Noah 5

We incorporate these protocols into every players training programs regardless as a precautionary measure.

(TRX Deep Squat Breathing)

3. Inadequate Throwing or Ramp-up – My mother once told me “common sense isn’t so common”. Well, the same goes for not ramping up your throwing prior to getting on the mound in-season. You wouldn’t take a Ferrari out on the highway in the middle of winter and just gun it so likewise.  Getting in adequate reps (bullpens) in January and February can be the difference between a great season and spending more than half of it on the DL.  Just for clarification, when I refer to a ramp-up I’m not talking about throwing once a week. Sorry guys, that’s just not gonna do it. Kids in the South throw too much but here in the Northeast, we have a tendency to not throw enough, especially as we ramp-up in the off-season.

Summary

Although no one can determine whether or not a player will be injured, throwing the ball at high velocities (and in Syndergaard’s case ridiculous velocities) merits extra pre-cautionary measures including:

  • Proper strength training
  • Adequate soft tissue and flexibility work
  • Ramping up enough in the pre-season

See ya’ in the gym…

 

Sign-up for Future Blogs (3)

 

Facebooktwittergoogle_plusredditpinterestlinkedintumblrmail