16 July 2018

Book Review: Play Ball (Baseball Medical Injury Guide)

A couple years ago, I reviewed Jeff Passan's The Arm.  It is written in a style similar to Michael Lewis' Moneyball with similar aims.  Passan had noted that he wished for the book to serve as a wakeup call and tool for parents to inform them about arm injuries.  The book was fairly popular within the baseball writing circles, but those with a more keen eye for the science found it to be underwhelming.  It was entertaining, but was also a convoluted mess that was often internally conflicting in the message (e.g. Trevor Bauer vs. overthrowing, Kyle Boddy vs. actual science).  In short, the book was about a journey through the muck of arm injuries in baseball, but was somehow presented as a step forward.

This summer comes Play Ball by New York Yankees Head Team Physician Christopher Ahmad and Major League Soccer's Medical Coordinator John Gallucci Jr.  What Play ball aims to do is to familiarize the reader with some of the most common injuries that amateurs and professionals face in baseball, including arm injuries.  The book presents the underlying issues thought to be the cause for these ailments, what symptoms arise, treatment options, and rehabilitation time frames.  The text is dense, but this is really an overview that helps, at least, to direct parents and players to proper information and to convey a message to not get too worked up about some things.

The book conveys similar information, especially about arm injuries, that The Arm does, but does so in a more clinical and, obviously, less entertaining way.  Ahmad and Gallucci are not trying to bro up their language to appear as belonging to the locker room as Passan is wont to do, but present themselves as professionals in the field.  Their writing is straight forward, but some will certainly need to have Wikipedia nearby to understand some of the terminology.

Where the book fails though is that even though the authors try to properly convey certainty in their writing, it falls a little short at times.  For instance, a passing comment about the inverted W, which refers to how a pitcher's arms may look when about to move forward in his throw (why is this not simply called an M, by the way?), suggests this likely increases injury without really any evidence of this.  Other parts of the book where a point is being made, the author provides some specifics about studies he has done or others have done that back up the point.  It makes other statements that are orphaned from scientific evaluation seem like unimportant or meaningless tangents.

Another failure is that while the book regularly mentions studies that have been done, they really should have provided an appendix or footnotes to identify what studies the authors are actually referring to.  For instance, there is a passage in the book about the use of platelet-rich plasma therapy.  Providing substance to the recommendation of this treatment is the mention of a study and how the participants were significantly helped by the therapy.  It should be noted that once tracking down this study that the methodology is poor.  It simply is a case study.  With the handful of individuals in the study, one would want there to be case controls and confounders to be addressed.  The study did not do it, so it really does not back up the recommendation.

The is found throughout the literature with platelet-rich plasma therapy studies.  Very few studies are worthy to be considered. Those studies have poor methodologies. The research base is fairly mixed in how effective it is and that uncertain effectiveness also appears to be highly contingent on the type of injury and severity.  The therapy is also presented as fairly complication free, which it is if you compare it to more substantial surgical approaches.  In reality, this therapy is extensively used in sports medicine and beyond.  With the volume of this work, one would figure there would be a fairly decent approach to evaluate the effectiveness of this therapy and it simply remains an unknown to my knowledge.

So...while this book has some well evidenced perspectives, it does provide a halo to other less evidenced advice.  The authors do a poor job distinguishing that and seemingly obscure it when they, in their expert opinion, truly belief in a therapy.  I see that as problematic, but certainly this is a step up from how The Arm presented the subject and flailed at providing solutions to the subject.  This book provides solutions and potential solutions as well as tries to explain how to prevent, detect, and resolve issues.

Sports injuries, arm injuries particularly, can be complicated.  Therapies sometimes take a long time and a lot of repetition before they establish definitive success.  Life is not always so clear cut.  That said, this book is a great complement to The Arm and, well, if you read one of them you should certainly read the other.


Play Ball: Don't Let Injuries Sideline You This Season
by Christopher Ahmad and John Gallucci, Jr.
Post Hill Press
238 pg


Pip said...

Really enjoy these reviews. What DO you recommend? The Passan book and this one seem too flawed to be of use to the novice, but I’m interested in the subject.

Jon Shepherd said...

I would say that there is no single book, manual, or whatever that properly covers the topics. Play Ball is, by far, the best one, but the authors have difficulty getting out of the way of their writing.

Broadly, I think what we kind of know is that kids should probably stick to one sport per season and three to four seasons a year. Specialization should not be considered until maybe 12 or 13 years old and full specialization should not be considered until junior or senior year of high school. If your kid really loves baseball, then I would say that pitching or catching should be limited to one season per year until you start specialization.