A Return to the Mound
When medication and rest failed to bring pain relief to pitcher Henry “Quinn” Stroube’s throwing elbow, his parents decided to seek a second medical opinion. With MRI in hand, they met with Peter Sabonghy, M.D., a Memorial Hermann-affiliated orthopedic surgeon who serves as medical director of the Memorial Hermann IRONMAN Sports Medicine Institute at Memorial City.
Immediately Dr. Sabonghy diagnosed Stroube’s condition as an overuse injury and put together a plan of action to help him return to the mound.
“Quinn had thrower’s elbow, a common injury that needs rest and the appropriate rehabilitation under the proper supervision,” said Dr. Sabonghy. “It doesn’t just affect the elbow. It can cause pain in the shoulder and throws off the body’s mechanics and kinetic chain. If you’re not careful, it can lead to back and hip pain, too.”
Much has been written about the kinetic chain. In pitching, the transfer of power from the planted foot to the tip of the throwing hand relies on strength, flexibility and range of motion in the foot, ankle, knee, thigh, hip, core, chest, shoulder, elbow, forearm and hand. If any muscles in this chain are weak, the transfer of power is diminished. The greater the weaknesses, the more chance the entire kinetic chain can go awry.
“I was surprised by the diagnosis,” said Stroube, a rising junior at Stratford High School who has played baseball since age 6. “First, Dr. Sabonghy had me rest the arm. Then I talked him into letting me play a little so I could DH [designated hitter] for Stratford, but no first base or pitching.”
Despite the restrictions, Stroube contributed to his team’s 17-6-0 winning season, delivering a .542 batting average in 35 plate appearances.
In addition to rest, Dr. Sabonghy’s plan included referring Stroube to the Institute’s expert team of physical therapists. First, they worked on rebalancing and multi-joint exercises. This was followed by a supervised throwing program of progressively greater distances and speed.
Mitch Blitz, P.T., M.P.T., conducted the initial assessment of Stroube, which included an analysis of his pitching.
“Whenever a patient comes in they generally have a specific area of pain, but we look at the body as a whole, examining mechanics and throwing technique,” explained Blitz. “We always look at the joints above and below the pain to see if something else is going on. With elbow pain, we need to look at shoulder strength and core stability that can create extra stresses that can lead to a mechanical breakdown further down the chain.”
As it turned out, Stroube needed to work on rotator cuff and scapular strengthening.
“I relate it to building construction,” said Blitz. “You can have a pretty building on the outside, but it’s what’s holding it up that’s important. If the scaffolding, or inner workings, are not properly positioned and firing the right way, it can create extra strain and cause problems.”
Besides supervised physical therapy at the Institute with Blitz and Zach Evans, P.T.A., Stroube did at- home exercises with resistance bands and weights. He has now integrated these exercises into his ongoing strength and conditioning program.
“The therapists answered my questions and got me to where I could do the exercises at home,” said Stroube. “I like the rotator cuff exercises because you can feel the burn. These exercises are harder than most people think.”
“I’m feeling a lot better now and I’m throwing at full speed. In fact, I think I’m now throwing faster than I ever have.”
Shoulder and elbow injuries, generally caused by overuse, are the most common injuries sustained by baseball players. These injuries usually begin as a nagging ache or pain, but can sideline players if not treated in the early stages. Fortunately for Stroube, he returned to the mound in competitive play just four months after he first visited the Institute.
“Quinn has had a great outcome,” said Dr. Sabonghy. “We let things heal and then we got him the right rehabilitation at the IRONMAN Institute.”
“I’m feeling a lot better now and I’m throwing at full speed,” said Stroube, who also plays select ball with Team Mizuno. “In fact, I think I’m now throwing faster than I ever have.”