Why Kris Medlen is Having Tommy John Surgery Again

Kris Medlen Pitching InjuryI just got home from a 3X VCamp early March and decided to turn on some spring training baseball. Kris Medlen was pitching for the Braves and I couldn’t help but cringe everytime he threw the ball. Especially on his off-speed pitches. He had two big mechanical flaws that felt like nails on a chalk board everytime I saw them. He had late hip rotation and early arm cocking. The worst mechanical combination for a pitcher in the 90’s.

It didn’t take long, he started holding his elbow and then he threw his final pitch. Not his final pitch of the inning but his final pitch of the game in the middle of the inning. He then made a beeline for the locker room. I haven’t seen that kind of an exit for a pitcher in a long time. When I tore my rotator cuff in the 4th inning of my first college appearance I stood on the mound in shock. I think the beeline was the better move. You can watch Kris Melden’s final pitch and exit here.

The major problem that exist today for Kris Medlen is that he is now having his second Tommy John Surgery which has a very poor success rate compared to the first. You can learn more about the success rate for Tommy John surgery in my article called, What Pitchers Need to Know About Tommy John Surgery. What young pitchers need to learn from Kris Medlen’s career is how to not only prevent arm injury but a second arm injury.

In this article, I will show my data on how late hip rotation correlates to more horizontal adduction and how it has been detrimental to Kris Medlen. I will also go over another underlining issue of early arm cocking and how it can combo the effects of late hip rotation at front foot strike on the pitching arm and finally how to deal with arm pain or injury for the first and second time in your career.

Late Hip Rotation Correlates to More Horizontal Adduction

I have done some work lately for a professional organization on injury rates of their pitchers. What I did was breakdown video of a few of their pitchers into the components and more that have been defined in the 3X Pitching Evaluation System. These parameters can then be put into a simply rating system showing who is more prone to having pitching injury. During the biomechanics analysis of their pitchers I found a strong correlation of the hip range of motion at front foot strike and horizontal adduction of the throwing arm before pitch release.

Horizontal adduction is when the throwing elbow moves down and forward before pitch release. High velocity pitchers will generate some horizontal adduction before pitch release but studies show too much will increase the load on the elbow to a harmful level (1).

The mean peak shoulder horizontal adduction angular velocity was 933° +- 320°/s, and pitchers who demonstrated lesser degrees of this angular velocity of shoulder horizontal adduction tended to limit this harmful elbow stress.

This study claims that this single parameter along with 3 others is a major cause of elbow stress:

Four parameters were identified in this study that were responsible for 97% of the variance in elbow valgus stress. These were (1) shoulder abduction angle at stride foot contact, (2) peak shoulder horizontal adduction angular velocity, (3) elbow angle at the instant of peak valgus stress, and (4) peak shoulder external rotation torque.

Kris Medlen also shows another one of these four red flags; too much shoulder abduction at stride foot contact. This is what I also call early arm cocking which I will define in the next section but first we must look at the link from poor hip rotation at front foot strike to more horizontal adduction at pitch release. Studies show that when a pitcher decreases his hip and trunk energy by 20% he must make up for this loss of energy by 34% with shoulder rotation to keep the same force on the ball (2). This means poor hip range of motion at front foot strike forces the pitcher to use more arm to generate velocity. This is a performance killer and an overuse problem.

Kris Medlen’s Early Arm Cocking

Early Arm CockingAnother major problem to add to his elbow valgus stress is his early arm cocking. This also compounds the issue of poor hip rotation at front foot strike. Kris is in the low cocked position in the middle of his stride while most healthy high velocity pitchers are in the low cocked position at front foot strike. Look at the pictures here of  Kris Medlen and Sonny Grey. They are both showing the low cocked position but Sonny Grey is at front foot strike and Kris is not.

At front foot strike we find Kris in the range of pitchers who have a higher amount of elbow stress.

Throwers with more limited ranges of shoulder abduction at the instant of stride foot contact (109° +- 33°) appear to have lesser degrees of valgus stress at the elbow.

Kris Medlen Front Foot StrikeHere is a picture of Kris Medlen at front foot strike. He is at full shoulder abduction before shoulder rotation. Most healthy arm slots do not move into full shoulder abduction until maximum external rotation.

The final red flag I identified in Kris Medlen’s pitching delivery that links to his UCL damage was his late pronation after pitch release. Studies show early pronation reduces the elbow valgus and varus stress. You can learn more about this in my article called, Research Proving Pronation Supports Pitching Velocity While Preventing Injury. You can see in the pictures below that compared to Tim Lincecum, who has early internal rotation and pronation, Kris is late to pronate at pitch release.

Late Pronation Kris MedlenIn my studies this is a direct result of the poor hip rotation and excessive horizontal abduction issue. This is proof that because the pitching delivery is a chain link (kinetic chain), pitchers who continue to damage the elbow joint have red flags first coming from the initial movements of the pitching delivery.

The type of biomechanic adjustments that Kris Medlen needs to make in his pitching delivery are a more linear and flexed Force Vector and more Triple Extension (3X) power into front foot strike. This will drive his hips more open at front foot strike which will provide the energy needed to load and unload the arm faster. This will increase his ball speed and reduce the stress on his elbow because more of his arm speed is coming from his lower half rather than mainly his throwing arm. This is the same approach we take with the 3X Pitching Velocity Program when working to develop ball speed and reduce the risk of injury.

Surviving Arm Injury Once and Even Twice

I have lived through and recovered from arm surgery once. I am very thankful that I didn’t need it a second time. The key to preventing it the first time is taking preventative measures in your career and not waiting for arm injury to change your mechanics or your strength and conditioning program. You need to get better at listening to your body and knowing what it needs at all times. To prevent arm injury the second time you must not continue down the same path that caused it the first time. I see this time and time again, a pitcher has arm surgery and then just jumps right back into his same old mechanics and old routines. There must be a change if you are not going to find yourself under the knife again. This is what I feel kept me from having surgery again and this is a lesson that Kris Medlen better learn now that he has had his second Tommy John Surgery because the same mistake again will end his career.

Pitching Reference:

  1. Werner SL1, Murray TA, Hawkins RJ, Gill TJ. – Relationship between throwing mechanics and elbow valgus in professional baseball pitchers. – J Shoulder Elbow Surg. 2002 Mar-Apr;11(2):151-5.
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