Does Icing Your Shoulder Still Work for Baseball Pitchers? - #AMR392

Pitchers are constantly looking for the best way to recover after a long outing. Walk into any training room, and you will hear the hum of massage guns and see guys strapped to ice machines. We're seeing newer things too, like ESTIM machines and even BFR after an outing. We know pitching causes microtrauma and neuromuscular fatigue. The debate over how to properly manage that fatigue never seems to stop.

A recent study finally put percussive massage and traditional ice therapy head to head. Researchers had collegiate pitchers throw 75 pitches and then gave them either a targeted massage gun session or 15 minutes of isolated icing. They tracked exactly what happened to the shoulder over the next 48 hours.

The results might force you to change how you handle your athletes post-game. One of these popular methods actually restored shoulder external rotation strength and proprioception. The other completely fell flat after two days. Check out this week's podcast episode to hear my breakdown of the data and find out exactly what you should be doing to keep your pitchers healthy and performing at their best.

To see full show notes and more, head to: https://mikereinold.com/does-icing-your-shoulder-still-work-for-baseball-pitchers/ 

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Transcript

SPEAKER_00 0:47

On this episode of the Ask Mike Rhinald Show, we review a recent journal article review that compared vibration gun versus icing after baseball pitching. And you're gonna want to watch this episode. I actually have changed my practice based on the results of this. The Ask Mike Rhinald Show. Helping people feel better, move better, perform better. Before we get to the podcast, I wanted to make sure you knew about my free online course on the introduction to performance therapy and training. If you want to learn how to get started optimizing and enhancing performance, this is the course for you. Head to micrennell.com/slash performance to sign up today.

Why This Study Matters

SPEAKER_00 1:37

Welcome back, everybody, to the latest episode of the Ask Mike Round show. We're up and champion PT Performance, answering your questions. Actually, we have another journal article review, which we're getting some great feedback uh on this kind of like mix between some journal article reviews and some of our questions. Again, uh just trying to break down some of the articles that we're finding, we're talking about a champion ourselves. Um, because if if they're changing our practice, then I'm sure they can change your practice as well. So we're gonna start covering those as well. But with me today, we have Brendan Gates, Dave Tilley, Mike Scaduto, Lenny McCrina, Kevin Coughlin, and Anthony

Free Course Quick Mention

SPEAKER_00 2:10

Vedetto. We are back with a journal article review today. And we have a an article from the Journal of Strength and Conditioning Research. And the name of the article is The Acute and Delayed Recovery Effects of Percussive and ICE Therapies on Shoulder Strength and Sensory Motor

Study Setup And Protocols

SPEAKER_00 2:27

Function After Baseball Pitching. And I gotta say, I was excited when I saw this title kind of come across my screen to read this a little bit, but this was a cool study. So what do we have? This is what they did basically in their study, and this was a study um that um I think did a good job. Let me say, all right, so we have basically 16 male college-age pitchers with a mean age of 22 years old, right? So um, you know, in in Asia, this from Taiwan, uh, pitching is is your baseball is very popular, right? So this is what I would consider some fairly high-level athletes, 22-year-old to high-level athletes for baseball. And what they had them do is they had them pitch a simulated game of five innings and 75 pitches with max effort. And what they tried to do is they tried to break it down into two groups: a group that did some vibration massage with a uh uh um a uh hypervolt vibration gun after they they pitched, and another group that iced uh for 15 minutes with a game ready system. Okay. So they compared two groups, the vibration gun and the ice. And what they did is they evaluated how they felt after pitching, after that treatment, and then more importantly, 48 hours later, which I think was an excellent thing to look at because that's when you're starting to recover from your outing, right? And you're starting to get prepared to maybe even throw like a bullpen or something like that in your next outcome. So that's what they looked at. I would say just right off the bat with the methodology, I don't love a lack of a control group that did neither, but okay, no big deal. I mean, we can still kind of compare it between the two. Uh, but again, what they essentially showed was that after pitching, your strength went down, your external rotation strength went down, and your internal rotation strength. But that to me, we've known, right? We've shown that in past studies that that it goes down. But I think what was really cool for me was that if you iced and not vibration gun, your strength significantly returned back to basically 100% external rotation by 48 hours. In the vibration group, it was still down 11% 48 hours afterwards. Now, internal rotation was similar, right? It got restored to about 95% of where it was, but we showed that it there was a decrease in strength and it came back into the group that iced. And same thing with proprio reception, it was improved, and same thing with subjective pain scales that also

The Results That Changed Practice

SPEAKER_00 4:57

improved. So, gosh, this is such a cool study for me because this is one of the clinical things we deal with pitchers all the time. One of the big trends we've seen in major league baseball on a five-day pitching cycle, and I think this is throughout, though, is that a lot of guys are saying that they're too sore or maybe they don't feel quite right on day two, so 48 hours after, when I would love for them to throw a bullpen. So a lot of them are pushing their bullpen back to day three, which was only two days out of their their their out their next you know, game that they need to pitch. So we know that pitching reduces your strength, it doesn't make you feel great. Why would you want to throw your bullpen so close to your outing? That's kind of like been my thing. And I think again, this study proves that you should have as much time as possible. But more importantly, ice-that's right, the nemesis of social media ice was shown to actually be effective. And that's really, really interesting with people because I don't really care about theoretical things about

Bullpen Timing And Real-World Soreness

SPEAKER_00 5:55

like inflammation and how that can help somebody or or not some help somebody. You know, I yes, I think if you go sit in a cave and just let your body heal, it's probably best to let inflammation ride its course and do a good job. But if you're getting paid or if you need to compete just several days later, I think we finally have a study now that's going to change my practice. And I'll say this, I'll add this. I we sent a group text out to all of our pro guys that we have like a group thread about and shared this article with them and talked to them about them. I would say over the course of my career, I've always said I'm pro-ICE, I like ice, but I've worked with so many players that do and don't ice that I do not have a strong opinion to say that you need to ice. I have so many successful pitchers that don't ice, right? So I haven't said that. But now, for the first time in my career, I officially have changed my opinion to be a little bit more stern with this and say ice is the way to go. Again, you don't have to, but if you want to have less pain and you want your strength to return for your bullpen on day two or whatever, your next outing, if if you're a reliever, that sort of thing, ice has been shown to finally do that. So I love the study. We send it out to everybody. I want to hear your guys' thoughts. What do you what do you guys think about it? Has this changed what what you guys think? If you start talking to people about this, what do you guys think? Uh, maybe Mike, you want to jump in? I know you've been you've been thinking about this article. What do you got?

SPEAKER_03 7:15

Oh, yeah, I think I think my key takeaway in terms of clinical practice is like I I think it's a no-brainer, right? Uh, it's such an easy modality to use, like it's an ice pack, right? In the study they used the game ready, like, and I don't know if they specified the amount of compression that they used with the game ready or not in the actual scene.

SPEAKER_00 7:33

No compression. Yeah, intentionally no compression. So that way it would just be the cold.

SPEAKER_03 7:37

Right, yeah. And and that's what I thought. So, I mean, it's an ice pack. Um, it's easy, it's it's not, you know, icing is not the most pleasant thing, but it's not like painful by any means. Like some people are more sensitive. But I I think it's like such an easy thing that we can implement. Everyone has the ability to get an ice pack. You know, the the findings in this study are pretty clear about the benefits. And those are things that we're we're really trying to achieve, right? I think we we're trying to get that strength back to be more prepared for um you know their next bull pen and their their midweek throwing. So I think, yes, to to answer that question, I think it's a it's a no-brainer decision. There's really in my mind, I know there's maybe some people out there that say there are some negative side effects of ICE, um, which maybe is a limiting factor of this study where they didn't do they didn't do any blood work to take the uh inflammatory biomarkers and and compare that. But I think that's not really the goal of this study. The goal is to see whether the strength returned um and the soreness, the perceived soreness was down. So um, in my opinion, I think those two things are more applicable to how the athlete's gonna feel uh the next time they take over baseball than you know, exactly the specifics of the biomarkers in their blood. Um, so you know, I think definitely, you know, we're gonna push people to ice um specifically their shoulder. Um, I think the study was interesting. Like if we dived a little deeper into the methods, like there were 16 people maybe would have liked to see you know a slightly bigger study. Um the the subjects you know, they served as their own control, meaning they did both they did the icing protocol and then they did the uh percussion protocol, um, and then they compared the difference within the same person. So um I don't mind that. I think the inclusion exclusion criteria, like you know, the inclusion criteria was a healthy baseball pitcher, even though those are tough to find, maybe. Um, so I don't I don't have any problem with that. Like, what else are you supposed to do? They excluded people with significant injuries to their shoulder. So, you know, overall, I think it was a well done study. Um would love to see, you know, future research um looking at this with maybe a slightly bigger study size, but I understand you know the the intent of this study, and I think it was well done overall.

SPEAKER_00 9:55

Awesome. Yeah, and Mike, I don't think I don't think I could agree anymore, right? It's you know, the the whole concept of of what ice does on the cellular level and slowing down or or speeding up healing, you know, you you have a study that showed less pain, better proprioception, and a and a return to your strength. That's I really don't care what their biomarkers on the inside of their inflammatory process really say. It's about the outcome, right? And you know, this is where, again, I think, you know, the debate online with ice, right? That's like, you know, my lord, it's gone so far about the anti-ICE movement with some some things and you know, uh, the push to to do some other things. Um, I think this is a really great example of maybe like the pendulum swinging, and maybe went a little too far with one concept. Um, and you know, some of the other outcomes other than just inflammatory markers, I think, you know, obviously are are more important. Uh what else? Anybody but what would anybody want to jump in on this one? Like, what would you say to somebody that talks about the anti, you know, the ice or you know, the inflammatory process? Like, does it matter? What would you what would you say to somebody said that? Well, doesn't it slow down healing? What would you say?

SPEAKER_02 10:59

I I mean, if if you guys are okay with me saying something, I um and my connection's okay. Um I I I I think you kind of alluded to it, the pendulum was swinging too far. And I think pitching 75 throws, I think your inflammation in your shoulder and your body is different than having a traumatic surgery or a car accident where you uh the your inflammatory markers are gonna be different. So I think uh this this study kind of matches my biases where I've never bought into the anti-ICE world where I still think ice is important um because it depends on the situation. Um so I think icing after throwing into throwing, no injury, just throwing. Now, throwing does injure locally, but you're not having this big blowout surgery injury, like I said. So I think that's one thing. Another thing is they used

Answering The Anti-Ice Argument

SPEAKER_02 11:49

massage guns for a prolonged period of time. And five minutes of massage gun. I love the massage gun. I use it myself. We love, we have them in our clinic. But I think five minutes, a five-minute session could have some inhibitory effects on the muscles. And I think this there's a bunch of research that shows vibration therapy, uh, if you do it excessively, can be inhibitory. And so you gotta be careful with the AMI and an ACL knee where you may want to uh you know do some vibration therapy to the quads uh after you do some icing to the uh to the capsule, which has been shown to be uh help improve quad uh recovery and quad activation. You gotta be careful. So I think maybe they did too much um too much massaging with the percussive, you know, with the with the uh massage gun, and that could have been uh inhibitory. So there's a couple things from the study that kind of were interesting to me that it met my biases that ice is not bad, and that maybe we need to be careful with you know using massage guns excessively.

SPEAKER_00 12:42

Yeah, it's an interesting slant to to their land, maybe on the massage. The good part for me is at least they did a vibration gun and then two days later they retested them. So to me, I don't think they were they were still inhibited by that. But I love your point though, it's it's a very valid point. And may maybe if they had a control group that did nothing, right? They would have done better, you know, which is good. But still, I mean, if you could if you were telling me that you know, after you throw your external rotation strength is down 22%, I believe that we've seen that in other studies. But if you ice, then it goes back to 100% by the second day. Right, that's awesome. Right. I mean, like, are you kidding? Like, yeah, what what did like that's I mean, that's a study right there. So what else? anybody else have anything they want to throw in on that? Dave, what do you got?

SPEAKER_01 13:25

Yeah, I think I I also was growing up in the ice is bad, never use it ever, you know, it's the demon kind of thing. And I think this study is a perfect example of how like you have to read research critically and then not to be like crude, but you have to like use your brain, right, to like apply stuff. And so there was this era when I was starting to get into more sports PT where like the wave was like that brand new study came out and it inhibits healing. And so, like, people were like, No ice ever. And if I if you know, if you use ice, I'm never gonna send you a patient again because you're malpractice. And it's like, all right, like there's very different context-specific uses of modalities, and an ice and an acute ankle fracture from a humane point of view, because someone's screaming and it's really painful, is different than ice AMI post-op knee, like Lenny just said, when it's very helpful to get the quad going versus 75 uh you know, outing throw. Like it's completely different of like the tool can be applied in different ways. And I think the fear that a lot of people have, if you're not reading critical research and using the application base, is like you start to get like, okay, this study says it's bad, I'm never using it again. Where this study said it's good, so I'm using on every person, like needling, right? When needling came out, everybody got needled all the time. And it was like, well, the number one outcome of if somebody wants needling to be effective is if they believe it's gonna work. So I'm not gonna needle somebody if they're afraid of needles, even though the study said it was really helpful. And I think as I read through the study, it's like, oh, that sounds like a great application, and I'm not obviously a huge baseball between innings kind of guy. You guys are doing all that work at champion. I'm like, if I was reading this as a young grad, I'd be like, oh, this is actually a good idea. Maybe I should think about using this critically, not just never ice anybody ever, no matter what.

SPEAKER_00 14:55

Yeah. So you're looking you have two options right now. I think this is the way, like, you know, listen to this podcast episode. We broke down, like maybe, you know, a very positive thing on ice, or go on social media, feel bad about yourself because somebody with a lot of followers shamed you into thinking you're a bad PT because you iced somebody once, right? Like, and that that's what we're dealing with right now, with some of the education that we see like online is like you know, very strong opinions that like to Dave's point, like there's a time and a place for most things. And I think hopefully we just found a time and a place for this. So um, yeah, I changed my opinion on based on this study. And you know, it still happens. We change our opinions all the time. But if somebody asked me, I say, definitely ice now. Again, I'm not gonna be mad at you if you don't, right? It's your body. Um, and then you know, the first thing somebody said, like in our group text with all our pro guys, was like, um, do you think this also applies to the elbow? In my mind, I was like, Yeah, absolutely. I mean, we we don't we don't have proof it does, but I can't imagine that it would be you know much different. So that's where like you're not always gonna have evidence, but you take the best evidence you can and apply it the best you can. So yeah, shoulder elbow ice after a pitching outing is is back on my kind of uh you know plate for what I think a pitcher should do if they want to prepare. And again, if you're that pitcher that is pretty sore for a few days after and it's limiting your ability to get ready for your next start, this is even more a no-brainer for you, right? Because I do, you know, on a five-day cycle, I do not want people throwing a bullpen on day three. I just think that is the wrong approach.

Applying This To Shoulder And Elbow

SPEAKER_00 16:26

So anything we can do to get that earlier. Seven-day cycle, same concept, but right, like the more recovery you can have from your your bullpen, you know, to your outing, the better. And if you know this helps you get ready, this would be great. And yes, I would ice after your bullpen too, by the way, based on this. Like somebody else in the pro group asked that same question, right? Somebody said, like, you know, should I do this after my side? Yeah, absolutely. I think this this study shows it. So uh awesome. Hope you guys enjoyed that. Please uh rate review us online so we can actually improve this podcast. We do read those and we do try to improve them based on your feedback. And be sure to subscribe, and you can get more updates when we release these podcast episodes. Thanks so much.