An Evidence-Based Reason Behind Throwing Arm Injuries: Part 1

We had an internal discussion today that needs to be brought to the table.

In our Certified ArmCare Specialist Course, we discuss what I am about to communicate in deep detail. Still, I think it's important to deliver the message in this newsletter clear and present because we are training our athletes into injuries, and it's happening everywhere.  

Our injuries are happening because we are spreading the intensity of training over a series of days, errors in scheduling, not counting throws as endurance training, hyper-volumizing arm care training, and not integrating data-led insights to customize training.  

The combination creates an insidious concoction that leads to greater microdamage, partial tears, and complete ruptures that require surgery.

THE BIG ROCKS CAUSING INJURY

It is customary to believe that immediately after high-intensity throwing work, we need to focus on recovery training (or minimally effective dosing).

In my opinion, this sets up athletes for future injury, and starters are becoming more exposed to elbow injury risks than they ever have in the game's history.  

Most training programs for pitchers go like this:

1. Post-Pitching Training is Mobility-Driven, Cardiovascular, and Light for the Throwing Arm
2. 24 hours Post-Pitching is a Heavy Lower Body Training Session 
3. 24 hours Post-Pitching is a Heavy ArmCare Session that is Repetition Heavy
4. 48 hours Post-Pitching, Weekly Bullpens are Scheduled for the Starting Pitcher 

Let's first talk about nervous system fatigue that presents itself through altered heart rate variability.  

I always thought a pitcher's nervous system was more taxed the day after pitching than any other day in a starter's schedule in the four days leading up to the next start in a 5-Day rotation. 

However, in a majority of pitchers, post-game strength loss is present. These throwing arm strength losses are due to peripheral nervous system fatigue due to metabolic fatigue (a build-up of byproduct ions from biochemical reactions in throwing muscles after high volume throwing) that can affect nerve conduction.  

Additionally, reduced glycogen stores (depleted energy storage in the throwing arm muscles) can lead to depreciated muscular contraction, force, and power.  

One clue that reaffirmed my nervous system impairment belief was a study that indicated heart rate rhythms became less variable 24 hours post-pitching. This shows that the autonomic system had impaired function (the nervous system component that affects sympathetic and parasympathetic control).  

In the case of disrupted autonomic function, pitchers are generally still in the fight or flight mode, requiring recovery methods to improve parasympathetic control to aid in recovery and lower stress on the first day after pitching.  

The second bit of confirmation I had was with the Angels as we studied grip strength in professional pitchers the day after pitching. Both the glove arm and throwing arm had a similar percentage in strength depreciation versus the day before pitching bouts which were used as a baseline.  

If both arms are affected by strength loss, that indicates a central nervous system fatigue phenomenon, as the glove arm is not taxed at the same degree as the throwing arm yet shows very similar strength loss percentages. 

Heart rate variability increases with each day after a start.  As you can see, there is less variability shown by shorter average beat-to-beat time at Day 1 (24 hours post-pitching), which means that the autonomic system has more sympathetic drive and lower parasympathetic tone. Heavy training days the day after starts may continue to drive down heart rate variability and alter throwing arm recovery.

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