If you’ve been following along, you now know the risk factors and improper pitching mechanics that often lead to injury in the medial ulnar collateral ligament (MUCL).
But of course, preventing injury (and consequential Tommy John surgery) is more than just knowing what not to do with your movement — it also requires proactive training.
Because ultimately, your MUCL will still be undergoing high volumes of stress and dynamic motion. Even with proper pitching mechanics, the tissue is still at risk of injury without ample strength to combat the high amounts of force being placed on your elbow joint.
Remember what we reviewed in the first part of this blog series: your MUCL can withstand approximately 33 Nm of force, but professional pitchers can generate upwards of 64 Nm of torque. In order to truly prevent ligament injury, the muscles and soft tissue structures surrounding the elbow have to make up the difference in force generation.
Thankfully, there are many programs available that specifically address this deficit! Some of the more common programs include the “Thrower’s Ten” and “Ballistic Six” set of exercises for pitchers.
To supplement these pre-existing workouts, we’re going to cover 5 essential workouts that will specifically target elbow stability to protect the joint against valgus forces. Let’s dive in.
The Top 5 Exercises to Prevent Elbow Injury
The tricky part about addressing elbow strength and stability is that there are so many relevant muscles and tissues involved.
When it comes down to the specific need for stability while the elbow joint is under valgus stress, research has shown that the wrist flexor/pronator muscles, tricep muscles, and anconeus muscles play the biggest role. But, there are many other tissues that can indirectly reduce stress at the elbow, including the scapular stabilizers, rotator cuff muscles, and biceps muscles. These particular muscle groups prevent elbow extension with throwing motions, thus limiting some of the excessive forces from directly impacting your elbow joint.
With all of this in mind, these 5 suggested exercises will not only target the tissues directly at the elbow joint, but they will also help strengthen the connected muscles as well.
#1. Wrist Flexor Roll-Ups
Grab a dowel and tie a weight (somewhere between 3-8 lbs) to its centerpoint. Stand with your arms straight out in front of you with your palms facing upward. Hold the dowel with both hands with the weight dangling between your arms.
Alternate flexing one wrist at a time so that the string rolls around the dowel with each “twist.” Continue this alternating pattern until you bring the weight up to arm height, then slowly lower it back down by rolling the dowel in the opposite direction. Repeat this movement for 3 sets and 15 reps.
#2. Wrist Pronation / Supination
Similar to the previous exercise, prepare a short dowel with a weight tied to it. This time, though, choose a weight between 3-5 lbs and tie it to the end of the dowel. You can either stand or sit for this exercise, as long as your forearm is supported while holding onto the dowel.
Slowly rotate the forearm so the palm of your hand moves from facing upward to facing downward, then return to the starting position. Though this exercise isn’t highly dynamic, that’s the point — the key with this exercise is to slowly rotate the forearm in isolation while keeping the shoulder and arm stable. Repeat this motion for 3 sets x 15 reps.
#3. Bicep Curls
You may already have bicep curls listed in your usual rotation, as it’s a classic workout for most athletes and gym goers. But, to truly benefit baseball players, the exercise should be modified to mimic a pitching position.
Position your shoulder and arm in a 90/90 position. Using an appropriate weight, slowly extend your elbow until it’s completely straight, then return it to the starting position. Focus on keeping your shoulder stable throughout the movement, pulling your shoulder blades back and down for optimal muscular control. Repeat this movement for 3 sets x 15 reps.
#4. External / Internal Rotation
This is another common exercise for athletes, especially for baseball pitchers. External and internal rotations — particularly with bands or weights — are used to strengthen the rotator cuff muscles, although it should be adapted to suit baseball-specific needs.
In order to make these rotations as effective as possible and more tailored to pitching, they should be performed with the shoulder abducted and the elbow flexed at 90 degrees.
Start with this 90/90 position and hold a band that’s tied to something sturdy. Similar to the sport-specific bicep curl, pull your shoulder back and down to increase its stability. Focus on rotating your arm backwards through its range of motion without moving anything else. Perform this for 3 sets x 15 reps, then turn around and repeat the exercise with a forward motion.
#5. Prone W’s and Y’s
Lastly, one of the most important muscle groups that are often neglected in pitchers are the scapular stabilizers, particularly the lower and middle trapezius. These scapular muscles are essential for a strong and stable base for your shoulder and arm to rely on while throwing. Without proper strength in these stabilizers, pitchers lose out on efficiency and power, and they introduce abnormal forces into the shoulder and elbow that increase stress levels.
Practicing prone W’s and Y’s are a great way to target those exact muscles! Lie down on your stomach on an exercise ball or bosu ball, positioning it underneath your hips to elevate your upper body off the ground. First move your arms into a “W” position by pinching the shoulder blades back and down. Then, holding your shoulder blades in this position, slowly raise your arms up and overhead into a “Y” position. Gradually move your arms back into a “W” position and back to neutral. You can perform these with or without weights, and run through 3 sets of 10 reps.
Final Thoughts
There you have it, fellow pitchers: the three-part series of how to avoid Tommy John surgery.
When it comes down to it, pitching is a highly impressive but complex movement to perform accurately and safely. From understanding your MUCL and the risk factors that can impact it to recognizing proper pitching mechanics and strengthening techniques, there are a lot of components that go into true injury prevention.
Pitchers should work with coaches and movement specialists to ensure that they are implementing the proper exercises and training. When you have a team to help you strengthen the shoulder and elbow, you’ll be well on your way to reducing injury risk and staying strong for your next season.
