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Wednesday, May 28, 2014

Position Statement for Tommy John Injuries in Baseball Pitchers

Not a long statement but it’s informative.

During the past few years there has been an “epidemic” rise in the number of professional pitchers requiring ulnar collateral ligament reconstruction (“Tommy John surgery”).1 This is like déjà vu, as a similar sharp rise was seen in adolescent pitchers near the turn of the century.2,3 These two rises are indeed connected; that is, today’s pro pitcher in his 20’s was an adolescent pitcher a dozen years ago. Thus in many cases, the injury leading to Tommy John surgery in today’s young pro pitchers actually began while they were adolescent amateurs. Observations by orthopaedic surgeons support this link, as the torn ulnar collateral ligament (UCL) in a pro pitcher usually looks like it has worn out over time.

Hat tip to Hardball Talk.

Jim Furtado Posted: May 28, 2014 at 10:29 PM | 19 comment(s) Login to Bookmark
  Tags: dr. james andrews, injuries, tommy john surgery

Reader Comments and Retorts

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   1. Robert in Manhattan Beach Posted: May 29, 2014 at 04:10 AM (#4715137)
“Lowering or eliminating the mound would reduce the stress on the elbow and reduce the number of UCL injuries.”
Not true. Elbow torques during full-effort pitching on a mound and full-effort throwing on flat ground are about the same. The real solution is for young pitchers to do less full-effort pitching and more throwing (practice throws, playing other positions, playing other sports).


The whole flat earth thing never made any sense. I remember pitching on a few flat mounds in the day. It sucked, I felt like I need to strain more to get as much on the ball because it felt like I was throwing uphill.

Most of the advice comes down to 'pitch less', the problem being that to get any good at pitching, you need to do some pitching. To get your mechanics down, you need to do some pitching. And so on.
   2. Harry Balsagne, anti-Centaur hate crime division Posted: May 29, 2014 at 10:39 AM (#4715208)
It seemed to me the final analysis was more like "don't be so concerned with lighting up the radar gun, change speeds or lose your arm".
   3. dr. scott Posted: May 29, 2014 at 02:10 PM (#4715439)
Performance-Enhancing Drugs (PEDs) may enable the athlete to achieve disproportionately strong muscles that overwhelm the UCL and lead to injury.


this is low down the list of recommendations/issues, so clearly is not the main issue in their minds. However it does make sense so given that we assume PED's were more rampant 10 years ago, it seems UCL injuries would have been higher then if a majority of pitchers were on PEDs.
   4. Golfing Great Mitch Cumstein Posted: May 29, 2014 at 09:57 PM (#4715848)
this is low down the list of recommendations/issues, so clearly is not the main issue in their minds. However it does make sense so given that we assume PED's were more rampant 10 years ago, it seems UCL injuries would have been higher then if a majority of pitchers were on PEDs.


On this issue generally, what is the physiological relationship between muscles and ligaments? And how would steroid use affect that? At the height of PED hysteria, I remember claims about how injuries were the result of muscles that were too strong for the ligaments that supported them or the joints the muscles were attached to.
   5. Pasta-diving Jeter (jmac66) Posted: May 29, 2014 at 10:05 PM (#4715859)
On this issue generally, what is the physiological relationship between muscles and ligaments? And how would steroid use affect that? At the height of PED hysteria, I remember claims about how injuries were the result of muscles that were too strong for the ligaments that supported them or the joints the muscles were attached to.

well--if you remember, ANY outcome was evidence of steroid use. Guys get hurt--steroids. Guys play longer than normal without getting hurt--steroids. The perfect tautology.
   6. PASTE Thinks This Trout Kid Might Be OK (Zeth) Posted: May 29, 2014 at 10:20 PM (#4715870)
It seemed to me the final analysis was more like "don't be so concerned with lighting up the radar gun, change speeds or lose your arm".


Yeah, but if you're a high school kid are you going to choose to take it easy, throw 90-92 and get $150,000 to sign, or squeeze every last drop of velocity you possibly can, throw 94-96 and get $1,500,000 to sign? I know what I would do.

High school kids with special arms are never going to choose anything but max velocity, because they and the people who advise them know very well that they are going to get paid based largely on velocity. Some, most or all major league organizations may well decide at some future time to sign kids that throw 94 and teach them to pitch sitting at 89-90, to save their arms, but

(a) That won't stop the kids from going for max velocity before they're drafted, doing significant damage to their arms, and

(b) It looks unlikely to me that any organization is going to encourage its young pitchers to throw softer unless there is very compelling evidence it will keep them substantially healthier--no such evidence exists, and I doubt the hypothesis is true.
   7. PASTE Thinks This Trout Kid Might Be OK (Zeth) Posted: May 29, 2014 at 10:23 PM (#4715872)
Double post deleted, sorry.
   8. Rob_Wood Posted: May 30, 2014 at 01:00 AM (#4715929)
not sure what you are saying, do you disagree with the viewpoint that pitchers who only throw at 85%, say, of max effort would remain substantially healthier than their balls-out-to-the-max counterpart? I would venture to guess that every major league pitcher could throw 200 pitches each outing if every pitch was a batting practice fastball.

Granted, I reach no conclusions based upon these observations, but I cannot believe that anyone would find these observations controversial.

If your point is that getting major league hitters out requires significantly higher effort than batting practice fastball effort, then we agree. But, I think we are still early in the game, so to speak. It would not surprise me if some organizations already focus upon non-velocity aspects of pitching (I remember the Baltimore Orioles organization mantra did not emphasize pitching velocity).
   9. The Clarence Thomas of BBTF (scott) Posted: May 30, 2014 at 02:14 AM (#4715936)
Yeah, but if you're a high school kid are you going to choose to take it easy, throw 90-92 and get $150,000 to sign, or squeeze every last drop of velocity you possibly can, throw 94-96 and get $1,500,000 to sign? I know what I would do.


I could see over time teams becoming risk averse and not drafting teens who sit at 94-96 with max effort, knowing that they're going to get a kid who's already worn down his arm a great deal and is thus a likely injury risk. They'd rather see that kid throwing 90 during games, and showing during workouts that he can pump it up to 97-98 at times. It's going to be a long while before that happens, you only need one dumb team to keep rewarding the destruction of young arms, but I can see how it would start to happen.
   10. SoCalDemon Posted: May 30, 2014 at 09:38 AM (#4715997)
I highly doubt that will ever be true. There is a big difference in the risk for the individual (getting injured vs never getting any sort of real shot) versus for a team that drafts/signs 50 guys a year, of whom they are hoping 2-3 have any impact on the MLB. Teams will never shoot for the Tommy Milones, they want the chance for a Nolan Ryan or Randy Johnson or Roger Clemens, and they know that 99% of guys who can throw that hard will be ineffective or injured or something, but there is that chance. The guy that tops out at 90 has a much much much hard time having any chance of being an impact player. Returning to Milone, I really love the fact that the A's have Milone; he has given them at this point 426 innings of 99 ERA+ pitching...but I wince every time I see him start because he is riding a real thin line, because he doesn't have the velocity of most other guys. And for the most part, I think teams are well aware of the risk of higher velocity, and for lack of a better phrase do not give a ####. They know 95% plus of guys are going to get hurt or jsut not have the other skills to be effective, so they want to start with the skills that correlate most highly with success, and velocity is a big part of that. We can come up with individual pitchers who are successful without speed, but for the league as a whole, the correlation is pretty strong.
   11. boteman is not here 'til October Posted: May 30, 2014 at 09:40 AM (#4716000)
A while back I was reading an article discussing incredible feats of strength. One such instance related a man who was hiking in the backcountry of the western U.S. who somehow managed to find himself underneath a massive boulder. Facing certain death he chose the alternative to summon all his strength to move this huge rock to one side and wriggle free. No doctors could understand how it was possible, yet he did it. He also messed up his muscles and connecting tissue to the point that his arms lost a good deal of mobility and strength, a tradeoff he was willing to make under the circumstances.

This is an extreme outlier, but it comes to mind when these discussions of maximum effort come up. So where does a pitcher draw the line?
   12. Greg Pope thinks the Cubs are reeking havoc Posted: May 30, 2014 at 09:55 AM (#4716018)
I think the question that would need to be answered is whether the strain on the ligaments is relative or absolute. Temporarily let's set aside the fact that some people may have stronger ligaments than others. Take a group of pitchers that max out at 97 and a group that maxes out at 90. Have them throw a month's worth of games at max effort. If the 97 group has more damage, then the strain on the ligaments is absolute. You just shouldn't be throwing that hard. If the groups have the same damage, then the strain is relative.

Do we know the answer to that now? I don't think so. How would this help? If it's relative then drafting the 90 guy doesn't offer you much benefit. He's maxing out so he's a candidate for ligament damage and you don't get the upside. But if it's absolute, then you draft the 90 guy thinking that he's less likely to need the surgery.

In either case, though, it would behoove you to draft the 97 guy and teach him to be effective at 92. Which should be possible I would think. Tell him he can't dial it up to 97 more than 5 times a game. Strictly enforce it in the minors where the games don't matter, and then when he gets to the majors you just monitor it.

I don't think that the question of absolute vs. relative is answered. Although I think the prevailing opinion seems to be absolute. People talk about slow throwers being able to throw more pitches. But I think that's anecdotal.
   13. snapper (history's 42nd greatest monster) Posted: May 30, 2014 at 10:07 AM (#4716031)
I don't think that the question of absolute vs. relative is answered. Although I think the prevailing opinion seems to be absolute. People talk about slow throwers being able to throw more pitches. But I think that's anecdotal.

I think it almost has to absolute. We're talking about material strength, and physical stress. Your tires don't get stronger because you drive faster. You can't "exercise" your ligaments to make them stronger.

   14. Jose Can Still Seabiscuit Posted: May 30, 2014 at 11:17 AM (#4716075)
I think it almost has to absolute. We're talking about material strength, and physical stress. Your tires don't get stronger because you drive faster. You can't "exercise" your ligaments to make them stronger.


No but some tires are stronger than other tires. I think it's pretty easy to assume that some people can throw 98 without injury and others can't.

I think this talk about the guys throwing hard being the cause is a case of finding data to support a conclusion. I am not a doctor so this is a completely worthless analysis on my part but I'm still heavily on the side of "we are better at diagnosing these injuries" rather than "there is an epidemic of new cases."
   15. if nature called, ladodger34 would listen Posted: May 30, 2014 at 11:35 AM (#4716085)
The whole flat earth thing never made any sense. I remember pitching on a few flat mounds in the day. It sucked, I felt like I need to strain more to get as much on the ball because it felt like I was throwing uphill.


I'm 37 and in my area, most of us didn't throw off a mound until right around high school. And even though they probably did exist, the idea of having a portable mound was just foreign. Now it seems like just about every youth league has a portable mound. Of course, back when I played, the idea of a "kid pitch" league for the Pinto division (7-8 years old) in Pony was also a foreign concept. T-ball was also just t-ball. And get off my lawn!
   16. snapper (history's 42nd greatest monster) Posted: May 30, 2014 at 11:38 AM (#4716087)
No but some tires are stronger than other tires. I think it's pretty easy to assume that some people can throw 98 without injury and others can't.

Oh sure. I just don't think the strong ligaments will be correlated with velocity. You may be afreak who can throw 98 MPH w/o injury (Nolan Ryan), but you don't have that trait because you throw 98 MPH.
   17. Greg K Posted: May 30, 2014 at 11:41 AM (#4716091)
I'm 37 and in my area, most of us didn't throw off a mound until right around high school. And even though they probably did exist, the idea of having a portable mound was just foreign. Now it seems like just about every youth league has a portable mound. Of course, back when I played, the idea of a "kid pitch" league for the Pinto division (7-8 years old) in Pony was also a foreign concept. T-ball was also just t-ball. And get off my lawn!

We had to build one for the team I played with in Nottingham. The city let us dig up dirt circles for home plate and the bases in the field we were using, but they said any mound work would have to be something we could dismantle in a weekend if they ever decided to kick us off the land. So the club president bought some wood and outdoor carpeting from Home Depot and knocked a mound up one weekend. It came in about 6-7 pieces that could be driven to the park on gameday and assembled with various ropes and cords. Local rivals from Leicester dubbed it "The Hedgehog". After a couple years the club got established and last spring we just buried it and covered it with dirt to get the proper mound shape. I imagine some British archaeologist is going to have fun finding that thing a few years from now.
   18. Sean Forman Posted: May 30, 2014 at 02:07 PM (#4716167)
I'm curious if changes in nutrition could have any impact. Perhaps we need to start feeding prospects Spicy Beef Tendon, Smoked ribs, and more Offal.
   19. Greg K Posted: May 30, 2014 at 02:10 PM (#4716169)
I'm curious if changes in nutrition could have any impact. Perhaps we need to start feeding prospects Spicy Beef Tendon, Smoked ribs, and more Offal.

I'd suggest more tripe. That stuff is awesome! I can't have a bowl of pho without it.

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