Mysterious Pitching Pain

For the past two years I have been experiencing bad pain the seems to be coming from under or around the brachialis muscle. I am not quite sure how to explain this pain but although it tends to be pretty severe, I can’t quite pinpoint where its exactly coming from. During the past two season I have been to three different doctors none of them seemed to be very concerned with anything going on in my arm. MRIs have just shown inflammation in the brachialis muscle but no underlying cause. While on the mound, about 20 pitches in, the pain begins and with it my arm starts to feel weaker, (Specifically the brachialis, bicep, and forearm muscles feel weak). My velocity goes down and I slowly loose accuracy. I am a pretty strong kid, workout plenty, went through a throwing program and PT pre-season in an attempt to resolve the pain, and throw low 80’s at 16. None of the doctors have helped and nothing that I have done in my attempt to relieve the pain has worked.

Here were the doctor’s impressions from my most recent MRI:

“Low-grade muscle strain of the lateral aspect of the biceps brachii muscle manifest by
mild intramuscular edema. No intramuscular hematoma formation. No tendon tear visualized.”

Any help is appreciated as I am legitimately considering giving up pitching because of this issue.

Thank you

Lots of things to consider that might need tweaking/improvement:

Flexibility/mobility
Mechanics
Workload
Lifting workload (lifting in-season?)
Technique
Rest (short term and long term)
Nutrition
Etc.

Could be a combination of things

Just joined and saw your post. I am 15 and have the same exact symptoms. Wondering if you pitched this past season and if you had any improvement?

“cmm014, AJS,”

“For the past two years I have been experiencing bad pain the seems to be coming from under or around the brachialis muscle.”

You are very perceptive in that normally Dr’s diagnose this as a Biceps problem, then have you mitigate it by time off. This injury is common and intuitive.

“I am not quite sure how to explain this pain but although it tends to be pretty severe, I can’t quite pinpoint where its exactly coming from.”

This is one of the many throwing related discoveries and mitigations put forth by kinesiologist Dr. Mike Marshall.

He charactorizes this injury as an eccentric (contracting while lengthening) contraction muscle failure, where the kinetic chain used is broken and causes degradation.

“During the past two season I have been to three different doctors none of them seemed to be very concerned with anything going on in my arm.”

They were more concerned with finding related joint injury knowing that even high graded muscle injury heals fast, 1 week to 8 weeks depending.

“ MRIs have just shown inflammation in the brachialis muscle but no underlying cause.”

The underlying cause is Kinesioanotomial and will be mitigated with the same science, this problem is never use in adults or youth…

“While on the mound, about 20 pitches in, the pain begins and with it my arm starts to feel weaker”
“(Specifically the brachialis, bicep, and forearm muscles feel weak).” “(Specifically the brachialis, bicep, and forearm muscles feel weak).”

This is because you perform “intuitive forearm flyout” where the action produces the tendency towards Forearm supinated drives. The Brachialis is a secondary forearm supinator.

My velocity goes down and I slowly loose accuracy.

“I am a pretty strong kid, workout plenty,”

If you perform pathomechanically, strengthening only creates more joint stress.

“went through a throwing program”

Were you warned about forearm actions and their effect on you’re Elbow?

'PT pre-season in an attempt to resolve the pain”

From where I sit, I believe PT’s are going to be the ones that will give us a chance to make mitigating changes in the way throwing pacients leave the healing process. They must understand all these kinesiological cause and mitigations by actually going through mechanical live changes with the PT, not your local pitching coach who will extend you’re misery. Some are!

“None of the doctors have helped and nothing that I have done in my attempt to relieve the pain has worked.”

Par for the course. This is how it is currently done as in the past, let’s blame “pitch counts” in this way nothing is actually mitigated physically and then, repetition ignorance.

“Here were the doctor’s impressions from my most recent MRI:
Low-grade muscle strain of the lateral aspect of the biceps brachii muscle manifest by
mild intramuscular edema. No intramuscular hematoma formation. No tendon tear visualized.”

This is great information as told to him by his radiologist. What now?

“Any help is appreciated as I am legitimately considering giving up pitching because of this issue.
Thank you”

Kinesioanotimical cause:

When thrower/pitchers perform intuitive forearm driven supination where they centrifuge their arm action “outside of vertical” (forearm drive to the outside of vertical orientation) they fail to engage the Triceps to extend their Elbows ( break in Kinetic chain) because the brackialis is firing off first concentrically (while shortening) to supinate the drive, then it keeps firing off to keep the Elbow joint and forearm joint from crashing together ballistically (this is a whole other set of assults on the Elbow) and is now contracting to keep this assault from happening but in the end fails resulting in muscle failure at the Biceps and Brackiallis, with the Brachiallis taking the brunt.

Mitigation:

All throw types must be voluntarily forearm pronated during drive , release and recovery!
In order for this to happen you must learn how to bring you’re ball side forearm back by supinating it on the way back to ¾ of it’s range of motion simultaneously with glove side foot plant then immediatly raise you’re ball side Elbow so you’re triceps are facing the target, now they are in position to fire and extend your Elbow voluntarily with pronation and full length start inwards rotation of you’re Humerus. This cleans up the second break in the Kinetic chain of the traditional motion where if you supinate your forearm is traveling in the oppositwe direction of you’re Humerus!
Look for you’re Elbow to Pop up not pull down, coach Newton want’s you to throw across.
Fix this and watch pronation snap give you a velocity boost and more pitch types.

later,

Lon Fullmer

certified Dr. Mike Marshall pitching coach

Thank you so much for the info!

First, I am not a doctor! Just my advice to you from experience with my son.

Edema is swelling, which in your case is said to be mild and mid muscle in location. The lack of hematoma is positive, meaning no rupture in muscle. Both of these are good, as far as your situation is concerned.

Taking multiple MRI’s without a contrast is a mistake. Why the MRI/contrast is not done first for a baseball player is unknown to me (cost??), but after one MRI is taken and the condition persists, it is my opinion if another MRI is requested the contrast is needed in order to determine if tiny tears in ligaments and elbow joint tissue exist that won’t show up without it.

Now, like many young kids, you want velocity at all costs. So, you mentioned you started a velocity throwing program. Well, I’d bet dollars to doughnuts the revered throwing program caused the problem. So, in my opinion, what you need is rest and rehab. The throwing program may, or may not, be a a good one. And most likely, you weren’t physically ready to start the program no matter how much you think you train (See below). The dirty little secret is that anyone who starts a Velocity Throwing program is at risk of increased injury, and it can result in serious injury.

Not all rehab/PT is the same! I started out with a terrible one with my son, made a switch, and whoa!, what a difference. Not all doctors are the same. I found a terrific Shoulder/arm surgeon, and the advice/information made all the difference.

You MOST LIKELY DO NOT have anything serious yet, but trouble could arise because you almost assuredly have a muscle imbalance (Training Routine?). Improper muscle development can even make you think you have a nerve or ligament damage because of how the nerves and muscles converge around the elbow. This can result in you describing UCL pain when you actually don’t have an issue with the ligament, but have an issue with the ulna nerve instead, and that can be cause by muscle imbalance. If the pain was structural (meaning joint specific), the pain and discomfort would occur immediately and progress with each throw. Your strength training needs to be reviewed, perhaps certified. A good strength and conditioning coach should be consulted. Maybe your Highs School has one, and also a PT as well. It is my opinion you arm is taking the brunt of the stress when throwing. You lack good shoulder and rotator cuff development. Perhaps your front shoulder is much more trained than your back muscles/back shoulder muscles. START BAND TRAINING IMMEDIATELY to help the rotator cuff.

You’re 16, so I’m sure you train the Bi’s hard. This is not allowing your muscles to heal. The fastest way to get stronger is to stop working out for a week or so. Why? Because your muscles will heal fully. Then go back to to work at getting stronger again. Instead of 5 days a week working out, cut back to 4 days and allow at least a 2 day break in between which allows you more consecutive recovery time. You simply can’t work out to tear down muscle like a body builder and expect to throw max out without causing some problems. If you overwork the same muscles day in and day out, you are causing your own problem. The Biceps and Triceps are the type of muscles where this can happen. Remember this: you train so you can be prepared to throw max out all game. Performing when your muscles are in a compromised state is foolish.

Training advice given that baseballis about to start in March: Give yourself 2 weeks of doing NO arm specific training. DON’T Throw! TRAIN: A good training program will hit the arms, but not directly. The goal is to heal, and working out will enhance blood flow to the arms and allowing to keep your arm strength. You want to heal. Don’t lift anything like you would do a bicep curl. That’s easier said than done! After 2 weeks, start throwing. Use bands to work the rotator cuff muscles before and after throwing. This will help you to arm up and cool down.

DO NOT THROW USING A PITCHER MOTION!
This is what worked for my son, I hope it works for you. My son threw the same velocity as you at your age!

Week 1: Start throwing at 60- 75 percent. Use your body, full easy throws. just don’t strong arm it. throw as prescribed moving from 25 throws to 60 throws at about 60-75 feet tops. Throw everyday if no pain. Increase throw count about 6 per day. Don’t overthrow, in effort, or throw count. Most likely you’ll be at about 75% because it’s hard t throttle it back…We want a progression in throw count which acts as a load that slightly increases as the week goes on.

We are building up as you go along: no need to rush it.

Week 2: If you are at 60 throws after week 1, just having a fun catch with no pain, step it up. Go to 80-85%, starting at 20 throws, working to 60 by end of week. If there is pain at any time while throwing, you’ll have to assess as to how severe and how it feels compared to what you experience now. If the pain comes back but much lighter, than I would say you have confirmation that the muscles aren’t yet sufficiently healed. But, you are on the right rack.
Week 3: If all is good and no pain, the next step is to start throwing as you feel comfortable. If there is pain at any time while throwing, reassess.

If the pain is gone, and you feel like you can throw as you would want to, the only thing to do
is try and do it. Start with increasing distance as in long toss to increase the effort. Then do a blend of long toss and hard throwing as part of your routine. Then, build in flat ground pitching before mound pitching. It’s going to TAKE TIME. The only way to get back to throwing like you want is to convince yourself that the proper training and arm preparation solved your problem. Time will tell if you can put this out of your mind or not.

Time is your friend, but can be your worst enemy if you rush. This time of year is hard to get the rest you need, but you have to grow up and commit. Talk to people you can trust. Be honest with yourself. You are the only one who can communicate what is going on