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On this episode of the sports physical therapy podcast. I am joined by my good friend and mentor Kevin Wilke, Kevin C associate clinical director at champion sports medicine and the director of rehabilitation research at the American sports medicine Institute in Birmingham, Alabama, but Kevin likely needs no introduction. It's probably one of the most published clinicians and always traveling to speak at seminars and conferences. On this episode, we're going to discuss the current state of baseball injuries. And how they've evolved over the course of our careers.
Mike:Hey, Kevin, how's it going? Thanks so much for joining us on the podcast.
Kevin:Yeah. It's going great. Mike. It's certainly a pleasure to be with you this morning and I hope you're doing.
Mike:Yeah, no, thanks so much. And I'm, you know, I'm excited about this episode, obviously, you know, you and I, um, w we've said that kidding around a few times, but you and I have some pretty cool conversations on the phone or when we see each other at a meeting, uh, about some of the current states of baseball injuries. And, and we've always said, wow, we should just record this conversation. I bet you, a lot of people would want to hear it. Well, this is what we get to do now with the podcast. We get to record our conversation right
Kevin:Sounds good. Let's let's uh, let's get into it. Yeah. We certainly have had some conversations, you know, as it says, all evolved through the years and really a much has changed rapidly in the last five or seven.
Mike:Right. Yeah. I completely agree with that. And I liked that you use the word rapid there too, because you're right. It is it's the evolution is, is happening at a pace that we're just, You know, it's, it's kinda mind blowing what we're seeing. As I look back over the course of my career itself, I always think, wow. Like some of the injuries that we used to see 10, 20 years ago are a lot different than what we're seeing today. Right. And I'm sure you've seen that. Um, I think maybe sometimes you take for granted the diversity of the types of injuries that you probably see that, you know, when you. I don't want to say exclusively, because I know you work with more than just baseball players, but when you have such a strong niche towards baseball players, um, you get to see so many different types of things evolve over the years. Uh, why don't we start with that and kind of talk a little bit about. you're kind of perspective of even, you know, generationally from the nineties to the two thousands to the 2000 tens. But you know, what we used to think was pretty common 20 years ago. I think we're seeing less common. Now. Can you maybe start with that and talk about how injuries evolved over the course of your career?
Kevin:Yeah. You know, uh, you're absolutely correct. You're a hundred percent correct. And, uh, unfortunately I can go back to the eighties late eighties where everything was related to, uh, what Dr. Jobe has taught us, uh, the shoulder. Kind of this hypermobility of the Earl Orel Hershiser type of syndrome, if you will, uh, where his shoulder was loose and, and couldn't, you know, couldn't pitch and, and this and that. And we always thought, well, because of this hypermobility that makes them really good athletes. And if they have a problem, it's, it's always the shoulder and all that has really evolved. You know, when you think about it today, the injuries I see in the current. Are usually overused related to the shoulder and kids. And the other thing we're seeing related to the shoulder is not so many problems that go to surgery. I mean, I can't remember the last thrower that had shoulder surgery, whereas in the nineties, that was the surgeon. Nobody operated on the elbow. The elbow is kind of tendonitis and the shoulder was, you know, there's hypermobility and you know, you got to get it tightened up and, or I'll slap, right. When's the last time you saw slap repair? I mean, I can't remember an overhead athlete. Seriously. I go to meetings and I talk about that. And then I know people are still doing slap repairs and throwers, but it's an adaptation. And it took us 10, 15 years to evolve. Now we're seeing these like blowouts, we're seeing lat strains and lap tears and, and certainly elbows UCL injuries. And, you know, in the eighties and nineties, that was unheard of. I mean, when I think back on my career here with Dr. Andrew starting in the late eighties, 89 90, I mean, there was probably 12, 15, UCLS a year
Mike:yeah.
Kevin:Mike on a daily basis
Mike:that was yesterday.
Kevin:We see five or six UCLS a day that just had surgery five or six a day. You know, the record here is Andrew's one time did 12 in one day. Um, that's crazy. And it's just because I think. The velocity has been the game, so to speak. And you've taught us a lot on that. The way the training is it's all changed the weighted balls and distance throwing, and there we're seeing more blowouts instead of the ligament, just kind of stretching out and not working. I mean, now there's like full thickness tears in the UCL,
Mike:Right. Even in youth and younger kids too. They're you're seeing these bigger, these bigger chair instead of the chronic, a wear and tear. It's, we're even seeing traumatic blowout type injuries in the young kids.
Kevin:Yeah. Yeah. Last week we had two 14 year olds that had. Uh, reconstruction one had a reconstruction, one hand internal brace. So it's all changing, you know, to your point. And, and it's dramatically changing. It's not like this slow process. It's just boom, like five, seven years ago. If we look back on what changed five, seven years ago. And it's probably in my opinion, probably the way we're training and the velocity.
Mike:Right. And, and, and I think some of the concepts of what we do in the off season, just in general, and I don't know if it's one specific thing, everyone's always trying to blame it on one thing. Right. We've done research on weighted balls. Like, you know, we used to talk about long toss it's, it's probably, you know, nothing in and of itself is evil, but when you put it all together, you have to start looking at the patterns and scratching your head and say, what are we doing wrong?
Kevin:Yeah. And also, you know, also, you know, as we've talked about numerous times in meetings, this whole issue of specialization, you know, those 14 year olds that were in last week, uh they're from, you know, one was from California, actually. One was from the Northeast up in Maine and, uh, they just played baseball. And when I asked them to play another. And they look at you almost like nowadays, you know, high school kids, coaches don't even allow them to play another sport. Right? So if they're, if they're a baseball player, the coach forces them to specialize at a young age and get an off season program to throw, see a performance person. And you hope that that performance person is on target. With what should be done in the off season? A lot of times it's not as you well know I'm on social media. And sometimes the reason I am is because I'm catching what my patients are doing
Mike:Right.
Kevin:when they're not here.
Mike:Yeah. Right. Absolutely. Um, You know it's funny, you mentioned that in, in like the nineties and so the shoulder was the big thing I remember. So. Those those really big things that I don't think we've seen in decades now, but remember like rotator cuff repairs in baseball pitchers, like, like that's just th th that to me, that's a, that's, that's a sign that we've evolved from players getting into. Thirties, right. Maybe mid thirties and starting to show that degenerative changes that you wonder, are we not having things like rotator cuff tears or, or more of those degenerative things? Just because we're blowing out so much earlier that we don't have an opportunity to slowly degenerate like that. Um, you know, what, what do you think about that? When's the last time you've seen a rotator cuff tear or even more so a repair in a baseball player
Kevin:Yeah, repair wise, uh, you
Mike:and
Kevin:Dr. Andrew still talks about it, that that's the, you know, that's the mother of all of all injuries. The granddaddy, I think, is what he actually calls it, the granddaddy of all. But I think to your point is you have to last long enough for this to wear out and probably your elbow will go for. Um, at least in my opinion, but you know, I think, you know, some of that is just natural, you know, thinning of the cough, if you're at it long enough. Um, but you're right. I mean, we've learned the hard way when I say we, I mean, all the healthcare professionals, but particularly orthopedic surgeon is don't operate on a slap. That's an adaptation. The peel back occurs from the arm being back there. The cuff is going to thin. Leave it alone. Uh, do do some, you know, recovery things where after they throw, do some rehabilitation, try to get some tissue, changes, nutrition, all those things factor in, leave those things alone. Because if you, if you mess with them, they don't do well. Postoperatively. The success is very, very low and we've learned that sometimes it just takes time. Whereas these elbow injuries we use. I think that's a different story. Um, when your, when your ligaments stretched out and you're in that late cocking, early acceleration phase, um, it's really tough to deal with that unless you really change your pitching style.
Mike:So do you think we have seen less shoulder surgeries because, um, maybe are we treating shoulders back? Uh, preventatively. Are we, um, just realizing that maybe some of these injuries are a normal occurrence or do you think, like we're just, we're seeing the same types of injuries. We're just realizing that maybe we shouldn't do surgery on all these things. Are we really evolving to different injuries? Or if we just learned that maybe we overtreated them in the past.
Kevin:Yeah, that's a tough question. I don't really know the answer to that. Um, I think what you said is all true. I think it's all the above to a degree. I think, you know, when somebody has thinning of the cuff now, I think, and they have symptoms and they get an MRI. Uh, many times a physician will say, well, we're going to shut you down. We may do PRP or stem cell. So there's a few other options available today that weren't before. So they may try that course and maybe allow that athlete to rehab for a while. I think we've gotten better. With our rehab for those problems. And I think the physician also has realized a rehab is the best option, because if they, I do operate on them, they have a very, very low rate of returning. I think the other aspect is I think you hit it on the head. I think we're just better at training these individuals. So I think, I think you got a better shot at training, a shoulder than an elbow,
Mike:Right.
Kevin:and I think it's just the name.
Mike:and it's a different injury.
Kevin:and the, and the biomechanics that happens when you throw that you're going to stress the heck out of your meal elbow and the higher the velocities go. The more stress it is, we're at the shoulder a little bit more bulk. You can work on dynamic stabilization, proprioception, good body position, good mechanics. And I think, I don't think you can change them much at the elbow.
Mike:Right. Right. And I mean, when you, when you heard a ligament and in the ligament becomes, uh, let's just say, even if it's not torn completely right. But a partial tear, but let's just say it's insufficient at doing its job. It is what it is, right. I mean, there's not much you can do at the elbow at, at the shoulder. It's that balance where they all tend to have poor static stability. It's how do we maximize their dynamics to build.
Kevin:Yeah, no, I totally agree. And it, you know, we can maximize dynamic stabilization of the shoulder. We can change things, but at the moment, I'm not quite sure we can. I mean, we've got the flexor pronator muscle mass over it. That certainly helps a bit, but you're in such a bit curious situation years ago here at the American sports medicine Institute. When you were here, we did some studies and basically showed in the lab that if you threw maximally, every time you threw, you should tear your UCL. The forces are that great reason. You don't tear UCLS muscle absorbs some of it and bone. So you can tell if your F your, you know, your arms fatigue. You know, maybe, or you don't have the, quite the strength that you did, you know, before later in the season, more stress is going in the ligament and to your point, it becomes insufficient. I think that's the best way of thinking about it. I think that's an excellent point instead of like an ACL that blows out this ligament becomes insufficient and nine out of 10 people, 99% of the time there, they come to have surgery because they have pain.
Mike:Right?
Kevin:Right? Most of the ones that I see here. About 50% have a ridiculous symptoms that all adage that you get numbness. Because I think today people pull the trigger faster. I got elbow pain. I've had it now for three starts. I'm not getting over the hump. I got to see a doctor to get an MRI. They show the ligaments a little bit torn or stretched out. Boom, let's fix it. Cause 95% of these people make it back. You know what I mean? I think that's the mindset people have.
Mike:Yeah, I have a particular minor leaguer now that I've been working with for about probably six or seven years, uh, partial thickness, UCL tear. That's probably slowly evolved for six, seven years. And he's at the point now where his Vilo is down probably five miles per hour. Um, and, and he's. You know, we texted like, you know, weekly, he's just like, I feel great. I have. no pain. I have no issues. What is wrong? And you know, what's starting to happen is he's starting to get some lateral, uh, bony issues, right. More than anything else. And, and that's, that's, that's where you start to say, like, you know, look, it's, it's great that you don't hurt, but it's pretty clear that your ligament is not sufficient. It's just not doing its job. And then your body has this leg, governor switch, right. It doesn't let it go full effort if it can't stabilize those traumatic forces. Right,
Kevin:Yeah, totally agree. And you see stuff lateral, every once in a while, we even see that the ligament starts to calcify. Right. And when the calcification occurs, you know, this has been going on for awhile. I've seen a couple recently where they went in to have surgery and I saw the x-rays and I'm like, holy macro, you know, half the ligament is calcified. And, you know, you talked to the physician physician said, yeah, you know, this person's had problems for you. On and off, he talked to the athlete and I'm like, yeah, I had a little bit of elbow pain. So some of these individuals can tolerate it. And one that I'm thinking of now is a high velocity guy, you know, he's a 98 guy and he was able to put up with it for several years. Now, the problem is, you know, they reconstructed it, but. On ligament. You know, a lot of times people don't realize it. They don't take that ligament out. Right. They put the graph on top of your own ligament, and that can be a little bit of a pain generator when your ligament is not good underneath because of calcification or whatever.
Mike:right. Yeah.
Kevin:I think that's why some people have problems with throwing programs later, they'll say, well, and you start thinking the worst. Sometimes it's just, you know, just the step you got to go through.
Mike:So, you know, earlier in my career, um, you know, I think if I were to say, who is a Tommy John candidate, it was probably somebody in there, you know, low to mid 30. Right. And they've had that chronic wear and tear on their elbow. Now we're seeing it even in high school. Right. It's just getting younger and younger and younger. Um, how has, how are those injuries changed from your perspective? Not so much in maybe like what it looks like on the inside, but maybe, maybe how they got into that mess. What's the difference between now and 20 years ago?
Kevin:Yeah, well, you know, I make a point of, uh, all of us here, my fellow, my PT fellow, my, my trainer, when we're taking a history on someone that has had an elbow problem, or more importantly, the next day after surgery, we always ask them, how do you think this has. W what do you do? Do you do weighted balls? What, how high do you go? How often do you do it? Do you do long toss? How far do you go? What do you do in the off season? And what do you think contributed to those injuries? So we make a real point. Now, again, this is anecdotal. I don't have any stats in front of me, but I'd say probably like 70%, 80% weighted balls. Long distance throwing. And when I say long distance, I'm talking two 50 and beyond a 250 feet that is and beyond. So I, I don't mean, you know, you go a 180 2 50 summer, even 300 now, granted, they only touch on it. You know what I mean? As you know, but just for the audience we say touch on it, they get one or two throws. They bring it back in. It's just like you got out there now you're coming back in. I still think those one or two have accumulated with. Um, I think the weighted balls, if not done properly, uh, not done under supervision, uh, not done in a right dosage can lead the problems as you taught us. I mean, you've done two classic studies on this that everyone should read and maybe even reread to pick up more info. Uh, but I think the weighted balls I do it, you know, I've been doing plyo since 96. Uh, what am I saying? That was a paper that came out of 93. I've been doing plyo since like 91,
Mike:I was going to say yeah, before that.
Kevin:right. 90, 91. Um, so we started doing plyo throws long before anybody else. Um, when I was in Chicago and that. Yeah, I actually, yeah, even the right, even before the nineties actually would Vern better with, with the white socks. But, um, but anyway, um, I think it's just different today. I think kids think more is better. I think they're very highly motivated. Their intentions are good and sometimes it gets off, off target sort of like that parent that's a coach, you know, they lose perspective sometimes.
Mike:Yeah, I mean, and there's a lot about it, you know, the business of sport now and you know, I've, I've two young girls that are in the middle of it. So I I see it every day with not only just town sports, but travel sports and paid programs that I see it, but you know it to me it's it's, it goes back to what you said about. Right. And I always try to do this, uh, this conversation with the kids and the parents. And it's kind of funny. It shows you that some of the efforts that we did, you know, 10, 20 years ago with education are working and some probably aren't, but I always ask the kids I'm like, would you. Would you throw a bullpen three times a week, all winter. Right. And I let them sit on it for a second. They're like, no, no, definitely not. I'm like, why not? There's like, oh, that's like, this is way too much. I can't do that. That's way too stressful. And I'm like, well, you know, long toss and weighted balls are probably equal to, if not more stressful than that. And you're doing. Four or five times a week, all winter and it's mind blowing to them. Now they think that these training methods, if you're not pitching off, her mound are essentially like free stress that they can apply to their body. It's crazy that this is the current generation.
Kevin:Yeah, I totally agree. I think that's a great, great point. That's a great way of explaining it to that young person, because they think the only way they're going to stress their arm. a high, stressful situation, you know, max velocity, high stress, but training is different. I can train. It's sort of like a weightlifter that thinks they can lift heavy each day as they get older. And they realize as their body starts to change, I got to make changes in my lifts. And I've always used a weightlifter as my analogy that as you mature, you get smarter. You know, now weightlifters, bodybuilders, they use lighter weights. They use BFR stuff like that together. Get enhancement instead of beating up their joints because you just can't do it. Same thing with throwing.
Mike:Yeah. And, and, and you try to stress that to them. And I don't think they understand it at first, but you know, it, I feel like we're always battling against these themes on social media that are just misinformation and, and probably harmful to, to some of this long-term development in our athletes. But you know, like a good example that I'd love to get your thoughts on here, as they say. You take time off from throwing your you're actually decreasing the capacity of your body to be able to handle throwing it. And maybe we're having all these injuries because we're throwing too little, which is, I know is insane to you. And I, because we see these injuries every day from the people that are doing too much, but, but what do you say when people say that? Well, I feel like I need to do that much throwing. so I could build a capacity in my ligament.
Kevin:Yeah. And I tell them that there's other ways of. Uh, you don't have to throw to strengthen a ligament. You don't have to throw or do a weighted ball to be able to get stronger, increased philosophy or transfer energy. So we try to show them other ways of doing it such as plyometrics, because I think plyometrics is a little bit more controlled type of stress. As long as you keep the, um, the, the. Under control that they don't try going too heavy with, uh, you know, one hand throw. And I think you can control your dosage and it's, they don't need a lot of equipment. Right? You can get, apply a ball, throw up against the wall, or you get a rebounder if they're really into it. But it doesn't seem to be as much stress as some of these other ways. And we haven't seen like what you pointed out in your one study in the journalist sports health with the change in motion. I have not anecdotally seen by doing pliers. These changes in.
Mike:Exactly. Right,
Kevin:I mean? And I think because they're not throwing quite as the effort, isn't quite as high.
Mike:right, right. I
Kevin:A couple of studies.
Mike:Yeah,
Kevin:Yep. Yeah. A couple of studies have been done right with Rafael's chameleon, myself, publishing medicine, science in sports that basically showed if you did plyometrics, you can increase. You can increase velocity about two or 3%. If you did exercise, you can increase philosophy by about 2%. Now it's not sexy. It's not cool. It's not as much fun. I get it. It's tedious. And, and, and in all fairness, you know, some of that might just be, as you get older, You know, even in the months you get better at throwing and your boss, you went up. So 2%, isn't a lot. Whereas weighted balls is what, four, 4.5 as a rural. Um, so I think there's other ways of doing so I try to explain that to them. And I think some get it some don't, some are gonna have to learn the hard way. I think the other point, Mike, and I'd love to get your input on this is I think having the surgery now, the TJ is almost like a badge.
Mike:Right.
Kevin:You know what I mean?
Mike:Yeah, for sure. Yeah. I, there's a certain group of people that look forward to it and then I go, oh, thank God. I got this out of The way. Right. Or, or, you know, or maybe it's timed appropriately. But, um, yeah, it's, it's, it's certainly changed where people think it's inevitable and what a shame. Right? What a shame we got to the point where we say like, look, just train so hard that you blow out. It's inevitable. Yeah. That's not true. It's not inevitable. It's inevitable if you train like that. Right,
Kevin:Yup. And I think too, is that when I meant by a badge, is it, it means that I'm. Good. If I had that surgery, I must be a good pitcher because the big leaguers are having it. Look, I got it too.
Mike:right,
Kevin:Before it was, you know, 15 years ago, 20 years ago, you had a TJ, you were kind of freaking out. I had surgery. Am I going to make it back now? It's very nonchalant. As you mentioned, it's I got it out of the way. A lot of them still think they're going to increase velocity as a result of having the surgery.
Mike:Well, I know a lot of bad baseball pitchers that had Tommy John surgery. So it's definitely not a congruent with congruent with you have to have surgery to be a good baseball pitcher. I don't know that's a correlation versus causation argument, but, um, but. You know, going, going back to the debate on capacity type thing, you know, I always, I try to explain it where, you know, a ligament is a lot different than a muscle. Right? How do you, how do you build a quad up? Right? Is you break it down to build back up? That's how a muscle recovers and then comes back stronger with a ligament. During a throw when you're working towards failure with each throw. Um, I, I don't think the ligament builds back up the same way. It's almost like it just continuously partially tears. And if you look at the study that came out a couple summers ago, um, showing like ultrasounds of the ligament over the course of a season and off season, it shows over the course of the season in everybody that the ligament gets looser in, in. And then over the course of the off season, if you take enough time off that lacks, that he comes back down and it actually decreases back in size like that, that almost swelling that interstitial swelling goes, goes back to normal. Which to me that might be the most important paper in the last two decades for baseball. And nobody's talking about it because it shows that, you know, throwing again is stressful and that taking a break is needed physiologically on the. Right. So, you know, I am I off base with that concept here that I think a ligament doesn't build back stronger to stress, like when you're working it to max failure every time. And is it different than.
Kevin:Yeah, it's definitely different than I'm also, it's different than attendant. Um, and I think to your point, How do you get recovery of a ligament? How do you tear down a ligament? And whether it's a ligament of the MCL of your knee or your ankle ladder, you know, your anterior talofibular ligament or UC all, I think the principles are the same. You certainly wouldn't take an ankle and, and keep inverting it, inverting it forcefully, and think that's going to be good for the ligament. You, you would probably freak out cause it concerns with ankle sprains. And all you have to do is look at enough ankle. Is once they have a couple bad ones that ligament becomes insufficient, right? A big answer drawers there, same thing at the knee. It takes a long time for that MCL of the knee to become an painful and or non painful, I should say. And also have better stability. I mean, studies from duke that studied MCLs for years and Dr. Fu and Dr. Wu from the university of Pittsburgh basically showed it's like a six month proposition to your point. So load, and I don't say unloading, but controlled load is really important. I think nutrition, I think we've missed the boat a little bit on telling kids what they should do for ligament, health longterm as well. Um, I think in time we'll get better, but I think to your point, the ligament changes due to stress and I think somewhat rest active rest is really.
Mike:Yeah. And, and, and it still boggles my mind that that narrative is being perpetuated online. That, that you, you need to work a ligament to failure to have it build back stronger. It's
Kevin:That's crazy. Yeah. Total, total crazy. You wouldn't do that with an ACL. You wouldn't do it with any other ligament in the body. So why do it at the elbow?
Mike:Right. Exactly. And it's crazy. So, all right. So we talked a lot about injuries, right? And I like, at the very beginning, you said how, what we're currently seeing is a little bit more traumatic in nature. Use the word traumatic, which I really liked. And if you, if you even just go back and think about what we've talked about, a lot of the things we saw 20 years ago, Or degenerative a traumatic wear and tear over time. Now they're a little bit more traumatic. Um, can you expand on that a little bit? Like, what are you seeing now and how do you think your approach to treating baseball injuries has changed over the years?
Kevin:Yeah. You know, as I mentioned, I see, you know, years ago we never saw last strains. Um, and let tears now, you know, you see. A lot of labs and some of that is straining and some of that is actual throwing. Uh, but I think, I think we probably see because of a combination, um, the kind of the blow outs at the elbow, so to speak, um, those are probably the big ones. I mean, I, you still see some shoulder discomfort, usually in the high school kid, what you see is kind of front and back. It's kind of that looseness type of thing. And it's usually due to kinetic chain, you know, weak, we kept weak legs, poor. Bad transfer of energy hypermobility in the scapula. That's kind of what we normally see in like a high school, lower level thrower. I say lower level, just hasn't quite reached their peak. I don't mean, you know, skill level, but I mean, physical maturity, um, as they mature, I think they get a little bit better, but as they get in college and, and the elite, that's where we start seeing them, my macro traumatic, whereas everything before we thought about it was micro. The macro was the football injury, you know, the tackle, the shoulder dislocation, lacrosse injury, and, and, you know, again, Dr. Joe would always say, you know, it's always micro instability, micro, traumatic injuries, overhead throwers. Now I think it's changed a bit
Mike:Yeah. And you think that's because of all this max effort training, is that what you're saying?
Kevin:max effort. 11 months, 12 months. I mean, if they do 11, I'm really happy actually, they're doing, they're doing 12, they're doing 12 months because they're afraid to take time off. Uh, and the reason they're afraid, right, is they're going to lose velocity or their coach is going to get upset or their performance trainer, you know, has them committed into doing things in as in a schedule, which is great. I get it. I love schedules. I love, you know, year round exercise, but it just has. Periodization, you know, periodization and changing the formula based on what, the time of year you don't have to fall. Ball drives me crazy. I gotta tell ya.
Mike:right.
Kevin:Fall ball. I don't get it.
Mike:Yeah.
Kevin:What's the advantage of fall ball?
Mike:Uh, well, there's fields out there and if they're not rented the not monetized and so we have to rent the fields. Well, you know what they're doing? You know, it's funny. We talk about this in baseball, but I think hockey is way worse right now. I'm up in new England. So it's different down there, but these kids are skating 11 months out of the year. I do not know. See What their hips look like, but you know why they do that for you? If you want to run a hockey program, you said like, Hey, can I rent the ice X times a week? This winter, they say sure. But you also have to rent it the fall and the spring and we won't rent it to you. So then if you rent it, you have to then do practice. Right. And then you have to skate and then it's, it's, it's this evolving thing. But, you know, it's,
Kevin:But, you know, the model that people should consider is football a little bit, because what's happened in football until two, three years ago, spring and summer. There was no control. I mean, there was contact, there were three a days now, even if the college ranks they're limited to their exposures and the reason they're limit is because people were dropping like flies. What do you, what do you want contact in football? Like in spring and. You're just going to beat up your body and then by the time fall comes, you're not ready. Again. That's collision sports. I get it. But to your, to your point with hockey, as well as baseball, your body needs some recovery.
Mike:Um,
Kevin:It just can't withstand that beating. It's just like weightlifting as well.
Mike:Right. Yeah. Everything for sure. And as you get older, you, you need that recovery time even more. But, um, have you noticed this, you know, I think, uh, pitching is, is sexier online. Like people like to train pitchers and, and, uh, show what they do for pitchers, but I think the hitters are. Just behind the pitchers in terms of like trying to change their training and what they're doing now, and everybody's focused on exit velocity. Right. And rightfully so. Right? The harder you hit the ball, the greater your chance of getting a hit, right? So exit velocity, launching all these fun things. You know what? I'm starting to see more and more this last year or two is we're going back to batter shoulders. So posterior instability from all this max efforts. All of the swinging that's happening in the winter now. Cause you can't, you can't take any time off. You have to be just reworking on this exit velocity all the time. Are you seeing that too? Or is that just something we're seeing up in new England?
Kevin:No. I agree. Yeah. I have two kids right now that have struggled to, they've kind of dealt with it at the school level. One's in high school, one's in college, but they almost have the same type of mechanism, not only shoulder, but that kind of rib scapula, you know, lack kind of problem in their lead shoulder, just from all the swings, all the swings and, and doing, as you mentioned, velocity training for bad speed.
Mike:Yeah. So it's always just how hard can I swing over and over for for months? And it's that's, That's not what people used to do in the winter. That's that's changed too.
Kevin:Yeah. I think if we change, you know, what's worked for me. Uh, I'd love to hear what you've done with those is obviously calmed the tissue down soft tissue work on mobility, mid, mid back kind of mobility, but I've gone to more pliers with those people to hand throws and things like that in the old, you know, kind of getting their hips engaged because I think they're so quick to kind of. Segmentally rotate with a bat, which is different than pliers. Um, and it's worked pretty well. Have you done similar
Mike:Yeah. I mean, same, same concept with the rehab concept. I think the bigger thing for us just, just comes back down to workload management, like over and over again. And, you know, I, I think the majority of players that we see with us, they tend to be like middle infield or centerfielder type people that they dive a lot. So, you know, it is what it is. They probably have some instability. I think what it shows you is that either they're doing too much. Um, or they're fatiguing out their dynamic stabilizers, and then it's just, it's just not, it's not going well. Right. And, and what happens with a hitter? If they're in a slump, what do they do?
Kevin:More hidden
Mike:Of course. Right. And, and it's so, I mean, let's do some early hitting tomorrow and some late hitting tomorrow. Right. Let's just keep going. But, uh, it's, it's crazy what they do. Um, and, and I wish they just knew that they're probably not swinging well because they're tired and they're not stabilizing. So,
Kevin:Yeah, no great points now. I totally agree.
Mike:Um, I know you got to go. I know we got just a few short minutes. I want to get to our high five, but I got one quick question. I want to ask. We had Dr. Dugas on recently for a podcast episode, you talked all about the UCL internal brace. I know you've probably rehab it, rehab more of those than anybody else. Can you just quickly just mention, like how how's the internal brace procedure going from your perspective as, as the rehab clinician and. Is this becoming the new gold standard or, or where do you think we are?
Kevin:Yeah. You know, I based it on. On several things. I based it on, you know, the first couple I saw kinda my mindset, but also the opinions of other physicians who were more skeptical, perhaps. So for me, I am, my nature is to be a little bit skeptical, a little bit cautious and then move from there. Uh, the physicians who jumped on the internal brace right away, they were very excited about, you know, shaving time off the back the pitch in five to six months. And, you know, I came from. You know, the reconstruction and nine months beer type of mentality. So I was like, wow, half the time. It's kind of freaking me out, uh, to be able to throw, you know, some people say throw it three months or even 10 weeks. It's just, I'm still trying to wrap my head around that. So generally, you know, for me, Really surprised. And I probably shouldn't say surprise, but I'm delighted and surprised how well these have done actually. Um, they've done a lot better than what I anticipated. Um, I think it is about 93. 95% success rate. I know some studies are a little bit less than that, but I think if you do everything right, and let me even go out on the limb and say this, if somebody did the protocol correctly and you slowed them down just a little bit and told them that look at the big picture and not how fast you can make it back. I think you can get up to the 97% success
Mike:Yeah. Wow.
Kevin:Now longevity is another issue with that. I don't really know. Uh, but it appears that they last some of the physician, friends of mine that deal with baseball almost exclusively were resistant in the beginning. And they're kind of the, kind of. They're kind of into it a little bit now they think there's a place for, so I use them as a barometer as well, just because I don't want to look at the world through my eyes only. I want to know what you think and what some others, I don't want to mention names, but what some others think. And when they start saying, well, you know, it is pretty good then I know it's just not my little world that these people are doing pretty well, but I will say this, the people that do the internal brace rehab, don't be afraid to slow it down in the program.
Mike:right.
Kevin:throw in, look at the big picture. You know, you have surgery in June or July and you don't have to be ready till the spring. I mean, give it some time. You don't, you don't have to be throwing it 12 weeks. You can slow it down and do other things. And you know that I know you've done that same approach.
Mike:Yeah. I, I re I remember when this was early on, we definitely talked on the phone and we were both like, why are we going so fast? Right. Anyway, we were, we were so nervous about it at the, at the time. And, you know, I think the point that, you know, I tried to get across with, with some of these kids, especially if they're high schoolers, right? Like at 10 weeks, I still think they're physical. Not ready because just 10 weeks ago they looked like crap going into surgery. I mean, I, I can't do that much success in terms of building back their strength and all these things after, after rehab in that period. So I'd love to take a longer approach if we can. Um, you know, and I you're right. I, I, I haven't seen any bad outcomes yet. I mean, it's been going great.
Kevin:Yeah. And, you know, some are even doing a hybrid now, you know, which is kind of interesting, but you know, it doesn't speak to just the internal brace, but an internal brace with a reconstruction for some of the more chronic scenarios, like the big leaguers have been around for a long time. So, you know, people need to realize that. I think the other thing, you know, maybe for the viewers to take in is what's going on with ACL's. You know, more and more data's coming out that if you just push it back a little bit. So, you know, I'm a, I'm a six month guy. That was always my target to get you back, at least getting into a practice scenario at six months after it UCA, excuse me, after an ACL now, more and more data has been shown that if you wait eight months, nine months, your reinjury rate starts to drop dramatically. Something is happening. And I think it goes back to what you mentioned about the ligament. You know, there's this ligamentization the ligament has to like college and it matures. There is MRI studies now on ACL's that are looking at six months, nine months, 12 months, 24 months. And they look at. They look different even a couple months makes a big difference. Once you get further out. I think that's true in the UCL as well. I would love to see more cereal. I know we're doing ultrasounds on it because it's superficial and you can get it. And ultrasounds are cheap and easy access, but it'd be interesting to see some MRIs studies of the colonization and the ligamentization of the ligament over.
Mike:Yeah, that would, that would be amazing. Awesome. Well, Kevin, thanks so much. Um, I like to end with a quick high five segment where five quick questions, five quick answers, really just getting inside your head a little bit, showing your growth mindset, that sort of thing. I just think it's, it's a good experience for, for people to hear, but let let's, let's fly through these real quick. First one is what are you currently working on for your own professional development? What, what have, what have you learned lately?
Kevin:Well, I'll try to be quick, but, uh, you know, some of this things that we talked about with training, uh, stress tissue remodeling, uh, some of the newer modalities I'm looking at more force play data now, functional testing in particular, that's a big interest of mine we're changing and probably the biggest area is the cognitive motor.
Mike:Right. Yeah.
Kevin:that's where I think it's at for me is the cognitive.
Mike:Yeah, I love it. I like that. What's one thing that you've recently changed or evolved your thoughts on.
Kevin:Um, probably workload a workload with not only exercise, but throwing, I think your program that you've done with your interval throwing program. I like a lot. I'm trying to get physicians to, to appreciate it better, but workload, especially with the interval throwing program.
Mike:Right. I like that. What's the biggest piece of advice that you like to give your students and fellows that are, that you're working with each day,
Kevin:Uh, open mind, listen, uh, ask questions. No stupid questions. I've asked the most stupid questions just as Dr. Andrews of anyone on the planet.
Mike:I tested that.
Kevin:and, and, uh, you know, the last thing is, you know, I go to meetings all the time and, you know, I w we had our football course last weekend and in Florida, I'm sitting in there and it's just amazing to me. direct about this. How many times people kind of walk out on talks and they, uh, I kind of know the subject,
Mike:Right,
Kevin:every talk I've learned stuff. You know what I mean? There's always, there's always a nugget in there, a perspective. I mean, seriously, it just drives me nuts when people go to meetings and they, they attend hardly any of the talks and they're in the hallway more than they're in the, I mean, the networking is fantastic, but taking the talks, some of these talks are gonna surprise you. So open mind.
Mike:right? And you look in the front row at some of those big meetings. And who do you see? It's like, it's George Davies. It's even Lynn Lynn Snyder. Macklin's was always in the first row. Like when I say, you know, it's, you know, Chuck big bat, those, those are the people that are always up front, you know? And it's, it's interesting. You say that, so that's awesome. Uh, what's coming up next for you. What can we, what can, what can we expect from.
Kevin:Yeah, I'm going to say, uh, you know, um, I'm trying to change the way we do functional testing. Um, both upper extremity, because obviously, probably a lot of people on this podcast are into baseball because of your expertise and so forth, but we're doing a lot of the cognitive motor testing. And I'm even doing it with throwers in my UCL. So they're in a high plank. We use the blaze pods and not only are they just reacting to the lights, but we're making you react with extremity corresponding to a light, if that makes sense. So a higher level of function. So you got to process react and move properly. The only challenge is, you know, we're doing some of these in a high plank. Some of them we're doing up against the wall. I want to get it more throwing specific if you know what I mean. Yeah. But right now it's more stability and body position specific. It's just not throwing specifics. So we need to talk on the phone and in person and figure this out together because it'd be really cool to have, especially for the young kids, reactive testing, to see where they're at from a, from a neuromuscular standard.
Mike:For sure. Yeah. We've learned so much about the ACL. We had to start applying that to the, to the shoulder and the elbow for sure. Um, awesome. Well, great stuff, Kevin. Um, for those that don't know, Kevin obviously, uh, has a bunch of educational content out there. Uh, he's on Instagram. Uh, you're doing, you're still doing a ton of. Those free zooms, where you're doing all these great educational content. That's out there for everybody that people really need to be taken advantage of still traveling all around the country teaching. But where can people find out more about you? Where's the best place to go to learn about Kevin?
Kevin:Yeah, probably the best place to go is Instagram. Uh, just my name, Wilke underscore Kevin. I try to post some of the seminars that we're doing and the grand rounds. Mike you've been on the grand rounds. We've got some really good experts in various areas and it's a free, um, I want to say hour, but it usually goes a little bit longer than that. Uh, probably about 90 minutes and, uh, it's great. It's interactive. We get you to participate doing live seminars, still through a Northeast seminars, and certainly try to speak at national meetings as well.
Mike:Awesome. Yeah. And, you know, be sure to check out Kevin, if you're at a big conference that he's speaking at, you know, obviously make sure you attend his session, but, uh, his seminars are, I mean, they're, they're top notch and they're some of the best out there. If you want to, you know, dig in deep on the knee and shoulder, be sure to go into, uh, one of his sessions. She's coming near you. So, uh, Kevin, thanks so much for sharing your vast experience with overhead athletes with us.
Kevin:That's great. I appreciate it. Mike had a fun time flew by and thanks so much for what you've done, uh, with our profession. Uh, certainly I would encourage you to continue your research and your guidance, not only in baseball, but just training and rehabilitation as well. All this stuff you put out there is super high quality and really appreciate it. It's a great contribution to our.
Mike:Well, awesome. Likewise, thanks, Kevin. And I'm sure it will have to get you on a future episode and we'll, we'll talk more. We can, we could've went for hours.
Kevin:Sounds good, buddy.