By Colin Bosley Smith and Connected Performance
One of the biggest misconceptions regarding pitching rehabilitation is misunderstanding the desired outcomes and end goals. The aim is not merely to alleviate pain in the elbow or restore basic shoulder functionality for everyday activities. For pitchers, the objective should be to return to, or exceed, their pre-injury performance levels in their sport. Unfortunately, many rehabilitation processes are not designed with this goal in mind. Although they claim to be, they often focus more on helping athletes feel better and heal post-operation rather than preparing them physically and mentally for the demands ahead in their sport.
A recent post by DAC Performance shed light on this issue. It discussed how treating an injury with excessive caution can lead to long-term inhibition of that body part. Common practices like immobilizing the arm in a brace and avoiding any stress or weight on it can instill a mindset that the arm is almost a separate entity from the body—an entity that can't handle stress. Yes, healing and rest are necessary, but it's equally important to integrate this new tissue into the high-stress environment of competitive sports. For example, converting a tendon graft into a ligament—a process known as ligamentization—requires not only physical adaptation but also psychological adaptation. The body, both physically and mentally, must recognize that the new ligament can handle everything demanded of it. This recognition doesn't occur if you treat the limb as a fragile, separate entity during rehabilitation.
Reflecting on my own experiences, I realize that my approach to rehabilitating my elbow over the past four years was flawed from the start. My elbow problems began in my senior year of high school, and the anxiety about how these issues might affect my upcoming freshman year at Duke was overwhelming. When the injury occurred, my focus was entirely on alleviating the pain rather than on restoring my elbow's functionality to compete effectively. I received a PRP injection during my freshman fall but never fully recovered or returned to my desired level of play. After months of playing through discomfort and feeling unlike myself, I underwent UCL repair and internal bracing during my sophomore fall. Having dealt with elbow pain for two years, I hoped this surgery would resolve my issues. However, I strictly adhered to the post-surgery protocols recommended by surgeons and physical therapists, still primarily focused on eliminating pain rather than enhancing performance.
The first surgery was technically successful, and I did return to play, but I never regained my high school performance levels. However, my velocity started to improve, and I felt better than I had in years, thanks to my recent work with Connected Performance and Mason Feole. But even when I returned to pitching in games, a deep-seated inhibition held me back. My mind was preoccupied with how my arm felt rather than focusing on the game's objective: getting batters out. This mindset likely stemmed from the initial weeks of my rehab, where I was locked in a brace and instructed not to move my arm, leading to extreme tightness and significant scar tissue buildup once I started moving again. My rehab was overly conservative, particularly in the weight room, where I was restricted from almost all upper body movements for several months.
Taking this overly cautious approach and then being asked to perform at a high level is not sustainable. If I couldn't trust my elbow to bear my body weight in a simple exercise like a dead hang, how could I expect it to withstand the forces involved in a competitive pitch? This realization has fundamentally changed my approach to my current rehab. Starting just two days post-surgery, I began moving my elbow within its limited range. Each day, I pushed my elbow to perform to the best of its capability, gradually building trust. Now, four weeks post-op, I've regained full extension. I feel comfortable loading it with my body weight in planks and hanging progressions—activities I didn't attempt until several months into my previous rehabs. I'm also progressing to equal weight in upper body exercises. Each day, as I build trust with my elbow, I see what it's capable of achieving. This approach has allowed me to treat my arm as normal, significantly reducing inhibition with weightlifting and everyday activities. I believe that when it's time to perform more demanding tasks like competing and throwing, my elbow will be ready, allowing me to compete freely without being held back by concerns over its condition.
This approach has been widely adopted throughout the Connected Performance team when addressing arm pain or return to throw. For a full case study you can check out how we helped JJ Niekro gain 5 mph in less than 12 months post operation and get signed by the Atlanta Braves (linked here). If you're struggling with arm pain, returning to what you used to be, or lost during your elbow or shoulder rehab then this approach is for you. We've helped hundreds just like JJ and Colin eliminate their arm pain and perform to the standard an elite level expects themselves to perform at. Stop waiting and start training. Reach out to training@connected-performance.com today.