Updated: Sep 10, 2020
2020 has been a very frustrating year for a multitude of reasons. A bright light on the horizon is the fact that baseball is starting to come back in the youth and club ball leagues. But, I don't believe that we're looking much further past the joy it'll bring. We must understand that with unusual situations, like the 2-month shelter-in-place due to the Covid-19 pandemic, there will be unusual circumstances. If we aren't careful with this transition we could see a higher spike in injuries that could alter these young athletes playing careers. A shoulder labral injury could easily change the trajectory of someones playing career.
Now more than ever we need to be strict on things like workload and throwing limits. We simply cannot allow athletes of any age to throw 150 competitive throws in a weekend with such little time to prepare their bodies to do so. Also with throwing limits, we need to consider total throws and not just the ones we count on the mound. All throws need to be considered into workload (warm-up/in-game) which is difficult to do but shouldn't be neglected. An approach must be taken by the athlete, the parent, and the coach to be smart on preparation and workload management as well as limit these injuries.
So what should we expect to see this season in terms of the types of injuries? I've had this discussion with several of my friends in the private training sector and in Major League Baseball and the majority of us agree that we'll probably see more core and tendon related injuries. We will probably see similar trends in UCL tears, but the spike will be in the tendons of bigger muscles like hamstrings, lats, and obliques. I also believe we'll see a spike in shoulder impingement syndrome due to the fact that the trunk and scapular muscle endurance will be lower so the natural compensation is to use the muscles at the glenohumeral joint (shoulder ball-and-socket) more.
These muscles need a ramp-up period where they take on more force and workload and gradually build up their neuromuscular contractility. A gradual increase in endurance will be the key here. Unfortunately, when you have to take off 2 months from practice and training you start losing that strength and endurance.
If we jump back too quickly we're not giving our body a chance to prepare itself. It's important to consider the acute/chronic workload ratio (ACWR) when getting back into gameplay. The basic idea behind the ACWR is that you want a smooth and gradual increase in the acute workload (3-7 days) over an extended period (3-6 weeks) which is the chronic workload. Check out more here: (https://support.catapultsports.com/hc/en-us/articles/360000538795-How-to-Set-Up-an-Acute-Chronic-Workload-Ratio-Chart).
Ideally, you'd like to see a 10% increase in workload week over week. Think of it as if you're throwing 3 times a week, 50 throws from 120ft. The next week you'll throw 3 times a week, 55 throws from 135ft. You don't have to stick firmly to the 10% when increasing workload as far as the numbers go if it gets confusing, you can round out those numbers to make it easier. The idea is that you want to stick close to that 10% increase every week to reduce the risk of injury. Consider this principle now as we jump right into tournament play after only a week or 2 of practice and training. This is exactly why we're going to be seeing these injuries from lack of preparation. It's on the coaches to take this into consideration when they want to win a random 15U tournament and would have to use their best pitcher for multiple games/innings.
So we may not have the necessary time to get our body ready for this rapid start to games after a 2-month rest, but we can do everything possible to build up that strength, stability, and endurance. The best time to start was 3 months ago, but the second-best time to start is today so let's get rolling. The trunk and lower half are pivotal aspects to throwing and hitting so we need to make sure we're covering those with everything we do from our warm-ups to our practice and training. To maximize trunk/core activation as well as energy transfer we need to make sure that we're creating good intra-abdominal pressure by breathing through our belly and activating our diaphragm. This will help stabilize our spine so that our extremities have a good foundation to move from. This should be one of the most important aspects that are addressed and implemented in every part of the process (warm-up, practice, training, gameplay, etc.). To do a breathing self-assessment on breathing patterns, you can lie down on your back with your feet propped up. Put one hand on your chest and the other over your belly button. Try to get the hand on your belly raise up higher than the hand on your chest. You want to create 360 degrees of outward pressure in the trunk/core.
The video below is an example of creating intra-abdominal pressure while still breathing and moving around. You want to be able to maintain that pressure during your activities, but not so much that it affects movement or performance in a negative way. The volume in the video isn't great...
So again the breathing is important because it sets up the rest of the body for movement and stability. The arms and legs move best when they have a strong foundation to move from. You want to be able to take this increased stability into weight training and athletic performance.
The next thing we need to focus on is strengthening the core with our new ability to create IAP (intra-abdominal pressure). Below are a few different exercises that you can do to continue to build up core strength and endurance.
The Low Bear
Next, we're going to need to look at the next major set of joints at play, the hips and shoulders. When our spine and core are strong and stable we limit the chance for us to develop movement compensations elsewhere down or up the chain which is what we're trying to avoid as we get back into baseball. The scapula (shoulder blade) controls what happens at the shoulder joint, so it's important to stabilize that as much as possible. The same idea goes for the hips in that if we're not moving well from them the spine is probably going to take on some of that stress as well as the muscles around the hips. It's all about balance and having an equal co-contraction of the muscles around the joints. Below are some exercises that will get you going.
Modified Low Oblique Sit w/ Reach
DNS Side Bridge (no audio)
You can include these in your regular band work routine or whatever you're currently doing to build shoulder, spine, and hip strength. Get comfortable doing these about twice a day as you're continuing to build back into competition. Obviously, weight training and/or plyocare work should be included as well, but these are all meant to help make the training more efficient and effective.
It's also important to make sure that you're warming up appropriately before games and practices. You'll want to get the heart rate up and wake up the neuromuscular system by activating some of these important little muscles that help move the big muscles. If you haven't already, you can download a free Dynamic Warm-up Ebook here: Dynamic Warm-up Ebook. It's a great resource for athletes, parents, and coaches. This resource is designed to get all of the muscular and fascial slings warmed up and also get the muscles and joints activated for baseball activities. Some of these moves can double as an exercise.
We want to reduce injuries this year as much as possible, which will take a group effort between the athlete, coach, and parent. Unfortunately, due to the pandemic, we are rapidly getting back into gameplay after an extended time off where we weren't able to train so we all need to be careful and diligent with our athletic readiness. So we need to:
Build a stronger and more stable core
Build strong/stable shoulders and hips
Warm-up well before games and practices
Avoid too much workload too soon, attempt to increase workload at a 10% increase week over week
We now offer remote training for individuals that want top-level individualized training and programming. Go to https://www.gestaltperformance.com/remote-training for more details.
If you're dealing with the injury bug already or you're looking for a little help getting your body ready to compete please come see us at the clinic.
Good luck this season!
Dr. Tyler White