Nuts and Bolts: Baseball and Elbow Injuries (Tommy John, UCL, Ulnar Collateral and Tennis Elbow)

Baseball, as it has been said by many coaches, is “90% preparation and 10% action”. Proper throwing execution is the key to saving your elbows. Elbow injuries and early ulnar collateral ligament aka Tommy John have come into the spotlight with many pro players and young hard-throwing pitchers, in some as early as 11-12 years old.

Generally speaking, elbows involve much rotational and bending forces called valgus forces when whipping a ball for a hard throw. To understand how this can become a problem, we need to understand the anatomy of the lower arm when enacting a throwing pattern. There are so many rotational components that go on with these 4-9 joints. The two elbow bones connect to the upper arm/brachium and the two adjacent forearm bones at the top and the bottom. Not to mention all of the connections of the forearm bones to the bones of your wrist at the distal end where we hold the ball. All these structures provide stability and torque or whipping action.

So you can see this elbow injury is a lot more complicated than just a door swinging open as many throwing coaches and amateur players may believe.

We will explore how we the breakdown of the elbow happens below.

Causes of the Elbow injuries

Although I list the top four chronic reasons for shoulders to break down, there are so many more weird ways and freak accidents shoulders can be hurt. If you can manage and address these four issues first then you are well on your way to be as safe as possible. The shoulder is what provides the stability for the elbow, so it's important to look there first. No sense in having a nice shiplap accent wall if the house is sitting on a cracked foundation.

1. Instability of the shoulder socket

Stability and more specifically dynamic stability is the key component to a healthy moving shoulder. As mentioned In our shoulder blog here, it is the muscles and alignment that need to be addressed with the exercises below that will keep it rotating and well lubricated to help the elbow have an even more stable base.

2. Faulty throwing mechanics

There are all kinds of weird throwing patterns and people tend to choose to emulate or adopt what seems to work best for them for power and accuracy. But power and accuracy don't always lead to safe throwing. Excess stress to the neck and shoulder and limited wrist flexibility is a sure fire way to increase those valgus forces in the elbow.

3. Habits: side sleeping and poor standing performance postures

I know I've said this in one of the past blogs but it holds true for any arm motion in poor posture. Sit down in a slumped, rounded shoulders position and try to raise your arm out in front of you. Do this carefully because I guarantee you won't be able to raise it the whole way up without an ouchie. Now, sit in a good posture and try to perform the same action. Much easier now, huh?

Even the slightest degree of poor standing posture will set you up for impingements, inflammation and irritation within the joint.

So if you feel that pinch or pain when you're just slowly raising your arm, imagine what a poor posture does to a pitcher trying to throw a fastball.

Also, sleeping on your shoulder as in sidelying will wind that shoulder up and is another source for repetitive strain.

4. Repetitive stresses on top of instability = wear and tear

Give your body a break from playing ball year-round. It's just too much on someone’s body. Look even pro players have a 4-5 month off-season in which they rehabilitate and work on strength, coordination, balance, and flexibility.

Repetitive stresses not only strain but under faulty mechanics start the inflammation process which then occupies space (remember our body doesn’t have a whole lot of space) ever try to twist a water balloon vs an unfilled balloon? It is different. Compounding effects increase the pressure exponentially if you don’t take care of it.

So here are our top 4 exercises to protect or rehabilitate the elbow and address the four issues above.

Elbow Plie: Keeping that upper elbow mobile and rotating safely allows that radius (small bone of the forearm) to rotate on axis while in a straightened position, as is necessary for finishing the throw.

Wrist Mobilization: Proper wrist flexion and extension is needed and the wrist bones just need to slide and glide past one another. Ideall one gets 90 degrees in both directions.

C’s and G’s: Correct intrinsic forearm, wrist, and hand muscles keep all those bones stable with dynamic motions. These will focus on the small stabilizing and slow-twitch muscle fibers. Many will opt to use those outer forearm muscles which are fast twitch and being overly redundant on exercises like weighted wrist extension or weighted pulley forearm blasters that won’t help. So learn to use those inner small muscles and allow those big muscles to relax.

Pronator Teres: This muscle is an important stabilizer to the forearm bones it also allows for control from a bent elbow into a straightened elbow when one finishes the throwing pattern.

When the upper arm throwing pattern is complex, applying the exercises for the shoulder specifically and the elbow is the key to preventing those big bad surgeries that could end one’s career.

Dr. Justin C. Lin