Good morning. Happy Thursday. I have neural coffee in hand and it is perfect. Please mute. If you have a question, please go to the chat function, indicate that you have a question. We'll answer them in the order in which they arrive most of the time. For those of you who don't know, it's Thanksgiving here in the United States. So I can't promise this will be a normal call. People coming in. All right, first question goes to Lalo. Today will be a silent call.

All right, we've got some Thanksgiving people on here.

For those of you who don't know, it's Thanksgiving here in the United States. So I can't promise this will be a normal call. People coming in. All right, first question goes to Lalo.

Okay, fire up Lalo. Hello, and I can't hear you. I heard you a moment ago. Today will be a silent call.

I tell you what, let's jump to Zach and we'll come back to Lalo when he comes back on. OK, hang on, Zach.

See if Lalo comes back on. See if it works.

Got it.

Are we there?

Yes, sir.

All right, that's better.

OK, so real quick. This is a pro baseball player with lots of years of experience who lacks internal rotation. I work with JP here and he's training them directly, but this pitcher lacks internal rotation. He has had Tommy John surgery.

And I wanted to- Right handed pitcher?

No, he said? Right handed pitcher. Okay. No, I'm sorry. Left handed pitcher.

Left handed pitcher. Okay.

All right. Lacks internal rotation. He lacks shoulder flexion at our level. We do table tests, but we try to do more like active tests, like back against the wall type. So what we've seen is just he stands already with his arm bent. His arm can't relax and go down. He's wide, very strong guy, lots of training experience. And the Tommy John, he had had surgery.

How long ago was the Tommy John?

Quartered. Last year. He hasn't thrown a season since. He's now starting to get his arm warmed up into throwing. As he's getting into it, he's starting to touch his elbow a lot. And we went over like what's happening. He's like, well, I still feel a little bit, still feel a little bit, still feel a little bit. So this is recurring. We have tried breathing exercises to start gaining some ranges of motion and we've tried, you know, in training, stuff that we've talked about, you know, the kettlebell carries, things of such. It's been really hard to gain him any type of range of motion and to get away from those, from that tweak that he's getting. So I just wanted to know from you, like, what is your view on Tommy John recurring and the arm bent? Maybe I'm missing a lot of pieces here.

Okay. So he hasn't thrown a season since?

No, he hasn't thrown. He's now starting to get his arm warmed up into throwing. As he's getting into it, he's starting to touch his elbow a lot. We went over what's happening. He says he still feels a little bit, still feels a little bit, still feels a little bit. So this is recurring. We've tried breathing exercises to gain some range of motion and we've tried training stuff like kettlebell carries, but it's been really hard to gain him any type of range of motion and to get away from that tweak he's getting. I just wanted to know your view on Tommy John recurring and the arm bend. Maybe I'm missing a lot of pieces here.

Well, okay, so number one, you said he's an older pitcher. He's got a lot of experience. He's got a lot of training history, right? Yeah. So he's going to have a lot, and he's a wide ISA, okay? So you got a triple whammy there. So you have a lot of muscle activity that you're dealing with that he doesn't manage well, right? So you have to understand like what the mechanics were that results in the medial elbow expanding to such a degree that the ligamentous structure is destroyed. Those mechanics are still there. The Tommy John surgery creates a replacement for the damaged structures. It does not alter the mechanics. So you have a lot of ER orientation. You have a lot of concentric orientation of the musculature that will keep him in ER for a prolonged period. So this is an elbow result. It is not the problem, okay? So I would be as worried about capturing medial foot contacts on this guy, getting the hip internal rotation, getting him the late hip IR, so we can push down into the ground, like all of those factors just as important as the direct measure of internal rotation at the shoulder.

Because he's wide, do I start him in... early and extended angles and then move him into IR.

What do you mean by extended angles?

So we're clear. If I have him on the ground, for example, and I'll do a hip extension, legs extended first or heels elevated goblets and things like early propulsive starting and then move him into the IR in order to move him into the late or should I start training him in late?

Well, okay, so this presents a question as to what we're starting with. He's a left-hander. He's probably going to have some IR compensatory strategy on the left side. Do you have an idea of what his HIP ER measures would be as far as which side has more?

Yes.

Yeah. Okay. Limited IR and ER.

So it's understood, but there's going to be a side bias. You're going to have a little more on one side than the other. And if you can tell me that, it can give you an idea where to start.

We'll go over that, see if there's a bias towards that.

So here's the thing. Just because history is experience and training history. You're going to lose motion when you throw and when you train. If you don't consistently recapture it, then you're starting from a deficit and progressively lose motion over time. He's got to capture the ER positions to throw. This is why Tommy John surgery results in the first place—the exposure to prolonged external rotation keeps the medial elbow expanded for longer than we would prefer, and then the ligament suffers. All the musculature that would expand the medial elbow, like the medial triceps for instance, is concentrically oriented under this circumstance and creates a twist across the elbow that keeps the medial elbow expanded. That was probably there prior to the surgery and is probably still just because that's who he is. Okay.

Yeah. I'm trying to get him to abduct the arm and it's just not opening.