Throwing Athletes: Preventing Shoulder and Elbow Injuries

[MUSIC PLAYING]

I want to welcome everybody
today to 30-minute Thursdays,

where we’ll be talking
about the throwing shoulder.

Today, we’re introducing
three speakers.

And I will be moderating.

I’m Dr. Karen Sutton,
and we’re joined

by Dr. Theodore
Blaine, and Dr. Taylor,

as well as Debbie Jones,
a physical therapist

at HHS Westchester.

Dr. Theodore Blaine is a sports
medicine orthopedic surgeon

at HHS Stamford, a former
competitive athlete

in swimming, football,
and lacrosse.

Dr. Blaine enjoys treating
all athletic injuries

of patients of all ages.

And he’s currently
the team physician

for Darian and Stamford
High School football teams.

Dr. Sam Taylor is
a sports medicine

orthopedic surgeon at HHS
Stamford, former homecoming

king at Greenwich High School, a
former intercollegiate athlete,

and Dr. Taylor has developed
a unique understanding

of the demands and anxieties
faced by injured athletes

at all levels.

He currently serves as associate
team physician for the New York

Giants.

We’re also here
welcoming Debbie Jones,

who’s a physical therapist
at HHS Westchester.

Her clinical interests
include treating

runners, overhead
athletes, and concussions.

Please note that in the
chat function in Zoom,

there’ll be information for
you to provide feedback,

ask questions, and then we
really do encourage questions

throughout this broadcast.

So feel free to write
those in the chat section.

So I’ll hand it
over to Dr. Blaine,

who will be starting our
presentation on the throwing

shoulder.

Thank you, Karen.

It’s a pleasure to be here,
and with all this great faculty

and panelists.

As Karen gave the sort
of background summary,

this is a topic that’s
near and dear to my heart.

I started my career at Columbia.

I had the opportunity
when I was there

to work with Dr. Steve Gershon
with the New York Yankees.

So really got very interested
in the throwing shoulder.

And then, since that
time, I’ve worked

with many collegiate
athletes at Columbia, Brown,

and most recently, Yale.

I’ve also had my own
shoulder injuries.

I’ve had three
operations on my labrum

as well as my rotator cuff.

So again, a topic that’s very
near and dear to my heart.

I’m looking forward to
the discussion today.

So this is 30-minute
Thursday, throwing shoulder.

I thought I would start
by talking a little bit

about the throwing
motion, because I

think that’s helpful
to understand

how we avoid injuries.

And then, how we can
treat them as well.

So the throwing
motion is shown here.

It’s six phases.

Really, the first phase
we see is the wind up.

There’s really
minimal shoulder force

that occurs during
this phase of throwing.

That, then, progresses
to early cocking phase,

where the arm is brought up
into an abducted position.

And then leads to a
late cocking phase,

where now the arm is in a
maximum external rotation

position.

In this position,
that’s where the rotator

cuff muscles and tendons really
kind of peak in their activity.

And there’s a lot of force that
occurs at least one times body

weight or 650
Newtons that is going

through the shoulder in
this phase of motion.

Then, we progress to
the acceleration phase.

So that’s where the
arm is then brought

from this maximum
external rotated position

out until ball release.

And in this phase of throwing,
the angular momentum is huge.

Really gets up to 7,000
rotations per second.

So 7,000 degrees per second.

So it’s really, really
a fast range of motion.

And then, the most
violent phase of motion

really is this
deceleration phase,

where all the muscles have to
contract to slow this arm down

after ball release.

And the forces that
happen to the shoulder

through this range,
this phase of throwing

is about 1,000 Newtons.

So really, really large.

And then you finish
with the follow

through, where
motion then stops.

And just to show what
this motion is like,

this is Aroldis Chapman.

Right now, he’s throwing a
pitch at 105 miles an hour.

I think his maximum ended up
being like 106 miles an hour.

But you can see the
tremendous motion that

occurs at his shoulder, and
the tremendous force that

occurs as a result of that.

So it’s important
to think about,

what are some of the key
components of the throw?

Because it’s not just
the ball and the hand.

So shoulder rotation
is incredibly important

as we can see here.

You need to have a
huge amount of rotation

to generate the wind
up so that, then, there

can be the maximum amount
of speed that comes out

of this ball release.

So shoulder rotation
is quite important,

and it’s something
that you really need

to have to be a good thrower.

But also, very important,
is core strength.

So what happens with
the throw, the force

is generated, actually,
from the ground.

Then it goes up through
the lower extremity,

and then into the core,
so that the hip muscles

and the abdominal
muscles are really

important to be able to
generate the force of the throw.

Then, it’s transmitted
to the shoulder blade

and then to the shoulder.

So in addition to
the core strength,

you also need to have this
scapulathoracic joint, which

is shown here,
the shoulder blade

needs to be stable
to allow the shoulder

to rotate and to
deliver the ball.

So in this case, you can
see that this shoulder blade

is actually lifted up because
these shoulder muscles are

weak around the shoulder.

And if that happens,
that can actually

create injuries and
problems in throwers.

So it’s not only–

we talk a lot about
the baseball pitch,

but there are other
types of throws

that can lead to injuries.

There is the football
throw, so quarterbacks.

This is a handball player here.

Cricket throwers, cricket
bowlers, water polo.

There’s a variety
of different throws

that can lead to problems.

And the throws are
not all the same.

So if you look at this guy
demonstrating a football throw,

or quarterback’s throw, this
throw is much more upright,

or erect, and has less
of a follow through

than we see with
a baseball throw.

So the forces are
a little bit less,

but they’re still substantial
and can still lead to injury.

In women’s sports, there’s also
many different types of throws

that are done.

So softball throw is the one
that’s been the most studied.

But also water polo
players, javelin throwers,

and a variety of different other
sports can involve a throw.

This is the one
that’s most studied.

This is the windmill
pitch in softball.

And that motion, also
a little bit less force

that’s generated as compared
to the baseball throw.

But it’s still substantial.

If you look at the
studies on this,

the forces can be at least
one times body weight as well,

which is pretty close to what
we see with the baseball throw.

So again, women’s sports can
lead to shoulder problems

just as they can in mens.

Karen and Debbie, do you
have any thoughts about how

women’s throwers may be a
little bit different than what

we see in male throwers?

I think one of the benefits
with the windmill throw

is that deceleration phase
that you talked about

with baseball players, they
do get a little bit of benefit

from gravity to help slow them,
slow them down a little bit.

But I do think that sometimes
you get a little bit of a like

there’s a little bit of a myth
that, oh, softball player.

It’s a more natural throw so
they won’t get hurt as often.

But certainly what they
may make up for in force,

they make up for in volume.

And so I don’t,
you certainly don’t

see any less injuries from
them than you do your baseball

players.

Maybe even more.

But it may probably more
comes from the shoulder

than the elbow that you may
see in baseball players.

OK, I know you’re going
to talk a little bit more

about how you rehab
people try and prevent

and also treat injuries later.

And probably can talk
to those issues as well.

The other thing we
tend to see, too,

in our female athletes,
as we’re talking

about the various
throwing, is predisposition

to multi-directional
instability, where we’re

thinking about the shoulder
doesn’t sit perfectly

in the glenohumeral
joint or the ball

and socket of the shoulder.

And the shoulder tends
to have a bit more play.

So where all the muscles,
called periscapular muscles

are trying to
stabilize the shoulder,

they have to work
a little bit harder

in some of our female
athletes who may

have a looser or lax shoulder.

So we do work closely with our
physical therapists as well as

our performance coaches to
make sure we’re emphasizing

those periscapular muscles for
some of those female athletes

who may have a looser shoulder.

And I would just add
one other thing, too,

that Deb was kind of talking
about and getting at here,

is that when you particularly
look at these softball

pitchers throw the
windmill mechanics here,

what you don’t
get there that you

do get in some of
the other overhead

throwing mechanics is the
kinds of stresses on the elbow

itself.

And so while the
shoulder is still

expected to perform in a
very wide range of degrees

of freedom and with power in
similar fashions coming through

to generate these
rotational moments,

the elbow doesn’t necessarily
see the same stress

as it does in an overhead throw
like you see in the water polo

player, the javelin player.

So the types of injuries can
be a little bit different.

And Sam, what’s
your thoughts on how

you treat, you take
care of the Giants

and treat a lot of
the football athletes?

What are your thoughts
about the incidents

and the types of injuries that
you see on the football throw?

I know the throw’s a
little bit different,

you really lead with your elbow
and it’s really more in line

than it would be with
a baseball pitch.

Are you seeing less
injuries in quarterbacks

than you would in a pitcher?

Yeah, I mean, we do tend
to see less, I think,

less shoulder injuries
in quarterbacks

than we do in baseball players.

I think that some of that
has to do with repetition.

Another part of that may have
to do with the size and weight

of the ball which is thrown
that may help control

the rotational moments
in a different fashion

than they do in baseball.

And certainly, the
mechanics, as you mentioned,

are different in
kind of leading more

with the elbow rather than
this kind of far out type

position here.

I know we’re not going to hammer
on elbow stuff too much today,

and focus more on the shoulder,
but one thing I would say

is, in the news we read a lot
about the Tommy John, the UCL

reconstructions and the elbows
of baseball players and javelin

throwers, but we
rarely ever hear

about that in the
football-throwing athlete,

the quarterbacks.

And in fact, studies looking
at those types of injuries

in NFL quarterbacks showed that
the vast majority of people

with those types
of injuries do not

undergo surgery to reconstruct
it and actually do quite well.

So every sport is a
little bit different

and has different
demands and needs

to be thought about in a little
bit of a different context.

So sort of to emphasize your
point, if you look at this,

this is the quarterbacks
coach from Columbia

and you can see how, really,
his elbow is right in line

with his shoulder and his body.

So probably much
less force going

to the elbow in a
football throw that there

would be in a baseball throw.

Mm-hmm.

So I thought what
we’d do next, I’m

just going to mention what
structures we’re talking about.

And then, if Dr. Taylor
doesn’t mind talking about some

of the more common injuries,
then we can go into discussion.

Just so everybody
knows what structures

are part of the problem
in a throwing shoulder.

So this is the labrum here,
which really lines the shoulder

joint.

And it’s where the
biceps tendon comes off.

So as the bicep
tendon contracts,

it can actually
pull on that labrum

and it can create injury.

And then the rotator cuff.

So the rotator cuff
is four muscles.

This is a subscapularis
muscle on the front.

The supraspinatus muscle,
which sits on top, also seen

from the side here, is the one
that’s most commonly injured.

And then there’s
the infraspinatus

and the teres minor muscles
that are in the back,

and their tendons, and those
can be commonly injured

in throwing.

And these are the
types of the injuries

that we most commonly see.

And if you don’t mind, Sam, I’ll
hand it over to you here, and–

Yeah, sure.

I’ll just, I’ll hit on it
just briefly so that we

have a little bit of
time to really hammer out

some of the question
and answer part of it.

But one of the things that
was, starting with the rotator

cuff, which is a super important
structure, as Dr. Blaine

was talking about that
essentially kind of grabs

the ball almost like a glove.

And it’s four tendons, a
big one in the front, two up

on the top, and one all
the way in the back.

And their job is
really to help hold

that ball centered
in the socket.

So as you’re going
through a motion,

the ball stays
centered in the socket

and rotates appropriately.

And so a good coordination
of those rotator cuff muscles

is extremely important
to allow the shoulder

to function through
the range of motion

that you need in order to
effectively throw a ball.

Now, rotator cuff tears in young
throwing athletes, acute, real,

rotator cuff tears are
extremely uncommon and usually

more related to a big
traumatic incident rather

than a repetitive
throwing type situation.

You can get irritation
of the rotator cuff,

some fraying of the rotator
cuff, some partial tearing

of the rotator from repetitive
type stresses on the shoulder.

Sam, could you go into
that a little bit more?

Sorry to interrupt.

But I think we get so
many parents or baseball

players coming in saying
that they’ve been told

they have a rotator cuff tear.

And why, from our
perspective, do

we think that’s such
a big difference,

rotator cuff tear versus the
other diagnoses of rotator cuff

that you mentioned?

Yeah, so in the young–

and guys, feel free to disagree
with me because it’ll make

it more fun if we disagree.

It’s always more fun if we–

I did warn Debbie about that.

All right, because I
like to say, just–

And we’re going to address
you as homecoming king.

Yeah, well, but then the person
who is the real homecoming king

is going to get
upset, so we’re just

going to let that one slide.

All right, so with the
rotator cuff itself,

as the shoulder, the humeral
head, the ball rotates,

one of the things that we do
see, as you see listed here–

and I am going to address your
comment, Karen, in a second–

is what we call
internal impingement.

And so what that basically means
is as the ball rotates further

towards the back, in kind
of an adaptive mechanism

to allow you to get this bigger
external rotation, to allow

the arm to come further
back, what happens sometimes

in repetitive type
situations is we start

to get some partial tearing on
the underside of the rotator

cuff.

And this is really an
adaptive mechanism.

And one of the big
things that we’ve

found in our field
over the last 20 years

was, initially this was
thought to be, oh my gosh,

there’s a rotator cuff
tear, I must fix it.

And in fact, fixing
it often ends careers.

Because what that
is, is we’ve found,

is more of an adaptive
change to allow the shoulder

to get an even bigger
range of motion

to generate the kind of force
that you need to throw a ball.

And by fixing
something like that,

you tighten the shoulder
up, you lose your motion,

and you lose your velocity.

So to what you were
saying earlier, Karen,

I would say that the
rotator cuff is often

a huge problem among
the adolescent throwers,

the young throwers.

But it’s not
necessarily a rotator

cuff tear that’s the
problem, but rather

a kind of deconditioning event
where all of the muscles that

are involved in
making the shoulder

function through a range of
motion kind of go out of whack.

And it becomes our
job as clinicians,

as parents, as players to help
get that shoulder back in line,

and that comes through
things like rest,

through choosing to do other
activities other than just

year-round throwing.

And then a number of things
that I would turn over to Deb

to talk about to help
re-educate that rotator cuff

and those muscles around
the shoulder blade, which

are extremely important.

Deb?

Yeah, so I think we’ll talk a
little bit later on about some

the exact things
that you have to do,

but that’s, working
that cuff is basically

one of the most important
things that you can do,

as well as Dr. Sutton
mentioned earlier,

some of the interscapular and
periscapular muscle getting

that shoulder blade basically
in proper position as well.

I think just to emphasize
some of the points

that Sam was making,
and I’m sorry, Sam,

I have to agree with you.

[SAM GROANS]

I apologize for that.

But yeah, I mean, you’re
almost are going to have,

there’s this thing called
the shoulder paradox,

or thrower’s paradox,
where, like, you

need to have a very
loose or lax shoulder,

and almost an unstable
shoulder to get

your arm into that extreme
external rotation position

and cocking to be able
to generate force.

So you need to get your
arm in a position that’s

got to pinch the rotator cuff.

It’s just going to happen.

So you need that.

But at the same time, that
instability or that motion,

then, can cause the injury.

So it really is a paradox.

But you know you don’t
want to take away

that motion thing you’re
going to make patients better.

You actually will
make the thrower worse

if you either repair that
rotator cuff or tighten

that shoulder.

So I think that’s a
really important point.

One of the things
that I would also

say when Karen was talking about
the muscles around the shoulder

blade being extremely
important, and oftentimes,

what happens in
these throwers is

there’s some event that
causes a decompensation.

So it doesn’t even
have to be a big thing.

But there’s some, you get
some kind of painful event

that basically sets the
whole cycle out of whack.

And then the rotator
cuff starts to function

without the kind of synchrony
that it normally does.

And then the muscles
around the shoulder blade

aren’t doing their job.

And then, one thing
leads to another, and all

of a sudden you
just you get caught

in the cycle of more pain,
weakness, dysfunction,

and you’re just kind of
cycling around and around.

And those muscles around
the shoulder blade,

which they’re extremely
important and extremely

complex, and I can’t
even figure them out,

still, to this day,
exactly how it all works–

How many are there, Sam?

[INTERPOSING VOICES]

There are so many, Dr. Sutton.

There’s lots of them.

But one of the things we’ll
often see in these throwers,

like, there was a picture
earlier that Ted had up,

or that we had up, where
the kind of shoulder blade

was winging a little bit.

I don’t know if we
can go back to that.

But oftentimes what happens
with these adolescent kids,

like this picture
here, is they come in

and they say, oh my shoulder’s
so weak, it’s so weak.

And they’re raising
their arm and you

see the shoulder blade
just kind of wing out

like this because the muscles
around the shoulder blade

aren’t controlling
that shoulder blade.

And that control of
that shoulder blade

is what the entire, everything
else around the shoulder

is based on the functioning
and stability of that shoulder

blade.

And so what’s often
impressive in an exam room is

how you will test somebody’s
strength, and oh my gosh,

they have no rotator
cuff strength at all.

But if you stabilize
their shoulder blade,

you just manually hold
their shoulder blade

against their chest wall, for
the parents, all of a sudden

the rotator cuff is
rock solid strong.

And so it’s a very
interesting way

to demonstrate how
important those muscles are

to the whole throwing motion.

And without any pun intended,
I would throw it over to Debbie

to educate Sam on
those 17 muscles

that surround the scapula.

And if you could talk
a little bit about–

[LAUGHS]

Why don’t I go through
some of these injuries,

if you don’t mind, Karen, and
go right to where Debbie’s

going to tell us how to–

Oh, sure, perfect.

Because we just don’t have
enough time in 30 minutes

to go over the
injuries in detail.

But yeah, why don’t
we throw it to Deb

and have her tell us how
to prevent these problems?

Right, and just a
quick point about what

Dr. Taylor was saying about that
pattern that throwers get into.

There’s often that pressure to
keep pushing through that pain,

and keep pitching and
throwing through that pain.

And I feel like the
longer that they go,

the harder it is to pull
them out of that pattern

that they end up developing.

So as if they’ve seen you
guys, whether you end up

operating on them,
or injecting them,

or whatever ends up happening
to get them to us, pulling them

out of that pattern
that they’ve developed,

the longer that
they’ve been in it,

the harder it is to
get them out of it.

So emphasizing the
idea of continuing

to pitch through and push
through that pain, is just,

it’s so important
to not do that.

So a good strengthening
program, we

know we’ve hammered on
the idea of rotator cuff,

rotator cuff, rotator
cuff, the serratus anterior

is the primary muscle
that keeps that shoulder

blade from lifting off
the back of the rib cage

and in doing that neat little
trick of winging out like that.

I get a lot of kids
that come and say,

look at this neat
trick I can do.

Like, that’s not a neat trick.

Like, that’s basically
your shoulder being weak.

So your interscapular
muscles, those muscles

in between your shoulder blades,
your middle and lower traps,

your rhomboids,
another important point

is that it’s not just about,
like, I’m going to just

get, like, one plane of motion.

Like, if you’re a thrower, you
need to be getting up here,

you need to be getting here, you
need to be getting down here.

You need to be getting multiple
angles of your serratus.

So making sure that you’re
hitting all of these

angles that you’re ultimately
going to need to be in.

A nice little program
that you can find online

is the Thrower’s 10 or
the Advanced Thrower’s 10.

And so then, beyond
your arm care program

is on the next slide.

the next slide.

Oh, I’m sorry.

I’m not the best manager here.

A couple things OK, here you go.

Is the trunk stabilization.

And so as we were
talking about, Dr. Blaine

showed earlier, that it’s
about the entire kinetic chain.

And so the power comes from
the hips and the glutes

and transfers through the
trunk and then into the arm.

And so if you don’t have that
entire chain taking care of,

then you’re going
to lose something,

and that’s ultimately going
to transfer too much stress

to the arm.

So making sure that
you hit that trunk,

that you hit your
hips and your glutes.

I’ll sell this on
the idea that it’s

not just about
injury prevention,

but that you draw your
power from your throw

through your hips
and your glutes.

So the stronger that
you can get those

is a better motor for your arm.

But then, the injury
prevention part of that

is that if you don’t strengthen
that part of the power,

then you’re going
to try to drive

too much through your
arm, and it’s all

going to come through your arm.

You spend a lot of time
on one leg in your throw,

so you need to do some
single-leg activities.

And then just you got to
hit your overall fitness.

So some biking and jogging.

I don’t think pitchers should be
running marathons or anything,

but they need to be overall,
you need to be overall fit.

All right, so I’m going to turn
it back over to the Dr. Sutton

to manage discussion.

Sure.

So just to note, we
do have attendees who

were former baseball pitchers.

So I think focusing on that.

One thing that I’d
like to discuss

is pitch count in our
youth, high school, college,

and professional athletes.

And if anybody wants to comment
on how pitch count may not

be specifically
relevant as we get back

from the pandemic and
our resuming some sports.

If you want to read my
mind, basically, I’m

a little worried
that the exact pitch

count may be too high right
now as athletes are maybe

deconditioned.

Yeah, I think just to
make a comment on, like,

what is the pitch count?

I usually have to look it up.

It all various based on
the age of the patient,

the age of the thrower,
and their activity level.

But in general, I kind of
think about the rule of eights.

So really, people should be
pitching for about eight months

a year.

They probably need four
months of rest in between.

And about 80 pitches
a game is kind

of, I think, I think
about 80 pitches a game.

And the faster pitches
are more of a problem.

So if you’re about 85 miles an
hour that’s usually an issue.

So just some general terms, it
makes it easier to remember.

Deb, what do you think
about adolescents

throwing curve balls?

That’s kind of one
of the big things

that people ask frequently.

I think a long time ago
we thought that that

was a really bad idea.

And I think that the
latest research has

said that it really,
honestly, the breaking balls

don’t really put any more force
through the arm and shoulder

than fastballs.

In fact, fastballs, probably
because they generate

more speed, put more through.

I don’t necessarily think that
your 11 and 12-year-olds need

to be working on those.

But I don’t necessarily think
that they shouldn’t, either.

Yeah, I think there has been
some change in the thinking

on that.

But for a while,
we were thinking

that adolescents shouldn’t
throw any curve balls.

I think it’s changed
a little bit.

But just common sense.

So you’ve got to believe
that there is a lot of force,

though, with curve balls.

Sam, one other question
that comes up a lot

are subluxations
versus dislocations.

I know you have to diagnose
those really quickly, too,

especially taking
care of the Giants.

How would you
classify a subluxation

versus a dislocation?

Mainly talking about a
first time subluxation.

So I mean, so that–

so it’s interesting, because
when we talk about instability

of the shoulder, I think
that you can think about it

in a few different ways.

And so you’ve got your
traumatic dislocations, which,

in the throwing type athlete,
a baseball or softball player,

for example, may
come diving largely

in a big traumatic event
like diving for a ball,

you have the outfielder, a
headfirst slide into a base,

versus the other
kind of instability

is more of what we call a micro
instability type pattern, where

through repetition,
with the stretch

over and over on the tissues in
the front part of the shoulder

can lead to instability of
the ball and socket joints,

so that it’s not
necessarily dislocating,

but there’s some micro motion
there that results in things

not rotating and firing
the way that they should.

So I think that when we
think about instability,

you kind of think two
different buckets.

So you’ve got your
thrower’s instability,

a micro instability
type pattern,

which is a lot
more of a challenge

to diagnose and
potentially treat,

versus the traumatic
instability or dislocation.

Just to echo on
that point, I think,

like we said before, being
unstable for a thrower is often

a good thing.

And often I’ll tell people
who come in the office,

they say, oh I’m really lax.

I got really loose joints.

And I say, well, you
must be a good athlete.

So it actually
is, I mean, it can

be a problem if it’s too
much, if the ball actually

dislocates.

But if there is a lot of motion
and there’s microinstability,

that may actually
be a good thing.

Mm-hmm.

There was one question that
came in from a guest about, what

about frozen shoulder as an
early sign of dislocation?

So I think of those in
two different genres.

But Sam, do you
want to touch base

on frozen shoulder
versus dislocation?

Well, I mean, those are,
they’re kind of two,

kind of, polar ends
of the spectrum.

When we think about
a frozen shoulder,

you’re thinking about something
that is essentially too stiff,

versus instability, which is
something where it’s too loose.

Now, it is true that a
instability event or a shoulder

that’s not functioning
correctly can lead to irritation

that causes stiff shoulder.

But in general, they’re two
kind of very separate camps,

at least in my mind, the
way that I think about it.

What do you think?

The only time where I’ve seen
those concept converge is

there’s some patients
who are may be developing

some arthritis in the shoulder.

And those patients,
actually, they’re stiff,

but they feel unstable.

So that’s usually the category
that I see where they’re

coming in with both problems.

Right, that’s a good point.

And then, Deb, Debbie,
I’ll send it over to you,

too, in terms of when
a lot of our athletes

now are training at home during
this coronavirus pandemic,

are there specific exercises
that you would really emphasize

them avoiding during this time?

I don’t necessarily think
that there’s anything

that I would have them avoid.

I think that there’s, more so
when they start to get back

into things, and it’s
just jumping back

into their activities
with both feet.

So if they’d shouldn’t jump
right on the mound, day one.

So almost everybody has to
think about this like they’re

coming out of an off season,
or they’re coming off

of a rehab stint, or there needs
to be a gradual progression

back into everything.

So just basically taking
it slow and looking

at their overall workload so
that three months from now

we’re not seeing a ton
of tendinitis and overuse

injuries.

Not that we don’t appreciate
the business, but you know.

Yeah, I agree.

I think it’s going to
be a challenging time.

And I just want to thank
all of our speakers today.

This was a great topic.

And I think a lot of us
could talk forever on it.

But I’d like everybody
to tune in next week

for our topic on the
weight room, avoiding back

and other common injuries.

So thank you very much
to all of our guests,

and we’ve got a lot
of great information

on the throwing shoulder
here in this topic.

Everybody.

Thanks, everyone.

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