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Last week, a young man flew into Tampa to train with us for a few days. I’ll call him Cade. A barrel chested Lefty who, at 6’0” and 210 lbs, Cade clearly excelled in the weight room, He was having pain in the lateral upper arm and forearm. He said he had experienced the same symptoms during every high school outing this year.  Each day, when he started his throwing routine here, he could only manage about 10 throws before succumbing to throbbing/radiating pain and weakness in his left arm.

For 2 days, we worked with Cade to try to solve his pain. We tried the Durathro Training Sock, we did a physical evaluation and a high-speed video analysis of his movement pattern… nothing jumped out at us.I performed several clinical tests without significant findings. Then, I checked him for one more possible mality.
With his hand by his side, I placed my fingers on his wrist found his bounding pulse. Then with my fingers still on his pulse, I raised his arm to above shoulder height. His pulse immediately disappeared under my fingers, his palm went snowy white, and he reported aching in his forearm.I stopped and said, “I think you might have thoracic outlet syndrome.”
This marked the 3rd time in the last 12 months I had seen a pitcher who came in with thoracic outline (TOS). With the first 2, I totally whiffed and didn't figure out until I went with them to see  Dr. Eaton.But not this time.What is thoracic outlet syndrome (TOS)?It s a rare but significant problem in which a branch of the brachial plexus, and/or the subclavian artery and vein are trapped in the space between the subclavius, the  scalene muscles, the costoclavicular ligament, and the first rib.

The symptoms of TOS usually present as pain, numbness, and tingling in the neck, shoulder, upper arm, and forearm, and can include weakness and, ultimately, loss of muscle mass.The symptoms usually start gradually and increase with the number of throws made during a game or a training session. Rest usually makes the arm feel better, but when the pitcher resumes throwing, the symptoms return.

What Causes TOS?

Medical literature indicates that sometimes the problem is due to a congenital defect – an extra cervical rib that pinches off the neurovascular bundle. Heavy weight lifting has also been cited as contributing factor. Increased muscle mass and loss of mobility can predispose a pitcher to TOS. In two of the three recent TOS pitchers I've seen, improper weightlifting certainly played a role.

Both bought into the idea that they needed to do to throw harder was to get bigger and stronger.

You see, too many pitchers fall prey to myth that all they need to do is "add mass" and they will throw harder. I guess I understand the idea, and it's not always a bad thing to add mass. Pitching is largely about gaining and taking advantage of momentum. In physics, momentum is represented by the lower case "p". The formula for momentum is p = mv (where m = mass and v = velocity).

So create momentum, adding mass can be a good thing.  But adding mass that you cannot move is useless.


Weight lifting like a body builder by pushing and pulling weights in the sagittal plane can create bulk, but it doesn't improve velocity. Indeed, it can contribute to injury.






And as Eric Cressey said in a a recent twittter post

A truly effective weight training program for pitchers must be based on movements in the frontal plane, transverse plane, diagonal planes and exercises focusing on glutes, core, scaps, and one legged maneuvers.

But most importantly,  every weight lifting program must be hyper-individualized -- customized for the specific needs of every single guy. And every program must be reassessed and modified frequently as the athlete's body changes.

That is why we opened our fitness fusion gym and started our ARMory Strong: Functional Weight Lifting for Baseball Players, Rocket Fuel Nutrition, and HARDCORE Fusion.

CLICK HERE to see info on all 3 of these incredible programs.

So lets get back to Cade.  First of all, he has stopped lifting. He is seeing a vascular surgeon this week.

Occasionally TOS responds well to physical therapy, including stretching exercises and manual therapy, but sometimes it requires surgery to remove the first rib, or to decompress the area of impingement.

The recovery time after the surgery can vary, but it’s usually about 4 -6 months before the athlete is able to throw without limitation.

Major Leaguers who have undergone the procedure include Alex Cobb, Jaime Garcia, Josh Beckett, Chris Carpenter, and Shaun Marcum, Matt Harrison, Kenny Rogers.

The outlook for full recovery is good, but there have been a few pitchers that never regained full form after the procedure.

He should be back in action for the spring season.

Are you having arm pain?

Need to add some velocity?

Call my office and at 1-866-STRIKE3 and schedule a Precision Strike 1-Day, 1-on-1 Evaluation and Training session. I’ll take you through the most comprehensive evaluation and training experience you've ever encountered. You'll learn all the necessary corrective physical exercises and throwing drills.

You'll also have the opportunity to add a Superhuman power building workout, and you can add on an ARMory Strong session and training plan (Hyper-individualized, of course).

We'll be waiting to hear from you,