Connected: A Case Study How KPI Treats High Level Arms

At KPI, we take arm care and health very seriously.  We go to great extremes to use all of our resources to create an environment that is the most beneficial to an athlete’s health and performance.  

In this week’s blog we are going to outline the process we used to shutdown, and subsequently bring back, one of our high level arms.  This pitcher was a Division I level arm at the time of the shutdown, but we took his case very seriously, treated it with the right focus, and now this pitcher is not only pain free and performing well, but is also one of the hottest draft prospects of the 2023 Class. 

Symptoms Leading to Shutdown Phase

• Velo Peak (consistent 90-93mph) weeks of March 14 & March 21
  • Velo peaks are often followed by deficit sessions because the body is primed for performance and experiences a stress level that it has never been at before.  The consequential reaction is to pull back and protect the body from the new stress
• Elbow and forearm pain at full extension
• Dynamometer Readings 
  • Displaying deficits in internal range of motion and internal/external rotational strength in shoulder when compared to last month’s levels
• Severe velocity drop – The velocity is down about 10% since the peak a couple of weeks ago
  • Drastic velocity drops are a hallmark sign of over-stress in the arm/body
• Loss of control – when the body is overstressed it usually does not sequence properly, leading to control issues
• Force Plate Readings
  • The force plates are showing high levels of fatigue.  The force output is way down (dark blue) and the ability to transfer the force is also down (red).  He is also taking way more time to get to full force (light blue).  

Subjective Evaluation: The athlete is showing classic signs of being overstressed and fatigued.  Lack of strength is the cause of approximately 68% of arm injuries in Major League Baseball.  The main cause of lack of strength is fatigue. This is perfectly understandable given his growth in the past year, propensity for training, and the workload he has carried this Spring.  Individually, each of these symptoms is cause for concern.  Collectively, there is really no choice but to shut down.  This is one of the strongest cases we have ever had to preemptively shut a pitcher down.

KPI Recommendations:

• Shutdown Phase (4-5 weeks) – elimination of pain in elbow area
  • Soft Tissue Work from Dr. _____ (Sundays and another appointment at _______- recommended during the week)
  • Marc Pro 3-4 times per day
  • Complete rest from any activity that creates Valgus stress in the UCL
    • Throwing
    • Lifts that create tension in elbow area
    • Any other activity that could potentially cause tension in the area
  • If pain persists past 1 week of shutdown, we will refer out to an orthopedic and re-evaluate the plan
• Ramp-Up Throwing
  • Week 1: 3 days of KPI Ramp-Up throwing template (M/W/F)
• On-Ramp Throwing
  • Weeks 2-3: 5 days per week of On-Ramp throwing (M/T/Th/Fr/Sat)
• Mound On-Ramp
  • KPI’s Return to Pitching template will be followed. Below is an example of what that mound progress would look like (we can adjust based on his arm strength and recovery levels)

Week of May 9

• Throw Days – M/Tu/Th/Fri 
• Tuesday – Bullpen at 60-70% (20 pitches)
• Friday – Bullpen at 70-80% (20 pitches)

Week of May 16

• Throw Days – M/Tu/Th/Fri/Sat
• Tuesday – Bullpen at 80% (25 pitches)
• Saturday – Bullpen at 80-90% (30 pitches, 2 rounds of 15 pitches)

Week of May 23

• Throw Days – M/Tu/Th/Fri/Sat
• Tuesday – Bullpen at 90% (25 pitches)
• Saturday – Live AB’s (20 pitches)

Week of May 30

• Throw Days – M/Tu/Th/Fri/Sat
• Tuesday – Bullpen at 90% (25 pitches)
• Saturday – Live AB’s (30 pitches, 2 sets of 15 pitches)

Week of June 6

• Normal Weekly Throwing Template
• Live AB Throwing: 2 innings (40 pitches max)

Week of June 13

• Normal Weekly Throwing Template 
• Live AB Throwing: 3 innings (50 pitches max)

Results

The pitcher returned to pitching in mid-Summer.  After 2 in-game sessions where we continued his on-ramp, the pitcher saw a velo jump of 4 mph and the pitcher subsequently shifted his focus.  He is now completely healthy, throwing well, and on-pace to have a major impact on this Spring of 2023.