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Wednesday, April 16, 2014

Verducci: Overuse of young pitchers fueling MLB’s Tommy John surgery problem

On MLB Network, Mitch Williams got so worked up arguing with Verducci over this…they’re still scraping Suavecito pomadesplosion residue off the walls.

What’s going on? Just in recent years, American teenage pitchers significantly have increased the intensity of two of the greatest risk factors for injury: Velocity and volume. And because of the growth in the travel/showcase model, the risks are only growing worse.

First, here is a basic understanding of how the arm works. It is “accepted wisdom” that pitchers break down because the act of throwing a baseball is “an unnatural motion.” That is flat out bunk. The oldest skeleton ever found, the Nariokotome skeleton, which is about 1.5 million years old, showed the biomechanical adaptation for overhand throwing found in the modern Homo sapiens. Man has been throwing spears and rocks and such for eons.

What is “unnatural” is throwing 95 miles an hour under the stress of competition for as much as 10 months out of a year—or more. And that’s where pitching has become more dangerous, especially for teenagers. By throwing harder and more often under stress that requires maximum effort (tournaments and showcases), they are pushing their bodies closer to their physical limit more often with less rest. The intensity is an important distinction, because all throwing is not created equal.

“People like to say you have only so many bullets,” Fleisig said. “That’s not exactly true. One thousand pitches over a month is much different than 1,000 pitches over the course of two years.”

Fleisig likes to use this analogy to capture how the tendons and ligaments of the arm and shoulder are stressed by pitching: Imagine those tendons and ligaments are a rubber band that can withstand 100 pounds of pressure before it breaks. If you apply 90 pounds of pressure nine or 10 times—continually pushing the band to the brink of its limit—small tears begin to form, and the band will break from the stress.

Now apply 50 pounds of pressure to the rubber band. If you do that 10 times—20 times, 50 times, whatever—the band never breaks. That’s because no tears form. It’s the intensity of pitching that matters, not pitching itself. And the American amateur market keeps raising that intensity.

Repoz Posted: April 16, 2014 at 08:44 AM | 44 comment(s) Login to Bookmark
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   1. Depressoteric Posted: April 16, 2014 at 09:33 AM (#4686799)
This is a really fantastic 'explainer' article. In particular I found the comparison between American pitching prospects and Latin American pitching prospects to be near-revelatory.
   2. Rants Mulliniks Posted: April 16, 2014 at 09:46 AM (#4686808)
Pretty sad how many high schoolers are having TJ surgery, but when just making the majors for as little as one season makes you comparatively wealthy its not going to stop.
   3. Drexl Spivey Posted: April 16, 2014 at 10:02 AM (#4686824)
This is a really fantastic 'explainer' article. In particular I found the comparison between American pitching prospects and Latin American pitching prospects to be near-revelatory.


I agree.

A Latin American pitcher can be signed by an MLB team at age 16. His development will then be closely monitored by the signing team.

A 16 year old in the US will try to max out his velocity from ages 16-18 (for draft/college reasons). He will have an increased injury risk as a result.
   4. JRVJ Posted: April 16, 2014 at 10:03 AM (#4686825)
If Verducci is right, this problem will persist AT LEAST for the next 7 years, in the best of cases, as kids who are currently 14 or 15 are weaned from these practices.

That's a sobering thought.
   5. Yeaarrgghhhh Posted: April 16, 2014 at 10:06 AM (#4686829)
Agreed -- really good article.
   6. if nature called, ladodger34 would listen Posted: April 16, 2014 at 10:19 AM (#4686840)
I agree.

A Latin American pitcher can be signed by an MLB team at age 16. His development will then be closely monitored by the signing team.

A 16 year old in the US will try to max out his velocity from ages 16-18 (for draft/college reasons). He will have an increased injury risk as a result.


I think I tried to make this point the other day (albeit poorly). The Latin American kids in the academies or in the minor league system are viewed as assets to the big clubs. They have an incredible incentive to protect those guys.

The travel ball, youth league, and high school coaches don't have the same incentive. That said, the parents are just as guilty for letting their kids play that many games and racking up those innings.
   7. Repoz Posted: April 16, 2014 at 10:28 AM (#4686843)
On MLB Nutwork...Mitch Williams confronted Verducci about all of this with how he never once soft-tossed in the bullpen and how every pitcher should throw as hard as they can at all times to build up muscle. Or something.
   8. if nature called, ladodger34 would listen Posted: April 16, 2014 at 11:13 AM (#4686878)
On MLB Nutwork...Mitch Williams confronted Verducci about all of this with how he never once soft-tossed in the bullpen and how every pitcher should throw as hard as they can at all times to build up muscle. Or something.


Ah, yes. The Mitch Williams that was essentially done as a pitcher when he was 28. We should listen to him because his longevity and wisdom.
   9. puck Posted: April 16, 2014 at 11:18 AM (#4686884)
Ok, I can't be the only one surprised by all the leading comments being so laudatory. Thanks for noting that so we know to actually RTFA.
   10. PreservedFish Posted: April 16, 2014 at 11:22 AM (#4686888)
Very interesting. It's a strong case.
   11. puck Posted: April 16, 2014 at 11:23 AM (#4686889)
Ah, yes. The Mitch Williams that was essentially done as a pitcher when he was 28. We should listen to him because his longevity and wisdom.


His is sort of the conventional wisdom, isn't it? Throwing a lot while growing up builds the arm.
   12. Robinson Cano Plate Like Home Posted: April 16, 2014 at 11:24 AM (#4686894)
Great piece. It would be far better for baseball if MLB took action in this arena instead of worrying about replay. MLB, the NCAA, Little League, etc. need to get this information out to kids and families, and we need to stop destroying our children's bodies.
   13. Mike Emeigh Posted: April 16, 2014 at 11:28 AM (#4686895)
The travel ball, youth league, and high school coaches don't have the same incentive. That said, the parents are just as guilty for letting their kids play that many games and racking up those innings.


The parents actually don't have a lot of say here. The elite kids are going to play travel ball, and once they get into the travel ball and showcase circuit, it's all about pushing as hard as they can to show what they have every time out.

-- MWE
   14. Yeaarrgghhhh Posted: April 16, 2014 at 11:36 AM (#4686901)
Far be it from me to contradict the wisdom of Mitch William, but Dylan Bundy was the poster boy for the perfect high school pitching prospect: In addition to amazing stuff, mechanics, and make up, he was also a workout fanatic who was well known in high school for using boxing, weight lifting, and other techniques to build up his arm strength. And he still needed TJ surgery.
   15. if nature called, ladodger34 would listen Posted: April 16, 2014 at 12:03 PM (#4686918)
The parents actually don't have a lot of say here. The elite kids are going to play travel ball, and once they get into the travel ball and showcase circuit, it's all about pushing as hard as they can to show what they have every time out.


Hey, they can choose for their kids to not play Rec League ball at the same time that they are on a travel team. They can also make sure the kids have downtime at some point during the season to give the kids a bit of rest.

At the same time, I know you're mostly right Mike. The problem is that the travel ball and showcase circuit ended up being modeled on the softball circuit and softball (especially pitching wise) is far easier on the arm than baseball ever will be. It's just sad that a good percentage of parents can't say "from November to January (or whatever), no baseball"

   16. KT's Pot Arb Posted: April 16, 2014 at 12:08 PM (#4686922)
It's not just the kids and parents. NC State, in the middle of a crappy 5-11 year, sent Carlos Rodon (the #1 rated prospect in all of baseball) back out for a final inning despite being already at 118 pitches. The coach is apparently desperate to try to save season, and Carlos ends up throwing 134 pitches in 7&2/3 innings. Pretty sure no MLB pitcher has thrown that many pitches in less than 8 innings in the last decade, unless Edwin Jackson did it in his no hitter.

Mitch Williams should give that coach a shout out.
   17. JE (Jason Epstein) Posted: April 16, 2014 at 12:17 PM (#4686929)
Man has been throwing spears and rocks and such for eons.

And Vin Scully has done play-by-play for every one of them.
   18. bunyon Posted: April 16, 2014 at 12:21 PM (#4686934)


His is sort of the conventional wisdom, isn't it? Throwing a lot while growing up builds the arm.


The oldtimer advice I got was: "throw a lot, pitch little". Which makes sense to me. Catch, long-toss, etc. But not high intensity pitching with lots of breaking stuff.

Of course, I hurt my elbow when I was 18 so there. I wish high schoolers had gotten TJ when I was a kid.
   19. if nature called, ladodger34 would listen Posted: April 16, 2014 at 12:34 PM (#4686953)
I'm in the camp that thinks that specialization is a bad thing for the most part in sports (would love to see studies about it). One of the worst things that has happened to high school sports here in CA is that they can essentially practice year round. The coach gets to control most of those kids to a single sport if they choose to.

My wife coaches Cross Country and has a heck of a time when kids from another sport want to run on her team instead of going to practice with the basketball or soccer team (heck, even baseball). I think it's sad that the coaches in basketball and soccer don't see a value in having their kids practice with cross country a couple of times a week, especially since you can get your kids conditioned prior to the season with little effort on your own (for that matter, a varsity baseball coach should have his pitchers (at the very least) from the freshman - varsity level run cross country in the fall). It's a good time to rest the arm, but also build up stamina.
   20. snapper (history's 42nd greatest monster) Posted: April 16, 2014 at 12:36 PM (#4686954)
His is sort of the conventional wisdom, isn't it? Throwing a lot while growing up builds the arm.

I would bet that throwing a lot is good, but throwing a lot at maximum velocity is bad.

If these kids were throwing a lot while putzing around in sandlots or on regular HS teams throwing 80-85 MPH,it probably would strengthen their arms.

The problem seems to be throwing balls out all the time at high maximum velocities.

Edit: Coke to Bunyon
   21. cercopithecus aethiops Posted: April 16, 2014 at 01:06 PM (#4686989)
The oldtimer advice I got was: "throw a lot, pitch little". Which makes sense to me. Catch, long-toss, etc. But not high intensity pitching with lots of breaking stuff.


Exactly. Pitching in games doesn't build arm strength. Pitching in games is what you need to build arm strength for.

My kid played a fair bit of travel ball. I can assure you that no one other than parents are watching the overwhelming majority of those games. Sure, maybe it's different for the elite of the elite, but that's not an explanation/justification for 13 year-olds going balls to the wall for six or seven innings on cold rainy April Saturday mornings.

EDIT: I can also assure you that plenty of parents constantly berate their kids' coaches about not taking care of little Johnny's billion dollar arm.

My kid also played three sports from middle school through HS graduation, and as a result eventually had to stop playing travel baseball except in the summers. He'd throw maybe three times a week during football and swim seasons -- long toss in the fall and bullpens in the winter (but no breaking stuff until January). Never had so much as a twinge in his elbow or shoulder. Still went to some showcases, and had some DIII offers. I kinda doubt that making him a one-sport specialist from the age of 12 would have turned him into a DI prospect.
   22. if nature called, ladodger34 would listen Posted: April 16, 2014 at 01:18 PM (#4687002)
My kid also played three sports from middle school through HS graduation, and as a result eventually had to stop playing travel baseball except in the summers. He'd throw maybe three times a week during football and swim seasons -- long toss in the fall and bullpens in the winter (but no breaking stuff until January). Never had so much as a twinge in his elbow or shoulder. Still went to some showcases, and had some DIII offers. I kinda doubt that making him a one-sport specialist from the age of 12 would have turned him into a DI prospect.


My oldest is only turning 6, but we play baseball in the spring and soccer during the fall. I only played baseball growing up (it was my choice - however, I decided not to give my kids that choice). So far, he really loves playing both sports. Realistically, his favorite thing to do is run and if his body type stays the same (long and lean) he'll probably be a distance runner. Even more realistically, he is a smart kid and his greatest successes will be in the classroom rather than on the field. We'll just see!
   23. thetailor Posted: April 16, 2014 at 01:30 PM (#4687015)
In one of the biggest studies of youth pitchers, a 10-year prospective study published in 2011, ASMI tracked 481 pitchers between the ages of nine and 14. Researchers found that pitchers who threw 100 innings or more in a calendar year were three and a half times more likely to be injured than those who pitched less. They recommended that no youth pitcher exceed 100 innings in a year and "no pitcher should continue to pitch when fatigued."

Wow.

And I too am glad to see that the article isn't being panned as a retraction of the Verducci Effect :)
   24. Karl from NY Posted: April 16, 2014 at 02:24 PM (#4687068)
It's a good article because Verducci stays off the soapbox. He's not yammering for restrictions on travel teams and whatnot. Just laying out the facts of the situation with some excellent data. There is a tonal undercurrent that sounds like he wishes something could be done, but he leaves the reader to come to the same conclusion on their own.

His Verducci Effect articles have been similar. He doesn't propose that teams should somehow be prohibited from those pitcher usage patterns, it reads more like cautionary advice hoping teams will do that autonomously.
   25. SoSHially Unacceptable Posted: April 16, 2014 at 02:34 PM (#4687081)
My oldest is only turning 6, but we play baseball in the spring and soccer during the fall. I only played baseball growing up (it was my choice - however, I decided not to give my kids that choice). So far, he really loves playing both sports. Realistically, his favorite thing to do is run and if his body type stays the same (long and lean) he'll probably be a distance runner. Even more realistically, he is a smart kid and his greatest successes will be in the classroom rather than on the field. We'll just see!


SoSH the youngest is playing his first season of travelish ball*, after five years in regular Little League. He's a pitcher, but I doubt he'll get overworked (if for no other reason than it shouldn't be necessary). He's only playing on this team, so I don't have to worry about cross league contamination.

I've never been very fond of the Youth Sports Industrial Complex, so we're entering the thing with a healthy dose of caution.

* It's not one of those living out of a hotel room every weekend kind of deals, but a team that plays one mid-week game and a nearby tournament each weekend.
   26. if nature called, ladodger34 would listen Posted: April 16, 2014 at 02:52 PM (#4687101)
It's not one of those living out of a hotel room every weekend kind of deals, but a team that plays one mid-week game and a nearby tournament each weekend.


I think that is probably more healthy than what quite a few kids deal with.
   27. bunyon Posted: April 16, 2014 at 03:02 PM (#4687107)
Yes to running. I say this as an overweight 40 something. But I only ever ran as punishment. I can't help but think that had I been in better shape everythng about my amateur athletic career would have been better. It also likely would have stuck with me.

I'd think getting your HS baseball guys on the cross country team, or at least working out with them, would be awesome for everyone.
   28. TDF, situational idiot Posted: April 16, 2014 at 03:25 PM (#4687137)
First, here is a basic understanding of how the arm works. It is “accepted wisdom” that pitchers break down because the act of throwing a baseball is “an unnatural motion.” That is flat out bunk. The oldest skeleton ever found, the Nariokotome skeleton, which is about 1.5 million years old, showed the biomechanical adaptation for overhand throwing found in the modern Homo sapiens. Man has been throwing spears and rocks and such for eons.
I thought that the "Accepted Wisdom" about throwing a baseball wasn't about throwing, but about throwing a baseball in particular - that throwing a football (or a spear) is a much more natural motion (and why you don't see QBs with elbow issues).

Also, a star fast-pitch softball pitcher will throw every inning of almost every game with no arm problems. I know it's a completely different motion, but there's still stresses (not every pitch is a fastball).
   29. cercopithecus aethiops Posted: April 16, 2014 at 03:25 PM (#4687139)
The thing that I found most impressive about my son's HS athletic career was how remarkably well-conditioned he was even as an eighth- or ninth-grader. And yes, I attribute this directly to all of that cross-training. He never got very bulky in the upper body, but his core strength from an early age is something I've been very jealous of.

OTOH, I can't join in with all of the ringing endorsements of cross country. My daughter spent most of her HS career dealing with various over-training injuries, as did a ridiculously high percentage of her teammates. It seems there are just way too many bad coaches in that sport.
   30. Walt Davis Posted: April 16, 2014 at 05:14 PM (#4687268)
In one of the biggest studies of youth pitchers, a 10-year prospective study published in 2011, ASMI tracked 481 pitchers between the ages of nine and 14. Researchers found that pitchers who threw 100 innings or more in a calendar year were three and a half times more likely to be injured than those who pitched less. They recommended that no youth pitcher exceed 100 innings in a year and "no pitcher should continue to pitch when fatigued."

Not that it's not a big effect but be careful in interpreting statements like the above. I haven't seen the study but, especially in summaries designed for the press, "three times as likely" is usually a statement about the odds ratio.

The odds ratio is p/(1-p). So say there's a 20% chance of injury, that's an odds of 1/4. Triple the odds and it's 3/4 which translates to a p of about 42% (double) not 60% as you might think from the phrase "three times as likely."

For relatively low levels of p (say less than 10%), then the two effects are about the same. For example, p-.01 gives odds of 1/99 and triple those and the resulting p is .029. The issue at this end of the scale is whether that is an acceptable increase in risk given whatever benefits might be derived.

So (1) don't get misled by "three times as likely" and (2) it's really important to know what a reasonable range of baseline risks are. And in this particular excerpt, it's important to know how they are defining "injury" -- i.e. "major" injury or just any old injury that might sideline somebody for two weeks or ...
   31. if nature called, ladodger34 would listen Posted: April 16, 2014 at 05:16 PM (#4687270)
OTOH, I can't join in with all of the ringing endorsements of cross country. My daughter spent most of her HS career dealing with various over-training injuries, as did a ridiculously high percentage of her teammates. It seems there are just way too many bad coaches in that sport.


I can see that side as well. At least in my wife's case, she gets those kids for a really short time. They do summer conditioning starting at the end of July and are done by Halloween. Most of the races her team runs are essentially 5ks (some a little more, some a little less) so they don't run a heck of a lot more than that (I think the long runs about 6-7 miles).

Granted, this is in southern CA and I realize that cross-country is far more competitive and different animal in other parts of the country.
   32. cercopithecus aethiops Posted: April 16, 2014 at 05:24 PM (#4687279)
Here ya go, Walt. You might be able to access the full text if you're at work.

EDIT: Highlights...

Injury was defined as elbow surgery, shoulder surgery, or retirement due to throwing injury.

...

The cumulative incidence of injury was 5.0%. Participants who pitched more than 100 innings in a year were 3.5 times more likely to be injured (95% confidence interval = 1.16 to 10.44).
   33. Jim Wisinski Posted: April 16, 2014 at 06:01 PM (#4687316)
Pretty sure no MLB pitcher has thrown that many pitches in less than 8 innings in the last decade, unless Edwin Jackson did it in his no hitter.


That doesn't quite make sense, KT :-)
   34. puck Posted: April 16, 2014 at 06:18 PM (#4687328)
The oldtimer advice I got was: "throw a lot, pitch little". Which makes sense to me. Catch, long-toss, etc. But not high intensity pitching with lots of breaking stuff.


Maybe we're not going old-timey enough (I don't know how old everyone is). I'm talking the days when kids would play pick up games (50's, 60's I guess), so there would be pitching involved. I'm not saying it's right, just this is how people typically used to respond. "When we were kids we were always playing, always throwing, so our arms got strong, etc."
   35. LionoftheSenate (Brewers v A's World Series) Posted: April 16, 2014 at 06:23 PM (#4687334)
I'm not really doubting the claim that throwing is natural for man, but it seems to me the problem is throwing breaking pitches, which require unnatural tweaking of the fingers, wrist and hand compared to throwing a spear.
   36. cercopithecus aethiops Posted: April 16, 2014 at 06:30 PM (#4687344)
I'm talking the days when kids would play pick up games (50's, 60's I guess), so there would be pitching involved.


In my old days, the pitching involved was pretty much of the batting practice variety. Pickup games aren't much fun if somebody is throwing sliders and striking everybody out.
   37. Steve Treder Posted: April 16, 2014 at 06:42 PM (#4687353)
In my old days, the pitching involved was pretty much of the batting practice variety. Pickup games aren't much fun if somebody is throwing sliders and striking everybody out.

Yes. I played copious amounts of pickup ball in the late '60s/early '70s, and the pitcher's job was to lay it right in there. There was no umpire, no called strikes, no walks, and the catcher had no mask/shin guards/catcher's mitt etc. Indeed, depending on the number of players, the pitcher was often on the batting team, rotating out when his turn to bat came up.
   38. cardsfanboy Posted: April 16, 2014 at 08:01 PM (#4687384)
Ah, yes. The Mitch Williams that was essentially done as a pitcher when he was 28. We should listen to him because his longevity and wisdom.


Not trying to negate your point, which was spot on. But I think a person who has blown out their arm from over use, would be a good person to listen to on the issue, if they happened to have any self awareness.
   39. cardsfanboy Posted: April 16, 2014 at 08:09 PM (#4687389)
Ok, I can't be the only one surprised by all the leading comments being so laudatory. Thanks for noting that so we know to actually RTFA.


Agreed, I came over here to snark on the article...(without reading...as my practice...arrive...bad mouth...then read....need to change that) (although Michael Pineda as the healthy example was kinda weird)

I do question it's sample size and numbers personally, but it's articles like this that get these numbers more available.
   40. cardsfanboy Posted: April 16, 2014 at 08:19 PM (#4687398)
First, here is a basic understanding of how the arm works. It is “accepted wisdom” that pitchers break down because the act of throwing a baseball is “an unnatural motion.” That is flat out bunk. The oldest skeleton ever found, the Nariokotome skeleton, which is about 1.5 million years old, showed the biomechanical adaptation for overhand throwing found in the modern Homo sapiens. Man has been throwing spears and rocks and such for eons.


Pedantic for pedantic sake. There is no reason to think that 1.5+ million years of evolution would have evolved to make throwing a natural motion. The human eye is inferior because of adaptions it made to exist in the water hundreds of millions of years ago, the recurrent laryngeal nerve hasn't improved from it's natural development cycle just because it's there. Just because people have been throwing for years, doesn't mean it's natural or that the body is designed to handle it. Lifespans were much shorter then, so what does it matter if you blew out your elbow/shoulder past your ability to procreate?


   41. zachtoma Posted: April 16, 2014 at 11:56 PM (#4687531)
(and why you don't see QBs with elbow issues).


QBs throw about 40 times once a week for about 4-5 months. Of course they practice all week during that time, but in terms of total volume of throws, it still can't be anywhere near what a major league pitcher puts on his arm. I also think that throwing downfield is less stressful than throwing a straight line into a strikezone 60 feet in front of you.
   42. if nature called, ladodger34 would listen Posted: April 17, 2014 at 12:29 AM (#4687539)
Not trying to negate your point, which was spot on. But I think a person who has blown out their arm from over use, would be a good person to listen to on the issue, if they happened to have any self awareness.


No, you are absolutely correct in your assessment. Someone with some self awareness about how his career was shortened by an arm injury would be an invaluable resource. Mitch isn't that guy, though.
   43. KT's Pot Arb Posted: April 17, 2014 at 12:51 AM (#4687544)
That doesn't quite make sense, KT :-)


It would if written by a better writer.

Rodon threw 134 pitches in 7 and 2/3s innings. That's the more pitches per inning/out (ie a higher stress level) than any MLB pitcher has done in maybe decades

since the start of the 2010 season, only four MLB pitchers have thrown 134 or more pitches. Three were no-hitters, one was Brandon Morrow's 17-strikeout one-hitter in 2010, and all four spread those pitches over nine innings rather than Rodon's 7 2/3 innings

http://insider.espn.go.com/blog/keith-law/post?id=2258


So it's unlikely that any MLB pitcher who has thrown as many pitches as Carlos did in a start without pitching into the 9th inning, which he did not do.

In his no-hitter Edwin Jackson threw 149 pitches, 15 in the 9th inning. So his pitch count at end of 8th inning was 134, same as Rodon did in 1 less out. And Edwin Jackson was a work-horse in his 8th MLB season.
   44. Arbitol Dijaler Posted: April 17, 2014 at 09:39 AM (#4687596)
I think he was saying Edwin Jackson is a ham and egger.

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