18 November 2011

Interview with an Arm Injury Researcher, Part II

 by Will Beaudoin
Will is a freelance writer who has written for Camden Depot previously.

Long Toss Mechanics (Picture from Dick Mills' site.)
During my discussion with Dr. Fleisig, I asked him for a few examples of compelling research in the field of biomechanics from the past year. Interestingly enough, he directed me towards two articles he had a hand in creaing—“Biomechanical Comparison of Baseball Pitching and Long-Toss: Implications for Training and Rehabilitation” (Fleisig, Bolt, et al, 2011; Ed. note: Camden Depot discussed this article briefly in a previous post) and “Risk of Serious Injury For Young Baseball Pitchers: A 10-Year Prospective Study” (Fleisig, Andrews, et al, 2011).

The first piece, concerning itself with the somewhat controversial training and rehabilitation practice known long-toss, Fleisig et al. (2011) set for the hypothesis that there are “kinetic…differences in the throwing shoulder and elbow” in long-toss when compared to pitching off a mound (p. 297). More than a dozen college-level pitchers were asked to long-toss from 37 meters, 55 meters, and from a “maximum distance”. For the 37 meter and 55 meter throws, the pitchers were required to throw with little to no arc, while no such restriction was placed on the “maximum distance” toss. Data from this session was collected using a motion capture device. On a separate occasion, the same pitchers were asked to throw their “standard” fastball from a mound, again whilst recorded by a motion capture device.

As Orioles fans, this is a study that should interest us considering the controversy surrounding Dylan Bundy’s own long-toss program around draft time and it’s potential long-term physical effects. While this particular study doesn’t provide any conclusive evidence in regard to long-term injury outlook, the study does show that both “shoulder and elbow torque increase with throwing distance” (p. 302). This leads the researchers to believe that long-toss, especially “maximum” distance long-toss may in fact be harmful to a pitcher—perhaps something to keep in mind when thinking about Bundy’s long-term health.

The article titled, “Risk of Serious Injury For Young Baseball Pitchers: a 10-Year Prospective Study”, focused on pitching injuries in young pitchers and seemingly dispels the widespread belief that youth pitchers shouldn’t throw breaking balls for fear of injury. A long-term study, the researchers monitored nearly 500 pitchers under the age of fourteen over a ten-year period. After hundreds and hundreds of interviews over the course of a decade, it was discovered that it wasn’t so much the pitch-type that led to injury, but rather the amount of pitches and innings thrown. Over the course of the study, Fleisig et al. discovered that pitchers who threw more than 100 innings in a single year “had about 3.5 times as much chance of serious injury as those who pitched less” while they couldn’t “determine whether pitchers who started throwing curveballs before age 13 years [had] a higher chance of injury” (p. 256). While not necessarily directly applicable to the major league level, research such as this only goes to show that so much of injury prevention lies within the rather simple philosophy of volume management.

I also had the chance to talk briefly with Will Carroll in regard to pitching injuries. Will, who got his start at Baseball Prospectus, now writes for Sports Illustrated, and has authored several books dealing with sports injuries, was kind enough to answer a couple of my questions.

A common theme when discussing pitching injuries on the Internet is the phrase “inverted w.”  Do you have any thoughts on the validity of inverted w's being dangerous to a pitcher's health?
I'm not a proponent of the Inverted W. Back when I was first learning about biomechanics, I talked to a lot of the top minds in the game and I felt like I knew enough to just look and see things. Well, as with umpires and the strike zone, sometimes our eyes lie. I want more than just observations - I want data. With biomechanics analysis, we can figure out how much stress a pitcher is actually putting on joints, how much force they're exerting, and then we need to move to fatigue and recovery. Few teams are doing the first part of this and fewer are doing the second. Should we wonder then why baseball has lost over a BILLION dollars to pitcher injuries in the last ten years? Moneyball talked about ASMI and their biomechanics lab, but you know how many teams use it now? Maybe two. 

Tommy John surgery has seemingly reached a point where we expect the pitcher to make a full recovery after 16-18 months. However, shoulder tears are still viewed as the boogey man of injuries. Will this always be the case? Can we expect to reach a point in the (relatively) near future in which pitchers who suffer labrum tears are expected to fully recover?
No. Dr. Neal ElAttrache was on a panel with me this summer and he's the guy for shoulders. (Once, Jim Andrews was asked what the first thing he does when he sees a torn labrum case and he said "call Neal for a consult.") Neal gave a great explanation which might still be up at the SABR site [Ed. Note: Audio of the panel can be found here] - the panel was at their annual convention - about how the shoulder is so complex, that its like putting together a puzzle without the box top. The elbow is a hinge. It moves one way. Look at how many things the shoulder can do and how many structures it takes to do it. Just move your shoulder around and pay attention to what it takes to move through various motions and you'll understand why it’s so tough to get it back to original condition.

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