Episode 74: Casey Mulholland - The Pitch Count Lie: Why Baseball's Most Trusted Injury Metric Doesn't Work

Episode 74: Casey Mulholland - The Pitch Count Lie: Why Baseball's Most Trusted Injury Metric Doesn't Work

Why are pitching injuries continuing to rise exponentially despite rapid advancements in sports science and tech? According to baseball development innovator Casey Mulholland, the industry is breaking a fundamental principle of human physiology by leaning into excessive, unpredictable loads without allowing the body time to adapt. In this episode, Mulholland joins hosts Andrew Rizza and Dr. Cameron Roth to challenge some of baseball's most widely accepted injury prevention strategies. Drawing on his own career-ending injuries, years of professional player development, and hundreds of thousands of tracked throws, Mulholland argues that pitch counts alone offer a dangerously incomplete picture of an athlete's workload. He breaks down why velocity has become an unfair scapegoat for arm injuries, the tension between objective data and coaching intuition, and his concerns about how private equity money is reshaping youth baseball and the potential long-term effects on athletic development. MEET THE GUEST Casey Mulholland - Founder, Kinetic Pro Performance - Expert in Pitching Workload Management and Throwing Development TOPICS DISCUSSED - Why pitch counts fail to measure true throwing workload - The relationship between velocity, mechanics, and injury risk - Balancing objective biometric data with coaching intuition - Bridging communication gaps between orthopedists, PTs, and coaches - The quiet takeover of private equity in youth travel baseball - Why baseball technology suffers from a crucial user-experience problem HIGHLIGHTS 00:00 – Intro 01:06 – How Mulholland's Personal Injuries Influenced His Current Mission 03:12 – Sponsor: Boston Orthopedics and Wellness | Beck Bode 04:43 – Why Are Pitching Injuries Rising Despite Modern Sports Science? 07:03 – Is Workload Management the New Buzzword? 08:32 – Does Chasing Velocity Cause More Injuries? 14:30 – Valgus Torque Protocols and the True Capacity of the UCL 19:13 – Why Traditional Pitch Counts and Guidelines Are Flawed 25:57 – Building a Better Workload Management System 31:19 – Better Collaboration Between Coaches and Medical Providers 34:22 – Advice for Orthopedic Surgeons Treating Young Pitchers 41:20 – Balancing Objective Data with Coaching Intuition 46:51 – Inside the New KP App 49:39 – The Rise of Private Equity in Youth Baseball 57:56 – One Change Mulholland Wants to See in Baseball 59:13 – Lightning Round: Favorite Pitchers, Fishing Analogies & Shohei Ohtani QUOTES: 02:33 - “‘I don't understand. Again, when I was at my strongest, when I had my best mechanics, I got hurt. What do you think caused my injury?’ And he said, ‘Well, I don't know what caused your injury, but there's definitely another category that you're not thinking of. And that's workload management.’" 58:07 - “I'd like to see all throws tracked. Simple as that.” LINKS Casey Mulholland - https://www.linkedin.com/in/casey-mulholland-35ab7542 KineticPro Performance - https://www.kineticprobaseball.com MLB Report on Pitcher Injuries, December 2024 - https://www.documentcloud.org/documents/25460405-mlb-pitching-injuries/ An Official Response: MLB Report On Pitching Injuries 2024 - https://www.kineticprobaseball.com/the-mlb-injuries-report-of-2024-got-it-wrong/ RELATED EPISODES The Surgeon Who Saved Sports - Meet Dr. Andrews - https://youtu.be/tkvI56ZiabA?si=ymcmY7dh7m4F5qXy Why “Fixing” a Pitcher’s Mechanics Might Make Them a Worse Player (with Eric Schoenberg) - https://youtu.be/0FdYIW2PcOQ?si=Op_LF3mvvqhq8Zua Curt Schilling on Why Pitching is Broken (and the Real Story Behind the Bloody Sock) - https://youtu.be/Zj9GYxyT3iI?si=WPz-Sy0Pw_h30Aj2 SPONSORS Boston Orthopedics and Wellness helps you recover faster, move better, and perform at your best with advanced orthopedic and wellness care. Get 15% off your first visit: https://www.bostonorthopedicandwellness.com/ Beck Bode is a fee-only fiduciary firm that builds personalized roadmaps to keep your money aligned with your life goals. See what real planning looks like at https://beckbode.com DISCLAIMER The opinions presented on Behind the Sports Medicine are those of the host and guests. They do not necessarily reflect the opinions of any affiliated institutions or partners. The content is for informational purposes only and does not constitute medical advice. Always consult a licensed medical professional before making any health or treatment decisions. Behind the Sports Medicine and its affiliates assume no liability for the accuracy or application of the information discussed. #YouthBaseball #SportsMedicine #PitchCounts #WorkloadManagement #InjuryPrevention

Episode 73: Corey Tremble - Managing the Team Behind the Team: What the Best Sports Medicine Departments Do Differently

Managing the Team Behind the Team: What the Best Sports Medicine Departments Do Differently How do you keep an elite medical staff focused, dialed in, and performing at their absolute highest level across a 162-game season? Instead of focusing on treating players directly, today’s guest instead invests in making the clinicians around him better. In this episode, Corey Tremble, Director of Medical Operations for the Miami Marlins, joins hosts Andrew Rizza and Dr. Cameron Roth to discuss what it takes to build a high-performing sports medicine team inside a Major League Baseball organization. Drawing on his extensive background working under legendary sports medicine mentors and alongside major front-office figures like Gabe Kapler, Tremble breaks down how the Marlins have revolutionized performance nutrition and why the mental health component of return-to-play is so overlooked. He also dives into the modern velocity epidemic driving new UCL tear patterns, what he prioritizes when scouting new sports medicine talent, and his work as the chair of the National Athletic Trainers Association (NATA) Cannabis Task Force to build a science-backed educational framework for pain management. MEET THE GUEST Corey Tremble, DAT, LAT, ATC * Director of Medical Operations, Miami Marlins * Chair, National Athletic Trainers' Association Cannabis Task Force TOPICS DISCUSSED * Building collaborative sports medicine departments that improve athlete outcomes * The evolution of Tommy John surgery and UCL tear patterns * Preventing burnout while leading high-performance medical teams * Building a best-in-class nutrition program in professional baseball * Bridging the education gap around cannabinoids and athlete pain management * Destigmatizing delegation and managing staff burnout * The future of AI, wearables, and workload management in baseball HIGHLIGHTS 00:00 – Introduction 00:58 – Role of Director of Medical Operations for Miami Marlins 02:23 – Keeping Staff Focused over a 162-Game Season 04:28 – Sponsor: Beck Bode | Boston Orthopedics and Wellness 06:00 – Establishing Collaborative Decision Making 09:08 – Communicating with Coaches During Rehabilitation 11:04 – Successful Return to Play and the Mental Health Component 16:29 – MRI Use and Clinical Judgment 19:02 – The Shift in UCL Tear Patterns and Tommy John Surgery 24:34 – How Modern Pitching Is Changing Elbow Injuries 28:12 – Thoughts on Shohei Ohtani 30:06 – Nutrition as a Competitive Advantage 34:21 – Technology, Lab Testing & Objective Return-to-Play Metrics 36:06 – Hiring Great Athletic Trainers 39:14 – The NATA Cannabis Task Force and Educating Athletes 44:10 – Managing Burnout and Delegation 48:07 – Where Sports Medicine and Baseball Are Headed 51:59 – Lightning Round: Travel, Squats & Sleep QUOTES: 03:33 - “My goal is to take my unbelievably gifted, intelligent physical therapists and athletic trainers and give them the spotlight, give them the ability to really hone in on what they believe is really important, really give them the opportunity to have a voice and have a vision of what we should do as a department. And that's really what has, in turn, created a better space for our athletes to get better.” 46:44 - “It's the mark of bad leadership when you think that you have to do it all. And again, you feel guilty at the start of delegating and asking others on your team to do things that you could very easily do, but that's how they're going to grow.” LINKS Corey S. Tremble on LinkedIn – https://www.linkedin.com/in/trembleatc/ [https://www.linkedin.com/in/trembleatc/] Miami Marlins Official Website – https://www.mlb.com/marlins [https://www.mlb.com/marlins] National Athletic Trainers' Association (NATA) – https://www.nata.org [https://www.nata.org] PBATS Podcast - https://www.youtube.com/@pbats [https://www.youtube.com/@pbats] RELATED EPISODES The Surgeon Who Saved Sports - Meet Dr. Andrews - https://youtu.be/tkvI56ZiabA [https://youtu.be/tkvI56ZiabA] SPONSORS * Beck Bode is a fee-only fiduciary firm that builds personalized roadmaps to keep your money aligned with your life goals. See what real planning looks like at https://beckbode.com [https://beckbode.com] * Boston Orthopedics and Wellness helps you recover faster, move better, and perform at your best with advanced orthopedic and wellness care. Get 15% off your first visit: https://www.bostonorthopedicandwellness.com/ [https://www.bostonorthopedicandwellness.com/] DISCLAIMER The opinions presented on Behind the Sports Medicine are those of the host and guests. They do not necessarily reflect the opinions of any affiliated institutions or partners. The content is for informational purposes only and does not constitute medical advice. Always consult a licensed medical professional before making any health or treatment decisions. Behind the Sports Medicine and its affiliates assume no liability for the accuracy or application of the information discussed. #SportsMedicine #AthleticTraining #BaseballMedicine #MLBHealth #MiamiMarlins

Episode 72: Dr. Nicholas Rose - The Hook of Hamate: The Tiny Wrist Bone That Can Derail a Baseball Season

Standard X-rays miss this injury 60% of the time, leading many athletes to play through what they assume is just regular wrist soreness, but a hook of hamate fracture can destroy an athlete’s batting mechanics for seasons to come. According to hand and upper extremity surgeon Dr. Nicholas Rose, the modern obsession with home runs and bat speed has caused a drastic uptick in hook of hamate fractures. In this episode, he joins hosts Andrew Rizza and Dr. Cameron Roth to break down this unique injury. Drawing on decades of experience, Dr. Rose explains how athletic trainers and coaches can identify the subtle warning signs before a player's performance collapses, and why grip strength may be one of the most underutilized screening tools in baseball. The conversation explores diagnostic challenges, treatment options, return-to-play timelines, and the importance of collaboration between surgeons, therapists, athletic trainers, and hitting coaches. Dr. Rose also shares lessons learned from working with NHL players, Red Bull athletes, and some of the highest-level performers in professional sports. MEET THE GUEST Dr. Nicholas Rose, MD, FACS - Hand & Upper Extremity Surgeon, Southern California - Medical Consultant for NHL players and Red Bull Extreme Sports athletes TOPICS DISCUSSED - Why modern batting mechanics have increased hook of hamate injuries - The clinical signs athletic trainers and coaches should watch for - Why hook of hamate fractures are frequently missed on standard X-rays - Treatment options, surgery, and return-to-play timelines - The role of grip strength testing in early diagnosis - How collaboration between surgeons, therapists, trainers, and coaches improves outcomes - Lessons from treating professional baseball, hockey, and extreme sport athletes HIGHLIGHTS 01:05 – What Is the Hamate Bone and Why Is It Vulnerable? 01:54 – Modern Swing Mechanics and the Palmer Hamate Grip 04:01 – Baseball's Shift Toward a Power-First Game 05:50 – Sponsor: Boston Orthopedics and Wellness | Beck Bode 07:22 – Clinical Presentation: How to Spot a Hamate Injury 09:07 – Risks of Missed Hook of the Hamate Fracture Diagnosis 10:36 – Hamate Fracture Diagnostic Protocols 13:44 – Treatment: Casting vs. Surgical Intervention 15:20 – Return-to-Play Timeline & Post-Op Rehab 16:49 – Interdisciplinary Communication During Rehab 18:41 – Adjunct Therapies: PRP, Peptides, Bone Stimulators, etc 22:07 – Return to Fielding Timeline 23:08 – Regaining Confidence After Surgery 24:20 – Prevention and Future Trends in Wrist and Hand Injuries in Baseball 26:03 – Can Grip Strength Training Prevent Hamate Injuries? 27:54 – Return to Play Lessons from Treating Elite Athletes 32:43 – Shohei Ohtani's Unmatched Athleticism 35:28 – Lightning Round: Myths, Comebacks & Movies 38:46 – Working with Red Bull Extreme Athletes 40:03 – Key Hamate Takeaway for Clinicians and Athletes QUOTES: 35:38 - “‘Play through the pain.' I think with today's athletic trainers and orthopedic surgeons, there's no excuse for that. Get it checked out. Don't be a hero because you're ultimately hurting yourself in the end.” 36:41 - “I tell patients, ‘Look, my surgery's 50%, and your rehab is 50%, and you have to treat it that way.’ So I would say that the tool of the occupational therapists and the athletic trainers are vital, as vital as the surgeon.” LINKS Dr. Nicholas Rose on LinkedIn – https://www.linkedin.com/in/nicholasrose1214/ Dr. Nicholas Rose - https://www.drnicholasrose.com RELATED EPISODES Curt Schilling on Why Pitching is Broken (and the Real Story Behind the Bloody Sock) - https://www.youtube.com/watch?v=Zj9GYxyT3iI SPONSORS Boston Orthopedics and Wellness helps you recover faster, move better, and perform at your best with advanced orthopedic and wellness care. Get 15% off your first visit: https://www.bostonorthopedicandwellness.com/ Beck Bode is a fee-only fiduciary firm that builds personalized roadmaps to keep your money aligned with your life goals. See what real planning looks like at https://beckbode.com DISCLAIMER The opinions presented on Behind the Sports Medicine are those of the host and guests. They do not necessarily reflect the opinions of any affiliated institutions or partners. The content is for informational purposes only and does not constitute medical advice. Always consult a licensed medical professional before making any health or treatment decisions. Behind the Sports Medicine and its affiliates assume no liability for the accuracy or application of the information discussed. #HookOfHamate #HamateFracture #SportsMedicine #BaseballRehab #HandSurgery

Episode 71: Eric Schoenberg - Why “Fixing” a Pitcher’s Mechanics Might Make Them a Worse Player

Why “Fixing” a Pitcher’s Mechanics Might Make Them a Worse Player The old-school approach to sports medicine often tries to force every athlete into a standardized box, but when it comes to elite baseball players, that can be counter-productive. According to physical therapist and strength coach Eric Schoenberg, changing a pitcher's natural motor preferences may reduce pain, but it may also make them a worse baseball player. In this episode, Eric Schoenberg, owner of Diamond Physical Therapy, joins hosts Andrew Rizza and Dr. Cameron Roth for a wide-ranging conversation on baseball rehabilitation. Drawing on years of elite experience—including overseeing Justin Verlander's historic Tommy John rehabilitation at age 39—Schoenberg explains why protecting an athlete's uniqueness is the key to performance. He breaks down the subtle early warning signs of UCL and flexor pathology, what surgeons overlook during clinical exams, why the term "arm care" is fundamentally misleading, how the scapula and thoracic spine sit at the center of protecting the throwing athlete, and shares his thoughts on the modern youth injury epidemic. MEET THE GUEST Eric Schoenberg, PT, CSCS Owner, Diamond Physical Therapy at Cressey Sports Performance Florida Board Certified Physical Therapist & Strength and Conditioning Coach Specialist in baseball athlete rehabilitation and management TOPICS DISCUSSED Why coaching the uniqueness out of an athlete can ruin their performance The real drivers behind the youth baseball injury epidemic How to maximize rehab in the "no-throw" window The role of the scapula and thoracic spine in arm health Why traditional manual muscle testing fails throwing athletes What surgeons, therapists, and athletic trainers can learn from one another HIGHLIGHTS 00:00 – Introduction 00:55 – What Makes a Baseball Athlete Unique 02:36 – Balancing Athlete Uniqueness with Pain-Free Play 05:09 – Sponsor: Beck Bode | Boston Orthopedics and Wellness 06:41 – Most Prevalent Upper Extremity Injuries 07:40 – Is There a Rise in Youth Throwing Injuries? 09:01 – The Role of Physical Therapy in Rehab vs. Injury Prevention 11:12 – Turning Back the Clock on Private Equity in Youth Sports 14:47 – Early Warning Signs of UCL & Flexor Wad Issues 16:51 – Non-Operative Treatments for UCL Injuries 19:27 – The Role of Workload Management in Injury Prevention 22:03 – Strength vs. Mobility: What Athletes Need at Different Ages 24:05 – Incorporating Manual Therapy & Modalities in Recovery 26:57 – How Technology Is Changing Baseball Rehab 28:55 – Best Piece of Tech for a Clinician to Use 31:00 – What Orthopedic Surgeons Often Overlook 38:52 – Advice for New Athletic Trainers on Arm Health 41:43 – The Importance of Thoracic Mobility 46:54 – The Role of FMS in the Evaluation Process 48:57 – Lightning Round: Comebacks, Underrated Exercises & Overrated Tools 53:36 – Thoughts on Shohei Ohtani's Unicorn Status 55:02 – Red Sox or Yankees? QUOTES: 01:52 - “Sometimes we view something as, ‘Well, maybe this doesn't look right, or maybe this doesn't match up with another athlete, so therefore we have to change it.' And I think that's something that we need to be really careful about is just not coaching the uniqueness out of somebody, because that's usually what makes them great.” 51:50 - “Arm care is a bad name because you don't pitch with just your arm. So whenever anybody says, ‘I've got to do my arm care,’ I cringe because if you're not getting the rest of your body ready to throw, you're generally wasting your time.” LINKS Eric Schoenberg on LinkedIn - https://www.linkedin.com/in/eric-schoenberg-5593a320 Diamond Physical Therapy - https://diamondphystherapy.com Cressey Sports Performance - https://cresseyperformance.com RELATED EPISODES The Surgeon Who Saved Sports - Meet Dr. Andrews - https://www.youtube.com/watch?v=tkvI56ZiabA Stop Blaming Her Hormones — The Real Cause of ACL Injuries in Female Athletes - https://www.youtube.com/watch?v=Eb2Dm9xzfZg&t SPONSORS Beck Bodie is a fee-only fiduciary firm that builds personalized roadmaps to keep your money aligned with your life goals. See what real planning looks like at https://beckbode.com Boston Orthopedics and Wellness helps you recover faster, move better, and perform at your best with advanced orthopedic and wellness care. Get 15% off your first visit: https://www.bostonorthopedicandwellness.com/ DISCLAIMER The opinions presented on Behind the Sports Medicine are those of the host and guests. They do not necessarily reflect the opinions of any affiliated institutions or partners. The content is for informational purposes only and does not constitute medical advice. Always consult a licensed medical professional before making any health or treatment decisions. Behind the Sports Medicine and its affiliates assume no liability for the accuracy or application of the information discussed. #SportsMedicine #BaseballRehab #TommyJohn #PhysicalTherapy #PitchingMechanics

Episode 70: Erica Mulholland - Stop Blaming Her Hormones — The Real Cause of ACL Injuries in Female Athletes

The Real Reason Young Female Athletes Are Getting More ACL Injuries Adolescent girls are tearing ACLs at alarming rates, particularly in soccer, but the explanation most people reach for is wrong. According to strength coach and former All-American soccer player Erica Mulholland, the problem has far less to do with female anatomy or hormones than most people think. In this episode, Erica Mulholland joins hosts Andrew Rizza and Dr. Cameron Roth for a discussion on ACL injuries, strength training, long-term athletic development, and the growing pressures facing young female athletes. Drawing on her experience as a collegiate athlete, semi-professional player in Brazil, and author of the book Female Athlete, Mulholland explains why strength training remains the single biggest missing piece in a female athlete’s development. She challenges popular misconceptions around biomechanics and menstrual cycles, arguing that poor mechanics are often the result of fatigue and inadequate physical preparation, not the root cause of injury itself. The conversation also explores the role of parents and coaches in youth sports, the dangers of overscheduling young athletes, and why one well-designed strength session per week can completely change an athlete’s trajectory. MEET THE GUEST Erica Mulholland - Former All-American Soccer Player - Johns Hopkins University - Strength & Conditioning Coach - Author: Female Athlete TOPICS DISCUSSED - Why ACL injuries in girls are more about load management than anatomy - Why strength training is essential for adolescent female athletes - What a well-designed in-season strength programme looks like - The biggest myths surrounding menstrual cycles and ACL injuries - How coaches and parents can better support young athletes - Load management, recovery, sleep, and nutrition for injury prevention HIGHLIGHTS 00:00 – Intro 00:52 – Why ACL Injuries Are So Prevalent in Young Female Athletes 03:57 – Sponsor: Boston Orthopedics and Wellness | Beck Bode 05:29 – The Impact of Year-Round Youth Sports 08:24 – What Needs to Change: Parents, Coaches & Administration 14:47 – What a Typical Training Session Looks Like 17:33 – Are We Overcomplicating ACL Prevention? 21:54 – Getting Buy-In from Coaches, Athletic Directors & Parents 25:27 – American vs. International Approaches to the Weight Room 27:18 – What Separates a Good Strength Coach from a Bad One 28:48 – Training for Endurance in Soccer Athletes 30:11 – What Coaches Should Look for in a Strength Training 32:21 – When to Start Talking Nutrition and Sleep 34:28 – Nutrition and Supplements for Teens 38:05 – Best Technology Tools for Assessing Athletes 40:30 – Key Takeaways From the Female Athlete 45:06 – What Parents Should Prioritize & What Coaches Should Stop Overlooking 46:34 – Lightning Round: ACL Reconstruction, Load Management, etc 48:57 – Addressing Body Image Fears in the Weight Room 50:19 – Other Common Injuries in Young Female Athletes 52:45 – The Rise of Compartment Syndrome QUOTES: 01:04 - “We used to think it was just a female issue that, girls have wider hips or a larger Q angle and they had different mechanics than males, or there's hormonal factors at play — But it's really more a training load problem.” 06:40 - “I think parents fall into the trap that if they're not on the top team, they're not playing year round, they're not doing skill sessions year round, that their kid will fall behind, and they're not going to be on the top team when they hit puberty. Well, that's not the truth.” LINKS Erica Mulholland - https://ericasuter.com Female Athlete High Performance: Building Fast, Strong, and Powerful Female Athletes - https://www.amazon.com/Female-Athlete-High-Performance-Building/dp/B0CN8NJF2F PlayerPulse - https://playerpulseapp.com RELATED EPISODES The Surgeon Who Saved Sports - Meet Dr. Andrews - https://www.youtube.com/watch?v=tkvI56ZiabA&t SPONSORS - Boston Orthopedics and Wellness helps you recover faster, move better, and perform at your best with advanced orthopedic and wellness care. Get 15% off your first visit: https://www.bostonorthopedicandwellness.com/ - Beck Bode is a fee-only fiduciary firm that builds personalized roadmaps to keep your money aligned with your life goals. See what real planning looks like at https://beckbode.com DISCLAIMER The opinions presented on Behind the Sports Medicine are those of the host and guests. They do not necessarily reflect the opinions of any affiliated institutions or partners. The content is for informational purposes only and does not constitute medical advice. Always consult a licensed medical professional before making any health or treatment decisions. Behind the Sports Medicine and its affiliates assume no liability for the accuracy or application of the information discussed. #FemaleAthlete #ACLPrevention #YouthSports #WomensSoccer #StrengthAndConditioning