The arm-to-hand complex never stops moving during the pitching motion, and the precise lengthening and shortening of the elbow joint required during each phase of the pitching motion contributes to effective acceleration and deceleration of the ball. The position and movement of the forearm controlled by the radioulnar joint, as well as the actions of the wrist and finger joints, control the exact position of the ball during the motion to ensure deception and velocity and the pitch-type release. The strength and endurance of these muscles are essential for maintaining and protecting the career and health of the pitcher. Fatigue and weakness have been considered to be a primary contributor to injury (5,9). In addition to the concentric and eccentric roles of the muscles, their role in stabilization is of primary importance as a protective mechanism to underlying joint structures (5,19). An understanding of the pitching motion and the role of each joint is necessary to create target exercises for the pitcher.
PHASES OF THE PITCHING MOTION
The wind-up phase begins with initiation of the pitching motion and ends when the pitcher's lead knee has reached its maximum height. The hand and ball is in the glove during this phase, and the elbow is flexed with minimal kinetics present at this time (7).
The stride phase begins when the pitcher's knee has reached maximum height and begins its descent toward the ground. The phase ends when the lead foot makes contact with the pitching mound at stride foot contact (SFC). The elbow is extending to remove the ball from the glove and immediately flexes to shorten the arm for its early cocked position. This is the first critical moment for the elbow joint (4,5,8). At SFC, the elbow joint must be flexed between 80° and 100°, and stabilization of the elbow during this phase is essential (5). Excessive or diminished flexion at this moment can interfere with the proper positioning in the next phase of the motion during which the elbow is most vulnerable (5,17). See Table 1 for the critical moments and angle requirements for the elbow.
ARM COCKING PHASE
The arm cocking phase begins at the initial lead foot contact (or SFC) and ends when the throwing shoulder reaches maximum external rotation (MER). During this phase, the pitcher's pelvis and trunk rotate in segments to square-up to the plate. During this rotation, high levels of torque and kinetics are present at the medial aspect of the elbow (4,5,8), and the stabilization requirements of the elbow joint and the radioulnar joint are required to assist in compressing the joint and adding stability (5,7,18).
ARM ACCELERATION PHASE
The arm acceleration phase begins at the moment of MER and ends at ball release. This is the shortest phase and the most intense phase for the pitching elbow (1,5,7). The elbow begins its extension simultaneous to the upper trunk completing its rotation toward the plate. Elbow extension velocities of 2,100°/s to 2,700°/s have been reported (1,4,5,7,16,18). Even though it has been shown that the extension velocity is not due to the extensors of the elbow joint (5), it has been shown that the elbow extensors are responsible for the maintenance of the angle at MER before extension (5).
The follow-through (FT) phase begins at ball release and ends when the pitching motion ceases. This phase is also an intense phase for the elbow as the rapidly extending elbow must be decelerated by the elbow flexors. The elbow flexors are also responsible for maintaining the integrity of the posterior joint during the rapid extension (5).
KINESIOLOGY OF THE PITCHING ARM
The major flexor muscles of the elbow joint are the biceps brachii, brachialis, and brachioradialis. The flexors act concentrically to shorten the arm from the out-of-glove position to SFC and finally to MER and act eccentrically to decelerate the arm during the FT phase. The brachialis should be recognized as the only flexor muscle that functions with the forearm in all 3 positions. Additionally, the brachialis inserts directly into the anterior capsule of the elbow joint as a muscle rather than as a tendon and therefore acts as a major stabilizer to the elbow joint (19).
The major extensor muscles of the elbow joint are the triceps brachii and the anconeus. The anconeus is especially active in short-range speed movements (3). The elbow extensors act concentrically to rapidly accelerate the arm during the acceleration phase even though not considered to be a contributor to the velocity (5,7).
TARGET EXERCISE REQUIREMENTS FOR THE ELBOW JOINT
The elbow joint flexors must be able to maintain specific angle requirements and to provide stability to the underlying structures, particularly the ulnar collateral ligament (1,5,17). The brachialis is especially designed to do this and must be a major priority in elbow training. Therefore, the elbow flexors must be exercised with all 3 forearm positions: pronated, supinated, and neutral. The contraction requirements are concentric and eccentric and a rapid concentric/eccentric contraction cycle. The elbow flexors also decelerate the pitching arm and must be trained for deceleration with eccentric emphasis. Because the long head of the biceps is a biarticular muscle, acting as a shoulder flexor and an elbow flexor, the position of the shoulder during the exercises should include neutral and flexed positions.
The elbow extensors must be exercised for rapid acceleration and strength with varied forearm positions. Exercises that show dominance for the lateral head of the triceps are important due to its function as a stabilizer during the high-kinetics MER phase of the pitching motion (2). Additionally, due to the biarticular design of the triceps, the long head acts as a posterior shoulder stabilizer due to actions as an extensor of the shoulder joint (13). The position of the shoulder relative to flexion and extension is therefore an important consideration with regard to exercise selection. Because elbow contracture is a major problem for pitchers (19), full range of motion exercises should be included for the elbow extensors, which can act as an active stretch for the flexors.
The actions of the radioulnar joint are pronation and supination provided, respectively, by the pronator teres and pronator quadratus and by supinator. Because the pronator teres attaches at the medial side of the elbow, its strength and endurance can play a major role in the prevention of ulnar collateral ligament damage as well as in elbow stabilization (19,20). They play a significant role in elbow stabilization.
TARGET EXERCISE REQUIREMENTS FOR THE RADIOULNAR JOINT
The pronators should be trained for strength and endurance and for full range of motion. This can be accomplished by exercising the forearm in a full-range pronation and supination contractions. Their range of motion is especially important because of the significance that forearm position plays in the positioning of the wrist for ball release and location mechanics. Altered length can affect the wrist and its contribution to velocity (6,9,19).
WRIST AND FINGER JOINTS
The actions at the wrist joint are flexion, extension, ulnar flexion, and radial deviation (flexion). The muscles of the finger joints act along the same path as the wrist flexors and extensors. The wrist joint flexes through the actions of the flexor carpi radialis and flexor carpi ulnaris. The wrist joint extends through the actions of the extensor carpi radialis (brevis and longus) and extensor carpi ulnaris. The wrist joint undergoes radial flexion through the actions of the flexor carpi radialis, extensor carpi radialis longus, and abductor pollicis longus. The wrist joint undergoes ulnar flexion through the actions of the flexor carpi ulnaris and extensor carpi ulnaris.
TARGET EXERCISE REQUIREMENTS FOR THE WRIST AND FINGER JOINTS
During the pitching motion, the wrist joint is the final joint contributing to the velocity of the pitch and has been reported as contributing approximately 21% of the total velocity of the pitch (14). Its position and muscles activated during ball release change with the pitch type (10) (see Table 2). The fastball is delivered with the wrist moving from hyperextension to a neutral position through the action of (in the direction of) flexion. The action of the wrist for the curveball is ulnar flexion. The wrist should be worked, therefore, in both the sagittal and frontal plane. Additionally, because the finger and wrist flexors insert on the medial aspect of the elbow, their strength and healthy range of motion play a vast role in maintaining elbow integrity and injury prevention. A decreased wrist range of motion can affect the length-tension relationship at the elbow joint. Medial epicondylitis, a common medial elbow problem for pitchers, can be prevented by maintaining flexibility throughout the forearm and wrist complex (10,20). Full range of motion and multiple exercises are therefore included in the workout plan.
EXERCISE POSTURE REQUIREMENTS FOR ELBOW TRAINING
As has been mentioned previously, the elbow flexors and extensors are biarticular in nature, acting at the shoulder as well as at the elbow. For this reason, correct exercise posture is essential. The shoulder girdle houses the arm and should be properly aligned over a slightly elevated rib cage. Both right and left sides should be symmetrical, and the elbow and wrist should be aligned directly under each shoulder joint. Incorrect positioning of the arm can produce excessive tension at the shoulder, producing incorrect technique and creating vulnerability to injury.
The hammer curl (Figure 1) is an elbow joint flexion exercise that targets the brachioradialis along with the biceps brachii, especially the lateral head, because of the neutral grip (3,12). The brachioradialis has been reported to be the dominant muscle in the fastball (Table 2). The pitcher holds the dumbbells with a neutral grip and performs a dumbbell curl with the dumbbell remaining in the neutral grip position throughout the motion.
The reverse curl (Figure 2) is an elbow joint flexion and radioulnar joint pronation exercise.
Because of the pronated grip, it targets the brachialis (3) and the pronators. Fatigue of the forearm muscles has been reported to be a major contributor to failure at the level of the ulnar collateral ligament (7,10), and strength and endurance of this muscle can contribute to prevention of injuries to the medial elbow (9,19). This exercise is performed as a barbell curl with a pronated grip. An EZ-curl bar is recommended for easy positioning of the wrist joint.
Spider curl (Figure 3) is an elbow joint exercise that targets the biceps brachii and should be performed with an eccentric emphasis. The long head of the biceps brachii is a 2-joint muscle acting as a flexor of the shoulder joint. The position of this exercise using the flat side of a preacher bench places the proximal attachment at rest.
Overhead dumbbell extensions
The overhead dumbbell extension (Figure 4) is an elbow joint exercise that targets the triceps brachii, especially the lateral head (12). The lateral head is said to be the main stabilizer of the elbow during MER (2). Because the long head of the triceps is a 2-joint muscle acting as an extensor of the shoulder joint, this position puts the long head on slack, making it available for maximal recruitment. The position of the scapula should be isometrically stabilized during the performance of this exercise.
Lying dumbbell extensions with pronation
This exercise targets the elbow joint extensors and radioulnar joint pronators (Figure 5). The forearm is in neutral at the beginning of the contraction phase of the elbow extension. It then pronates as the elbow reaches full extension. The lowering of the resistance, or eccentric phase, reverses the movement. The position of the shoulder joint, along with the elbow extension and pronation, makes this a skill-specific exercise for a pitcher.
The radioulnar joint is targeted with this exercise that works both actions of the joint (Figure 6). Because of the tendency toward fatigue in the pronator flexor mass of the pitcher (9), this exercise is extremely important for injury prevention. Additionally, the range of motion of the muscles can be maintained through the agonist/antagonistic contraction/stretch relationship.
Plate ball-grip wrist motions
The wrist joint actions of flexion/extension and radial/ulnar deviation are targeted during this exercise (Figure 7). The grip used on the plate involves the important index and middle fingers for pitching and makes this a skill-specific exercise.
Submerging the hand, wrist, and forearm in a bucket of rice and performing grabs and motions that involve the intrinsic muscles of the wrist and fingers makes this an important exercise for pitchers. Because the finger muscles insert on the medial and lateral elbow, strength throughout this musculature is an important injury prevention measure. Fill a 5-gallon or larger bucket with raw rice. Make sure the bucket is filled with an amount of rice deep enough for the pitcher to be able to submerge an open hand and at least half of his forearm. Have the pitcher alternate through the following movements: (a) submerge an open hand and grab and squeeze out fistfuls of rice for 30 seconds while the hand remains submerged in the rice. Remind the pitcher to emphasize pressure for the middle and index fingers. Remove the hand and rest for 30 seconds. (b) Submerge again an open hand and grab an amount of rice that spreads the fingers in a fastball-grip position. Flex and extend the wrist for 30 seconds. Again, remind the pitcher to emphasize pressure for the middle and index fingers. Remove hand and rest for 30 seconds. (c) Submerge an open hand and at least half the forearm with a straight elbow. With the elbow joint remaining still and the hand holding a fistful of rice, rotate the forearm clockwise and counter-clockwise (pronating and supinating) for 30 seconds.
Elbow-high cable curls
This exercise targets the elbow flexors in a flexed shoulder position (Figure 8). The shoulder must remain stabilized, disallowing movement of the arm during performance of the curls.
Overhead rope extension
This exercise for the elbow extensors has a dual role of emphasizing scapular positioning (Figure 9). The pitcher's posture should be emphasized with scapular retraction and stabilization of the shoulder joint. This exercise targets all 3 heads of the triceps brachii (12).
Cable wrist flexions and extensions
This exercise develops the finger, wrist, and forearm musculature (Figure 10). During the flexions, the bar should roll to the finger tips on the eccentric phase of the exercise.
This is an exercise for the elbow flexors targeting deceleration strength. The exercise begins with the pitcher performing a single-arm low cable curl and holding the contraction isometrically against the resistance of the cable. The pitcher should hold the contraction for 6 seconds, followed by rapid extension of the elbow and an immediate and fast return to the isometrically flexed elbow position.
Rapid fire cable extensions
This exercise targets rapid extension of the elbow joint, with the shoulder in a 90° flexed position (Figure 11). The contractions should be of a fast short arc nature returning to or slightly more than a 90° elbow flexion position between contractions.
Weighted ball wrist releases
The pitcher is performing a fastball-grip wrist release alternating through a series of weighted balls (Figure 12). Five repetitions (reps) should be performed with a regulation weight ball, followed by 5 reps at each weight (7, 8, 9, 10, and 11 oz) and finishing with 5 reps at regulation weight. The wrist moves from hyperextension (in the direction of flexion) to neutral. No elbow extension should be allowed.
INTEGRATED WORKOUT PLAN FOR OFF-SEASON TRAINING
To fulfill the many needs of the pitcher's arm, the number of exercises that should be performed is more than what would be practical for a single bout. An alternating workout plan is suggested as a way to solve the dilemma and is demonstrated in Table 3. Each workout contains exercises that have a synergistic effect among the target exercises as well as with the subsequent workouts.
In the sample off-season protocol (Table 4), the pitcher is on a 3-day cycle training plan (upper body/lower body/off) and the elbow training is included with the upper-body day and alternated for each workout during the 14-day microcycle. The objective of the off-season protocol should be to restore full range of motion, hypertrophy, strength, and strength endurance. The 4 workouts are designed to progress from hard, medium, and easy to specialized. The purpose of this organization is to give adequate recovery to the dominant flexors and forearm muscles that are the primary focus of the first workout. Because of the demands of the pitching motion to the flexors of the elbow with varied positions of the forearm, it is necessary to emphasize varied grip positions for flexion exercises ensuring preferential recruitment of the desired muscles.
GUIDELINES FOR ELBOW TRAINING DURING THE PITCHING SEASONS
Elbow training should be given careful thought during the pitching seasons (preseason and in-season) because this is when the pitcher is most vulnerable to injury. His range of motion, muscular strength, and muscular endurance must therefore be maintained. His pitching and bullpen schedule become the dominant factor when determining not only the days for his elbow training but also the individual workout objectives and exercise selection. Programming should be implemented for each pitcher with careful consideration of his injury and/or pain/soreness profile, his training experience, and his role (starter, middle relief, or closer).
A SAMPLE WORKOUT SCHEDULE DURING THE PITCHING SEASONS
The pitcher can alternate between workouts that are designed to restore/recover the musculature and workouts designed for strength maintenance/endurance. The restoration/recovery workout can be performed the same day after the pitching bout (game) or the next day. The strength maintenance/endurance workout can be performed 2 days before pitching. See Table 5 for a sample workout schedule.
EXERCISE SELECTION, SETS, AND REPETITION DURING THE PITCHING SEASONS
Exercises that first address the specific needs of the pitcher should be selected.
For example, a pitcher who has had a history of a prior surgery on his elbow may not be able to do what we might consider “maintenance” during the in-season. His needs may warrant that his elbow become stronger, not weaker, as the season progresses. In this case, the exercises can be selected on their appropriateness to his need (Table 6). The second consideration for exercise selection during the pitching season is that they be varied to still meet the comprehensive demands of the pitching motion without creating overuse. For example, specialized exercises such as deceleration (drop curls) or rapid elbow extension (rapid fire extensions) may be inappropriate. See Table 6 for exercise selection.
Sets and reps for a restoration/recovery workout should be performed with the objectives of range of motion and increased blood flow. Thus, a higher rep pattern (12-16) can be utilized. Depending on the fatigue level, 1-3 sets may be sufficient. Sets and reps for a strength maintenance/endurance workout should be performed for 2-3 sets of 10-12 reps except in the case of forearm and wrist exercises where higher reps are warranted. The challenge for the strength coach during the pitching season is to make adjustments to balance the pitcher's needs for strength maintenance/endurance and rest and recovery (11,15).
THE PITCHER'S FEEDBACK: THE MOST IMPORTANT VARIABLE FOR PROGRAMMING
Although the exercises suggested are comprehensive in addressing the needs of the pitcher as per the demands of the pitching motion, his personal needs must be taken into consideration as the primary source of the requisites for his program design. Once the program is in place, the feedback from the pitcher with regard to soreness and recovery time and training effect should serve as a guide to the strength coach for fine-tuning the sets and reps to meet each pitcher's requirements. There can be no replacement for the ability to have in-depth discussions with each pitcher regarding post-pitching soreness or pain to determine how to vary the workouts and exercise selection.
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