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

The Most Important Baseball Book Is A Swamp

The Tommy John epidemic, my stomach turns and an eye roll image occupies my mind.  The word epidemic, in this context, is chosen when the person speaking wishes to gin up concern in his audience.  Epidemics, of course, result from infectious agents while pitchers bust UCLs by throwing a baseball. Properly translated, the message is that the incidence of ligament replacement surgery for arm injuries is increasing at epidemic proportions as pitchers at the professional and amateur levels are lying down on operating tables in record numbers.  That hard count concerns many and Jeff Passan's The Arm addresses this issue.  Passan intent is for his work will have far-reaching consequences.

We want every person involved with youth baseball to #ReadTheArm. I think it's an important book. I think you'llagree once you read it.

— Jeff Passan(@JeffPassan) March 23, 2016

The book familiarizes the reader with how elbow ligaments are torn and how the joint is repaired.  It opens with a description of the procedure that Frank Jobe created and performed on Tommy John.  Briefly, holes are drilled through bone.  A tendon is then procured from the patient or a cadaver, is laced through the holes, and ties the joint together.  Over time, the tendon transforms into a ligament.  Over time, players go through immense physical and mental challenges to return to the mound.  Over time, MLB continues to make, at best, half-hearted attempts to address what may have always been happening: throwing a ball destroys arms and crushes dreams.

Passan pays particular attention to the youth game in the United States and the one in Japan.  In the United States, he paints the sports medicine culture progressive, yet reactionary.  He describes youth baseball organizations in the throes of grabbing as much money as possible.  Passan uses Japan as foil.  The country is characterized as medically regressive.  The sport hampered with an obligation to follow a historical bushido-influenced baseball code which legitimizes practices like nagekomi.  This approach to pitching utlizes daily marathon throwing sessions to establish "perfect" throwing mechanics.  Of course, children in both countries though find themselves broken and in pain.  Neither appears to be addressing the situation well.

Interlaced between the 30,000 foot narrative are the two personal stories of Daniel Hudson and Todd Coffey.  Both are going through difficulties recovering from ligament revisions (second surgeries).  The long, slow, inch-by-inch rehabilitation process toys with the competitive mind and invites depression.  Individuals must practice extreme self-discipline and benefit greatly with a strong family support structure.  Throughout the book, Passan returns to them to give gravity, and sometimes levity, to this issue.

The fourth prong is Passan trying to wade through the swamp that is the field of arm injury prevention.  He tries to consolidate the efforts used to prevent arm injuries from happening in the first place.  He meanders through the sideshows of pitching gurus and snake oil salesmen to fall upon the work of Kyle Boddy and James Buffi.  To varying extends, both use scientific tools and foundations to develop applications to improve preventative approaches to avoid arm injuries as well as increase velocity.  The section is perhaps a bit too brief.  Passan familiarizes that there are many approaches currently trying to address this issue and that none will likely produce sound results beyond logical inference and case study success.

While reading, I did have three major contentions with the narrative presented and I will address them below.

On Youth Baseball
Major League Baseball drives baseball in this country, often indirectly.  MLB is notoriously reactionary and tends to be more concerned with optics than impact.  For example, the league's concern with steroids was limited to a bargaining chip against the union until congress became irrationally involved.  This resulted in a PED program that is focused on punishment as opposed to player health.  The arm injury issue is fairly similar.  Injuries have always been an issue, but with cries of "Think of the children!" increasing in volume MLB might decide to wield its clumsy hammer.

The playbook is simple.  The first thing MLB does is to lay blame elsewhere.  That target is Perfect Game and it is pretty clear in this book that the league's message has found its way into the pages.  Perfect Game came into being because MLB ignored amateur baseball and its members were not interested in joining forces to make scouting easier.  Perhaps, the clubs with better scouting departments did not want to make things easier for others.  Anyway, Perfect Game filled that hole by organizing showcases and tournaments to make it easier for amateurs to be seen by scouts.  In turn, scouts are thankful that Perfect Game streamlines the process to see the big named amateurs.

Of course, this service costs money to run.  Owners and employees like to support families as well as have nice things, so additional money will need to exchange hands.  Likewise, the customer base has to find all these services worth the money.  Once Perfect Game found the sweet spot for success, competitors came in.  Perfect Game then engages families of children as young as four and five in order to pipeline them into teen tournaments when they get older.  The problems inherent in the industry magnify with Perfect Game as a convenient target.

This too is how The Arm treats Perfect Game, as a target.  Parents and MLB are upset over arm injuries, but placing blame on the infrastructure that all parties desired is misguided.  The infrastructure is not the problem.  It merely highlights it while it tries to implement heralded approaches to keep arms safe.  Those heralded approaches are akin to alchemy, but implementing the best ideas around is the most one can expect of companies like Perfect Game.

This not to say that Perfect Game is a flawless moral actor in youth baseball.  The Arm notes that they present to parents of seven year olds reports that indicate whether their kid is on the same path as Mike Trout.  That is some vicious exploitation of parents and children.  There is no reason for them to publicly communicate that to parents because it is so misleading.  I would understand if they did that for internal records in order to figure out who to keep tabs on and provide invitations, but it is not something that parents are likely able to comprehend.  Then again, people like bells and whistles, so maybe the customer desires to be willingly misled.

The Arm also discusses how baseball in Japan is grueling.  It presents the Japanese style as a practice in recreational bushido.  Coaches demand total allegiance, unending repetition, and suffering.  Arm injuries are treated with throwing, which is a concept that American medicine abandoned 50 years ago.  While American medical counterparts are composed of individuals well-trained in tendon and ligament injuries, Japanese sports medicine appears to be dominated by bone specialists with passing knowledge of ligament replacement.  The Arm suggests that by ignoring ligament injuries, the Japanese way is regressive, but that might be more damning in relation to adult pitchers as opposed to children.  Of course, the demanding nature of Koshien (i.e., a pitcher throwing over 500 pitches is normal over the short length of the tournament) and daily practices appear to be absurd, but maybe they are not.

The Arm tends to make a Gonzo style narrative conclusion and then later dismantles that conclusion without much contemplation.  For instance, Passan is appalled at how the Japanese game tears up its youth.  That conclusion is later challenged with an adoring description of supposedly how Trevor Bauer turned himself into a wunderkind by throwing 360 days a year.  For the well-disciplined reader, this communicates how the industry is unsure how to solve this issue and acts almost completely on what simply sounds like a good idea.  Again, this is what alchemy is and a lot of smart people like Newton logically thought lead could be turned to gold.  Logic is quite important, but it can lead you down some errant rabbit holes.

Convoluted Section on Avoiding Injury
The Arm aggressively notes problems and then languidly searches for answers.  The whole thesis leads up to a brief section infatuated with the efforts of Kyle Boddy and, to a lesser extent, James Buffi.  Passan presents two individuals who many consider the most forward thinking arm researchers in the game.  Largely ignored are established researchers like Glen Flesig and his group at ASMI.  In that way, the book frames Boddy and Buffi as the future.

Personally, I know several smart baseball folks who believe in Boddy.  I also do not consider what Boddy does as science.  His work is more on an applied engineering scale or perhaps similar to a doctor using a medicine off label and publishing a case study.  Yes, there may be something there and it relies on established science, but Boddy is not carrying the scientific method forward.  Instead, his work relies on lottery tickets to establish the perception of success.  Without the amazing success of Casey Weathers, Boddy would not have much to point toward.  One could just as easily focus on Nick Hagadone who did not reap benefits by working with Boddy.  As with most pitching success mantras, people forget the failure and provide a narrative for the success.

Boddy can implement a wide range of peer-reviewed mechanics papers into his approaches.  While the foundation of his work is connected with science, his work and his evaluation of his work is not science.  Again, this does not mean Boddy is wrong.  Instead, he likely gets some things right similar to other pitching specialists.  There are probably many ways to skin a baseball as opposed to one Way.  Maybe there is a single way at this elite level, but that has not been firmly established.

Boddy certainly is a rarity amongst pitching gurus.  He does publicize his errors in reasoning when he takes a turn in his approach.  His manner comes across more cleanly than that of someone like Chris O'Leary with his defensive obsession with letter shaped arm angles inverted-W (as seemingly described in the Arm).  Most everyone has a gimmick and if you take in a cynical perspective, Boddy's gimmick is "Science!" in a suit filled with alchemy.  In essence though, this field is still an applied mish mash of what sounds like good ideas.  Practitioners are often snake oil salesmen and I am unsure if this book effectively communicates that.

Pointless Vulgarity
I struggled with whether I would include this section in the review.  However, Passan emphasized that this work is intended to be read by anyone involve in youth baseball, so I should write to how he misses that mark.  In one way he missed was his infrequent, yet noticeable, use of vulgarity throughout the work.  While players or wives cussing in quotes provides a closer intimation of who they are as real people, I am at a loss why Passan chooses for him as a narrator to indulge in ways that do not meaningfully improve how he communicates his message.  Instead, his profanity appears to communicate a desire of the author to be one with the players in the training room and in the dugout.

For instance, Passan writes vaguely about Todd Coffey doing everything right as a model AAA relief pitcher on and off the field as he believes he was promised to be the first player called up to Seattle.  Instead, he is passed over for younger arms. Passan states Coffey is being blue-balled.  For those offended, I apologize for writing that term, but for some in the audience it may be unfamiliar.  The term is slang for a sexually frustrated man who thinks a women strongly led him on and then rejects him.  It is a term that blames a woman for reconsidering consent.  While aptly empathizing the situation Coffey experiences, I find it quite strange for this to be written and pass by the eyes of editors when the intent for this work to serve as a public outreach tool.

While many families will read these words and wind up unfazed, we all can imagine that a significant portion would hesitate handing over language like this to their kid.  Whether or not you think parents should be more open to language use like this, the fact remains that these words consequentially may bring exclusivity to the message.  One wonders if the author is so moved by the suffering of pitchers the world over, why would he think of using a few words here or there to challenge them to reject his writing.  At best, this is obtuse or, maybe, spreading the word was a last minute idea to drive sales.  Perhaps, that is unfairly cynical.  To be clear, language like this is infrequent in this 300 some page book.  With that in mind, maybe more sensitive readers will be inclined to gloss over those passages. However, I am wholly nonplussed by its inclusion.  The language does not contribute to the overall message and potentially works against his message that he has self-ordained to be so important and so consequential in the production of this work.

Conclusion
Everyone should read the Arm.  Everyone.  The book has warts, most books do.  The author often paints himself in a corner only to fleetingly admit that he is contradicting previous conclusions.  Passan can oversell what he deems as a success, but is so soft in his final vague suggestion of a solution that I think it is passable.  It passes unlike another break-the-mold book like Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World has Never Seen.  That book wrongly inspired many people to think that minimalist shoes, chia-lime water, and 80 mile runs were good for everyone.  Passan's soft shrug of a sale puts the Arm in a better context.

However, by lacking cohesive in his final statement, Passan ultimately fails if we hold him to his stated intent of impacting youth baseball.  If a reader comes into this book, like me, with a strong understanding of what is occurring, then a disciplined and balanced reading may prove thought provoking.  If the reader is a concerned local coach or parent, then they have very little in their hands at the end of the book beyond concern and confusion.  While the book notes the toll on youth pitchers, it provides no solution or path for them.  The only solution suggested is in a few beams of light being swallowed up by individual MLB teams that will keep that information proprietary.  Instead, Passan leaves the adults on the lowest rung lost in the swamp.  One might suggest that the book lets these individuals become aware of the swamp, but what good is that when it provides nothing instructive and no real place to turn.

To reiterate, a reader must pay attention and be critical when reading this book.  The narrative jumps around, which keeps a reader interested but will often leave the message disjointed.  There is also one-sidedness to the discussion as Passan inserts himself in discussions and begins to paint himself as a reluctantly competent on the issue.  This may be a product of access or cutting things out to improve narrative flow.  Chris O'Leary, one of Passan's punching bags, has complained publicly that his interview consisted of sitting with Passan at a Cardinals game for two innings and that he was never offered a full interview to explain his thoughts.  Sometimes, that happens in research with pressing deadlines or simply moving narratives.  However, one should not consider this book to be a comprehensive look at all the near science being sermonized in baseball.  The work is simply Passan's sometimes chosen and sometimes permitted journey through this swamp of an issue.

-----

The Arm: Inside the Billion-Dollar Mystery of the Most Valuable Commodity in Sports
by Jeff Passan
Harper
368 pp.

Cup o' jO's: Rick Peterson and the O's Arms

Just a quick entry this morning...

Rick Peterson and his pitching lab will apparently be in full effect for the Orioles in 2012.  His analytical technique has been hailed as a major prevention tool against injuries.  I have disabled list numbers of starting pitchers from part of his tenure with the A's and all of his tenure with the Mets, giving us a time line from 2001 to 2007.  I also have disabled numbers of Orioles' starting pitchers in 2009 and 2010.

Rick Peterson
2001 - No starting pitchers visited the DL
2002 - 3 DL visits, 84 missed days
2003 - 3, 60
2004 - 3, 91
2005 - 3, 205
2006 - 5, 382
2007 - 3, 215

I am not sure what to make of the above except to note that much of the injury issues with the Mets were with aging retreads as they tried to fill out their pitching rotation for another post season run.  I look at those numbers and they appear to be quite impressive.  Although, he did have one of the more unfortunate statements to have been uttered during his time with the Mets.  He noted that he could fix Victor Zambrano's performance in "ten minutes" while Scott Kazmir was at least three years from performing in the big leagues.  Zambrano, as many expected, quickly fell apart and Kazmir becames the Rays' ace.  At the time and in hindsight, it was an awful deal and incredibly perplexing.

Now, looking at the Orioles
2009 - 4, 304
2010 - 4, 192

That does not appear to be much different than the end of Peterson's run with the Mets.

In a future post, I hope to get into these numbers a bit deeper.

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.

An Interview with an Arm Injury Researcher, Part I

by Will Beaudouin

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

Hayden Penn is now a Chiba Lotte Marines in JPL

Remember how we all used to pencil Chorye Spoone into future Orioles’ rotations? Can you recall the excitement surrounding Hayden Penn after he struck out 120 batters in 110 innings at Bowie? These were guys who were going to anchor the next great pitching staff in Baltimore. Unfortunately, both of their careers were hindered by various arm and shoulder injuries. Penn, along with falling down a set of stairs and being impaled by a broken bat, had elbow issues and went under the knife in 2007. Spoone suffered a labrum tear that appears to have ended any expectation of him becoming a Major League starter. If Penn and Spoone had stayed healthy, who knows what would have happened--it really can’t be over emphasized how important it is to keep your young pitchers healthy. Fortunately, there’s hope on the horizon that pitching injuries, as we know them, could be greatly diminished in the future.

Dr. Glenn Fleisig, research director at the American Sports Medicine Institute, is considered an expert in the field of pitching biomechanics and was kind enough to grant us an interview. At ASMI, Dr. Fleisig works with various pitchers—both professional and amateur—to correct flaws in their pitching mechanics with the ultimate goal of reducing injury. It’s his work that’s giving baseball fans hope that their favorite pitchers may soon have longer, healthier careers. A world in which a pitching prospects future is defined solely by their ability, rather than hearing the constant refrain of TINSTAAP (there is no such thing as a pitching prospect)? I’d take that.

In the past you’ve worked with pitchers from the Mets, A’s, and Red Sox. What sort of information are you able to provide them?  How prevalent is it that teams request services like yours?

Pitchers of all levels – from youth league to Major Leagues – come to ASMI for biomechanical evaluation.  The purpose of the visit is usually two-fold: to minimize the risk of injury and maximize performance.  The pitcher’s biomechanics are compared against elite pitchers previously tested at ASMI and then we use our biomechanics knowledge to identify areas for improvement.  We are pretty much measuring motions and forces such as those discussed in [scholarly research] papers, but explaining it to the pitcher in coach in a much clearer way, with videos, pictures, and descriptions.  You can see what the process looks like at this link.

Several professional teams send players to ASMI, but we do not disclose the names of the teams or players to protect their privacy.  The team or player is welcomed to disclose that they came to ASMI, if they wish.  This is our privacy policy for professionals and for amateurs.

The key to successful evaluation is the coach (pitching coach and strength coach).  The biomechanical analysis is simply an evaluation of what is wrong and what should be fixed.  The evaluation is a diagnostic tool for the coach, as the coach is the one who works with the athlete.  I view this as analogous to an MRI for an injury.  An MRI doesn’t fix an injury; an MRI gives information to the medical professional who is the one who treats the injury.

What’s the future for the field of baseball and biomechanics?

Behind the scenes, many professional teams are now trying to use biomechanics to keep their pitchers healthy and successful.  Some of the teams work with ASMI on this, and others work with our biomechanists.  Biomechanics is helping some teams and some players, and I predict that this effort will continue to grow.  Think of this as “Moneyball, Part 2.”  As you know Michael Lewis’ Moneyball showed how the science of statistical trends can improve the performance of players and teams.  The science of biomechanics is now being used to improve the performance of players and teams.  “Moneyball, Part 2” is actually a very appropriate name for this phenomenon, as the Oakland A’s were the first pro team is use biomechanics as part of their program.  The A’s pitching coach Rick Peterson started bringing pitchers like Barry Zito and Tim Hudson to ASMI in 2002 (the season featured in the Moneyball movie). For more details of how this started in pro baseball, read this old interview.

So, to answer your question, I think biomechanics is being used more by some MLB teams than people realize.  I think the impact will become even greater in the near future.  I think the success depends on the following three issues:

1. The ability of biomechanists to clearly explain findings to coaches.

2. The ability of coaches to make changes in the mechanics of pitchers.

        3. The convenience of biomechanical testing. 

Note: up until now, a pitcher had to come to ASMI for an evaluation.  Pitchers still come to ASMI from all across the country, but ASMI now also has the capability to bring its lab to a team’s spring training facility.

In Part II we’ll talk about specific types of injuries, along with a look into some of Dr. Fleisig’s—and colleagues’—published research.

The Science of Baseball: May 22, 2011

citation

I will be starting a new feature that seems unique based on what I have seen out in the internet and is something I may be more in tune with than most.  That would be a review of scientific literature about baseball.  Each Sunday night I plan to post on three recent journal articles that deal with baseball.  I have reviewed the literature in the past for this blog, but it has always been very much directed.  For example, a few weeks ago I wrote about hGH and how it is unlikely that it affects performance in baseball.  This column will be not be as focused on a single issue.  Here we go:

Fleisig et al. 2011. Risk of serious injury for young baseball pitchers: a 10 year prospective study. Am J Sport Med 39:253-257

The study focused on 481 youths aged between 9 and 14.  Injury incidence was simply defined as elbow/shoulder injuries and retirement due to injuries.  The study also looked at how throwing more than 100 innings a year, throwing curveballs at age 13, and spending three years at catcher affected injury rates.  They found that 5% of young pitchers will suffer a major arm injury within ten years and that this probability increases by 3.5x if the pitcher throws more than 100 innings per year.  I could not tell if 100 innings per year is causation or mere correlation.  I write this because very good young pitchers tend to pitch a lot into their high school years.  In such a situation, they will have more opportunity to be injured.  Additionally, the study suggests that young pitchers should not double as catchers.

Fry et al. 2011. Relationships between muscular strength and batting performances in collegiate baseball. J Strength Cond Res 25

Thirty one members of a Division I baseball team volunteered for this study.  Muscular strength was measured as grip strength, parallel barbell back squat, and incline bench press, and ball velocity off tee.  Performance metrics were batting average and slugging percentage. [If you cannot tell already, I would have completely overhauled this experimental design.]  The study concluded that motor coordination is certainly important, but that muscular strength is a factor in batting performance and they suggest all programs need a weight training component.  I do not think the study entirely shows that, but it is certainly an idea that would have been ground breaking back in 1975 when it is was thought that flexibility and thin lean muscle was ideal.  Nowadays . . . not so much.  I included this study to show that not all science being released in ground breaking.  A lot of it tries to substantiate common sense.

Kaplan et al. 2011. Comparison of shoulder range of motion, strength, and playing time in uninjured high school baseball pitchers who reside in warm- and cold-weather climates. Am J Sports Med 39:320-328.

In this study, the researchers were trying to determine whether there were physical differences between the shoulders of pitchers in warm weather climates when compared to cold weather climates.  The idea being that warm weather pitchers will pitch more and that this increased workload results in destabilizing the shoulder, which is thought to lead to arm injury.  50 pitchers were included from warm weather climates and another 50 were selected from cold weather climates.  None of these pitchers had a significant history of injury.  Rotational range and strength tests were conducted for each population and then the two groups were compared.  Cold weather pitchers had less of a range of motion in comparison to the warm weather pitchers.  They also had more external rotation strength.  It is generally considered a tighter shoulder (resulting in less range of motion) and a stronger shoulder results in fewer injuries.  It was also verified that these issues were related to playing time in a dose dependent manner (this means motion and strength are incrementally affected with time played).  This suggests that a healthy pitcher pitches less.  However, there is also considerable data suggesting that the number of repetitions correlates to future success.  As such, there needs to be a happy medium between being overworked and getting in enough experience.  There is probably no bright line criteria for determining what that level is as arms vary in their resiliency.