Latest / The Layback Podcast / Dr. Emily Ferree, Physical Therapist and Biomechanist (Ep. 69)

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Dr. Emily Ferree, Physical Therapist and Biomechanist (Ep. 69) · The Layback Podcast

0:00
Hey everyone, welcome back to the Layback Podcast.
0:02
Joining us today is Doctor Emily Ferri.
0:06
She's a physical therapist. I'm a mechanist and probably 35
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other things that I can't even begin to explain.
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But before I do butcher anything, of course, I'm going
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to punt it to her and let her take care of the rest.
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She does run her own physical therapy clinic out in Southern
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California. And if you guys maybe didn't
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know, this is like the one cool fact I definitely know about
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Emily. She was a soccer player that was
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then thrust into the baseball world.
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Thankfully, we have an outsider taking care of us a little bit,
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probably talk a little bit about that in the process.
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So Emily, I apologize if I stole your fun fact, but I felt like I
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needed to get that out. Yeah, that's great.
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I know people always want to ask me like, did you play softball?
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I'm like, not a day in my life, not for one day.
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Did I ever play a sport that involves throwing?
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I did play volleyball a little bit in my youth, but that's
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about the extent of my hand eye coordination.
1:00
So I always tell people, do as I say, not as I do.
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I can in slow motion demonstrate A pitching delivery, really
1:07
Florida State, and I know exactly what's supposed to
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happen. Do not ask me to throw the ball
1:13
at any because I by brain couldn't actually coordinate my
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body to do it. But I know what's supposed to
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happen. Well if I can interrupt real
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quick before the bio, how is your humoral retro version you?
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Don't want to know it's that was.
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It's not important. It's not important.
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OK, yeah. So I mean, that's stuck with me
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forever from the first time I heard you speak at what was
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that? Maybe the 2022 bridge seminar.
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I want to say I think you opened up with saying first and
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foremost, everyone throw like a girl.
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Not real. It's just because girls weren't
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exposed to humoral retro version of throwing a ball at young
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ages. So they just can't get the lay
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back that the male athletes that we usually label as having that
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access. So that's stuck with me forever,
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and it's more pertinent now because my wife and I are due
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with baby girl in August. Yes, congratulations.
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Thank you. That's my bio mechanics.
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Fun fact. Because everything in movement
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is physics, right? Like we are all bound by the
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same laws of physics. And with little kids, when girls
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start to play throwing sports, we hand them a softball, which
2:16
is bigger and heavier and they have smaller hands and so we
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hand them a ball that they can't palm so they have to turn it up.
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What happens when you turn a ball up, you throw with with the
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mechanics that we call throw like a girl.
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That's because we've constrained girls with external constraints
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and then punish them for those external constraints.
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Whereas little boys, we hand them a baseball which is small
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enough to palm and it's lighter. And so they can actually throw
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it with good mechanics because we've provided the external
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constraints to do that. So if you want your little girls
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to throw, well, give them the same balls that we give little
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boys and they will learn great throwing mechanics.
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It is almost like motor learning is a real thing.
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It's crazy how that works right? Like.
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That isn't that crazy. Yeah, well, sorry to dive deep
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right away. We can back it up.
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And I actually do want you to take us through your bio.
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I know we hit bits and pieces of it in that process, but please
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would love to hear more about you.
3:12
So First off, I am a physical therapist.
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I'm a physical therapist by degree in trade.
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So I got my doctorate physical therapy and then I'm a double
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board certified sports clinical specialist.
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I'm also I'm in the sports performance world.
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So I have my strength and conditioning certification and
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I'm a certified manual therapist and I did extra training outside
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of school to learn all the bio mechanics.
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So I also do biomechanical analysis and kind of the
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analysis of the physics of human and sport movement.
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I wear a lot of hats, but I wear a lot of hats.
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Not to be kind of a Jack of all trades and a master of none, but
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because I think in order to actually address the full
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spectrum of an athlete, you have to be hitting all of those
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elements. I can't just be a manual
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therapist, make somebody feel better for a day or two.
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I have to be able to fix the problem.
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Fixing the problem forces you to jump into the sports performance
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world and be able to train athletes.
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You can't just be giving them banded clamshells and expect to
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return them to the field. Like you have to be able to dive
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into that world of force performance and know how to
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train an athlete. And if I'm actually going to fix
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the problem, I can't just send an athlete back to do exactly
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what they were doing when they got injured.
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So I have to be able to know bio mechanics and no movement and
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then know how to train that movement.
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And so to me, the really the answer to treat athletes at a
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high level is you have to be able to kind of go in that full
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360 and address the full picture of what the athlete does and and
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who they are as as not just a mover, but as a whole system.
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I'm glad you said full 360, my exact words were going to be
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just sounds like you're doing full spectrum athlete care.
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Literally from intervention all the way back to peak performance
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and everything in between is just from following a bit of
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what you do. I know this is getting away from
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some of what we do want to talk about.
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It does seem like you are doing a lot of check insurance or spot
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work with guys knowing that you're working with such a high
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caliber of athlete that you are forced to come in and do the
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manual therapy to help somebody feel better before their next
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game or next outing or during the football season between
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Sunday to Sunday. Yeah, absolutely.
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I think that's the real beauty of the type of practice that
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I've cultivated is that a lot of the athletes that I treat are
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with me year round. And so you're training them in
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the offseason and prepping them for what they need to do.
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But if and when they get injured, you get to run the
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rehab process or are there to run the rehab process.
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And then in the middle of the season, when little things come
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up that maybe aren't keeping them out of practice or games,
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but are issues that they're dealing with, then you get to
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address those as well. And there's all these trends and
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people love to like argue about what's best practice with
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physical therapy. And there's kind of this divide
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in our profession of manual therapy versus their ex and
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what's better. And I always tell people, you've
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never treated a professional athlete if you're going to land
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yourself on one of those two spectrums.
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Because the answer is both. Because when an athlete comes to
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me and they have to play a game in two days, when they leave
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their session with me, they have to feel better.
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I don't care how good you are prescribing therapeutic
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exercise, there's not a therapeutic exercise.
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It's going to make that athlete feel better if they have a soft
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tissue injury. Like yes, you're getting them on
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the road to healing it, but in two days they have to feel
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better and they have to feel better when they leave my office
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or else I'm not going to get the buy in.
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So that's what manual therapy does.
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Manual therapy addresses in the moment, Can I do something that
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makes this athlete feel better, that allows us injury to be
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manageable, that can get them onto the field to practice
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tomorrow? Therapeutic exercise can't do
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that. But manual therapy can't
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actually fix the issue. So in the short term, manual
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therapy helps us, but in the long term, therapeutic exercise
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helps us. So the answer is both.
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But I'll tell you right now, if a professional athlete comes to
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see you and they don't leave your session feeling better,
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they're not coming back. I'm really glad you went down
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that route. I guess it's not something that
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I think about a ton, but when we step back and look at the
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baseball rehab injury world or just rehab for high athletes, I
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guess the industry is kind of shifted for the most part in a
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good way. Focusing more on therapeutic
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exercise from my perspective, because now we're, we're getting
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athletes better, healthier long term.
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But we, we have gone so far to the therapeutic exercise
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perspective with better understanding of bloating
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principles and all the things that we ultimately need for a
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few months down the road. However, like you said, if the
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athlete doesn't feel better, it really doesn't mean a whole heck
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of a lot because we can't get to that point where we can be
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loading up a squat bar again or making cuts on a field or
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rotating at the speeds you need to rotate coming down the mound.
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And ultimately, like if there's things that we can do with our
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hands or with our modalities that it can affect an athlete's
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Physiology, it can affect blood flow.
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We know we can basically stimulate fibroblastic activity.
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Like there's things that we can do that speed up the body's own
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ability to heal itself because ultimately the body's healing
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itself, right? But there's things that we can
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do to help facilitate that. So if I can even speed that up
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by like a day or two with my hands, I have to because time is
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of the essence for a lot of these people, especially if
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they're in season. Well, before we we shift out of
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it, I like the route we've gone down here.
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So I'm going to ask a couple more questions on it, if that's
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all right. For a elbow injury in a baseball
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player, what does manual care normally look like for you?
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And then I feel like the therapeutic exercises become a
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little more obvious as time has gone on.
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That's what we spend this entire podcast talking about.
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Basically, if we ever bring on a physical therapist or someone in
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the SNC world. But what does the manual therapy
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look like? Obviously we want someone to
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feel good. I, I think when we hear manual
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therapy as an industry, we just automatically go to massage.
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But I'm sure there's so much more that comes from that
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umbrella term of massage. So I'd love if you could just
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open up that book for us. Yeah, even if we're just going
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to deep dive into like I think when we hear like the term like
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soft tissue mobilization or massage more colloquially, like
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you just think about what a massage therapist does.
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But if you break down a really good manual therapist, there's
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deep tissue work, there's art or active release techniques,
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there's pin and stretch techniques that are both
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designed to release or decrease trigger points.
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There's fascial manipulation where we're affecting more the
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fascial plane and connective tissue adhesions.
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There is cross friction, which we're basically trying to rough
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up tendons to get fibroblasts to activate to increase blood flow
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to the area. There's like efflerage where
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we're working on more lymphatic drainage and getting swelling
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out of an area. So I mean, if you just take
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massage as this umbrella term, somebody who's actually very
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good at manual therapy is actually assessing the tissue,
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figuring out what needs to happen and then doing more
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specialized techniques than just rubbing something, right.
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So I think that's why a lot of PTS who want to be really in the
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upper echelon, they try and move away from things like massage or
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soft tissue because they don't want to be loved in with massage
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therapists, they're like, you know, I'm a doctor, I doctor
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physical therapy. I'm not a massage therapist.
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I don't want to be confused as a massage therapist.
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But if you're really an expert in manual therapy, you are using
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your doctoral level of education to assess what's going on with
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the tissue. And you're using the art form of
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our profession to feel what you need to feel, to assess and then
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to pick a very specialized form of manual therapy to address
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what you need to address, focusing on what physiologic do
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I want to make in this tissue? So it really depends what's
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wrong with the athlete with a lot of elbow injuries, so many
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CL injuries come with concurrent common flexor tendon issues or
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flexor mass strains, adhesions, trigger points, things like
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that. So again, depending on what
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exactly is wrong with the tissue, we're going to pick our
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modality based off of that. But a lot of it has to do with
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addressing concurrent flexor tendon or flexor mass issues.
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And then a lot of it's based on essentially just trying to get
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blood flow to the area because again, your body heals itself.
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Inflammation is not the enemy. And inflammation is essentially,
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especially in those first three days, it is a chemical trigger
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to send out signals to bring in the the mediators that our body
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sends cellularly to initiate tissue regeneration, a new
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tissue synthesis to initiate basically that whole renovation
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process in your soft tissue to heal and create new tissue.
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So some of it's to bring blood flow, some of it's to address
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adhesions or trigger points and things in the muscle.
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But it really depends on what's going on with the athlete.
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So you have to be able to assess that.
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Slight shift here but still semi related because it seems like
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it's that kind of time of year. I guess anytime in the spring
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and early summers, that time of year for Tommy John surgeries,
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but constantly I'm being asked, how quickly should I mobilize
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after surgery? How quickly should I start
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loading after surgery? Obviously every athlete is
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individual case dependent and there are so many factors that
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go into the decisions that you make.
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But from your perspective, your experience, generally, what time
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frames are you looking at? Or maybe what biases do you have
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in looking to mobilize an athlete again, or letting them
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get outside of a sling? That's a great question.
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Some of it depends on what type of repair the athlete got and it
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really majorly depends on if they also had a common flexor
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tendon repair too. So a lot of elbow blowouts that
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we see like through one pitch picture grabs his arm like it
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blew in that moment. It wasn't kind of the slowly
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building pain issue and we didn't MRI and realized it was
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mostly torn. Like when we truly get blowouts,
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a lot of times there is tearing of that common flexor tendon.
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Now if the surgeon had to go in and reattach a common flexor
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tendon and do a common flexor tendon repair, the process is so
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much slower because really the fragile part of that repair is
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the common flexor tendon. It's not really the UCL, it's
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common flexor tendon. So there's a lot more
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precautions if that happens. Assuming there's not a common
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flexor tendon repair, athletes are usually in the brace for six
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weeks and there is a progressive range of motion progression over
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those six weeks. They gained about 10° in both
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directions every week. And that's largely not done by
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manual mobilization, that is just done by changing the lock
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mechanism on the brace. So basically the brace has a
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dial with a degree of range of motion and you are just
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increasing at 10° every week in both directions and allowing the
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athlete to move. So it's mostly active, not
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passive with Tommy John or UCL repair surgeries.
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We really do not want to force the issue like we are not trying
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to over pressure at the end of range of motion.
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There's not a lot of elbow joint range of motion stuff we need to
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do. So most of that is it honestly
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comes back on its own range of motion wise.
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And then as far as loading, my big thing if the athlete has not
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had a common flexor tendon to repair is early and often
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isometrics because the more in an isometric with the elbow at
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90° of flexion supported and in the brace outside of internal
14:04
rotation. So we avoid internal rotation
14:05
initially. But outside of that like you are
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not going to maladaptively load that elbow post surgery.
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You're not adding valgus stress to that elbow again, as long as
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you're not pulling into your internal rotation early.
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But basically every other direction we are doing
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isometrics early and often around the elbow and shoulder
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because the more we can even just activate and turn on the
14:24
forearm muscles in all directions faster and better, an
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athlete will be able to progress and load as their surgical
14:32
precautions and and timeline allows.
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But it's the same thing with basically every surgery.
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So I'm a huge propellant of, you know, labral surgeries.
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We are doing isometrics day one. That is probably where I differ
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a little bit from some physical therapists or a little bit more
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cautious around loading up the elbow.
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I feel very confident that I can do isometrics at the elbow and
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shoulder without adding those loads in the valgus direction of
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the elbow that's going to be maladaptive after surgery.
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I feel very confident I can do that in a Safeway.
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And we're doing that as much as possible because just the
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timeline of how much more quickly that they can progress
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is pretty night and day when you start that early.
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I think that's great insight. I appreciate you going down that
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road. As I'm sure you could guess, I
15:13
am a large proponent of isometrics myself, especially
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with objective loading to the area.
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I would like to think that's pretty obvious to the listeners
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at this point given given the platform and given the way we
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attack these things. But there was another selfish
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piece in there where now I'm regretting not being able to see
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you when I blew out my shoulder because the way that I attacked
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it was very different, very slow, very conservative.
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I had labor man rotator cuff repair.
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And of course, I end up getting diagnosed with frozen shoulder
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later in the process because I was in my brace for so long
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because the surgery was so intensive.
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And then I just lose the ability to be a regular human being just
15:57
a few months after surgery. Yeah, I had a slightly off
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topic, but Speaking of the shoulder, I had a NFL
16:04
quarterback who had a labral prayer and he rehabbed with me
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and early and often isometrics is the only thing I did
16:11
differently than another quarterback on the same team who
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had the same surgery, same timeline.
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He was back throwing 4 weeks earlier than the other athletes.
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The only difference was, you know, 1 athlete stayed in rehab
16:25
with the team when I came in rehab with me.
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And the only difference was the early and often isometrics and
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how we took that first very early phase of rehab.
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And he progressed infinitely more quickly than this other
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athlete. So I just think that's huge and
16:40
sometimes overlooked in our profession because people are so
16:43
cautious post surgery to do anything that's going to disrupt
16:45
the repair. And surgeons especially are very
16:48
cautious as they should be. But it's a little bit self
16:51
protective, right? Like they did this surgery, it's
16:53
a great surgery and if you re injure yourself or you do
16:56
something to affect the repair, it looks bad on them, right?
16:59
Like if they need to have a revision or something like that.
17:00
So sometimes these surgical protocols are overly cautious.
17:04
So we as physical therapists need to figure out and add a
17:07
little bit of common sense into it sometimes of like, hey, if I
17:10
do an isometric in neutral in a supportive position, not in a
17:14
direction that's going to load this specific tissue, like am I
17:16
really going to affect the repair?
17:18
How much force actually needs to go through this area to actually
17:20
affect the repair to actually like loosen a bone screw or
17:23
things like this? Like we need to add a little bit
17:25
of common sense to it sometimes and be able to have a little bit
17:29
of that critical thinking around surgical protocols that exists.
17:32
I'm not saying go outside of surgical protocols, but I'm
17:33
saying within surgical protocols, we need to figure out
17:37
really like how best can we start to load this limb.
17:40
Dumbing it down a little bit from my side just to make sure
17:42
I'm internalizing everything you said from what you said a little
17:45
bit earlier, unless the flexor mass is involved in the repairs
17:50
somehow. So assuming the flexor mass is
17:53
not involved now, it basically means the only thing that was
17:56
touched in the surgery was a ligament.
18:00
Maybe there is a nerve transposition or something, but
18:02
the muscle tendon unit was not impacted in any way, thus its
18:08
native strong tissue. The area might have swelling,
18:11
the area might have inflammation or discomfort just because a
18:16
foreign body went in there, but the muscle tendon unit actually
18:20
wasn't impacted. So why would we hesitate in
18:23
loading that? Is that fair?
18:25
Am I on point with that? Correct.
18:28
Cool. OK.
18:29
And then the other piece, early and often being aggressive early
18:34
seems like something that we as an entire industry could
18:38
probably lean to a little bit more heavily from your
18:41
perspective. Yeah, and even, like I said,
18:45
finally people are catching up. We know our our as a physical
18:48
therapy profession, we're no longer recommending like Rice,
18:51
right? If you have an injury, rest,
18:52
ice, compression, elevation. And now it's kind of this, like
18:55
the colloquial term is like peace and love.
18:56
We're like protect it, but move it.
18:58
But, you know, all this kind of stuff.
19:00
Part of that really and often is, is movement too.
19:02
So let's take TJ for example. They're in an arm brace.
19:06
A lot of guys spend the first six weeks like I'm in this arm
19:08
brace. I don't want to move it.
19:09
I'm doing everything where they have these kind of range of
19:12
motion boundaries that they're in per what week of rehab
19:14
they're at. But in there like 24 hour day,
19:18
they're really not moving a ton. I tell my guys every half hour
19:21
you are pumping out within your range of motion restriction.
19:24
So we are not going outside of their surgical protocols, but
19:28
they are doing as much as humanly possible within their
19:31
surgical protocol limitations and they are moving that thing
19:34
as often as they can. And the guys who are basically
19:37
constantly moving their elbow, they have no issues progressing
19:40
their range of motion week to week.
19:41
The guys who do not move their elbows and are kind of
19:43
stationary and like just do the rehab and then go home for the
19:46
rest of the day and they're kind of really protective of that
19:48
elbow. Every time we go to move that
19:51
brace 10°, that end range of motion is hard to get.
19:54
So the early and often goes into movement as well.
19:58
Switching now to the athlete or the patient in mind that you're
20:02
working with, knowing everything you just explained, I feel like
20:07
part of the hesitation from the athlete is fear.
20:11
So how, how do you help an athlete overcome that fear that
20:15
something isn't going to go wrong like you said, within the
20:19
surgical protocol? Everything you said to me makes
20:21
complete sense because I feel like you mapped it out plain
20:24
black and white. So is it really just?
20:27
Honing in on that communication process, the education, making
20:30
sure the athlete understands. Or are there other things that
20:33
we are missing? I think so much of it goes into
20:36
education, so having the athlete know like what happened in their
20:40
elbow, like where did the graft come from?
20:43
How is it placed in their elbow? How is their UCL now secured?
20:47
What type of loads are going to disrupt that graft and just
20:50
disrupt those anchors? What is their actual surgical
20:54
protocol for rehab? What are we allowed to do?
20:56
What are we not allowed to do? If they really understand those
20:59
things, I, I tend to see that they feel more comfortable
21:01
within like, OK, here's what you're not allowed to do.
21:04
We aren't doing any of that, but here's what you are allowed to
21:06
do. So we're going to do everything
21:07
over here in this bucket. I find that they feel a little
21:09
more comfortable with that. Just having the education of
21:11
really understanding what's going on in their elbow and why
21:14
they can't or can't do certain things and really knowing, OK,
21:16
these things are safe. So I can trust that I can do
21:18
these things. And like with all rehab
21:21
processes, like pain is present, right?
21:24
And so educating them on like what types of discomfort are OK
21:27
and which types of discomfort are not OK.
21:29
So they kind of have an internal monitoring system that they can
21:31
trust as well. And I want to call back on
21:34
something that we talked a little bit about earlier, just
21:37
sticking with that range of motion theme.
21:40
Is there ever a point where you do start to intentionally attack
21:46
range of motion? Like is there a point where it
21:48
starts to become a red flag, even though early on you're
21:52
expecting the athlete to gain it actively on their own?
21:56
It's going to come with time. But is there like a line in the
21:59
sand for you where you do say like, hey, this is going to be a
22:03
problem down the line, we need to do something about it?
22:07
Yeah, usually if by 10 weeks an athlete doesn't have full pain
22:10
free range of motion, it is a problem usually at the eight
22:12
week mark and you can start attacking extension before you
22:15
attack flexion. So usually by the eight week
22:17
mark if they're like a little stiff into end range extension
22:19
like we'll start to do some manual therapy to basically
22:22
encourage that end range extension.
22:24
I'm still probably out. I've been cranking flexion at
22:25
that point. But once we get to the 10 week
22:29
mark, if they do not have full range of motion, it's a problem.
22:32
A lot of times that ends up in a referral back to the surgeon to
22:35
figure out if it's, if it's a gross change in range of motion
22:38
or like a, you know, a gross discrepancy in range of motion.
22:43
It might be a referral back to the to the surgeon.
22:45
If we're like off by a few degrees each direction, then
22:47
we're going to start manual therapy.
22:50
When you say off a few degrees either direction or a gross
22:55
change, is that in relation to the contralateral limb or is
22:59
that in pre surgical data if you're lucky enough to have it
23:03
or is it against the kind of I guess industry expected standard
23:09
for range of motion? A little bit of all three.
23:12
OK, So most pitchers have their reflection, extension, range of
23:16
motion from teams because they do these generalized kind of
23:19
assessments at the beginning of spring training.
23:21
So usually we have that data pre injury.
23:23
What is your normal extension With pitchers, especially
23:26
pitchers without a lot of service time, sometimes
23:28
extension range of motion changes.
23:29
Most of us have what we call like negative range of motion
23:32
into extension. So we have hyperextension.
23:34
Most human beings do, not all pitchers do.
23:38
It's not uncommon to lose a degree or two of extension.
23:41
Is that ideal? Not necessarily.
23:44
Does it happen? Yes.
23:45
So if you know if a pitcher only had 0° of extension so they
23:48
didn't have hyperextension before surgery, I'm not
23:50
expecting them to get hyper extension after surgery.
23:52
If we don't have that range of motion measurement from pre
23:56
surgery, we are comparing it to the other limb, the non surgical
23:59
limb. And then flexion wise, Flexion
24:02
for the vast majority of the population, even pitchers, it
24:05
should be limited by basically their muscle mass.
24:08
So when their forearm hits their bicep like that really should be
24:11
the limiting factor. Their joint itself should not be
24:13
the limiting factor. And the way we can tell this
24:15
essentially is what flexion feels like.
24:17
If I get to the entering flexion and it's kind of bouncy like
24:19
even if you like get there like it's bouncy.
24:22
If I get to their end reflection and it's what we call a firm or
24:25
a hard end feel that is their capsule or at their actually
24:29
their Bony structure that's blocking me.
24:30
That isn't that is a joint issue and that really should not be
24:34
your limiting factor with flexion.
24:35
So some of it is how that end range of motion feels.
24:38
This has been incredibly educational thus far and you may
24:41
have provided the perfect segue into some of the biomechanical
24:45
stuff. So what are what are issues that
24:48
can arise that you might see if an athlete doesn't have full
24:53
range of motion because you said it can become a problem down the
24:56
line. So let's say you get a late
25:00
stage rehab guy that comes to see you because he knows he's
25:03
just not right. He's previous big league service
25:07
time coming back from an injury and you notice the elbow doesn't
25:12
have full range of motion or something.
25:14
What are those red flags now? Like are you seeing increased
25:17
torques? Are you seeing poor patterning
25:20
on a biomech report? Like what does that really play
25:24
out to be? Yeah, a lot of times it's poor
25:28
patterning. A lot of times it's poor arm
25:31
path. And a lot of times that results
25:33
in not matching planes or rotation between the arm and
25:36
more proximal segments like torso and the hips.
25:40
And that most of the time is generally not due to a specific
25:44
range of motion restriction. Like I don't have enough elbow,
25:47
I don't have end range elbow flexion.
25:49
So my delivery is no different because the only end range you
25:52
get into with pitching is usually extension at the very
25:55
end. But if an athlete doesn't have
25:57
full range of motion, your body is smart and your body is self
26:00
protective neurologically without you even thinking about
26:02
it. And So what we see a lot of
26:04
times is these guys have deliveries that are protective,
26:10
but ironically, that ends up resulting in movements that
26:13
actually add more torque to the elbow.
26:16
For whatever reason, when when a body is trying to protect the
26:18
elbow, arms get really chubby. I don't know why that is because
26:22
it's very maladaptive and it does the opposite of what the
26:25
body's trying to do and it actually overexposes the elbow.
26:28
But I think guys are not necessarily even cognitively,
26:32
but maybe subconsciously they're really afraid of like letting
26:34
the arm like catch rotation and whip.
26:37
But that is more protective of the elbow than shoving the elbow
26:41
head of the body and leaving, letting that forearm fly out and
26:44
basically leaving the elbow out to dry while your torso is
26:46
rotating. And so I I more see arm path
26:49
issues, I think more from a subconscious place trying to
26:51
protect the elbow, not necessarily because it can't get
26:53
into a specific range of motion, if that makes sense.
26:56
Yeah, totally. And I think that's probably even
26:59
what I was curious about. Is it the the body's protective
27:03
mechanism that's creating the issue, or is it the actual range
27:08
of motion issue? So I it sounds like it could be
27:11
kind of chicken or egg to an extent, because if the range of
27:13
motion issue wasn't there, the body probably wouldn't be going
27:17
through its protective mechanism.
27:18
But the range of motion issue really doesn't matter that much.
27:22
It's just you need to be able to overcome it somehow.
27:25
Yeah, yeah. And A and a healthy,
27:29
unobstructed delivery. The arm is essentially catching
27:32
rotational momentum from the torso and then getting whipped
27:36
through. And when guys are coming back
27:39
from an injury, it's hard to trust that.
27:42
And so they want to have more control over their arm, I think
27:46
even subconsciously. And so they're trying to
27:48
basically leave the delivery with their arm, and it ends up
27:50
with them being chubby, and it usually ends up with them out of
27:52
plane with their torso because they're not trying to just let
27:54
that arm catch. They're trying to control where
27:56
the arm is and like carefully get into their delivery and
28:00
protect it and it ends up with all sorts of both performance
28:04
and injury risk issues. When you see something that
28:07
doesn't look right, for lack of a better scientific term, at
28:11
least in the way I'm asking the question in a biomech report,
28:14
what could that be? Obviously there's tons that
28:17
could go wrong, but normally in the populations that you are
28:21
working with. So upper level athletes, whether
28:24
it's draft prospect, high school kids all the way up to shy young
28:28
award winners. What is what is the Houston we
28:31
have a problem like flag that pops up in a biotech report most
28:36
often? The red flags.
28:38
That's a good question. I'm going to answer it.
28:40
But the first thing I'm going to say that leads into this is I
28:43
get asked all the time, like what age a pitcher should get
28:45
evaluated. And this leads into this
28:48
question, I promise. But if your 11 year old comes
28:51
into the lab, I'm sorry, everything is wrong with his
28:54
delivery. Like so many things, he's not
28:59
skeletally mature, he's not strong.
29:03
Your kid needs to get stronger and play more baseball.
29:06
Like that's that was your bio mechanics report right there.
29:09
Now when they're 141516, yes, come in and see me and let's
29:15
start addressing some things because now your kids throwing
29:16
hard enough that if they're doing something bad, they are
29:18
going to get hurt, but they also have more of the motor control
29:22
to address it. There have established motor
29:24
patterns at this point when your kids 9/10/11 every season they
29:28
throw, their movements going to change a little bit because
29:30
their body is changing so much and they are learning how to be
29:34
an athlete in this world essentially.
29:36
So if that's too young, there's too many things wrong.
29:38
There's going to be 18 different red flags.
29:40
But by the way, when your kids throwing 40 miles an hour, like
29:43
it's probably fine. So no offense to the little
29:46
leaguers, we love you, but getting a full bio mechanics
29:50
report at that age is probably a waste of your time and money.
29:52
And it's going to look like catastrophe, right?
29:55
Like your bio mechanics report is going to look like, you know,
29:57
red flags everywhere. We're not trying to instill
29:58
panic. Your kid needs to get strong.
30:01
They need to work on being, not just being throwers.
30:03
They need to work on just general athleticism, body
30:06
awareness, body control. And so much of that stuff is
30:09
going to clean itself up. So if I can interject real quick
30:12
on that, Emily, because great point is puberty kind of the cut
30:16
off line for you? If you're pre pubescent, there's
30:19
no point. If you're post pubescent, you're
30:21
probably not going to be changing as much.
30:24
So if you're serious enough about baseball, come on in,
30:27
let's do it. Yeah.
30:28
And then I think like just the volume change too, at that point
30:33
with travel ball, with adding in high school, with adding in like
30:36
showcases and stuff that these kids are doing.
30:38
So the volume change adds a level of risk that makes it
30:42
like, yeah, let's assess you and make sure you're not doing
30:43
something that's going to get you hurt.
30:45
They're at the point where like they might be doing more
30:48
specific strength training or things like that, that can
30:50
either complement or not complement their delivery.
30:52
So I just think that just that whole time just lends itself
30:55
better, whereas like the actual way a kid moves just changes so
30:59
much prepubescently because growth and motor control
31:04
development, all of this stuff is still happening and in such a
31:08
chaos chasm in their little bodies that it's just it's just
31:12
too early and it's not going to be as helpful as you think it's
31:14
going to be. So my biggest suggestion to
31:17
parents with preview Pheasant baseball players is train them
31:21
to be athletic, train them to be adaptable, train them to be
31:27
reactive, train them in multiple ranges of motion variability.
31:31
Like just allow them to be from a motor control standpoint, like
31:36
so flexible and adaptive in their bodies.
31:39
Not necessarily like literal flexibility, I feel to do the
31:41
splits, but flexible in their motor patterns.
31:43
Like they can throw from their knees, they can throw from their
31:45
feet, they can turn and throw, they can jump and throw.
31:47
Like that type of flexibility, that type of variability that
31:50
I'm talking about because that's what's going to allow them to
31:53
optimize motor planning, but also basically self organized
31:57
within their body to be more efficient.
31:58
It's that's why we say like a lot of these professional
32:00
pitchers that have made it so far and done so well, they
32:03
played shortstop until they were 16 and then they became a
32:07
pitcher only, right? So it's in these shortstops that
32:10
have these very reactive variable athletic throws.
32:13
They can self organize in their body very well.
32:15
Like those are the most athletic kids and they didn't get like
32:20
stuck in one pitching pattern from the age of 11 because their
32:23
dad was like, my kids going to be a pitcher and he's going to
32:25
play Division One baseball and I'm not going to pay for
32:27
college. And so he just from the age of
32:29
11 on was like, you're only thrown downhill and you are a
32:31
pitcher. And I'm going to tell you how to
32:32
throw at 11 when that kid at 11 doesn't have the motor pattern
32:35
skills to do what you're asking him to do.
32:37
And now you're just creating bad habits.
32:39
But the kid who played shortstop till he was 16, his body had to
32:42
learn to be efficient because he's throwing on the move,
32:44
because he's turning and throwing because he's reacting.
32:46
And your body is smart, your body wants to be efficient.
32:49
And he really learned how to be an athlete.
32:51
And that translates so much better to pitching then keeping
32:56
a kid on the mound till he's from 11 years old all the way
32:58
on. Again, I'm going to interject
33:00
because I feel like you made another great point that I would
33:02
like to comment on and eventually we will get to the
33:05
the biomech question. But I feel like you just took my
33:10
argument for slash against early sports specialization and just
33:15
set it in a more sophisticated manner than I ever could.
33:18
Because I am a huge proponent that early sports
33:21
specialization, I think completely gets mislabeled that
33:26
I don't care if an athlete only wants to play baseball their
33:29
entire life. The specialization is doing the
33:32
same thing over and over and over again.
33:33
So if all you do is the same pitching lesson and try to throw
33:37
the exact same way from age 12 to age 20, yeah, that's probably
33:41
early sports specialization. But if you're playing every
33:43
sport on the field and you're doing the training that you
33:46
should do to support those things, you are not quote UN
33:50
quote specializing. You might care most about the
33:52
sport of baseball compared to everything else, but if your
33:55
training is done properly, So what?
33:58
Who cares? It's exposing you to all the
34:00
athletic demands that you could ever need.
34:02
It doesn't matter if you're kicking a ball, just to say you
34:05
do a different sport. I'm so glad you said that.
34:07
And this is the soapbox that I've been on for years because
34:10
it's the catch 22, right? Like we've all these parents
34:12
that heard the like 10,000 hours rule, right?
34:15
Like all these people that get to the elite level sport they
34:17
did, you know, at least 10,000 hours.
34:19
And it takes so much time to be really good at one thing.
34:23
And let's be honest, baseball is a skill based sport.
34:26
You have to be really good at some very specific skills that
34:29
take a crap ton of time to get really good at.
34:33
And it is such an all-encompassing baseball,
34:36
literally travel ball culture is wild.
34:38
And if you want to be competitive, you have to play
34:41
the game as your kid can't play in the spring every year until
34:46
he's 17 and expect to be competitive.
34:48
But that's just the reality. So there's this, you know, kind
34:50
of these two different schools of thought of early.
34:52
We know the research tells us early sports specialization.
34:55
Your kids probably not going to make it to an elite level and
34:57
they're most likely going to get very injured.
35:00
But then we take the 10,000 hour rule, we say, but also your kid
35:03
needs to be playing so much baseball to be good at it.
35:06
So how do we not specialize them but also get them to play so
35:08
much baseball that they can actually get to an elite level?
35:10
And the answer is you need to create variability within the
35:14
sport. They should be playing every
35:15
position. They also, I tell people all the
35:18
time, especially your younger kids, which I know expense time,
35:21
this is all a barrier. But as much as you can, your
35:23
kids should be training outside of baseball.
35:25
They need to be doing some sort of strength and conditioning.
35:28
They need to be doing some sort of athletic agility, speed, like
35:32
other kind of stuff that's all going to lend itself to
35:34
baseball. But isn't specifically like a
35:36
throwing drill, a hitting drill. Do you know what I mean?
35:38
Like they're getting that at practice.
35:41
They don't necessarily need extra pitching lessons.
35:43
They need to be doing something that's going to train just
35:45
overall athleticism that's going to lend itself to baseball, but
35:48
something that's not baseball specific training.
35:50
And then let your kid play basketball on the weekends, Like
35:53
take your trip to the lake and let them learn how to wake
35:55
board. Like allow your kid to go skiing
35:58
if you go on vacation, right? Like, you know, there's so many
36:01
baseball parents that are like, my kid never skied because I'm
36:03
so afraid he's going to get hurt.
36:04
I'm like, OK, so we don't need to sign them up for eight
36:06
different sports to avoid specialization, but they have to
36:08
be able to live their life. That's going to add
36:11
specialization. Shooting hoops with friends on
36:12
the weekends, like going out to the lake on vacation, wake
36:15
boarding, like all this stuff is developing athleticism within a
36:18
kid. That's going to add variability.
36:20
But anyways, if you can't do all those things, play every
36:23
position in outside of baseball, that's how you're going to add.
36:26
That's how you're going to get away from that early
36:28
specialization. Yes, so we are both to blame for
36:33
this tangent. But back to the original
36:35
question, which you laid fantastic groundwork for the
36:39
different flags that you're normally seeing popping up in
36:42
the high level biomech reports. So it was really hard not to
36:45
continue down that path. So maybe we'll go back there
36:48
eventually, but just the fact that I asked this question, I
36:51
was going to feel really bad for either the listeners or myself
36:56
that it didn't get answered. So the most common issues and,
37:01
and I know you mentioned my talk at the Bridge seminar in 2022.
37:05
So another soapbox is there's so many things we can measure in a
37:08
bio mechanics report. What data points actually
37:10
matter, because I can list a bunch of things in a bio
37:13
mechanics report that may not be optimal, but we have to be able
37:15
to look at which variables are results and which ones are
37:19
causes. So cause and effect, right?
37:21
And a lot of times we're trying to change things that are
37:24
effects. And if you're going to go down a
37:27
rabbit hole, make yourself crazy, you're going to make your
37:29
athlete really cognitive and in their head and it's never going
37:33
to actually change or needs to change.
37:36
My favorite example of this is lead leg blocking.
37:39
That is such a result of what you do on the backside, not the
37:42
front side, unless an athlete is specifically weak, which if
37:45
you're at high level, if you're in even the minor leagues or big
37:47
leagues, like you're probably not weak.
37:49
It's probably a mechanics issue. But anyways, I digress.
37:52
So the issues that I think are actually causes and big time red
37:57
flags is 1. How we use the back leg.
38:00
Essentially does the back leg rotate?
38:02
Does it rotate in time and does it rotate all together?
38:05
A big one that I see is that the athlete will initiate rotation
38:09
at the femur so that you'll see the hip start to rotate.
38:11
So the basically the knee starts to turn towards the ground and
38:14
the lower leg is not rotating. So basically that athlete is
38:17
staying foot congruent with the rubber and that heel stays down.
38:21
I need to see that whole leg rotate together and this one's
38:24
really easy to feel. If you get into like a wide leg
38:26
stance, like if you're in your stride and then you keep your
38:30
foot flat on the ground, toes facing if you're right-handed,
38:33
toes facing third base, keep your foot flat on the ground and
38:35
then turn your knee down as hard as you can versus getting that
38:39
stance. And then like you're smashing a
38:41
bug, turn your hip as hard as you can, but let your foot come
38:44
with it and really drive from the ground with your foot.
38:46
So you're driving rotation bottom up instead of at the top
38:50
by itself. So instead of just at the hip,
38:52
you're driving rotation starting at the foot with the hip.
38:54
And when you get that whole leg to rotate together, you are
38:57
creating so much more power out of the ground.
38:58
You're actually creating that rotational ground reaction
39:00
force. And you can, you can feel the
39:02
difference. So that's the first one is how
39:04
an athlete uses the back leg. If we're getting basically hip
39:08
rotation and isolation or if that whole leg's rotating
39:10
together. The other big one is matching
39:14
planes of rotation. So the easy one to see is the
39:18
arm, the upper arm and the torso.
39:21
So if I drew a line from shoulder joint to shoulder joint
39:23
and then connected those two dots, basically whatever angle
39:26
that line is, the upper arm needs to match that angle as
39:29
it's unwinding. If it is too high or too low,
39:32
the angular momentum that you're creating at your torso, angular
39:35
momentum is directional. If your arm is not in line with
39:38
your torso, that transfer momentum is not going to be
39:41
optimal. We actually create some
39:43
decelerate deceleration and then you basically have to, in order
39:46
to pick up speed again at the arm.
39:48
You have to rely on internal torques and muscular demand.
39:51
All that to say, it is one of the biggest indicators of
39:55
increased elbow torque and injury.
39:57
Good. A shout out Jimmy Buffy with
39:58
Reboot Motion. They actually did a study on the
40:00
data that they had with professional pitchers and the
40:02
one of the biggest correlations they saw were guys whose arms
40:06
did not match plan of rotation and elbow torque injuries.
40:10
So we're increased what we call various loading, various torque,
40:14
which is what UCL and arm injuries that was most
40:17
correlated with not matching planes of rotation.
40:19
And I think he presented that data either in 2022 with the
40:22
Bridge Seminar 2023 that was 23. So that's a big one, but the
40:28
other one that we don't often see that can kind of 'cause that
40:30
mismatch in angular momentum is if you look at the pelvis, the
40:33
other big one that can set you up to not match a plane's
40:36
rotation further down the delivery is what angle you
40:39
retain that pelvis. A lot of times I think in an
40:41
effort to like generate momentum and kind of back load before
40:44
they go off the mound, sometimes pitchers will angle their pelvis
40:48
uphill. Essentially, even though they're
40:50
about to move downhill, the person that's on top of the
40:53
pelvis, you get a torso tilt that goes with it.
40:55
Now your torso, the plane of rotation your torso is moving in
40:57
is totally altered or you have to come out of that plane
40:59
rotation that you just set yourself up in.
41:01
So that can be an issue too. But overall, that whole bucket
41:04
is whether or not you match planes of rotation, pelvis,
41:07
torso, arm. The big one most people know
41:09
about is forearm fly out. So basically if the pitcher
41:12
never gets that ball inside of 90 before they start to lay back
41:15
and and get to the Max external rotation, that one has a ton of
41:18
extra torque essentially because you're adding drag on the elbow.
41:22
Those would be my big ones. Those are my big red flags.
41:24
There's a ton of other things that we can see that go wrong in
41:26
a delivery. A lot of them are all we can
41:28
trace all the way back to those basically those three things.
41:32
How did you use your back leg? Do you match planes of rotation?
41:35
Is your arm path what we call healthy, which to me is 2
41:38
criteria? Does that ball make it inside
41:40
the pocket and does your arm match points rotation?
41:43
Those are my big red flags. Those are all things I think are
41:45
worth addressing. And just additional
41:47
clarification on the forearm fly out since of course this is a
41:51
podcast, so not everyone will be watching.
41:54
I I just want to reiterate when you were explaining it, you said
41:57
it's about getting so the forearm inside 90 prior to Max
42:02
layback, correct? Yeah, right.
42:04
OK, Yeah, I I always think that's a helpful point to hammer
42:09
home because you think about the conversations that we have, it's
42:14
the theory of the unwinding of the arm or the natural whip has
42:19
become so much more commonplace. But then you have people that
42:23
say, well, what about forearm fly out?
42:25
Doesn't that mean my forearms flying out because my arm is
42:28
shooting out away from my body? But that is occurring after
42:32
maximum maximum rotation. So that's just catching the
42:34
energy that you've transferred up through the arm, correct?
42:37
Yeah, yeah. And sometimes when we talk about
42:39
forearm fly out, so yes, obviously that forearm is going
42:42
to quote, quote fly out as you get towards release.
42:45
But we look at timing of that. So you look at timing of elbow
42:48
extension velocity. If that's happening early, we
42:50
can consider that forearm fly out.
42:52
But the other issue is basically before you hit Max external
42:55
rotation, does that ball sneak towards your shoulder just to
42:58
the inside of your elbow? You want to see hit that pocket.
43:00
And then when you basically, we do look at the timing of when
43:03
that elbow extension happens after Max external rotation.
43:06
And we basically time that up with when the torso has finished
43:09
its rotation. So basically if the torso and
43:13
elbow are moving away from each other too soon, the arm is left
43:17
out to dry like they're richening away from each other.
43:19
Basically the torsos should finish it's rotation and then
43:21
the arm is whipping behind it. If they're still rotating out
43:24
away from each other, that is also sometimes considered forum
43:27
fly out. Right.
43:28
That is what we would see, I guess, in our common coaching
43:33
vernacular as arm drag to an extent.
43:36
Yes, yes, exactly. Yeah, our less biomechanical
43:39
terms, just what we like to say, either arm drag or pushy arm or
43:43
whatever. Yeah, but you start to see the
43:46
the head in the hand working away from each other to an
43:49
extent. Yes, yes, yes.
43:52
Cool. OK.
43:53
Another point that I wanted to hit on, when you're talking
43:57
about these red flags, Biomech reports, you talked about the
44:02
hips or the pelvis working upward.
44:04
Although we are trying to go down the slope and there, there
44:08
are pieces here that I think it difficult when you start to
44:11
consider pitcher individuality and what makes them successful
44:16
in a sense of their ability to hide the ball or be funky, for
44:19
lack of a better term. Where or how?
44:25
That's probably not even the right way to ask it.
44:27
When would you intervene if you see something that might pop up
44:34
as a flag, But you know it enables an athlete to do
44:38
something that is outlier or produce a result that helps them
44:45
cash a check at the end of the day?
44:46
Yeah, great question. Not everything is optimal, but
44:50
not everything is a problem. So sometimes there are pictures
44:53
that do things that you're like, that's not the most optimal
44:55
thing you could be doing. But the answer is if it's not
44:59
broke, don't fix it. So I have two reasons why I
45:02
would make a biomechanical change on somebody.
45:04
They are in pain or got injured. And so obviously we need to
45:08
change something or they have a performance issue, they do not
45:13
throw hard enough or they've lost velocity.
45:15
I am a big believer in in this is that bio mechanics are for
45:19
two reasons. They are for health and
45:21
efficiency, which go hand in hand, right?
45:24
A lot of people try to connect certain biomechanical variables
45:31
and things like strike percentage or command.
45:33
There is no research to show that there are specific
45:36
correlations with specific biomechanical markers and
45:39
performance metrics like ball flight data, strike percentage,
45:44
things like that. But what we do know is there are
45:46
biomechanical markers that are very strongly correlated with
45:48
injury risk and with velocity. So I'm very careful not to make
45:55
biomechanical changes and then promise a pitcher that he's
45:57
going to be a better pitcher, if that makes sense.
46:02
All that being said, I think there's two reasons to change
46:03
the way somebody moves. One, they need to add velocity,
46:07
or two, they have pain or an injury that we need to work
46:10
with. And so if a pitcher comes into
46:12
the lab and they want an evaluation, they're throwing 97
46:16
and they have no pain. And I see something that's not
46:18
optimal if they're elbow torque numbers are not catastrophic.
46:23
And I don't see any indicator of like you're ticking time bomb,
46:25
you're going to get injured. I'm not changing it because it's
46:28
part of who they are. And biomechanical changes,
46:31
especially at the higher level, big league level guys have a lot
46:34
of service time to change a movement pattern at that point
46:38
can really mess people up. And you can change the identity
46:41
of a pitcher, right? Like these really elite guys,
46:44
hopefully, and most of them do, they know who they are, they
46:47
know what they're good at. They know how they get guys out.
46:51
Now if you put them on the mound and they're thinking about how
46:54
they move and they're trying to do something different, you can
46:56
really mess somebody up. So there has to be a strong
47:00
reason why I'm making a biomechanical change and I'm not
47:03
going to make biomechanical changes with false promises.
47:07
And I think false promises. Are your commands going to be
47:10
better? Your first strike percentage is
47:12
going to be better, Things like that.
47:14
There might be something out there and we might, someone
47:16
might do a research study and prove me wrong.
47:18
Currently, we do not have any evidence to say if your pelvis
47:22
opens 60° at landing, you have better commands.
47:26
We don't know that. So that being said, velocity and
47:29
injury, those are the two reasons I'm making changes.
47:32
If those two things are not a problem, I'm probably not making
47:34
changes. Even if you're not quote UN
47:36
quote at all. The piece that I want to hammer
47:40
home, again, just trying to focus on take away messages.
47:43
You mentioned making a change won't necessarily make someone a
47:46
better pitcher. The way that I wanted to phrase
47:49
it, or how I received what you said, is there is a stark
47:54
difference between an efficient thrower and an effective
47:57
pitcher, and those two aren't always the same thing.
48:01
And this is where I think we've gotten so much better from when
48:04
I first started being in the the baseball bio mechanic space to
48:08
now we've gotten so much better at integrating departments.
48:12
But I think we can still do a better job in that sometimes
48:16
biomechanics get so in the weeds of data and movement that they
48:20
see anything that doesn't look good or doesn't look efficient
48:23
or could be improved and they are they're pumping out changes
48:26
how you need to do this. They're sending pitching
48:28
coaches. FYI, his lead leg extensions a
48:31
little bit slower than MLB average.
48:33
OK, but we always have to bring it back to a pitcher is good if
48:39
they can get guys out. That's that's the at the end of
48:41
the day, that's the bottom line. I need to help pitchers get guys
48:43
out and not be injured. So if what I'm doing is not
48:47
going to help them get guys out, they shouldn't be doing it
48:51
unless they are injured, unless they are injured and I need to
48:53
fix an injury. OK, that's, that's my caveat,
48:54
right? But This is why it's so
48:56
important to collaborate and integrate with people who are
49:00
purely on the performance side of pitching.
49:02
So biomechanists need to be talking to pitching strategists
49:06
and pitching coaches and guys who are just in the performance
49:09
space because they are the ones that know what this guy looks
49:13
like on the mound. They're the one that knows what
49:14
their trackman data looks like and knows how they get out and
49:17
knows that their stuff plays up and down or east and West or you
49:20
know what I mean? Like they're the ones who say
49:21
like, you know, they're the ones that are responsible for making
49:25
changes with these pictures, but they're also the ones that can
49:27
add that color. And from a performance
49:29
perspective, this is what this guy needs to do.
49:31
And if we change this, we're changing who he is.
49:34
Big red flag, right? So it's gotten so much better,
49:38
but the world of sports science needs to continue to integrate
49:41
better with these people who are the performance experts and who
49:44
are the specifically baseball experts, right?
49:47
I'm lucky that I have Mike Mcferrin to really like
49:50
integrate with. So him and I run the lab
49:51
together in Irvine. He's obviously looking at
49:54
everything from a pitching strategy perspective.
49:55
And then I'm looking at everything from a bio mechanics
49:57
perspective and being able to marry those and decide what
50:00
changes actually make sense for a pitcher.
50:02
And you know, sometimes he's working with a guy and he's just
50:04
like, he'll just give me a quick like, here's a video of this
50:07
guy. Anything I need to be concerned
50:09
with? So he's basically asking me
50:10
like, are there red flags here? And if there's not red flags, we
50:13
aren't making changes. So sometimes it's just quick,
50:16
like, can I roll with what this guy got?
50:17
And that now I'm just working on grips or teaching him to tunnel
50:21
these two pitches or like it, it can it be a purely a strategy
50:24
thing or like, do we actually need to change the way this guy
50:26
moves? And I, I wish more pitching
50:30
performance centers and I wish more teams had the chance to
50:33
integrate in that way because I think it allows bio mechanics to
50:36
be so much more actionable. And the biggest gripe I hear
50:40
from teams with bio mechanics is like they're just shoveling out
50:44
data and they don't know what it means.
50:45
They don't know how to use it or they feel like I'm making these
50:48
changes that are making guys worse.
50:51
Before we do move on to another topic, I I want you to shout out
50:55
anything you need to that you and Mike are doing, whether it's
50:58
how people can get in touch with you guys, if they want want to
51:02
be assessed or work with you. Yeah, absolutely.
51:04
So Mike and I work together at the pitching lab down in Irvine.
51:08
We do every eval together. He is analyzing pitching
51:11
performance. So he's looking at all the ball
51:13
flight data, so looking at electronic cameras, Trackman and
51:17
kind of getting the performance history of the athlete.
51:19
And then I'm looking at all the bio mechanics, so all the
51:21
physics of how the pitcher is moving and what the actual
51:23
delivery looks like and all of that data.
51:25
And then we write reports together and create a basically
51:29
a pitching development plan for the athlete, go over it with
51:31
them. And so, yeah, I'd really like to
51:34
say that we kind of take pitching from from both angles,
51:36
from the medical side and from the performance side and, and
51:39
try and figure out something that is going to make the
51:41
pitcher the best pitcher possible and not just the best
51:45
thrower, right? Because there's a lot of guys
51:48
that that throw really hard and are not playing professionally
51:50
right now because they don't they don't have good stuff or
51:53
they don't know how to use it or all that.
51:55
So I feel like it's really important to marry the two.
51:57
And yeah, we're in Irvine. If people want to get an
52:00
evaluation, they can e-mail me at emily@furrysportslab.com or
52:05
they can visit our Instagram page and message us.
52:08
Those are probably the two best ways to schedule.
52:11
Perfect. Yes, I wanted to make sure that
52:14
you got that in there because you talked about the great
52:16
things you did, but want to make sure people know how to access
52:20
the great things that you do I. Appreciate that.
52:22
Yeah, yeah, of course. And this might be a funky one
52:25
for you, so definitely feel free to pivot if we need to.
52:30
I want to backtrack in some of your earlier work and talk about
52:34
some of the research that you were involved in, if possible.
52:37
Because I know early on you, you were involved with some studies
52:41
when you were really, I think first hitting the scene with
52:43
what you do on the biomech side as well as a physical therapist
52:47
with how a few mechanical actions impact arm torque.
52:53
If I'm not mistaken, weren't you involved in like the recoil arm
52:57
study that Eugene Bleeker and his crew did?
53:01
Yeah, just for the science community out there, I want to
53:04
be careful of calling it a study.
53:05
We didn't publish anything. We basically, I'm going to call
53:08
it an experiment. We basically took things in the
53:10
lab. We measured it, we tested it,
53:12
calculated the data, looked at differences.
53:14
We didn't publish anything that requires IRB's and like all
53:18
sorts of organizational stuff that at the time a one woman lab
53:21
operation was not going to do. But we measured and studied some
53:24
things and then presented those findings.
53:26
We did not publish any studies, but that was a really
53:29
interesting one. Where at the time, I don't think
53:33
it's as big of an issue now, but at the time there was a big kind
53:37
of old school mantra going around about teaching pictures
53:40
to finish in their back pocket, like get their arm to their
53:43
opposite back pocket and kind of pull that arm through to protect
53:46
the shoulder and elbow. And basically a lot of guys
53:49
would naturally kind of finish and their arm would kind of fly
53:51
back into this recoil. And that was being coached out
53:54
of a lot of especially young players just being coached out
53:56
of them. They're being taught not to do
53:57
that until like, basically that, you know, they call it finish
54:00
strong, like pulled that back elbow, like keep your arm at
54:02
your side. And Eugene just kind of
54:05
intuitively was like, that doesn't make sense.
54:07
And guys who he called it pimping the finish.
54:10
So I see all these big leaguers that pimp the finish and they
54:12
look amazing. Like, I don't think we should be
54:15
coaching recoil out of somebody. I think it's natural.
54:17
I think we should do it. But he didn't really have the
54:18
science behind, like, why is that better?
54:21
And so we just ran a really simple study where we had a lot
54:24
of kids come through who he was training with at the time, and
54:28
we had them throw two different ways.
54:29
We had them finish into their back pocket.
54:31
And then he specifically coached them to kind of pinch them to
54:34
finish and pull their arm into that recoil.
54:37
And we saw a pretty massive decrease in elbow torque.
54:42
I don't remember what the numbers worth time.
54:43
This was a lot of years ago. Right.
54:46
This was 2018, wasn't it? That sounds about the right time
54:49
frame. I guess.
54:50
I'm not exactly sure what year it was.
54:52
So we saw a pretty big decrease in elbow torque.
54:55
We also saw some mechanical changes in arm path that looked
54:57
better. And now looking back, knowing
55:01
more than I did at the time, I think what him being the finish
55:04
was doing was it was putting the arm in plane with the torso.
55:09
So basically, and again, this is all hypothesis space, but I
55:13
think what it was doing was basically from a motor control
55:17
standpoint, like back chaining, basically the picture had in
55:19
their mind by the time I end my delivery, my arm needs to be
55:22
right here. And so they're putting their arm
55:25
there to then come back to there, if that makes sense.
55:27
So they're putting their arm where they knew they needed to
55:29
go back to previously, if that makes sense.
55:34
So I think there was some reverse chaining going on from a
55:36
motor control standpoint that put their arm in playing with
55:39
their torso. And an arm in playing with a
55:41
torso is going to have decrease varus torque.
55:44
And usually it helps with velocity too, because it helps
55:46
with that angular momentum transfer from torso to arm.
55:49
So looking back at that study, what we're doing, I think that's
55:52
what was going on. But what we measured was a
55:54
pretty significant decrease in elbow torque when they did that
55:57
recoil. Kind of bringing us full circle
56:00
in a sense when we started with the motor learning principle
56:03
with I guess a softball is an external load, but it is kind of
56:08
funky when I think about this, although there is an intrinsic
56:13
approach to it, like in an athlete is internally trying to
56:17
cue themselves to get back to a certain point.
56:21
To me you could almost think about it as if it is external
56:24
because it is happening after release.
56:27
So it is kind of to me like the motor learning conversation that
56:31
we started with in the softball world.
56:33
Yeah, for sure. I think it's kind of a version
56:35
of that. And that's the same thing.
56:37
We make movement changes. Even though you're trying to get
56:40
an athlete to think about something internal, essentially
56:42
because you're talking about their body and the way they're
56:44
moving. We try and make it as external
56:48
to the delivery as possible. So for example, a lot of times
56:50
what we're doing to, for example, affect the back leg
56:53
instead of when they're at their Max speed mid stride, make a
56:56
change. We're trying to set them up in
56:59
their knee lift better. We're trying to like basically
57:02
do something that's going to like set the marbles up to roll
57:05
down the hill in a certain direction versus trying to get
57:07
them midway down the hill doing something different, if that
57:09
makes sense. So even though it's technically
57:11
an internal cue, you're trying to make it as external to the
57:14
main delivery as possible. Right, it's It's harder to speed
57:17
up once you're already going. You might as well set yourself
57:20
up for success from the beginning.
57:22
Yep, Yep. For sure.
57:24
Well, Emily, we have covered a ton and what I think is kind of
57:27
funny when I, when I look at this prep sheet, I think maybe
57:30
we got to like 2 of the talking points on there because we just
57:33
went so heavy on the, on the rehab route from the jump, which
57:37
I, which I love. It's why we do it this way.
57:40
Is there anything major that you think we missed before we have
57:44
to let you go? Of course, there's tons of
57:46
things. So maybe maybe it's the fun fact
57:48
or something that you're really into right now that you think is
57:53
coming down the line in the research world or in the
57:56
physical therapy world or performance world.
57:59
Gosh, that's a good question. I don't even know where to go
58:01
with that. I think, well, here's an issue
58:05
one from the bio mechanics again, so we talked about Mike
58:09
from a performance standpoint is 1 who's really evaluating like
58:13
ball flight data and ball characteristics.
58:15
And then I'm looking more at the body.
58:16
Mike and I have not figured this out yet, but what's next on our
58:19
plate is really trying to correlate and marry the two
58:22
together. So looking at the specific spin
58:25
characteristics that a pitcher may have and looking at what bio
58:29
mechanics may or may not feed that and helping to optimize
58:32
that. So part of obviously getting
58:34
better spin and this is, is your world is strengthening the
58:37
fingers and the forearm, right? But is there a way that we can
58:40
set the body up to set the hand end up essentially?
58:44
So, you know, looking at like maybe a guy has looking at his
58:48
unique plane of rotation that he creates in his delivery and then
58:51
looking at the way his his hand spins the ball.
58:53
Is there a way that we can maybe make a guy very deceptive
58:56
because maybe he's a very flat rotator, but he gets a ton of
58:59
backspin. You wouldn't necessarily expect
59:01
that. You'd expect a guy that's a
59:02
little bit more sidearm, a little bit more flat rotator to
59:04
cut the ball more. So, so basically, can we trick
59:06
batters by getting a guy who rotates in one plane of motion
59:10
but spins the ball in another? Things like that of trying to
59:13
marry those two together a little bit, I think is probably
59:15
the next, the next frontier for bio mechanics and, and pitch
59:19
data to correlate a little bit more.
59:21
So we're still playing with that right now.
59:23
And I know from a research perspective, so I also, I'm a
59:26
peer reviewer for the American Journal sports medicine for
59:29
specifically bio mechanics papers.
59:30
And I know some of the research that is coming out right now is
59:33
finally looking at not just biomechanical data and velocity,
59:36
but we're actually looking at a couple papers are are in the
59:39
works right now to look at spin and correlating with elbow
59:42
torque and things like that. So I think that is very
59:45
important for both injury prevention and performance
59:48
training to realize like, you know, the way that somebody
59:50
spins the ball, how that correlates with elbow torque and
59:52
injury. Because obviously we know the
59:54
harder you throw, the more torque is going to go through
59:56
your elbow. Velocity increases torque at the
59:59
elbow, but fastballs aren't generally what blow guys elbows
1:00:02
out breaking balls do. Certain spin does.
1:00:04
There's a reason we don't tell young kids to throw curve balls
1:00:08
and things like this. Even those are slower pitches.
1:00:10
So it's counterintuitive, right? So we are finally looking at
1:00:13
even though they're slower pitches, what about the way
1:00:15
they're spinning the ball is increasing elbow torque.
1:00:19
And I know you guys have some really interesting data about
1:00:21
when the arm is supinated, that the forearm is weaker.
1:00:24
And I just think we are on the brink of potentially really
1:00:29
affecting some injury risk characteristics for pitchers
1:00:32
without decreasing performance. Because this is the big and
1:00:36
solvable problem with the MLB, right?
1:00:38
Pitchers are getting better and better and better.
1:00:40
They're throwing harder and harder and harder.
1:00:41
They have nastier and nastier stuff.
1:00:44
I mean, I, I just saw a pitcher who had like 21 inches of run on
1:00:50
one of his balls and it's like you are spinning the ball like
1:00:53
crazy, Sir. And there's some of these guys
1:00:55
that are cutting the ball so hard, which from a performance
1:00:58
standpoint is amazing, but from an injury risk standpoint is
1:01:01
catastrophic. And so we are from a performance
1:01:03
standpoint, we're getting these pictures to a place where the
1:01:06
game is progressing at such a rapid speed, the body is not
1:01:09
catching up. So in order to prevent injuries,
1:01:12
we have to tell pitchers not to be as nasty, which is not good
1:01:16
for the game. It'll never happen or we just
1:01:18
have to accept that. 10 players for per.
1:01:20
I just looked at these stats the other day because one of my
1:01:22
pitchers was asking me about it. On average, 10 guys per
1:01:25
organization are getting TJ every year, pages and minors,
1:01:28
and the number is rising. We either just have to accept
1:01:31
like, hey, if you're going to be elite, you are going to blow
1:01:34
out. As a physical therapist, I don't
1:01:36
want to accept that. Or we have to say just don't
1:01:39
throw as hard or be as good from a performance standpoint.
1:01:42
Nobody wants to say that. So I think finally being able to
1:01:47
marry spin data, ball flight data with bio mechanics and
1:01:53
strength data of the arm, if we can marry those things and
1:01:57
figure out how to get these guys to spin the ball in nasty ways
1:02:02
and still keep their elbow protected could be very
1:02:05
interesting for the game. I think that was the perfect mic
1:02:08
drop finish. That, that was tremendous.
1:02:09
Emily that that was an awesome take.
1:02:11
I love it. I'm like excited and want to
1:02:14
keep going. But of course, life doesn't
1:02:16
always work that way. So now I'm probably going to be
1:02:19
blowing you up trying to find out more what you're thinking,
1:02:22
just just to figure out what's next.
1:02:23
Like what, what can we do to get there sooner?
1:02:26
But Emily, thanks a ton for hopping on with us today.
1:02:29
Everybody definitely encourage you to reach out if you have
1:02:32
questions. As Emily said, she is available.
1:02:36
She is trying to help athletes get better, get healthier and
1:02:40
improve what they do. So Emily, once again, thanks a
1:02:43
ton. And to all the listeners, thanks
1:02:45
for laying back with us.