Shock Injuries: When the body isn’t prepared for what comes next.

Shock Injuries: When the Body Isn’t Prepared for What Comes Next

For years, we’ve heard about the “arm injury epidemic” in baseball.

And for years, a huge portion of the blame has been placed on overuse.

Throw too much. Pitch too much. Play too much baseball. Eventually, something breaks.

There is certainly truth to the idea that excessive workload can contribute to injury. But I think we’ve become so focused on overuse that we may be overlooking another problem entirely.

In some cases, I don’t think athletes are getting hurt because they’ve done too much.

I think they’re getting hurt because their bodies weren’t prepared for what they were suddenly asked to do.

I call these shock injuries.

What Is a Shock Injury?

“Shock injury” is simply the term I use for an injury that occurs when the body is suddenly exposed to a level or type of stress it hasn’t been prepared for recently.

The higher the intensity of the movement—and the longer it has been since the body performed that movement—the greater my concern becomes.

For a baseball player, the obvious example is throwing a baseball as hard as possible after barely throwing for an extended period.

But it isn’t limited to throwing.

A hitter who hasn’t swung a bat in three months and suddenly takes 100 max-effort swings can create the same problem.

So can the 40-year-old who has spent the last decade sitting behind a desk, decides basketball will be a fun way to get back in shape, and immediately starts sprinting, jumping and changing directions at full speed.

His cardiovascular system might survive just fine.

His Achilles tendon, hamstring, knee or ankle may have a different opinion.

The body doesn’t particularly like surprises.

The Problem With “Shocking the Body”

For some reason, the fitness world has spent years making “shocking the body” sound like a positive thing.

Muscle confusion.

Weed-out workouts.

Random brutal conditioning sessions.

Do something completely different and incredibly difficult because the body isn’t expecting it.

That might make for an entertaining workout, but athletes aren’t exercising simply to exercise.

They have to perform.

If someone with a normal desk job does a ridiculous boot camp workout and can’t perform at his physical maximum the next day, nobody notices.

If an athlete can’t perform at his physical maximum, that’s a problem.

And sometimes the consequences don’t show up the next morning.

That’s one of the most important things to understand about noncontact injuries.

Injuries Don’t Always Begin When They Happen

We tend to blame whatever an athlete was doing when an injury finally became obvious.

A pitcher grabs his elbow during a bullpen.

A hitter strains an oblique during batting practice.

A player pulls a hamstring while sprinting.

Naturally, we look at the activity happening at that moment and say:

That’s what caused the injury.

Maybe.

But not necessarily.

Think about a tire blowing out while you’re driving down the interstate.

Unless you hit something in the road, you don’t assume that particular stretch of highway single-handedly destroyed a perfectly healthy tire.

Maybe the tire was worn.

Maybe it had been slowly losing integrity for months.

The road you were driving on when it finally blew was simply where the accumulated problem became visible.

The same concept applies to many noncontact injuries.

The final throw, sprint, swing or change of direction may simply be the straw that broke the camel’s back.

The process that created the injury may have started days, weeks or even months earlier.

That’s one reason I’m not a fan of “weed-out” workouts, particularly when athletes are returning after a period of inactivity.

You may survive the workout and think everything went great.

That doesn’t necessarily mean you didn’t set something in motion that becomes a problem later.

And no, destroying athletes during a conditioning session doesn’t magically create mental toughness either.

Your Body Is Prepared for What It Has Recently Endured

One of the concepts that helps explain this is Davis’s Law.

In simple terms, soft tissue adapts to the demands regularly placed upon it.

My much less scientific translation is:

Your body is prepared for what it has recently endured.

Your body has a surprisingly short memory.

It doesn’t care that you threw 90 mph six months ago.

It doesn’t care that you used to squat 500 pounds.

It doesn’t care that you played basketball every day when you were 22.

If you haven’t exposed your body to those stresses recently, you shouldn’t assume it’s still prepared for them.

This is especially important with throwing.

Your arm doesn’t have deductive reasoning skills.

You can know perfectly well that you’re going to pitch Saturday.

Your arm doesn’t.

You can’t tell it:

“Hey, we’re busy this week, so we’re not going to throw much. But don’t worry—we have a district game Saturday, and I’m going to need you ready to throw as hard as possible.”

Physiologically, that’s not how this works.

Your body only understands the stresses it has recently experienced.

Remove a stress long enough and the body begins adapting to its absence.

Then suddenly reintroduce that stress at maximum intensity and you have exactly the situation I’m talking about.

A shock.

Rested and Prepared Are Not the Same Thing

Eric Cressey said something years ago that has always stuck with me:

There is a huge difference between being rested and being prepared.

I think this is where we’ve gotten ourselves into trouble with throwing.

We’ve scared parents, coaches and athletes so badly about arm injuries that the pendulum has swung too far in the opposite direction.

Some athletes barely touch a baseball unless they’re pitching.

They may play catch once during the week, do almost nothing else, and then climb onto a mound Saturday and throw at maximum intensity.

They’re certainly rested.

But are they prepared?

Those are two very different things.

We’ve created this idea that an arm has a limited number of throws in it, like bullets in a gun, and every unnecessary throw uses one up.

I don’t believe the body works that way.

Throwing itself is stress, and stress has to be managed.

But avoiding stress entirely doesn’t prepare you to tolerate stress later.

That’s the distinction.

The Throwing Intensity Pyramid

I like to picture throwing as a pyramid.

At the top are your highest-intensity throws:

Pitching.

Max-effort long toss.

Velocity work.

High-intent bullpens.

There should be relatively few of those throws.

But underneath them should be a huge base of low-intensity throwing.

That’s where I think many players get this wrong.

They think:

“I threw hard yesterday, so today I shouldn’t throw at all.”

I would rather hear:

“I threw hard yesterday, so today I shouldn’t throw hard.”

Those are not the same thing.

If you’re a healthy, properly prepared pitcher, low-intensity throwing helps maintain the base that allows you to tolerate higher-intensity throwing.

You can’t build that base with one massive throwing session.

It has to accumulate over time.

Small exposures.

Repeated consistently.

Success by a thousand check marks.

Throw Every Day Doesn’t Mean Pitch Every Day

This distinction is extremely important.

When I say an athlete needs a large base of throwing, I am not saying he should throw as hard as possible every day.

I’m definitely not saying he should pitch every day.

You have to manage stress.

A properly prepared pitcher’s week should look more like a wave than a flat line.

There are high-intensity days.

There are extremely low-intensity recovery days.

There are moderate throwing days where the athlete allows his arm to dictate how much intensity is appropriate.

There may also be an off day.

The mistake is treating every day the same.

After a high-intensity throwing day, I strongly prefer some very light throwing the following day rather than complete inactivity.

Maybe that’s only 20 or 30 extremely easy throws.

They may seem insignificant.

They’re not.

Those low-intensity throws are part of maintaining the enormous base underneath the high-intensity work.

As intensity increases, volume generally needs to decrease.

As intensity decreases, we can tolerate—and often need—more volume.

This Is Why I’ve Changed My Opinion on No-Throw Periods

Years ago, I was one of the biggest advocates you’ll find for mandatory extended periods without touching a baseball.

Eight weeks. Put the baseball away.

I don’t feel nearly as strongly about that anymore.

Not because rest isn’t important.

Because I’ve watched what happens afterward.

If an athlete doesn’t throw for eight weeks, he can’t simply pick up a baseball at the end of those eight weeks and immediately return to high-intensity throwing.

He needs an on-ramp.

The longer he has been away from throwing, the more carefully that throwing needs to be rebuilt.

The problem is the calendar.

An athlete takes eight weeks completely off.

Then everyone suddenly realizes the season is approaching.

His high school or college coach understandably needs him throwing bullpens and preparing to compete.

Now we’re trying to cram months of preparation into a few weeks.

That’s exactly the situation I’m trying to avoid.

I’ve become much more comfortable with no-throw-hard periods rather than mandatory no-throw periods.

There are certainly situations where complete rest is appropriate, particularly when dealing with an injury or medical recommendation.

But for a healthy athlete, I like maintaining some level of very low-intensity throwing so the movement never completely disappears from the body’s recent history.

It doesn’t have to be much.

It doesn’t even necessarily have to involve a baseball.

But keeping some form of the throwing movement present can make the eventual return to higher intensities much smoother.

If Overuse Explains Everything, I Have Questions

Here’s something I’ve thought about for years.

If overuse is the primary explanation for throwing injuries, why do we see so many injuries early in seasons?

And why do relief pitchers suffer serious elbow injuries?

A reliever may not accumulate anything close to the innings or pitch totals of a starting pitcher, yet relievers still suffer UCL injuries.

That doesn’t mean workload is irrelevant.

It means I don’t think total workload alone explains what we’re seeing.

We also need to consider:

What was the athlete prepared to tolerate when the workload occurred?

Ten high-intensity throws performed by an athlete prepared for them and ten high-intensity throws performed by an athlete who hasn’t thrown hard in months are not necessarily the same physiological event.

Context matters.

Preparation matters.

Don’t Let the Pendulum Swing Too Far

None of this should be interpreted as an excuse to throw pitchers on the mound every day.

That’s the other extreme.

We tend to operate like a pendulum.

We decide throwing is dangerous, so nobody throws.

Then we realize under-preparation may also be dangerous, so someone decides everybody should throw hard every day.

Both miss the point.

The goal isn’t more throwing.

The goal is appropriate preparation for the throwing the athlete will eventually be required to do.

That requires managing intensity, volume, recovery and the athlete’s individual response.

It also requires coaches to occasionally give athletes some autonomy.

Not every player’s arm feels the same every day.

Some days an athlete may feel incredible and naturally want to stretch things out.

Another athlete may feel terrible and need to keep everything extremely light.

A rigid calendar can’t always account for that.

Sometimes the athlete has to listen to his arm.

The Bigger Lesson

This concept extends far beyond baseball.

The body adapts to what you repeatedly ask it to do.

It also adapts when you stop asking it to do something.

That’s why preparation has to be progressive.

If you haven’t sprinted, don’t suddenly sprint at maximum intensity.

If you haven’t jumped, don’t start with maximal plyometrics.

If you haven’t lifted heavy, don’t begin with your old max.

If you haven’t swung a bat, don’t immediately take 150 max-effort swings.

And if you haven’t thrown, don’t assume rest has somehow kept your arm prepared to throw at maximum intensity.

Rest and preparation are not the same thing.

The solution isn’t avoiding stress.

It’s exposing the body to the right amount of stress, at the right intensity, often enough that it remains prepared for what you’re eventually going to ask it to do.

The body hates surprises.

Stop surprising it.