Brachialis Pain


#1

My 13 year old son experiences occasional pain at the distal biceps belly. Upon palpating it appears more tender at brachialis. I’ve read some of the comments regarding elbow height and pronation. I’m hoping to find someone locally who could work with my son’s mechanics and is familiar with these types of injuries, if that is the issue. I live in Covington, Louisiana. When his arm hurts he sometimes has problems even throwing from infield without lobbing it and batting without soreness. Any help would be appreciated.


#2

Charles2,

“My 13 year old son experiences occasional pain at the distal biceps belly. “

Your chronologically aged 13 yo son may be biologically aged 11. if he is you should treat his journey as if he was 11 to plan training and competitive oppertunities. have his biological age assessed. Is he early, delayed or Equated?

Upon palpating it appears more tender at brachialis.

This is a great diagnosis. I have not run into many Medical Dr’s who get this right and normally diagnose this as a biceps injury.

The Brachialis is an Elbow joint flexor and Forearm joint supinator. The much larger Biceps is an Elbow joint flexor.

When your son drives the ball he forearm supinates his pitch types. Because his forearm intuitively flies to the “outside of vertical” both the Brachialis and biceps are not used to extend the Elbow joint, centrifugal force does. When the Elbow joint nears full involuntary extension the Biceps and Brachialis contract to keep the Elbow bones from crashing together ballistically. The brachialis is the weak link here and grade tears.

This is one of the glaring disconnections of the traditional pitching approaches acceleration kinetic chain

“I’ve read some of the comments regarding elbow height and pronation.”

Mitigation comes by changing his pitch types to forearm pronated versions and staying tall and elevating his arm to the highest range of motion that is intuitive to “inside of vertical" performers. This will allow the Triceps to extent the Elbow joint the way it should be.

“I’m hoping to find someone locally who could work with my son’s mechanics familiar with these types of injuries”

Good luck !!! Unfortunately there are only a handful of pitching coaches that understand pitching mechanics to the point where they can mitigate pathomechanical response.

I always suggest fathers take this over themselves. Because you can be immediately effective in understanding what needs to be done and mitigate. Traditionally trained pitching coaches seem to be OK with the injury situation by ignoring this scientific info.


#3

Thank you very much for replying. My son has grown a fair amount over the last year. He is about 5’8” but only 130 lbs. with long arms and legs. I’ve always wondered if a part of his issue is that the soft tissue has not had enough time to adapt to these structural changes that are still occurring. Sometimes when my son pitches his arm looks great, in terms of his speed, and there are other times when it looks like he’s really not throwing it at all and he tells me he just feels like he can’t let it go or it’s going to hurt bad. Can also happen when playing 3rd base. It doesn’t happen all the time but in the worst instances he will hang his arm at the side and says it feels like it’s throbbing and tingling and he can’t really move his arm. The tingling never extends down his arm so I have never considered any type of nerve entrapment. His travel baseball coach who also coaches high school baseball noticed during bullpen that he is not allowing his body to naturally to decelerate after he releases the ball and is almost stopping himself a little short so that he’s in a position to field the ball. He has told my son that at this age his job is no longer to field the ball and that his only job is to throw the ball, so he needs his body to continue to move forward to naturally decelerate so that his biceps is not doing all the work of trying to slow down his arm. I think he’s correct about letting his body naturally decelerate but I no longer believe it’s the biceps and at this point after reading everything I have definitely feel it’s the brachialis. His coach is a good guy and he really loves my son but yesterday he pulled me aside and told me he starting to believe that it is 100% all in his head. For a second there he had me believing that was the case and I can see why considering that there’s no pattern to when this thing is going to happen. He just went about two weeks with no issues after dealing with it off and on for about a month. I will try to get some video of him to post for others to look at who may be better at diagnosing his mechanics than I am. But I have told him that he needs to focus on pronating his forearm when pitching. I didn’t want to try to become my son’s pitching coach but I am worried that what you said is true and they’re probably aren’t too many guys out there you can diagnose pathology based off pitching mechanics or correct pitching mechanics based off of pathology. I just hope I don’t make him worse. I’m not one of those parents who sit around and tell everybody my sons going to play college baseball or become the next great major-league pitcher but I definitely see qualities in him that show me he can be a solid too very good high school baseball player. After that I always tell him consider it icing on the cake if anything else happens. Thanks again for responding.


#4

One last question, if my son’s issue is related to supination at Drive and elbow below shoulder then how do I have him correct this? Other than explaining this to a 13 year old, soon to be 14, are there any drills for this? Thanks


#5

Charles 2,

Thank you very much for replying.

I will always reply to injury relief seeking parents who have nowhere to go as long as I’m allowed!

“ My son has grown a fair amount over the last year. He is about 5’8” but only 130 lbs. with long arms and legs. “

Since the internet use went up there has been a lot of Empirical evidence put forth that while youth pitchers are going thru a growth spurt they should not be competing using an adrenaline assisted ballistic activity. Makes perfect sense ta me!

“I’ve always wondered if a part of his issue is that the soft tissue has not had enough time to adapt to these structural changes that are still occurring. “

This is a fact even if you produce non injurious joint forces!

Dr. Mike Marshal says in a perfect world you would only learn motor skills thru daily Sport specific training until your growth plates solidify at biologically aged 16 the same chronologically if you are an equated maturer.

When you are a graduated HS senior you take 2 years off of competing, start College and adult training in to regression daily for 2 years, then compete and maintain.

But what fun is that !!! That’s how Olympians train.

“Sometimes when my son pitches his arm looks great, in terms of his speed, and there are other times when it looks like he’s really not throwing it at all and he tells me he just feels like he can’t let it go or it’s going to hurt bad.”

The bad news is, when pitchers forearm supinate their pitch types their brachialis and Biceps fail in keeping the Elbow from ballistically slamming the bones together at the end of that range of motion (ballistic hyper extension of the Elbow).

“Can also happen when playing 3rd base.”

If you step behind to throw (drop step) you mimic a traditional pitchers timing and inclinations.

If you true Crow hop (cross step) your Humerus has very good outwards rotational timing.

Don’t follow peer reviewed studies that do not know the difference!

“ It doesn’t happen all the time but in the worst instances he will hang his arm at the side and says it feels like it’s throbbing and tingling and he can’t really move his arm. The tingling never extends down his arm so I have never considered any type of nerve entrapment.”

The Ulnar nerve (controls the little finger, ring finger and the outer half of the middle finger) runs in a little grove right where the bones of the Elbow contact at end of range of motion, this problem is easily eliminated by simple surgery translocating the nerve to a safe area or you can stop forearm supinating your drives. You can just keep adding up the pathologies this mitigation covers.

“His travel baseball coach who also coaches high school baseball noticed during bullpen that he is not allowing his body to naturally to decelerate after he releases the ball and is almost stopping himself a little short so that he’s in a position to field the ball.”

He should recover his body by decelerating everything back in alignment by rotating 175 degrees, staying tall by pulling back against and rotating off his glove side leg. Voluntarily !!!

“He has told my son that at this age his job is no longer to field the ball”

When he starts forearm pronating his pitch type he will learn the lateral movement game in both directions causing many chippy ground balls, he better become the best fielder on the team and he will by ending his recovery by being in the perfect athletic position, drop stepped with both feet on the ground when Bubba’s up.

“that his only job is to throw the ball”

His job is to develop, playing games does not get that done best!

“His coach is a good guy and he really loves my son but yesterday he pulled me aside and told me he starting to believe that it is 100% all in his head.”

Red flag there! The pain in his Elbow is Spine/head related but not in his warped sense.

I will try to get some video of him to post for others to look at who may be better at diagnosing his mechanics than I am.

You can become very good , very quickly if you are curious enough take over dad.

“ But I have told him that he needs to focus on pronating his forearm when pitching.”

I didn’t want to try to become my son’s pitching coach but I am worried that what you said is true and they’re probably aren’t too many guys out there you can diagnose pathology based off pitching mechanics or correct pitching mechanics based off of pathology.

There is pretty much only one that has explained it in clear scientific detail with advanced discovery and training regimens for all levels. It’s free at Drmikemarshall.com

“I just hope I don’t make him worse.”

The axiom should be “Do no harm”

“if my son’s issue is related to supination at Drive”

It’s pretty much all of them!

“elbow below shoulder”

This is a first mention? Does he do this or is his Humerus just flying out and even with the shoulder line?

“how do I have him correct this?”

There are many motor drills you can use that progress as he learns. They are backwards chained so he learns the basic positions in part that work very well.

We use 4 main drills, these drills are performed with heavy balls, baseballs and wrist weights.

1. Wrong foot slingshots - Thrower stands with his ball side leg forwards and his arms straight out in front with the grip and wrist inclination for the pitch he is practicing and his glove forearm pronated.

Have him raise his Humerus straight up from the front where his Humerus is along side his ball side ear. have his simultaneously bring his forearm back above his head 'inside of vertical” and point it straight back with the Humerus still straight up, he has now just felt outwards rotation of the Humerus to full range of motion. Ask him to pull back on his glove by supinating his forearm back into his chest while simultaneously powerfully inwardly rotating only his Humerus and forearm. have him recover his arm near his ball side back pocket. There will be a weak outcome at first until he syncs in. We normally go thru all out pitch types with this drill.

2. Wrong foot loaded slingshots - Assume the Slingshot position then keep reaching back until you reach length, now you have real core separation that will be used while you are actually forwardly throwing the ball. Now the real learning begins when he learns when to elevate his Elbow so his forearm and ball travel over the Elbow.

3. Crow hop throws-Walk and throw, recover at 175 degrees of rotation. We are trying to bring the Crow hop to the mound.

4. Correct foot “No stride “ throws- *Virtually the best drill in the game! Have him stand with his glove leg forwards with the foot turned out. have him pendulum swing his arms actually equal and opposite by pronating his glove forearm to arrival and his ball arm forearm supinating to arrival (Humeral/forearm arrival) where the ball ends at head high and back with the Elbow slightly bent. At this fully lengthened position immediately pull back against the glove and glove side leg while simultaneously elevating the Elbow and then powerfully throwing. We often low arc long toss this way.

“Other than explaining this to a 13 year old, soon to be 14

I would suggest you are going to have to go thru the info with him and many times, each time he will get it better and better, there are some things that when he learns them, a light bulb will go off in him. One example is, he will learn what “axis presentation “means and how it is used to teach pitch types. The new Rapsodo equipment takes advantage of this teaching approach.


#6

I am by no means as knowledgeable as Dirtberry. There’s my disclaimer. As for pronation, look at Driveline’s info. They use wrist weights to achieve movement patterns as well as weighted baseballs. I know that weighted balls are a hot button topic but you can decide for yourself. My child was supinating to the point that he had growth plate issues. He still does but to a lesser extent. When he pronates properly, there is no pain. I would encourage you to look over their research. When mine went on their program he was pretty bullet proof. Good luck man. I hate that for your boy.


#7

Update. Took him to our high school pitching coach. Think he played college ball as a pitcher. Informed him on what I thought was going on (brachialis and altered mechanics). He was very open to my diagnosis and stated he was aware of this. Good news, he says my son is keeping the elbow up and pronating well. I’m not a pitching coach so I may butcher his explanation but he said he is not taking a long enough stride which is causing his upper body to rotate out too quickly leaving his arm too far out. This leads to him using too much arm and not enough lower body which causing pain when he attempts to decelerate the arm. Says he’s easily leaving 30% of his power on the mound due to poor mechanics. Other than that he says he’s got too good of an arm to not be able to throw more innings without hurting so we have some work to do to get this fixed. Interested in yall’s take on it.


#8

You have received a lot of information but haven’t heard this one yet.

Your child is young. He has lots of time to use weights and weighted balls.

What you and your son should do is go with what is universally accepted as good training
practice: USE BANDS and S-T-R-E-T-C-H. They come in many sizes and resistance levels. You can work heavy or lite, or combine both.

They don’t cost much and there are a ton of terrific exercises for addressing your issues.
Put him on a two week dedicated band workout and do not have him pitch or play catcher while you are in season during that time. He can do the bands everyday if he wants. I’ll recommend 5 days with two days off. So, 3 days on, 1 day off, 2 days n, 1 day off is fine. Or an y mix you like…lite band work can be done any day of the week. Your son will probably get addicted to using them.

Light band work before the game is good as it will really warm him up and get his flexibility going.

lastly, in my opinion, you are over analyzing the problem. I didn’t solve my son’s problems until I got a good doctor who listened to me, gave me great responses and advicde, and put him into a good PT Rehab program… The bands are excellent for establishing good upper back support , shoulder strength and stability, and range of motion which are all essential in a healthy and pain free arm.

I’ll bet dollars to donuts your son is simply not mature enough to play all this baseball and not doing something that is designed to keep his shoulders in tune and in shape. bands WILL do this because most problems with the arm originate with lack of physiological development in the shoulder/rotator cuff area.

If you go to any Physical Therapy that is worth it’s salt, they will IMMEDIATELY put him on a band exercise program. Perform these basic band exercises (YTWL) and you will be on your way to solving your problem. Your son can work as hard as he wants.

One last thing, if your son has begun to lift weights and has done benching or any other shoulder pressing, he probably has developed his own muscle imbalance between the front shoulder muscles and the rotator cuff muscles. Bands will rectify this.

Good Luck!


#9

Charles2,

“Good news, he says my son is keeping the elbow up and pronating well.”

Trust only yourself, knowledge is the course! Take video, the higher the frame rate the better, become an expert on amateur video manipulation along with your son.

Understand when lengthening is being performed and when that turns into ballistic forwards drive shortening into release. This is when pronating your forearm is most important. It is important to recover your arm in end of range pronation also and this is what traditional coaches call pronation.

It is not. Well, partial.

What they see in recovery pronation is not drive pronation!!!

What happens is pitchers who forearm supinate their drives find end of range of motion right at release (ballistic hyper extension) where at this timeline the forearm snaps back intuitively and involuntarily the other way in pronation to late to prevent drive injuries, when well meaning but lacking in enough understanding, traditional coaches all see pronation?

“ I’m not a pitching coach so I may butcher his explanation but he said he is not taking a long enough stride which is causing his upper body to rotate out too quickly leaving his arm too far out.”

How can his elbow be popping up when he is performing “forearm flyout” intuitive to forearm supination? These guy’s recover their arms across their bellies elbow down because they are pulling down and flying out.

When you stride longer you perturb rotational efficiency and make it very difficult to take advantage of the walking response that controls rotation where you pull back against and powerfully rotate off the glove leg not the ball side leg like traditionally. I get immediate Velo gains in everyone that makes this change.

You are seeing more and more MLB and other levels every year staying taller and rotating further while driving the ball. This is virtually why Velo is going up as predicted. When they discover “throwing inside of vertical “ with the forearm another jump in Velo will occur. All non joint injurious, allowing you to now train sport specifically.

“This leads to him using too much arm and not enough lower body which causing pain”when he attempts to decelerate the arm.

So, he also has pain in his posterior shoulder or back where all deceleration injuries emanate?

The brachialis is a drive injury because it violates the Kinetic chain principle, one of many with in the traditional approach.

“Says he’s easily leaving 30% of his power on the mound due to poor mechanics.”

These same poor mechanics produce very high velocity in many while they are healthy.