Baseball's Epidemic

The Growing Culture of Overuse and Specialization in Young Athletes and its Effect on the UCL

It is a diagnosis- and a story that is becoming more and more common among athletes of all ages. Tommy John surgery, an ACL tear, a ruptured Achilles, these catastrophic injuries can devastate an athlete mentally and physically, especially when they occur at a young age. A high school athlete robbed of his ability to play the sport he loves, and with that loss comes the forfeiture of a possible future playing baseball; college scholarships or perhaps even a major league contact. Luckily, in an age of advanced medicine, recovery from long-term sports injuries is increasingly possible and safe. However, before these revolutionary medical procedures are taken for granted, it is important that the general public understands several items, such as the causes for these injuries. In doing this, the athletic community can slow the growing rate of overuse injuries in young pitchers and lay a foundation making the game safer and more rewarding for generations of future athletes.

Increasingly in America, youth sports are being viewed as an industry. Discussions have arisen in recent years regarding paying college athletes (in addition to their scholarships), based mainly on the fact that major college athletics such as football and basketball are huge moneymakers. For example, the University of Alabama generated over 120 million dollars (expenses excluded) from their athletic programs. (NCAA 2015) From the Little League World series bringing in record TV ratings to travel teams full of high schoolers playing dozens of games every summer to the 50-round Major League Baseball amateur draft, baseball has long been on the forefront of a massive culture shift regarding our young athletes. (Kondro 2012)

Surprisingly enough, the main reason for the overall perversion of youth sports has been the parents and coaches of these young athletes. As the money available in professional sports has increased (particularly baseball, where the highest percentage of players sign contracts directly out of high school), parents and programs view youth sports as an industry, a path for their children to find success from one particular sport. This has led to a growing culture of specialization among young athletes, stemming from parental logic that seeks to push children toward one sport, training exclusively for this one particular set of skills. (O'Sullivan 2014) For many talented athletes, this means pitching year round, not taking a season to play other sports. Devoting all training to pitching also leads to “excessive stress on the shoulder and arm, rather than strengthening the whole body to develop a well-rounded athlete”. (Klein 2015) It almost goes without saying that young arms simply cannot handle the stress of training like a professional athlete, but this is not the only cause of elbow problems.

           
         The push from parents toward specialization is understandable when one understands the reasoning these parents and mentors apply. Many parents believe that if their children do not specialize and train exclusively in one sport, they will be left out, allowing the other children to get a leg up and thus earn spots on various travel teams, college scholarships, and other opportunities that could have gone to their children. (O'Sullivan 2014) This often robs children of the inherent joy that comes from sports, causing them to look at their practices and games as a job, or a means to an end. Psychologically, this can place an immense amount of pressure and stress on the young athletes, as they can feel the amount of money and time put into their sport weighting down on them, whether that pressure is real or fantasized. (Palaestra 2009)

            
         Development of the mechanics of young pitchers, despite professional training and counseling being more accessible and prevalent than ever, has severely lagged behind the progress of youth programs and the volume of pitching in general. Children are often taught the basics of pitching by their parents, or a coach with no formal training experience. (Fraser 2007) When children are immersed in a year-round intensive training program utilizing these shaky mechanics, their lack of proper understanding creates a system of wear and tear on the UCL (Alun D. Ackery 2011). Pitching a baseball overhand is inherently a dangerous process, as a single throw produces a force equal to “spinning one’s arm completely around 20 times per second”. (Klein 2015) On the other side of the spectrum, pitching a softball (underhanded) is, biomechanically speaking, a much safer process, causing almost no fatigue or possibility for overuse injuries. It is commonly regarded by experts of the softball culture that “a girl can windmill endlessly without physical consequences”. (Yorio 2015) Many college softball teams play only two pitchers, and Leanna Pittsenbarger, the top college softball pitcher of 2015, threw 202 innings in 30 games, a workload that would have surely spelled doom for a male, overhand pitcher. (NCAA 2015)

            
        Prior to 1974, the odds of a pitcher recovering from a UCL (Ulnar Collateral Ligament) tear were about 1 in 100, as it is essential to the act of throwing a baseball. It is also important to note that UCL tears were not nearly as common as they are in more recent times. In 1990, virtually no procedures were done on adolescents, whereas nearly 40% of the surgeries now take place on younger athletes. (O'Sullivan 2014) This all changed when physician Frank Jobe successfully transplanted a tendon from the lower arm that is not essential to throwing a baseball and threaded it through the ulna, allowing, after rehabilitation and strengthening exercises, Tommy John (the pitcher, for whom the procedure is named), to return to his career.  Since then, nearly 90 percent of “Tommy John” procedures have been a success. (Fraser 2007) Some pitchers have undergone the surgery multiple times, such as Royals starter Kris Medlen, who underwent the procedure for the second time in 2014 but signed a two-year contract soon after, proving the confidence teams and players alike have in the operation.

            
         Although the innovation that is Tommy John surgery has at large been a positive, the fact remains that the number of procedures done has been steadily on the climb for several years. Currently, twenty-five percent of active Major League pitchers have had the procedure done (showing the modern success rate and feasibility of the surgery). In fact, more pitchers had the procedure done in 2015 than in the entire 1990’s. (Klein 2015) While young pitchers’ UCL tears can mainly be attributed to overuse, it stands to reason that overuse and incorrect mechanics would not apply to these mature athletes. Surprisingly enough, the new wave of Major League injuries is also due to overuse. The previously discussed culture of specialization has prevailed for a long enough time that today’s fresh major leaguers have grown up in it. If this wave of players was fortunate enough to avoid an overuse injury during their adolescent careers, the ligament in their elbow will likely be racked with microscopic tears. At this point, it is likely that even a slight mishandling of pitch counts or limits will result in a tear, as such doctors have seen in the huge growth of cases recently. (Brett W. Gibson 2007) Another cause for the increase in number of cases is said to be advancements in the field of detection. Many pitchers may in the past have been treated for other injuries when the real problem was a torn UCL. Needless to say, many of these pitchers never returned to their pre-injury form, many having to retire, such as Sandy Koufax, whose nine year career was cut short by elbow issues-likely necessitating Tommy John had he pitched in today’s era. (Klein 2015)

            

           A rather curious consequence of the growing availability of rehabilitation programs and surgery techniques is a flurry of incorrect conceptions and “knowledge” relating to these procedures. Orthopedic surgeons have requested young athletes and their parents requesting Tommy John surgery not to rehabilitate an injury, but mistakenly under the impression that the procedure will improve the ability, performance, and strength of the arm. (Fraser 2007) This misconception is likely due to pitchers who have had the surgery experiencing advancements in their velocity and location following the surgery, a fact which in itself speaks to the degree of which the procedure has advanced. However, experts say this increase in ability and performance is due to the pitchers learning the correct mechanics during the surgery, learning to pitch the “right way” that not only improves their mechanics but will prevent future injuries as well. (Klein 2015) Oftentimes, rest and rehab alone will be the best strategy, as even though it has a lower success rate (sixty percent), it is non-invasive and can return a player to the field of play sooner. (Klein 2015) Although the surgery may be regarded a success, it remains that 20 percent of pitchers who go under the knife “never again attain prior levels of peak performance”. (Brett W. Gibson 2007) Tommy John surgery typically costs between $10000 and $20000, which makes it important that nobody rush in to the surgery for any cause less than total repair of the ligament. (Fraser 2007)

            Interestingly enough, physics, most specifically the study of biomechanics, has been used to understand the growing rate of pitching-related injuries. Pitching “gurus” such as Mike Marshall and Rick Peterson utilize Newton’s Laws of Motion in their teachings to young pitchers. Curiously, they have been regarded as somewhat of radicals by the baseball community at large as a result of their criticism of big league pitching coaches’ teaching techniques. (Falcioni 2009) Interest in the science of biomechanics relating to pitching has increased in recent years as methods of data collection have improved. Using the equations for torque, one can see how this torque on a pitchers elbow becomes so massive, as the rotation takes place over such a short amount of time.

            Athletes of all types in virtually every sport and action have been steadily improving in their crafts over the years due to improved training techniques, dietary regimens, and advancements in exercise science except for one specific athletic action – pitching velocity. Although no one had successfully recorded pitching velocity before the 1970’s, anecdotal evidence and careful inspection seems to support the belief that pitchers have not, in fact been getting faster. (Fraser 2007) This can be confusing until one delves deeper into the mechanics of athletic movement in baseball pitching. As it turns out, this phenomenon is due to the physical limitations of the shoulder ligaments. (Scheiber 2005)

           
              Most athletes improve upon a specific skill or motion with resistance and repetition, strengthening the muscle to function with more power and speed. However, it is the Ulnar Collateral Ligament, not the surrounding muscle tissue, that controls the motion of an overhead baseball pitch, and therefore limits the speed and injury threshold of a pitcher, meaning that the health of the elbow joint cannot effectively be “strengthened” thorough conventional means of weight lifting or strength training. (Falcioni 2009) According to the American Sports medicine Institute, a Major League level pitcher’s elbow experiences 80 Newtons of force during a pitch. Looking to explore the limits of torque on the human elbow, researchers tested cadavers and found the the average arm literally snapped at just over 80 Newtons. (Scheiber 2005) This brings forth the ligament itself as the limiting factor in increasing velocity. Because elite pitchers effectively cannot increase their velocity past a certain point, top health professionals have begun to recommend exercises that seek to prevent injuries instead of strengthen muscles. (Kondro 2012)  The use of biomechanics in treatment for pitchers is an important step towards integrating advanced data and physics into improving the health and quality of major sports. If these signs are ignored, the aforementioned unfortunate trends will only continue to worsen, leading top scientists to hypothesize “if biomechanics tells us something critical, baseball better listen”. (Falcioni 2009)

            When faced with an epidemic that threatens to harm the inner workings of the sport itself, it is increasingly important that young athletes, particularly pitchers, as well as their parents educate themselves on the issue detailed above. Overuse injuries are preventable, and all steps should be taken to protect against them. Young athletes can become athletically more functional and “well-rounded” by playing different sports in different seasons. Specifically to baseball, pitch counts and limits should be implemented and strictly adhered to. This being said, it is somewhat of a modern miracle that our young athlete who has been diagnosed does not have to give up on his major league dreams.

Bibliography

Alun D. Ackery, Allan S. Detsky, Paul C. Hebert, Matthew B. Stanbrook, Ken Flegel and Noni E. MacDonald. "Reducing lifelong disability from sports injuries in children." CMAJ: Canadian Medical Association Journal, 2011: 1235.

Brett W. Gibson, David Webner, G. Russell Huffman and Brian J. Sennett. "Ulnar collateral ligament reconstruction in major league baseball pitchers." The American Journal of Sports Medicine, April 2007: 575.

Falcioni, John G. "Newton, biomechanics, and baseball." Mechanical Engineering-CIME, April 2009: 6.

Fraser, Stephen. "Myth information: young baseball players are requesting inappropriate surgery to improve their pitching." Scholastic, 2007.

Klein, Andrew. "Back in the game: elbow injuries among baseball pitchers are on the rise--and so is a surgical procedure that can save their careers." Science World/Current Science, March 2015.

Kondro, Wayne. "Making men out of boys." Canadian Medical Association Journal, September 2012: 663.

NCAA. "Revenues And Expenses 2015." NCAA, 2015.

O'Sullivan, John. "Is it Wise to Specialize?" Changing The Game (Changing The Game Project), January 2014.

Palaestra. "Coaches, parents and scientists must work together." Sagamore , 2009: 55.

Scheiber, Noam. Why can't pitchers throw faster? Slate, 2005.

Yorio, Kara. "Lack Of Softball Pitching Can Lead To Injuries." Washington Times, October 2015.