Preventing UCL Injuries in Youth and Pro Pitchers

This is session number 84 of the Performance Place Sports Care Podcast. What's your favorite sports superstition? Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Okay, everyone, today I'm going to have on an awesome guest. This is Brett Winchester, who is a doctor who worked with the St. Louis Cardinals. So, we're going to be talking about ulnar collateral ligaments, or UCLs, today in not only professional sports, or sorry, professional baseball, but also, too, with minor leaguers and youth athletes.

So, we're going to go into a couple concepts which entail how we should screen these people, what are some corrections, what are some pitching mechanics that we need to be addressed, and so on. So, this is a really good topic we're going into. I enjoyed the conversation a lot. And Brett's a good dude, so you're going to learn that he has a lot to share. Now, before we actually go into it, we go in a little bit about superstition in baseball. So, I can tell you that my superstition, it's a little bit of a silly one. So, but it didn't, I don't think it worked, but I did it all the time. So, when I played high school baseball, we actually, during the time we went and we were shooting guns, too.

So, we go out to the mountains, find an area in the backwoods, and we would shoot at targets. And one of my favorite targets was a golf ball. So, we'd have this .22 rifle with a scope on it and just nail these golf balls. So, the golf balls would, they'd get hit and they would shoot up this hill. So, it was kind of cool. I always liked the targets that had a lot of actions. Like, I don't like going and shooting paper. I don't like indoor shooting ranges because there's no action. It's just, like, paper. How lame. So, I'd rather shoot cans, bottles, golf balls. But in this case, so this golf ball, I kept hitting this golf ball a lot.

And it didn't have a lot of damage on it. It just, I must have grazed it a handful of times. So, I thought, hey, this is a lucky golf ball. I'm going to bring this thing back home. So, I brought it back home. And for some reason, I used it as a rubber band storage. So, I had all these little rubber bands all over it and so on. So, it kind of covered it up. Now, I would have this in my bed. And it's just kind of next to it at the nightstand. I would have it on the nightstand only on game day nights. So, the night before the game, I would put this thing there. And I'm thinking, this golf ball, this lucky golf ball, it's going to bring good luck.

Eventually, I got rid of it. Because it was, I think, as you're going to hear on the podcast, is that sometimes you have the best game of your life when your lucky charm or your superstitious habit is not in place. So, it wasn't in play. I'm sure I probably had a good game. Just hits the ball. But either way, that's my story of my superstitious habit. Now, before we go into the podcast, I just want to remind you guys, just like every week, we are still doing the show notes. And all you have to do is go into ptsportscare.com slash the new way I'm doing it now is we're not doing a podcast slash pound net number.

So, all you have to do is go ptsportscare.com slash the session number, which in this case is going to be 84. And we actually started doing transcriptions. So, we started at the beginning of the year. So, if there's anything that you don't understand in the podcast, you just go on to that and you can read all of it right there. We had medical transcribers go through it. So, we get a lot of the terminology correct. If you're ever finding spelling errors, let me know. There's also a podcast player on there as well as any link that we speak about and the contact for Brett in this podcast. Also, too, if you haven't already, go on and do a review on iTunes.

Please subscribe, share with friends. And if you do review, take a picture, send that screenshot to info at ptsportscare.com. And I'm going to put you in the drawing for a soft as hell blue performance place t-shirt. One day, I might actually, funny, like I don't know if I'll actually do this, but we've gone down the concept of stiffness. McGill has a concept of super stiffness. So, I joke with patients and friends that stiffness is a thing that we need to talk about a little bit more than mobility as well as more than flexibility. So, we were messing around the other day. I was like, we should get a t-shirt that says, I got stiff at performance place.

And I know it's a little, it's a little crazy. I don't know if we're going to actually do it. But one day, if you want one of those t-shirts, maybe I'll start making them one-off for people. But I got stiff at performance place and that was part of the corrective care. Because stiffness, again, is about torso strength or torso, sorry, torso endurance. So, we can put the neurological drive to the appropriate joints to be athletic and be safe. So, although stiffness is kind of like a joke, it is a serious thing. We work on a lot of stiffness stuff here. Lastly, before we get into it, if you are a clinician, go onto the website.

Check out all the posters that we have available for you. YouTubeSportsKid.com slash shop. We're going to get into it right now. Welcome on, Brett, Dr. Brett Winchester. All right, everybody. As promised, we have Brett Winchester. Winchester. Winchester? You got it. It's like the rifle. I'm sure you've been asked so many times, are you a heir to the business and haunted by the ghost? I am an heir, but I've yet to see any money from it. So, over here, actually, in California, we have the Winchester house. I don't know if you've heard of that. San Jose, I know. Yeah. It's the, what was it, the story?

The lady built stairways to nowhere because the ghost told her? Yes, exactly. That basically sums it up. So, the Winchester rifle had killed a lot of the Indians. And so, she was worried that Indian spirits were, you know, coming after her. So, she kept, you know, building for, I don't know how long it was, like 20 or 30 or 40 years to, like you said, staircases to nowhere, empty rooms. It was insane. I feel like if ghosts were haunting me, I would probably, like, maybe eat pizza, would keep them away. It wouldn't have to be building houses. Yeah, she had an interesting approach. Okay, so, tell everybody about yourself.

And the topic today we're going to go over eventually is kind of debunking the causes for UCLs or ulnar collateral ligaments in not just professional baseball, but minor league as well as kids. Okay, but. Yeah. So, tell everyone about yourself first. I want to know about you. Yeah, so, a little bit about my background. I teach advanced biomechanics at Logan College of Chiropractic, which is the college here in St. Louis. We also, I'm on the board for Motion Palpation Institute, and I also teach for DNS and in other various rehab groups. How I got involved in baseball, I think I just kind of randomly got into it, just looking at the biomechanics of throwing.

And I started off with my background being in softball. So, I worked with a lot of high-level softball pitchers and collegiate programs, and then just started looking at baseball, and then just one connection led to another, and led to my employment now at the St. Louis Cardinals. So, that kind of sums up my life in general. Nice. How did you go from softball to, I mean, when I started looking at softball throwing, I pitched, or the, what do they call it? It's not the wind-up. Fast pitch, or? Oh, yeah, the, yeah, the. We still call it a wind-up. Do you want it wind-up? It's, I feel like the mechanics seem so foreign to playing baseball.

How did you go from one to the other? Yeah, softball is really fascinating just from a biomechanical standpoint, because you don't really, it's just a kinetic chain of events that need to happen for you. Said differently, if I had, like, if we had an average 10-year-old athlete, if we gave her a perfect environment, we could almost probably make her an All-American if, like, everything went perfectly for the next 10 years of her life. Baseball, there's got to be some structural adaptions that have to occur, and there's just, like, a lot of other things that are involved with being a good baseball pitcher.

So, there's a lot of differences. There's similarities, but there's definitely a lot of differences. Okay. One of the biggest similarities is, in all throwing sports, it always comes down to timing. So, that's, like, kind of the keys to the castle for being a good thrower, no matter what the implement is. And I think we're going to go into that a little bit later when we talk about the mechanics of a UCL, correct? Exactly. Okay. Because that's kind of been my latest charge or mission is, so, we've had a huge influx, almost an epidemic problem of UCL injuries. So, the first one was done, the first surgery was done in 1974, actually, on Tommy John.

So, Frank Jobe actually did the surgery. So, we've done approximately 1,300 Tommy John surgeries in professional baseball since the first one that was in 1974. So, we had our huge influx of surgeries happen in the mid-1990s. And we have a couple reasons on why that is. But our mission is really not really to change it at the professional level, but to understand why the injury is happening, you know, 10 years before and to understand the mechanics of why it's happening and the different variables. Yeah. So, explain that because I know there's probably a lot of coaches and parents listening into this and a lot of docs saying, like, well, why not address the professionals?

Why are we focusing only on the kids? I mean, everyone loves kids, but why not the professionals? Well, at that level, things get so ingrained from a motor engram or motor program standpoint. So, I'm not saying you can't make changes because if anybody can make a change, these neurologic savants, that being a professional athlete, can. However, the younger ages, they're much more moldable and easy to change, even from a mental standpoint. So, it's not that the professionals couldn't be changed, but the surgery is actually a medical marvel. So, they can have the surgery and they can still pitch another, you know, five to seven years on average.

So, it's not necessarily crucial for them because they can have the surgery and still be successful at that point. So, a lot of these guys who've had one surgery, they may not, you know, be willing to take the risk of not being able to perform as well if they made a technique change. I firmly believe, though, they could make the technique change and be able to do it. I just think, like, you know, when you start changing technique at the professional level, there's a lot of different things you have to consider. One thing, I think a good approach is just to kind of look at a staff and kind of bucket them into high risk, no risk, low risk.

And then, the people that are high risk, they can either make a change or we can just, you know, plug in the right rehabilitation exercises to almost act like an insurance policy, knowing that they're throwing in the wrong stereotype. With the caveat of is we never tell somebody they're throwing in the wrong stereotype. So, that's like the, it's no different than a medical professional over-educating on an x-ray or catastrophizing over an x-ray. So, we're very, very careful on how we word, you know, what we don't like about their pitching mechanics. Yeah. So, going to that part real quick, the, it sounds like that's a psychological part of an injury or at least psychological part about play where you don't want to let them know too much, but you want to let them know enough to make the correction?

That is exactly right. Yes. What happens to, like, in your observation, what happens if you give them too much? Well, I think, like, because of how litigious society is and across all levels of baseball, if we have an orthopedist look at an MRI or an arthrogram and let's just say a shoulder, it's really easy if you've thrown five million balls that, you know, to catastrophize and say, well, you have a little bit of frame of your rotator cuff or you might have a little bit of, you know, a labral tear, whatever it might be, when the reality of it is that's just normal wear and tear if you've thrown five million balls.

So it's no different than, like, wrinkles on your face or graying hair. So we would expect some degeneration to occur, but unfortunately what happens a lot of times, they're almost like weathermen where they say, well, we're not going to do anything right now, but we might have to do surgery in two, you know, in two years or whatever. And I think then you start to literally get fibromyalgia of your shoulders. So they literally think at that point that something's wrong with them. Conversely, if you walked in the room and you said, you know, your shoulder is structurally, isn't 100% perfect, but I would trade shoulders with you in a second.

So there's a little bit of degeneration here, but nothing out of the ordinary. And I think you're going to do great and wonderful. You'd see a totally different response out of those, out of the same athlete if they were educated in those two different ways. Yeah. I don't even have words to describe how important that is. And because of everybody kind of covering their butt and, and now, especially like if a guy's getting drafted, they're going to have an MRI or arthrogram on their elbow and their shoulders. So just, you know, the, the information's out there. It's what we do with it. That's so important.

So when, so when people come into you at that level, do you already have imaging of, of all those joints already? Usually. Yeah. So there is no shortage of imaging, especially it depends what level they're at, you know? So at the major league level, absolutely. Yes. And then at lower levels, usually there's been some imaging along the way though, has been my experience. I think you'll just continue to see that also. So then with, uh, if we're speaking to kids or parents of, uh, or of youth players, what, what age do you typically see that they have, uh, some type of degeneration as, as you say, not to like, or over glorify this, but I just want, cause some, some kids are probably going to go in and have an MRI and say, holy crap, this is already happening to me.

This is the end of the world. So at what level do you feel like it's normal to see that kind of stuff and not really have to worry about it too much yet? I would, I don't want to see it before 16, you know? So after 16, I think then you start to see like some changes. Um, and some of those changes are just, uh, normal for baseball for throwing, you know, balls and things like that. Like we might see some thickening of the UCL, which is normal because you're, you're throwing so much, but as far as like severe degenerative changes, I would never want to see that before the age of 16, but to directly answer your question, I would say that, um, we don't want to see any changes before the age of 16 would be a pretty good rule of thumb.

Okay. Now, uh, when we were talking off the air, you were talking about, um, actually, well, you alluded to it already. So high risk, low risk, and corrections that could be made for these people. Um, what are, what are some typical screening tools you'll use to screen out high risk, low risk, uh, UCL players? Yeah. So some of the things that we look at, uh, I forgot to mention the baseball side of it, which is what we call gestalt performance. So a lot of it is done through, um, really high level video analysis. So that tells us a ton. Um, the other thing is we use what's called a rap Soto unit, or you could use a track man track man's what we have at the stadium, which basically measures revolutions and, uh, uh, spin of the baseball or, uh, force plates.

All of this is, um, important information, but I think the most important is just the video analysis to see the timing of, uh, things that should be occurring. Cause in baseball, no movement in all of sports happens quicker than throwing a baseball. So it's really, in my opinion, uh, I think you have a charlatan. If somebody tells you they can see this without, you know, video, like, I feel like it's impossible as much as I've looked at baseball pitchers is I think that it's, it's crucial that you have video to be able to slow everything down and be able to look at it. Okay. Um, and just from your, your observation, usually at what level does anyone have, start having video analysis to even see high risk, low risk?

I would say my, I have eight year old kids coming in now with video. Oh yeah. Because, um, like these throwing academies, you know, everybody's kind of competing with each other in these throwing academies. So it's because of that, you have all these different technologies and in the, uh, cameras on the phones have gotten so good too, that, you know, it's, it's really like a lot of times if I'm consulting with someone who's far away from me, we can, we can learn a lot just by the dad or mom videoing off the, off the cell phone. I thought they were just doing that for, for Instagram and Facebook sharing this.

Different generation, but yes, I'm sure that that's all part of it. Yeah. So, um, let's go into some corrections and actually, uh, I'm thinking about how, how far we've gotten into this podcast already and how, how, uh, deep the information is. I might circle back to some of it a little bit. Um, and I might, I might break you off a little bit too and ask you some tangent questions that have no relevancy to the topic at all. Just to give people a brain break after this question probably. Um, okay. So give me some, uh, corrections that you like, um, or at least categories of corrections. I know we spoke about DNS or dynamic neuromuscular stabilization a little bit.

Um, lead us down that route. Yeah. So there, I look at it when somebody comes to me and let's say they have arm pain, whether it's the shoulder or the elbow. The first question is, do we have a musculoskeletal problem or do we have a throwing biomechanical problem? Or sometimes they have the fleas and the ticks and they have a little bit of both. The reality of usually who I deal with, they have both. So then at that point, it's, it's essentially my job to decide what the intervention is going to be. So if it's, you know, if we're looking at them, they don't know how to create intra-abdominal pressure.

They don't know how to stabilize their shoulder blades. Well, then, you know, we definitely want to pay attention to that and take them down that track. I would say the, you know, kind of the deadly combination would be poor mechanics, poor musculoskeletal. So, you know, then you, you got basically a ticking time bomb on your hands. So I think the, the assessment, just like it is with every, every other patient, the assessment kind of dictates, uh, the right treatment. So. Okay. So tell me, or actually before we go into the DNS part, all right, tangent question, would you rather have a permanent bill, but beer belly or permanent double chin?

And why? I enjoy working out. I think I would, uh, well in DNS. We definitely train a different look to the abdominal wall. So I think I could be okay with the beer belly and, uh, I do have celiac disease, so I'm not allowed to drink beer anymore, which, um, that's no fun, but, uh, I think I'd take the beer belly. Really? So. Yeah. What's so, what's so, uh, what's so wrong with the double chin? Nothing's wrong with it. Yeah. Just kind of, at least you'd be good for pictures, you know, and like doing this. So, I mean, like, uh, skypeing and stuff like that would, would have no effect. So. That's right.

Well, we did say earlier, you wouldn't have to wear pants so you can just let it overflow and you're fine. Um, yeah. Um, so, uh, uh, you said intra-abdominal pressure, you said scapular stabilization, and you train a different belly type in DNS. So, uh, go into DNS, talk about intra-abdominal pressure, and then, so lead us down that route of what people can expect when they're looking at how to stabilize when throwing. Yeah. So, in DNS, we look for a couple different things. One is, we need the position of the segments to be correct. So, what you'll see in all present-day pitchers, which, if I could take a step back one second, I would just say, in Major League Baseball, we have probably upwards of 96% of pitchers throwing in what we would consider the wrong stereotype.

Why that's important is I cannot think of another example across all of sports where you have the lion's share of a group of athletes doing what's actually not the most biomechanically efficient, uh, thing. But I think it's also our reason why we're seeing such an epidemic of, uh, elbow injuries. Are we counting video gamers as athletes? Because I'm pretty sure video gamers, they're just ergonomically and friendly. Sebastian, I'm so worried about this next generation. I don't even have words to describe it. You know what? Our manager for the Cardinals, Mike Matheny, he says it so perfectly, though, about the present-day Little League Baseball players.

He says, kids now, they only play baseball with their uniforms on. And that's a huge problem. So, when you and I were kids, uh, you know, we would go play wiffle ball. We'd play hot box. We'd play, you'd go out in the street and play stickball. You played many, many different variations of the game of baseball. And now, kids literally just don't do that. So, literally, they're only playing games, you know, in the environment of a select league or, you know, whatever it might be. So, that's a huge problem. I feel like you can only get so far when you spend X amount of time doing it. And, uh, the, I mean, I don't think RBI baseball counts.

It should count. I was awesome at RBI baseball. I missed that game so much. Yeah, right. I feel like, though, you could never steal a base. It was just, it was uncalled for. Like, the dudes didn't move fast enough in relationship to the ball movement. Well, we had, we played two where you had to throw strikes. Did you do that or not? Oh, no. That curveball was nasty, though. That wasn't even fair. Yeah. Exactly. Yeah. No. So, anyways. Go ahead. DNS. So, uh, I was really good at Tecmo football, but that'll be for a different day, too. But, uh. Was that Sega? Was that Sega or Nintendo? No. What?

Nintendo. Oh, okay. They had an undefensible play. Cap Bozo could run a slant that you could not defend against. So, there, there was a, there was a Super Nintendo game. It was, I think, Madden 96. And it was, uh, you could just do a right sweep and every single time it's just like a beeline for the end zone. 80 yards every time. You, you wonder if they knew that when they made the game, you know? Yeah, right. That's definitely on your, uh, I don't know if you ever got that magazine, Nintendo, what was it called? Nintendo Power? Nintendo Times? It was all the cheats in there and all that kind of stuff.

No, I never got it. There you go. Next time. So, Dean. Yeah, so, DNS, uh, sorry about the tangent. We had, uh, so position. So, what you'll see in a lot of these present day pitchers who we don't like their stereotype is we'll see them in, in DNS, what we call would be like an open, open scissored position where they've completely disconnected their rib cage from their pelvis. And one of the reasons you see that is actually, uh, because they're taught to do what's called a scapular pinch. So, as they come out of the glove, if you, um, see if we can maybe. You see me on video here. So, out of the glove, they come, uh, into pitcher's prayer and then they lead out of the glove with their elbows up.

So, that's the initiation of, uh, what starts to go wrong. And then when they go to, uh, load their shoulder blade, they're actually taught to pinch their shoulder blades together. And when you pinch your shoulder blades together, you, it's impossible not to put yourself in an anterior pelvic tilt. And, you know, other, you've had Rich on, on your podcast before, if the listeners have remembered some of the things he was saying. So, then what happens is you basically change how the central nervous system will use every muscle throughout the body. So, it really has a lot of consequences when we, when we see that positioning and throwing.

Yeah. You know, uh, by, by the way, everyone, uh, I'll put the link to Rich's podcast. I think it's 61 or 62. Um, uh, I don't, it's funny. I've, I've, I've, I've heard that. So, with baseball pitchers or certain types of athletes, they live in like extension or anterior tilt, right? So, the, the argument I heard was why would you take them out of this? You'd be, it'd be a detriment to their mechanics. So, is that something that you experienced where like you take them out of that slightly to accommodate that open scissor? Or is it something that's kind of leaving? Yeah, ironically, Rich and I talk about this all the time as far as, as long as there's intra-abdominal pressure being maintained, then, then it's actually okay.

But usually what we'll see is we'll see just complete over-recruitment of the, the paraspinal musculature. Uh, so that's not what we want to see. If somebody is in a little bit of anterior pelvic tilt, it's not a deal breaker, a hill to die on. But, um, I think like if I showed you video, you would see what I'm talking about when we see, uh, it being excessively done. So, again, it's all about moderation and balance, I guess. Yeah. So, um, go into that a little bit. I know that Rich went into it pretty, uh, detailed with lifting in his podcast, but, um, uh, talk about the over-dominance of the paraspinals in regards to that.

And, um, again, why it's an issue for intra-abdominal pressure. Well, I, I always kind of think of it as, um, the antagonist to the paraspinal musculature is intra-abdominal pressure. And we see just, again, almost like an epidemic problem from a functional standpoint of people not being able to generate the right amount of intra-abdominal pressure or not even have the right position of the abdominal wall to begin with. So that's really, in my opinion, what should be the starting point. The reason intra-abdominal pressure is so important is because throwing is literally throwing with these anatomical slings.

So one of the most important slings for throwing is what's called the anterior oblique sling. So basically it's going to be comprised of your pectoralis major, your external oblique, your abdominal wall going into your internal oblique. So if you don't have intra-abdominal pressure beneath this muscular sling, it's like having all the money in the world and you don't have an ATM card to get to it. So essentially that is crucial for throwing. And then of course, on the backside, you have a posterior oblique sling, which is made up with your, uh, lat, your thoracodorsal fascia and your glute on the canterolateral side.

So anybody who's made it to major league baseball, they, they are by default top 100 in the world at activating this anterior oblique sling. Now what's going to determine whether or not they're going to get hurt or not is the position they're going to put their arm in when they unload this anterior oblique sling. And I always tell a story just to tell you, like, you see a lot of people, you know, training, trying to train to throw or try to mimic throwing. And it's literally like trying to compare oranges and hand grenades because when you, when you throw, I, the story I like to tell is I was in our, um, in the training room one day and I thought everyone was out at batting practice.

And I heard this crazy sound. It almost sounded like one of those industrial gym fans. So I'm like, what the heck is that? So I thought I was alone in there. So I walked out of the doctor's office and turned the corner and there was one of our pitchers who was just basically going through the motion of pitching, but without the ball essentially. Which I wouldn't really agree with, but that's what he was doing. So anyways, I'll never forget that sound. So for just S and G's, I went back to my office. I'm like, okay, I want to see if I can even come close to generating that. It wasn't even neurologically possible for me to let my arm go in the same way that, that that athlete had done.

So right then and there, something got thrown in my face. And that was that, uh, throwing is something completely different than what people think it is and define things that would like spill over in training would be very, very difficult. So, yeah, so I'll, I'll leave it at that. But anyways, that's why intra-abdominal pressure is so very important for these throwers. And then for them to feel what it feels like to have it right in their body. So essentially what throwing is, it is a massive pulling movement. There's really no pushing involved at all. It's 100% of pulling through these muscular slings that, um, that we're talking about and the best throwers in the world, they are, they're, they're just the best at being able to unload this, this entry oblique sling where I come in as far as like looking at these pictures too, is if we, for example, have a trigger point in pectoralis major, that trigger point is robbing me of my ability to pull my rubber band back further as far as the elastic energy for my slings. So I always look at it and I take my job really, really seriously with, with them. And that if, you know, that's my job to go in there and make sure that I have nothing that's impeding the ability to one, elongate this sling, but then ballistically explode the sling. Cause that's essentially what needs to happen for pitching.

Okay. Um, well, first off, I want, I want, can you, can you make that sound with your, with your mouth right now? I can't, it was so crazy. And you know, that's where like, if I look on the internet, you see all these like baseball Pacific or pitching drills that are like, you see somebody like throwing a ball against the wall or something. And, uh, in the back of my mind, I'm like, it doesn't even come close to duplicating what's actually happening when you throw. So. I imagine it sounding just like a didgeridoo. I don't know if you, you know, those things. It was, yeah, it was, it was an insane sound that I've never heard before.

Yeah. So, um, I think too, when you go, when you get around them, like if you ever get around like a really high level minor league or major league baseball pitcher, like it, it just, if you get real close to it, it is amazing. Even just from the acoustics of it, the sound of, uh, on what they're able to do. They're really, really, really gifted athletes. Yeah. In, in regards to just humming or, or you said acoustics, it could be. Um, so, um, let me ask you then, cause you brought up, you brought up trigger points then. So probably people are probably thinking like, well, I got trigger points. My kid has trigger points.

Um, what type of things would you expect? What type of injuries are possible if mechanics are poor, musculoskeletal issues are in play? Um, cause I need, there's, I need, we've been talking about owner collateral a little bit and mechanics of, but what else is possible? Well, trigger points to me, we always find trigger points in muscles that are doing a job they're not designed to do. So trigger points also, they're, they're a really good thing in a poor functioning system is a good way to think of it. So whenever we're not ideally stabilizing, whatever joint is we're talking about in the body, then your central nervous system has an amazing ability to adapt to this bad situation by decreasing range of motion, by basically putting trigger points in, you know, whatever the musculature is around the shoulder. In baseball, the real common thing we see is tightness in the posterior capsule.

So if you ever like are, you know, at a baseball game and you see even like a little league game, you'll see the pitcher do a stretch similar to this. So what they're trying to do is they're trying to stretch their posterior capsule. So 10 to 15 years ago, the first paper came out on how tightness in the posterior capsule of the shoulder is leading to a slap lesion, which is a labral, uh, labral lesion of the shoulder. So after that, you had all of major league baseball aggressively stretching into internal rotation in an attempt to try to stretch the posterior capsule. So the irony of that was that you would want a tight posterior capsule if you're not stabilizing your shoulder blade exactly well. So I think a mistake that happens a lot in the treatment of the baseball players, we have a lot of soft tissue work to trigger points and things like that. When actually, when actually what we probably should do first is to have the right exercise plugged in to get the stabilization right and then come back and reassess. A lot of times what you'll see is that we don't need to do the soft tissue or manual technique. Sometimes we do. So like for the trigger points, sometimes like we'll do some DNS corrective exercise and then I might dry needle the trigger point. If it's still there, then we'll go back, you know, reintegrate the trigger point into active exercise. And I think that's really, really the best, best approach because really you could argue that like, if you just remove trigger points or did a bunch of soft tissue work on the tight posterior capsule, that maybe you destabilize them because you took away their one way to build it, their one way to stabilize. And now their central nervous system has to kind of scramble it and figure out how to, how to stabilize it now. Yeah. So I know on the, I know on the other side, because it's probably really common even in, in youth as well as professional to, to stretch and do massage and things like that. And I know it took even years for get people to do even that probably. But people probably, I'm guessing they're probably thinking, well, it feels good to do it. How is this wrong? You know, how, how does this look bad for my joint?

We always say prostitution feels good too, but that doesn't make it right. But, uh, I always say heroin is good, but not good for you. Yeah, exactly. Um, I don't know. As far as that goes, I do think it's a delicate balance. So you're, you know, you obviously have the athletes who gravitate more to the manual treatment and things like that. And I think that's a very important part of it. I definitely don't want to discount, you know, the benefit of some soft tissue work and, and all those wonderful techniques that help remedy those situations. But I would say it always needs to be integrated in with active exercise. So whether we're doing manipulation or aggressive soft tissue or fascial work or tool assisted work, in my mind, I always, after that, want to be sure that I've reintegrated the right, you know, muscle synergies around whatever joint it is we're talking about. Sounds good. I like it. Um, now, yeah. So then as far as the order of treatment, I would say not to mess the order up. So if, if we're going to do a bunch of manual work, I like to have that done first and then finish with the corrective exercise, uh, afterwards. I actually think the order is actually really important not to do the opposite. I, I agree with that. Um, I haven't talked to anyone about it though, but why do you think that for the clinicians out there? Cause I'm sure there's young clinicians listening.

Yeah. So I think too, it depends on your, how often you're seeing a patient. So in clinical practice, I see a patient every 15 minutes. So I have to, you know, be a little bit quick on, on what I'm doing versus like, if I'm at the stadium, I might have, you know, 40 minutes or a half hour with an athlete. So time is one issue. So, you know, one approach would be to do some corrective exercise and then kind of come back and reassess and see how much, you know, once the neurologic noise is out of the muscles and then you can read, uh, joint, play the joints and kind of see where you're at and manipulate or do soft tissue work and then finish with that. I think that what's easier in the clinical setting is probably to find whatever you need to manipulate, uh, whatever soft tissue work you need to have done and then finish with really good corrective exercise. And it doesn't necessarily have to be DNS could be whatever you're into. But I think, um, through trial and error and I really, at this point, there's no research out there to support what we're talking about right now. But for what it's worth, I have found my results were way better when I respected those rules. Yeah. I found that, um, when people come in, typically they want, uh, tissue work first and then, uh, then they're more suggestive of corrective exercise. But with eval, I usually go with the corrective exercise first after all the testing and see what, like, like you said, see what we can get back and then see what's left and then hit that and then come back and stabilize it again. Um, there, but for that reason, it's, for me, it's a really long process the first time. And then after that, I feel like, okay, well, I know what I worked with last time. We can start with that this time and then stabilize after, you know, but yeah, well, I think everyone is, uh, every case is so unique and individual and has so many different complexities to it that you really don't know, like you said, until you start playing with it. As much as you think assessment is going to perfectly drive how you're going to treat the patient, what really happens is, is you, you know, work with that patient, you start to see what positions are good for them to activate whatever muscle it is you're trying to activate. And, uh, I think it's a very dynamic process that's constantly changing. So to say that, you know, my assessment is going to perfectly tell me exactly what I'm going to do. That's not true because a lot of times you're kind of having to make changes on the fly, um, as you go along. And I think that comes with experience. I think my students now at chiropractic college, they don't have the experience, so they don't have the ability to do that yet.

So they have to like kind of live more by some hardcore rules, but then you earn the right to take a shortcut as your career moves along, I think. Yeah. Um, this just reminds me, you're talking about the dynamic aspect of, of testing the, is there any, is there anything that you found over the course of years working with, uh, medial elbow pain that surprisingly took the patient out of pain sooner than you thought? Um, maybe a stabilization test, maybe something that, you know, like I found the other day that I just, um, there was a medial elbow pain patient that came in and we did, uh, uh, I was testing him into like a resisted range of motion while seated and he's leaning over just really forcing me through. Right. And so he said, it hurt. And I sat, I said, sit up a little bit.

And he's like, Oh, in a way, you know, and like, okay, well, we're looking at something a little higher now, but is there anything that you found that you're like, Holy shit, I can't believe I didn't know this earlier. Well, in the throwing athlete, I think like the, probably the most, the greatest lesson I've learned in the last 16 years would be that technique is a big part of it. 15 years ago in the back of my mind, if I was watching sports center and I saw somebody was on the DL because of elbow problems, I was like, well, if they had good treatment, there's no way this would have ever happened. And then when I got involved with it, I saw real quickly that it's not just a musculoskeletal issue and, and technique is huge part of it. So I would say like, if I had a million bucks to fix a 10 year old's medial elbow pain right now, I would go change his technique.

And I bet I could take it away in a second. So, because at that age, typically you don't have that many musculoskeletal imbalances yet at that point. So I think the, the, the technique, and if you think about it, this is true across all sports. So, I mean, today, uh, some of your listeners might see a 50 year old, uh, golfer who's got wrist pain, let's just say, and you're beating yourself up over it because you're not getting his wrist better. But if you only saw a video of how this guy swings a golf club, it would become perfectly clear why this guy's wrist is hurting him. So at the end of the day, sometimes like your treatment literally doesn't matter if the technique side of it is, you know, the one that's kind of taken priority. Yeah. So, but, but I mean, I would say, uh, everything that would be taught in a DNS course, I think is really helpful.

The elbow is an interesting joint. I mean, it's, it's a relatively simple hinge joint really doesn't have like a local muscle system, um, can get restricted, but typically doesn't. My point is like, there goes all your tools, you know, like, I mean, you're not going to manipulate. There's not like a local muscle system to activate around there. So it can, it's kind of like the wrist or the AC joint. It's kind of difficult because of those, those parameters to treat, I think. So, um, yeah, I would say DNS principles. Um, I would also say from a diagnostic standpoint, if, uh, your listeners have access to diagnostic, uh, ultrasound, I think it is just literally clinical gold for assessment because we can, we can valgus load it and we can see it's a dynamic test. So we can see the, uh, integrity of the UCL. We can also see whether or not there's a hypermobile on our nerve, which is a big problem with throwers. And then the other thing we can see common flexor tendonitis. So basically with one test, you're able to see everything. And it's really like, you know, Arthur Graham is considered to be the gold standard, but I think in the elbow, actually diagnostic ultrasound is, uh, is probably the best original assessment. You may have to get an MR down the road, but the, uh, for everyone wondering what the heck that is, uh, I have a whole article on it. I'll post in the show notes too. Um, now, so if you, if you're speaking to like, uh, kids or actually adults that have kids, um, what, what would you suggest that they do tomorrow to help their kid not have a UCL injury? And where can they go? Cause they're probably thinking this sounds, this sounds all great, but there's nothing like that around me. What do I do?

Right. Well, I'll just throw this out there because it's interesting to talk about. I always say, if you want your kid to be a major league baseball pitcher, don't have them start pitching through high school till high school. So you'll see, you'll see across the board as you talk to major league baseball pitchers, which I've seen. I've talked to, um, there's a couple exceptions out there, but for the most part, you'll see almost all major league baseball pitchers. They got a late start into pitching could be coincidental, but I doubt it. So, but you still have to be throwing a ball. This is a really, really important point because while the growth plates are opening, we have to have the, um, right retro torsion and, uh, humoral torsion occur in the arm that, that happens when you throw the ball when you're, uh, young and as the, the adaptive process continues.

So they have to be throwing a ball because otherwise you don't have the structural changes that need to occur in the actual humorous of the arm and the orientation of the, of the shoulder joint. But we just don't want them being, you know, overly used as far as pitching. It'll be interesting as we've totally now changed the pitch counts and things like that. And for the most part, I think most good, um, academies are living by them that, you know, that might change. But what happened in the past is these young studs were used and abused, you know, in their youth and then, um, come to find out they, they never had anything left by the time they got to, uh, college or, or major league baseball. So, um, we always joke if you watch a little league world series, none of those pitchers will pitch in the major league baseball.

So, but I'm not saying that you shouldn't pitch. I'm just saying like there, there's a, there's a lesson to be learned there and that we just need to be really, really careful with these kids at a young age throwing because, um, stories like that. And also just the damage that we see, we're now doing Tommy John surgery on 12 year olds, which, you know, just seems insane to me, you know? Yeah. So I think that my advice I would give to the parents is I, it's, it's a really good question actually, because now it's really sexy to say that, um, we want our, all kids to have sports specialization. I want you playing five different sports basically. I get that. And I agree with that up until the age of 12 or 13. However, like if I look at some of our players, um, like in, uh, the Dominican and Cuba, when they're five years old, they wake up and guess what they do all day long? They only play baseball. So as much as I want to say, you want to be a three sport athlete and you want to, you know, do this. The reality of it is that you need to play a lot of baseball to be good at baseball. So, so then how do you, how do you think parents should navigate with the, when the coach says, well, your son is awesome. Let's, uh, let's throw them all the time.

It's like, how do they address that? Cause I know they're going to be the advocates for their kids. Right. So yeah, I'm sure you're, you're well aware of like educating these coaches. It can be really, really, really challenging. So, I mean, all we can do is try to put them in a good environment where the coaches are, you know, well aware of, um, everything that we're talking about, but to back up, I think starting in the right throwing stereotype or pitching stereotype, I would also say is crucial to the point you asked me before where, um, why don't we change major league baseball guys? The thing is, it's, it's like, why is it hard for you and I to learn a second language at this point in our life? You know? So it's better if when they're learning, they learn with the right stereotype, the right technique, so they can feel that in their body the right way the first time. So I think getting the right instruction early on and with the caveat, I, I, that is a challenging process. So there is so much, um, out there in baseball that is wrong, you know? So finding the right people, I don't have a great answer for you. Like, it depends what city you're in. And you know, like I just, I, it's a, it's like when someone asks you or I, you know, who's good in this particular city? Yeah. Like sometimes you don't have a person, you know, like, so all you can do is hope and guess and hope that you put in a good, a good situation. Yeah. I know, I know it's a tough question, but like the, I know that when we were talking off air the last week that, you know, we were, we were kind of figuring out what we should talk about and you're like, well, I'd start with the kids, you know, and, and just the passion you have with it. Um, the, I don't know, I tend to think, and the one reason I did this podcast was because I'm, I'm tired of people getting misinformation, right? They walk in and it's like the general public doesn't, not to say that they're ignorant with it. It's just to say they don't know where they're getting fed poor stuff. So I don't know. My, my goal is to get people to understand and I don't want to be frustrated thinking that they're not understanding, but also I didn't do my part to educate, you know? So I'm going to say you should be the guy. They should send all their videos to you. You're going to have me divorced here soon.

No, you just get your wife to eval it too. I think you, or there you go. What does she do? She's, is she a Kyra too? No, she, uh, she actually, her, uh, undergrad degree was broadcast journalism. Oh, she can educate the public about it. Yeah, exactly. So now she's in the PR side of it. So yes, that would, that would be good. Yeah. It's a, it is a epidemic problem that no one has a great answer to. So, uh, we do feel like we have an answer to it. So that's a, that's really a good feeling. And, um, and whatever you do. So, I mean, we have a major problem and we feel like we're on the, on the right track. I think the hardest thing that we're working through now is we're 100% certain we can, we can assess and know who's going to get hurt. Um, for the most part, there's outliers. The question is like the queuing and the right things to tell the athlete to make the change that you want. That's like where the rubber hits the road. And I think even from a clinician standpoint for the clinicians out there, the next level of clinician is being able to coach these, uh, concepts like intrabedominal pressure into your, um, uh, uh, your athletes instead of just like assuming because it was right on the table and not having it apply, you know, to their sport. So I have tons of good examples of how, like I'll work with an athlete and everything, you know, in my mind was good. And, you know, we get them up and just for the hell of it, I have them grab a bat and they, they just sat through three weeks of me educating them on all these concepts. They grab the that and then they immediately just hold the abdominal wall right back in again after learning all of that. So that was a, that was a really good epiphany moment for me in my career was that, you know, you think everything is just guaranteed because you got it right in the, in the treatment room, but there's a whole, there's rarefied error for the clinician who's able to take these concepts and plug it into people's life or sport and like struggle and find the right words for them to feel what it should feel like in their own body when it is right. And that takes a lot of imagery out of the athlete. Like if the, if the athletes got a really good brain to imagine what things should feel like in their body, then that makes it a whole heck of a lot easier. Yeah. And thankfully in the professional level, these, these, the gnosis or the ability of these athletes to feel their body is like nothing you've ever seen in your life. So like the pitchers, they may, you know, they may not like the, the pitching rubber in St.

Louis, but they love the pitching rubber at Citi Field in New York or whatever the example might be. You and I would step on that rubber and it would all feel the same to us. Yeah. But they have such tactile acuity and they have such amazing ability to feel in their bodies that like all these little things can matter. And I don't know if you watch the world series this year where they're having trouble with the ball being slick. You and I, if we picked up that ball, it would feel the same no matter what. But because, you know, they have such an amazing ability to feel their bodies that, uh, and that, that's also one of their neurologic gifts.

Yeah. I thought, I thought you were going to lead into this is why they all have their own, uh, shoe brand and glove brand tactile sensation. That's all being driven by the agents. That is, that's, that's a, we could do a whole podcast on, on the downsides of that maybe the good end of that. Yeah. I, I had a, I had a friend that he just, he just had a birthday and he just loves Mike Trout. So we got a Mike Trout signed cleat and I looked at the cleat and I'm like, this looks new. And I felt kind of bad for Trout. I'm like, does he have to change shoes every game? I would, I would kill somebody if you had to keep changing stuff just to sell it on the market, you know? Um, cause that would drive my sensory thing. I don't know if when you played on a, like I was really superstitious. I know a lot of players are, um, were you superstitious at all? It's superstitious. Well, um, I, as a, as a rule, I'm a superstitious person. Yeah. Baseball is worse than any other sport. I think you put golf up there, uh, also, but I think the new current thought on that idea as far as sports psychology is we actually want to have them be able to live with some uncertainty and not be superstitious, um, which is a delicate little balance. But I think like if you're dealing with a, an athlete, I think like the right education would be for them to be able to live with some uncertainty that way when they're on the road and they don't have the exact same thing happen to them, then, you know, they can still go out and perform. And an interesting point is like, you'll have a lot of guys who will like go out and throw a no hitter when everything was wrong leading up to the game. Yeah. So, uh, it's, it's, or like, you know, you have your Michael Jordan flu game, you know, when things don't think they're going to be horrible, all of a sudden we have this amazing performance. I think it's, I mean, we're all going to struggle with this and educating our athletes on this idea, but I think being able to live with uncertainty and not being superstitious is really, really important because as you know, it just continues to change. Like there, you know, you never find the one thing that works across the board that might work for two weeks and all of a sudden it's no longer working, you know? So, but baseball, I mean, when we say it's a mental game, it is such a mental game. It's really, um, it's really hard to fathom, you know, the difference between a triple A baseball player and a major A baseball player is literally between their ears. So it's, uh, it's challenging. Yeah. Um, so as we start to, we've been in about 45 minutes here. I want to, I want to ask you some things that are tangent to, to UCL a little bit. Um, yeah. So just overall, just, uh, this is a little bit more for clinicians, uh, and myself, uh, over the past year or so, is there anything that you're really excited about in sports medicine and working with athletes and doesn't have to be UCL correlated or DNS or anything like that? I think just, I think the world of treatment is getting better at like kind of borrowing slash stealing from all the different techniques to allow for one model that that's really kind of all encompassing. So that would be, you know, obviously having, you know, DNS, a lot of people are in the PRI, um, understanding, you know, neurodynamics, understanding McKinsey concepts, understanding dry needling and being able to incorporate all these different things in the treatment of the athlete, I think is where it's all going. I think it, you know, because of that, I think we've seen amazing results in sports medicine, as far as like what you and I do is treating the athlete as far as recovery. Obviously we, there is so much out there now on that. I know at the stadium, I mean, we were using blood flow restriction, um, you know, all the latest and greatest of, of everything basically. And, uh, I mean, and then you have to have the conversation would be, uh, stem cell and other things, which as far as the UCL, I think the verdict is still out on stem cell and, uh, PRP and other, uh, regenerative, you know, medicine things for, for that particular injury. So, uh, but anyways, I think like we're going to see in the next five to 10 years, probably like a little bit of an influx of, of that. I think also maybe being able to, on ultrasound, assess the UCL and kind of see, you know, where they're at, even, even before they played baseball to see like, if there's some congenital anomalies or anything that could be, you know, leading them up to a problem. I don't know if you remember the story about, uh, Brady Aiken. So he was, uh, he didn't get drafted basically because of what they saw in the MRI. He had a real congenitally small UCL. So they thought he was at high risk for, for a tear. So everyone thought that I think it was the Astros.

Everybody thought the Astros were crazy for not drafting them. And, uh, sure enough that next year at IMG, he tore his, uh, he tore his UCL. Well, you almost want to have the image at that point, huh? Well, I mean, that's, what's interesting about athletes. Like a lot of, like a lot of times the agents will tell the athletes, like they don't even want an FMS screen on them. Like they don't want, you know, the less information, the better because it could be used against them down the road. So, uh, I think though, like in the, in the world of recovery, we're learning a ton. I think we're kind of in our infancy of learning, um, how the athlete should recover. And I think as far as the treatment, I think it's just about incorporating all these wonderful techniques that are out there and be able to take kind of the high points and be able to use them all together for, for an all encompassing, uh, approach.

Okay. Um, so I remember when I spoke with Rich, we were talking about, um, you know, incorporating a lot of these things as well, but then he mentioned stay in your lane, which I've heard a lot of people say as well. So at what point do you think are, are, are, are, are lane lines? And I mean, should we be doing, uh, strength training? Should we be, uh, coaching mechanics and so on? Or is, do we strictly stay in the table? Oh, that is such a great question. And Rich and I have talked a lot about this also. Um, I think most like major league baseball teams, they have an approach of stay in your lane. So, um, I think people, they're going to know you have that knowledge base. So when they come asking, then you're there to offer up what, you know, but I would say if you're going to work for a professional team, it is all about the team. Like to me, I walk in there and I, I don't want to be the hero. I literally want to do the best job I can to make our medical team better. So if everybody can have that approach, I think it, it, it goes way better where you run into troubles when you have like these individuals who are trying to go into a system and just blow it up basically, and then be the, be the new hero. So, um, which I mean, if you're going to work in private practice, that's not a problem, I guess. But if you, if you want to be affiliated with a team, you will learn how to use everyone around you and, um, be very humble and meek and be willing to learn what other people are doing. And I think, uh, that approach is, uh, is where it's all at. So I would definitely be an advocate for staying in your lane because my experience has been, if you're really good at something, eventually you get exposed. Like there's no way that 10 years from now, if you know, if you're the best in the world at looking at, uh, whatever we're talking about shooting a basketball, there's no way at some point you don't get exposed. So I think being patient and, uh, waiting for your moment is where it's all at. Oh, cool. Yeah. I, I definitely, I think over the years of practice, I've noticed that, um, you know, PTs, chiropractic, ATCs, like trainers, coaches, like we, a lot of the techniques that people use seem to blend into one person. It's almost like there's not a differentiation of a profession anymore, which I don't think is bad, but, um, I don't, I don't know if patients have a full comprehension yet of, of the reach that someone like you could do, you know? No, I think that that is an issue. And to your point too, cause I'm at a chiropractic college. So I understand, you know, all the views with, um, who should adjust, who shouldn't, things like that, which is, which is a good question. Uh, our stance is, you know, just, just work on yourself, you know what I mean? And even like manipulation, manipulation is a huge skill within itself. So you could go on a weekend seminar and learn, you know, a couple of techniques for manipulation, but I mean, to be good at manipulation takes years and years and years to be really good. And I always say there's 30 people in the world who are really good at manipulation, you know? So, I mean, there's millions of people who are doing it. So it's a skill just like, uh, anything else. So, um, what would you recommend two things that young clinicians should do while they're still in school? What do you tell your students?

You know, it, what's happening now, Sebastian, that is a big problem is there's so many people vying for their attention. So you have literally, um, them trying to, we call them seminar gypsies where every weekend they're at a new seminar. And I mean, we've had people in DNS, I've, I've taught in a one weekend, literally had the same person show up in a different city for a B the following weekend. And yeah, so I think this idea of like accruing certifications, you know, because everyone, you know, every weekend there's a new seminar in these cities, I think it's creating a huge problem. So, and I think, have you ever read Zen in the Art of Motorcycle Maintenance?

No. By Robert Persig. But anyways, he's got the book. I mean, he says it so perfectly. He compares it to like a brick wall. Instead of putting more bricks on a brick wall, we actually need to look at one brick and work on the depth of that brick. So, and I think that's, if I was telling a student, I think like you want to map out what you want to, you know, um, have in your, your treatment box, if you will. But then you also want to spend enough time in those areas to be really good at. If you're a try one through three chiropractic student, I would say, learn how to palpate and adjust joints for right now. And then when you get good at that, then you can start to add some rehab or some soft tissue. But I think, like I said, I mean, people are just like, you have try ones now taking a DNS course. I mean, can you imagine that? I mean, you know, it's just, you talk about being inundated with information. And then I would say that the next important point is you pick the right profession, whether you're PT, chiro, or, uh, in the world of training, because I think we're in such an amazing time right now, as far as treatment of the athlete, being able to incorporate everything that you and I know. And then I, I look at every day as like a little mini career. So I, when I walk out of the office, I want to be exponentially better than I was when I walked in and, you know, like just kind of understanding the journey of this and like, not just going into a treatment room, brain dead, like going in and understanding that that's just one more piece of information that you have to make yourself better long-term. And it's the same concept that Bobby Fisher talked about in chess. So he, he called it building memory traces basically. So they literally thought Bobby Fisher was cheating because what he'd done is he, he could remember every single situation and opponent he'd been in. So then he could, he could basically know their next move, but he can know their fourth next move.

And if you really think about it, that's what you and I are doing in practice every day. So you're gathering information, you're making a decision, and then we get to see like what our outcome is right in front of our face and then not being hung up and chasing pain. You know, I walk into a room and I almost just kind of mind deaf myself and say, I do not care about their pain. Just don't even care. Don't even ask about it. Like I am there to change the function of their body. And that is what I do. And that's what, you know, that's what I think I'm pretty good at. So, but if I go in and I say, Hey, Nancy, how's your back? And she's got tripper fibromyalgia and a touch of rabies. There's no telling what my answer is going to be from her, you know? So I think, I think like understanding how, what to do to get good at this craft. And I learned it from, you know, Carol Levitt. So I got to see him treat patients when he was, I think it was 97. So for those of you who don't know who he was, he was a famous neurologist who basically, you know, did work like we do. And, uh, so he still carried a leather book around with him to his treatment rooms at that age, not because he was writing another book, but simply he was still writing down clinical pearls to help him get better at practice. Yeah. And, uh, that was a valuable lesson. And, uh, one other quick little story about him. I saw him time after time, work up patients that he was not biased by their pain. The one that just sticks out, cervical genic headache. The patient had it for years. He scours this patient's body. I mean, really kicks the tires, checks the trunk. An hour later, he'd never got ahead of himself. He just assessed the patient. He thought the biggest finding was a trigger point in the patient's soleus gets out a needle, dry needles. That that's all he did.

Patient gets up. He's like, my, my headaches completely gone. And so because we were there a while, we got to see the patients come back. So, uh, maybe he got lucky, but, uh, I saw him do it over and over again while I was there. And, uh, just a really amazing epiphany moment in my career to see like what can happen when you don't treat pain and you actually, um, treat whatever is dysfunctional. Yeah. Well, that's amazing. You got to see him. I know that, uh, he's, he's gone now. The, yeah. Um, but for all the, for all the patients out there, it's almost like if we were to a philosopher to be able to meet Socrates. Um, so it's, it's a big honor. I wonder where that book is, by the way, we should get that book. Uh, I know. Yeah. So I, I've been told you can't get it anymore. And, uh, the leather book. Yeah. Oh my gosh. Who knows where that is? Yeah. I would, well, I won't say what I would pay, but I would pay a lot of money to get my hands on that book, but actually his books out of print now. So no one, everyone's having all this trouble finding it. So if you have one, um, yeah, it's worth a lot of money. Yeah. Yeah. Um, I, I thought, oh crap, I forgot what I was going to say. Now you, uh, you mentioned something about, about Leavitt, but, oh, well I'll come, I'll come back to it if I think about it. Um, yeah. Uh, okay. So last thing, what would you tell parents of kids with possible UCL or that are going to pitch? Two things.

I would say I've seen a lot of crazy things. I think I've actually seen more crazy things since youth softball because of the dad, female daughter relationship, like just craziness. But I see, I see hints of it also in baseball. So I would say the first thing would be, um, to, you know, handle yourself well in these situations and let your kid be a kid and not try to live vicariously through your kid would be the first piece of advice I would give as far as baseball. The second part would be, um, understanding the pitch counts, um, understanding the right mechanics of pitching and throwing. Um, and then kind of also understanding as far as like an overreaching concept of baseball. Now we have all these select teams and club teams.

So you literally have this crazy situation where you're almost competing against your own teammate to look better, you know? And if you think about it, that is like so wrong as far as sports. So, so basically what you end up having, you end up having the kids and the parents actually rooting against a 13 year old on your own team to do poorly, because that would give your son, uh, a better daughter, a better chance to go play. If you just take a step back and think about that, I mean, how bizarre that is, you know, right. It doesn't place in a team sport. Right. But I mean, that's where team sports are going, you know? So, I mean, that's really kind of a scary thought. And I will be the first to tell you, there is a dark underbelly to baseball and professional sports, of course, you know, like when you have agents dictating, you know, different things. So, um, you know, we have to, I think, be sure we continue to, uh, preach the team concept. And then I think too, the other thing is obviously, um, being in, um, the right baseball shape, if you will. Um, and we could, you know, do another podcast on what that would entail, but also eating well and, you know, all the stuff that I think our listeners know, but probably may not, you know, uh, do. So those are all real important ideas and teaching people how to compete.

That's the other thing. You know, my experience has been for the most part, kids are not taught what it means to compete well, what it means and, um, how to have good sportsmanship once the game's over. So those are good. I honestly think I bet that professional sports would be, would be better if we went back to the days where like, uh, Ted Williams had to go off to war and they, you know, to go to a game was probably like five cents. And, uh, I feel like you take the money out of it. It would be, I know they wouldn't like that, but you take the money out of it. It'd probably be a little bit more pure, you know? Well, Ted Williams, I mean, he was such an amazing athlete, but he's a great story because so he missed five years in the middle of his career because he was fighting in two wars, as you said. But anyways, he was an amazing fighter pilot. So when he showed up at his training center to, um, uh, when he got called up, they're like, who is this guy? Like they could not believe how good he was. And I don't know if you know the story about when, um, they used to write numbers on the balls and he could see the number on the ball as it was coming into him or different colors and stuff.

And I always ask our players, I'm like, could you possibly be able to do that? And they're always like, there is no way I could do that. You know? And then he went on, he was a, um, world-class fisherman too. So, you know, he's had, he had an amazing gift for like visual spatial relationships. Now what's up for debate is if you're not the world's best at that, can you, because of neuroplasticity, can we get better at that? So I think that it's a, it's fun to kind of talk about, but he had an amazing ability to not necessarily like on a Snellen chart to see things, but to be able to, you know, understand the relationships that with vision and all the other five senses, which is what also makes for great athletes.

Yeah. That, that would be probably part of that, uh, that baseball shape podcast is visual training. Um, Oh, it's so important. I have heard that story about it. It's crucial. Yeah, no, it's, it's, uh, it's, it's quite fascinating, but I would say all these professional athletes, every day they'll do something that will just blow your mind that they think is no big deal. You know, they're, they're just really, they're neurologic savants and, and being able to use their body. Yeah. It probably, it probably, uh, it makes me feel a little bit better about just stopping baseball in college and continuing down this route. Cause I can never see those numbers.

Well, what's hard is if you play minor league baseball, you basically take that time of your life, like in your middle of your twenties, when you would be in college or starting your career and you're basically in this holding pattern, you know? So, uh, that is a hard thing. I mean, I feel like it's a hard thing. They probably end up having no education. I mean, I think there's education now for minor league is right, but like, you don't, you don't have that college experience and you don't really have a direction of profession other than baseball. Right. And I mean, the difference between minor league baseball and, uh, professional is like, I can't tell you the difference, even from triple A to major league, as far as like accommodations, hotels, travel. So it is, uh, it's, it's not always fun in the minor leagues.

So, um, how can everyone reach you? And if they were to sneak a video in and email it to you, where would it go? Um, they can use my email, which I think, are you providing my email or, uh, I can provide anyone you want to, like, I didn't know if that, or that one looked like an official one that I have, right? The wind spine is BW at wind spine and sport.com. Yeah. That's probably the, that's probably the best way to, to reach me. So, um, uh, yeah, I would say, don't just inundate me with a million videos, but if you have any questions, I can, uh, I can definitely, hopefully point you in the right direction depending on where you're, where you're from.

So what's your, the other, the other gestalt performance is the other thing that we started where it's just all rolling out right now. So that would, uh, and I have a partner with that, his name's, uh, Tyler white. So he's way more interactive on social media than I am. I'm kind of the old buzzard of the group, but, uh, so he's always, you know, working, working on stuff with that. So I think there's, there'll be a lot more to come on that gestalt performance platform. So cool. I will put a link to all these in the show notes too. Um, well, great. Um, I don't think I have any more questions, but do you, do you have any, uh, anything last to say?

No, thanks for, it's been great meeting you. Yeah. It's been fun. Yeah, it has been fun. Okay, everyone. That was Brett Winchester and he mentioned his website. I will have it in the show notes as well. I know you're probably all driving, walking your dog and running, so you can't really write it down. Anyways, if you're looking for those show notes, uh, I changed the format a little bit to make it so it's p2sportscare.com slash the number of the session. So just, so just look onto where you're listening to it, maybe on iTunes, maybe on my website, but you'll see that it'll have a session number, just no pound or anything like that.

p2sportscare.com slash the number, and you'll be directed to it. And I'm attempting to do in this one, I'm, I'm going to do it, uh, transcripts to all of the web, all of the podcast. So if you didn't understand something we were speaking about, go onto that and you'll be able to access the transcripts, any links that we spoke about and so on. Now, if you have not already in your young clinician, I want you to go to the website and check out all of the content we have for you. The, the section you'll see when you get into the website, there is two buttons. There's, uh, currently there's two buttons we might redesign, but there's, I'm a patient, I'm a clinician or I'm a professional. Now, the reason why I have those two divisions is because for patients, I have a ton of articles. And if you agree with everything I've said with the podcast so far, you're probably going to like a lot of the content I put on as well.

And the reason why these are there for you is not to steal a patient or anything of that nature. Obviously we're probably thousands of, or hundreds of miles away from each other. So I believe that we can set these patients up for success if we give them a little bit more education. So I have endless articles upon back pain, uh, flexion intolerance, uh, posture, uh, sleeping in the, in this case, uh, I have one on musculoskeletal ultrasound, uh, the new, the new core of the pillar system, so on. So these are all tools for you guys who use to send to your patients. So you don't have to have these long conversations. I mean, I wrote 30 pages just on the concept of core of the pillar system, intra-abdominal pressure and co-contraction of everything that goes around the torso as well. So I commonly refer patients to this and actually I had a really good experience with a patient recently that where we have a initial email we send to someone who books, um, a certain type of exam. I have my back exams differentiated from a lot or back or lumbar spine or, uh, nerve, uh, uh, distal or radiculopathy type of exam. I have it differentiated from a musculoskeletal of other joints. And the reason is because I want to make sure I know kind of what the person is thinking they have before they actually come in. We send them an email that has two podcasts, one with, uh, it's 66, one was 67, one Stuart McGill. One of them is, uh, Dr. Seth Myers. And so I've had patients come in and they're like, I listened to both of those podcasts. They were one hour each. I understand. Let's do this. So I'm like, Hey, did we talk about this, this, this?

They're like, yep. Listen to it. It was great. Cool. What else you got? And they would even go through like postural modifications. I have one video on how to sit, how to sleep, how to, how to sit into a car. So these are things which oftentimes I teach for those lumbar spine exams that are, they take a little bit of time, but I've had patients come in and this patient in particular, they're like, I, I looked at those and I tried them and the intention wasn't to have them try it right away. Cause I didn't examine them yet, but they, they use it as a resource and they had such good success with it that they had so much buy-in when they first came into the office.

And I was excited because I was able to get to more stuff, to more content, to more exam, to more corrections, more manual cueing with this person than I could with a lot of other ones that might come in and say, Hey, what is a joint? What is a spine? You know, at that point, you're kind of like an anatomy teacher. And that's not the, that's not what I want to have the patient know. I want them to know how, uh, all these other concepts that will be helpful to their improvement. Now, so I go on there and explore that. By the way, this is why all the podcasts are created too. So share the podcast when you, uh, hear one you like and you have a patient in mind too. So without any further ado, I'm going to close the podcast now. And if you guys have questions for me, reach out Seb, that's S E B at P2 sportscare.com. Thanks for listening. Talk to you guys soon.