Case Study: Applying The Joint By Joint Approach to A Pitcher With Lower Back Pain
Recently I was referred a pitcher who was experiencing lower back pain primarily while pitching. He was having pain with medicine ball throws trying to work on maximizing hip to shoulder separation. During the drill the player was getting into his stride position. From here he would rotate the hips open and then try to counter rotate the shoulders closed. Yes, it has been shown that hip to shoulder separation is something that is utilized by some of hardest throwers in baseball, such as Aroldis Chapman. Chapman is able to generate over 60 degrees of hip to shoulder separation which is well above the MLB average. However, caution must be taken when trying to apply this information to high school and amateur pitchers. These pros have very unique physical capabilities that allow them to do these things. The reality is that the majority of high school pitchers do not possess these same physical characteristics and asking them to try to do this in their delivery without first checking their physical capabilities can lead to decreased performance and in some cases pain and injury.
Do you or your player have the same physical capabilities as pros such as Aroldis Chapman? If you don't move live them, don't expect to throw like them.
While pain and injuries can be due to complex and multifactorial, I think this case highlights a couple of principles and concepts that can be applied to pitching rehabilitation and performance programs.
1. Don’t try to do something that you aren’t physically capable of: If you follow any of my content you have likely seen a variety of screens and assessments for pitching. Some of the screening techniques we use with hitters and pitchers looks at your physical capability to create hip to shoulder separation. The ability to create hip to shoulder separation requires adequate mobility in your hips and thoracic spine. You also need the ability to stabilize the upper half as the lower half rotates and initiates the sequence. If you are significantly lacking in one of these areas, then it is likely a physical issue why you are not achieving the mechanics you desire. This is important baseline information to possess before giving any technical advice or drills to the pitcher. Each player will have their own unique movement and physical capabilities and their technical/mechanical instruction should take that into account. If it’s obvious that the player is lacking in these basic movement patterns and capabilities, then it’s probably going to be more effective to first address those issues before jumping into a technical drill for the issue.
The concept of movement screening and assessment in baseball is relatively new, but is becoming more common and can be very beneficial for coaches to give the most appropriate recommendations and instruction to the athlete. If a player has some limitations preventing them from achieving certain things in their delivery such as hip to shoulder separation, the coach can utilize the other team members such as fitness and medical professionals to help address these limitations. This can allow the player to better achieve the positions the coach is asking and help make their instruction more effective (Click here to read more about the Team Approach).
2. This case also highlights another principle we have about the body called the Joint by Joint Approach. The joint by joint approach of the body was proposed by Gray Cook and Mike Boyle and is a simple way of looking at human movement. It states that “the body works in an alternating pattern of stable segments connected by mobile joints. If this pattern is altered-dysfunction and compensation will occur”. In this model the hips and thoracic spine are considered the mobile joints as they can move freely in all planes of motion. In contrast the lower back is considered a stable segment and should not be the primary producer of movement compared to those other joints. In this case this pitcher's pattern was broken and the athlete presented with limited hip mobility as well as limited thoracic spine rotation. So when he was trying to perform the drill, he was likely compensating with excessive motion from the lower back. When athletes ask an area of the body to compensate for another it can be a recipe for injury. Typically, when an athlete is experiencing back pain they think they just need to do more core work, but this isn’t always the solution as it doesn't address some of the underlying causes of the pain.
How was this case ultimately handled?
From a rehabilitation standpoint we initially advised the coach and athlete to hold off on the drills causing the pain. Once removing the drills that were irritating the players symptoms, the pain subsided quickly. We initially worked on restoring and improving motion in the hip and thoracic spine to help reduce some of the torque on the lower back. We followed this up with exercises that worked on controlling and stabilizing this new range of motion and also worked on building strength and capacity of the body. The athlete was able to return to the full participation without issue.
As mentioned above, Injuries and pain can be multifactorial and have different contributing factors. However it is important to understand the demands of the sport/position and how the body functions during that when diagnosing and treating injuries and progressing to return to sport.