quote:
The American Academy of Orthopedic Surgeons classifies UCL injuries as “overuse injuries.” This article with some of the best in the world at treating UCL injuries provides much more information

just understand that fixing UCL tears is not the same as understanding how to prevent them

here is some links to read. much of this info comes from in house studies

hoe the 90mph formula helps prevent ucl tears

so the above link goes into it but here is a overview

-the UCL ligament can only handle 30-40NM of valgus stress

-a fast ball puts the most stress on the elbow, more than a curveball, change, splitter, slider etc LINK

- the fastball causing the most stress is based on velocity only. once velocity is equated the curveball then slider causes the most, but overall fastball causes much more stress on the elbow. there is quite a bit of debate in the community right now if the supination of the forearm during a cruve/slider is distributing the load differently onto the elbow that we dont understand right now. again no definite answer. Phil Rosengren actually lays out the case they should throw curves LINK

- what we do know, pitching off a mound puts roughly 50-120nm of valgus stress on the elbow at the ucl....

quote:
Looking at the current research on valgus stress levels that the ulnar collateral ligament is up to 3 times weaker than the amount of force is exerted on a throw with a baseball.

so if the ucl can only 30-40nm how do we not tear it immediately when throwing off a mound?

-simple the muscles surrounding the elbow and those that provide stability and deceleration need to be really strong. what are those muscles

forearm- we know grip strength is huge and loss of grip strength is big indicator that UCL injury could happen if you throw with intent knowing that you have had a loss of grip strength from baseline. you can find the research here LINK the links to the studies are in the article.

lat strength- we know that the lats are the primary deceleration muscle used during the pitch. How do we test this and mobility required to throw....we test chin up strength, chest to bar. direct from ATP in house study on 1000 athletes

quote:
-If you can do a 1.5+x bw reverse lunge, 2+x deadlift, and 13+ bw chin ups you increase your likelihood of not having UCL surgery by 480%
?

quote:
Correlation to decrease risk of injury (in order):
1) chin-up
2) reverse lunge
3) deadlift

reverse lunge-....to quote Dr Heenan

quote:
If you ahve elbow pain, the answer isnt advil and icing, its fixing your reverse lunge
Fix the lunge — you fix the pelvis
Fix the pelvis — you fix the lumbar spine
Fix the lumbar spine — you fix the thoracic spine
Fix the thoracic spine — you fix the ribs
Fix the ribs — you fix the scap
Fix the thoracic spine and ribs — you fix the cervical spine
Fix the cervical spine and ribs — you fix the glenohumeral joint
Fix the glenohumeral joint — you fix the elbow

why does this work, lets look at kinimatic chain? because most elbow issues are derived from scap stability issues. scap stability issues are usually trunk issues. most trunk issues are pelvis issues and most pelvis issues derive from lack of stability in the lunge position.

from heenan, based on a 1000 person in house study at ATP--

quote:
-If you can do a 1.5x bw reverse lunge, you increase your likelihood of not having UCL surgery by 98.3%

LINK

deadlift- the why....

quote:
t’s a multipurpose metric to test force production, control of the spine, and grip strength (which has many neurological benefits for everyday people and some unique to throwers) for limiting factors that can decrease ball velo and potentially increase risk of injury. -
The deadlift is self-limiting in many ways and tests whole spine/pelvis control which has implications from basically every joint in the boys. It’s a fantastic catch all.
-
Utilized properly, the deadlift is arguably the most important movement we have in our gross movement database. How you execute has large global impact to the body.
-
The deadlift asks you to control the totality of the spine (most people forget to control their neck). We want the body to have a diverse set of movements that we can control. Total body tension/relaxation and control are vital for force transfer. It’s just a simple way to test a ton of qualities.

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i dont have time to go into each one of these. but Ryan Crotin has a bunch of research out on things LINK where he talks about relationships of ER/IR strengths and other items where he discusses injury prevention.

here is a paper on the "throwers 10" for armcare LINK

driveline items that go over the studies on the ucl stresses
how elbow injuries happen LINK

comparing-flat-ground-mound-elbow-torques

post TJ research

what causes TJ surgery why overuse is not the problem

how muscles protect the ucl

why dr andrews is wrong LINK

final one im gonna post and is essentially a review of everythign and blowing holes in many of the myths by Kyle Brody
LINK

This post was edited on 5/4/23 at 12:04 pm

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Posted by deathvalleytiger10

Member since Sep 2009

7647 posts

Posted on 5/4/23 at 4:49 pm to lsu777

Thanks for the links. Unfortunately, I was hoping to get actual scientific research to support your previous posts. Most of these are claims, theories, and opinions by the different authors. These ideas could all be proven 100% correct, but as of now it is not.

A disclaimer... I have spent time with several of the people you linked in this and previous post. I have known Randy Sullivan with the Florida Armory since before he even opened the facility. I have seen his training first hand at his Florida facility. I am a big believer in what he teaches.

I have also been involved with Dr. Jeff Dugas at Andrews Sports Medicine, along with Kevin Wilk(the pt that has rehabbed countless professionals in pretty much every sport), and also Dr. Glenn Fleisig that has published several research papers with Dr. Andrews, Kevin and Dr. Dugas.

Back to Randy at Florida Armory. His program involves much of the training metrics you list from the other groups. He uses the motus to measure stress on the elbow and utilizes film to correct biomechanical flaws.

Like others, his program works on stability, external and internal rotation, strengthening to help protect the joint as much as possible.

All of that being said, he will tell you, just like several of the articles you linked, that UCL tears are not a one pitch injury. It is cumulative, thus overuse is involved.

He will also tell you that you can do everything "right" and still get the injury.

Now, to the measurements you listed with all of these wild claims of 480% decrease in chance of injury, etc.. There is no science to back it up. It is just a claim by the author. There is no scientific study to back it up. Just his "survey" of athletes. That doesn't cut the mustard. Sorry.

Also, these measurements are not obtainable for the vast majority of baseball players until well after puberty and until they have fully developed. By then, they have years of baseball behind them. The UCL has been subjected to microtears the entire time.

That is why so many advocate getting several months of rest each year from competitive baseball and from high leverage throwing. Especially during growth phases of physical development. You can strength train all you want, but if there is not adequate rest, you are still at a higher risk.

Dr. Dugas told me is sees countless kids that get injured while they are having large growth spurts and when their body as not developed. This supports your claims of physical development helping to prevent injury. The problem is that every kids goes through this process and at various times and speeds of development. They are not going to stop playing. And, you can't get every kid to stop pitching. Although, as a parent, I would have my boys not pitch for a few years during this time.

Dr. Mike Marshall??? Wow, haven't heard that name in years. He is a loon. I am guessing you happened to see his article you linked that went against Andrews and Fleisig. Go look at the video on his site from years ago and how a pitcher is supposed to pitch to prevent UCL injury. It is comical. And is the reason that I have yet to see a single person pitching the way he advocates at any level of baseball.

All that being said, I commend you doing everything you can to educate yourself and protect your players( I assume to work with players?) All we can do is do our best to help them with the information we have. But, there is no surefire method to stop this.

IMO, players should have their biomechanics evaluated and measured. (that is not possible as not very many have that capability). They should work to train appropriately starting as young as possible to protect their arm. (Again, not everyone has access to people that know how to do this.) They should take off adequate time from pitching, train, ramp up for the season, and be PO's if they really want to protect their arm. (not feasible for a lot of kids with small high school teams). Lastly, not push hard for velocity until their bodies are developed.

Even with all of this, injuries will still occur. You just give yourself a chance.

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