By Jane Ehrhardt
Major League Baseball recently released a broad-based report on pitching injuries. In investigating the causes of a growing rise in injuries, the league surveyed experts who ran the gamut from orthopedic surgeons, bio-mechanists, and sports medicine physicians to pitching coaches, trainers, player agents, front office execs, and former MLB pitchers.
“I was very pleased with the report. They interviewed 200-plus people, and the report might have had 200 different answers. But almost everybody agreed,” says Glenn Fleisig, PhD, the biomechanics research director with American Sports Medicine Institute in Birmingham. ASMI is the nonprofit sports medicine research and education institute created in 1987 by Andrews Sports Medicine founder James Andrews, MD.
“The report here does not prove what causes injuries,” says Fleisig, who has worked with MLB for over a decade as their injury research advisor. “But since people from different realms anecdotally think it’s the same things, then we feel pretty strong that these are the roots of the problem. It points us in the right direction for what needs to be fixed.”
The sports current focus on maximum velocity pitches was consistently named as the primary cause of injuries. “It’s pretty widely held that throwing a max effort pitch is not a great idea in repetition, because you lose control, and you’re putting the ligament under a lot of stress,” Jeffrey Dugas, MD says.
A common and one of the most devastating injuries for pitchers relates to tearing the ulnar collateral ligament (UCL) on the medial side of the elbow. Surgeries to reconstruct that ligament, called a Tommy John surgery, have paralleled the increase in fastball velocities in the league.
“The reason that Major League Baseball commissioned this project was because they saw an uptick in UCL injuries in pitchers early in the season over the previous few years,” Dugas says. “They’re trying to understand it better to try to create strategies that decrease the risk.”
Spin is the other culprit cited by the experts in the report. This covers the combination of spin, velocity, and movement to make the ball weave, dip, and rise. “That means you’re using your muscles to turn the ball, and those muscles originate on the same part of the elbow as the ligament,” Dugas says. “The decrease in tack on the ball is also a source of more pitcher injuries. Years ago, they decreased the height of the seams in order to advantage hitters, and pitchers were less able to generate spin. So pitchers gripped harder to compensate for less tack, leading to more injuries.”
Fleisig feels differently about the grip’s connection to injuries. “When you grip the ball harder, it makes more tension in your forearm and, in my opinion, that actually protects the elbow ligament by reducing the load on the ligament,” he says. “However, as those forearm muscles fatigue later in the game from maximum effort, the UCL becomes vulnerable again.”
That max effort in every pitch was also highlighted in the report as a cause of injuries. “I’ve spoken to a lot of the greatest pitchers of our times, Hall of Famers,” Fleisig says. “And when I spoke to them ten years ago, they all said that they alter their velocities, throwing some fastballs harder than some others; the same with curveballs. These days, though, pitchers never let up.”
Biomechanics hold the potential for new solutions for pitchers. To that end, Major League Baseball has been making large investments into assessing players’ movements. For about the past five years, they’ve been installing biomechanic cameras in every stadium and most of the minor league ones as well. “If you’re going to throw hard, you might as well throw with proper mechanics. So all the teams are doing that,” Fleisig says.
The problem is not only hiring people on each team to interpret the data, like bio-mechanists, but then also have the expertise on hand to convert the data into sound training advice for coaches, trainers, and pitchers.
“Getting the best mechanics will help you,” Fleisig says. “But again, our research has shown that even with the best mechanics, if you’re throwing every pitch as hard as possible, you are stressing out your elbow.
“For years the scientific message to players and coaches to voluntarily do what’s best for themselves hasn’t worked so rule changes may be needed. Those things still have to be worked out. But baseball has made changes when needed like adjusting age-old rules to shorten and liven up games, including adding a pitcher clock. So I’m optimistic they’ll make the safety changes.”
