Elbow pain and injury is one of the most common issues requiring adjustments to training and causing missed training time or missed playing time. In amateur players this inhibits development and, in some cases, ends careers prematurely. If you can’t train or play, it’s difficult to get better. In professional athletes this costs players millions of dollars. Per the MLB collective bargaining agreement, players have to play three to six seasons professionally before they earn significant money. That means staying healthy for a long period of time is a must if making a living playing baseball is the goal.
While health is extremely important, without an extremely high level of performance, an athlete will still have no chance of a professional career. According to FanGraphs the average Major League fastball was 93.7 mph in 2020, meaning 95 mph is no longer special, but rather a necessity. This requires pitchers to push their performance to higher and higher levels, which is awesome to watch, but does carry a certain level of risk.
Any time we’re dealing with elite performance and pushing ourselves to the limits of what we’re capable of, there’s the potential that we go too far and run into problems. However, we can mitigate these risks with intelligent training and recovery practices. This starts with the basics-monitoring training and throwing load, eating and hydrating well, and sleeping enough. But beyond this we can do more as well.
Connective Tissue Health
One of the practices that can be helpful is utilizing training sessions focused on connective tissue health.
Tendons are made up of cross-linked collagen – the most abundant protein in the body and the main structural protein that makes up connective tissue. Depending on how we train we can elicit specific adaptations to these tissues – specifically stiffness and compliance.
A mix of stiffness and compliance is needed for athletic movements. Compliance is necessary to produce force and stiffness is necessary to transfer it. Depending on the athlete, the division of these training goals will be different. Fast, bouncy athletes with a history of muscle pulls, pain, and health issues may benefit from training toward greater compliance. Slow, plodding athletes can likely benefit from more stiffness.
Connective Tissue and Pitching
The UCL or Ulnar Collateral Ligament helps stabilize the elbow during the valgus stress that occurs during pitching. Cadaveric studies have shown that the valgus stress that occurs during pitching exceeds the capability of the UCL (Dillman et al., 1991). Additionally, higher velocity tends to increase the load on these structures, thus increasing the need for stability around the elbow (Olson et al., 2006). It’s important to note, however, that the UCL is not taking the full load when stabilizing the elbow. The musculature around the elbow helps as well: the flexor pronator mass as well as the elbow flexor-extensors play important roles (Van Trigt et al., 2020).
Through training we can affect change at the muscular level, but we can also change the connective tissue. Per Khalil et al. we know that the UCL thickens during a season of pitching and becomes less thick during periods of rest. This makes sense as it’s the SAID (specific adaptations to imposed demands) in action as it relates to throwing. Other important adaptations that take place which are less positive are the elbow/wrist range of motion (ROM) changes that can take place as throwing load increases. Elbow extension ROM and supination ROM may decrease. This can have important implications for the distribution of load and potential increases in injury risk in some athletes.
Finally, pain or discomfort can make higher intensity training sessions, which are necessary for improving velocity, impossible. By training in specific ways, we can limit the problems caused by pain and discomfort and allow training to continue with fewer interruptions and adjustments.
Yielding isometrics can help us with a few of these issues: they have an analgesic (pain relieving) effect, they can build strength at longer muscle lengths, which tends to have a greater effect on strength over the full ROM than shorter muscle lengths, and they can help return ROM to these joints through less neural guarding.
From Dr. Keith Baar’s research we know that connective tissues receive their maximum benefit every 6 hours and in about the first 5-10 minutes of a session. This means that a connective tissue health session should occur about 6 hours after your main session for the day and be pretty short.
In addition to the training session itself, specific supplementation can be helpful for maintaining and improving am health. Collagen supplementation has some promising research behind it, and if it is ingested along with vitamin C about an hour before training it has been shown to improve collagen synthesis.
Here are the yielding isometrics I’ve been using during these sessions:
- Pronation Iso Hold
- Supination Iso Hold
- Ulnar and Radial Deviation Iso Holds
- Flexion and Extension Iso Holds-at finger tips
- Elbow flexion Iso Hold
- Elbow extension Iso Hold
Check out the full video for demonstrations and more information!
In order to reach the highest performance level possible health and availability are extremely important. While the basics like monitoring training load, sleep, nutrition, and hydration all have a huge impact, connective tissue strength and health sessions can provide additional benefits. These sessions can be performed 2-4 times per week and should be separated from the main session by about 6 hours. Sessions should be 5-10 minutes long and collagen supplementation an hour prior to the session may improve results. Give these a try 2-4 times per week, likely on your main throwing days, and about 6 hours after your main session for the day and see how it goes!