Injuries

BROKEN ELBOWS: Prevention

This is the fourth of a six-part series on ulnar collateral ligament injuries and the corrective procedure known as Tommy John surgery. The fifth part, about breakthroughs in the study of biomechanics related to UCL injuries, will run on Monday. 

Problem  |  Causes  |  Surgery  |  Prevention  |  Biomechanics  |  Prognosis

It’s been 40 years since Tommy John and Frank Jobe set in motion a revolution in elbow resilience. The pathbreaking surgery to replace a pitcher’s UCL has become as commonplace as Roger Goodell’s losses in federal court. But even when the Tommy John procedure is successful, the pitcher misses a full season of baseball or more. Surely during the past four decades we’ve come up with new solutions for ligament tears that don’t involve Kevlar.

Can anything be done to prevent UCL injuries in the first place?

Rewiring the Incentive Structure

A good start would be giving the radar guns a little breather. (I know, radar guns don’t snap ligaments, people snap ligaments.)

Playing time in high school, college scholarships and professional contracts create powerful incentives. They provide the impetus for a bunch of unhealthy trends in youth baseball. Panicked about not falling behind, young pitchers (and their parents) are drawn to year-round baseball and elbow-stressing showcases. They are pulled in this direction by the belief that recruiters and scouts care more about pitch speeds than pitching arm well-being. That’s easy to understand since scouts and recruiters don’t measure young arms with valgus stress tests.

Scouts at a recent high school game in California.  Photo: Jamie Scott Lytle

Professional leagues and some college baseball teams are beginning to push back against that harmful narrative. MLB, for example, has a website devoted to providing health information to young pitchers and their family members. Education efforts like Pitch Smart are a start.

But until the rewards of playing time, scholarships and contracts are rewired, education will ring hollow and therefore be ineffective.

If colleges and professional organizations prioritized pitchers who have protected their arms, it would begin to address the motivation behind the destructive behavior. Teams could instruct their scouts and recruiters to insist on honest counts of how many innings a young player has pitched and the number of showcases he has attended. College and professional clubs could also devote resources to injury diagnosis during the scouting and recruitment process. The New York Yankees have a full-time, year-round medical staff assigned to draft preparation.

If players and parents knew that college and professional baseball teams valued healthier arms and diverse athletic experience, it would reverse the powerful incentive structure. Learning and developing proper pitch mechanics would be at a premium. Rewarding arm health would help parents resist the siren song of travel and club team coaches pushing damaging year-long participation.

Flexing the Research Muscle

One factor leading to the rise in elbow injuries is improving strength of pitching shoulders. New conditioning regimens are rapidly reducing the time lost to shoulder injuries. But stronger shoulders transfer the stress of pitching down the arm to the elbow. Because ligaments can’t be beefed up through exercise, it is commonly assumed that training won’t have any positive effect on UCL injuries.

But new research (2015) from biomedical engineers at Northwestern University challenges this conventional wisdom. The researchers developed a computer model based on bone, muscle and ligament dimensions taken from cadavers and muscle volume and strength measurements from live subjects. It’s the same methodology used to study arm and hand control for advanced prosthetics.

The NU researchers found that muscles can reduce stress on ligaments. Ten muscles cross the elbow and forearm and help keep the bones together. While training programs can’t directly strengthen ligaments, they can reinforce the muscles and shield the ligaments.

“Muscles matter in baseball,” said Dr. James Buffi, author of the research and graduate in biomedical engineering at NU’s McCormick School of Engineering and Applied Science. “We showed that a pitcher could be at a really high risk or a really low risk of elbow injury, depending on how strong and capable his muscles are.”

His research showed that more force from those muscles relieves stress on the UCL. Therefore, arm muscles that protect the UCL can be targeted in specific conditioning regimens that include resistance training, wrist weights, weighted balls and other advanced protocols.

“If you want to prevent Tommy John surgery, focus on making the forearm and elbow muscles as strong as possible,” Dr. Buffi concludes.

Something Up Their Sleeve

Finally, to help monitor and regulate stress on the elbow, teams can turn to advanced technology and data analysis.

One new device is a sleek half-sleeve that fits over the elbow. The Motus Pitcher Sleeve, or mThrow, can monitor pitcher mechanics. The sleeve fits over the elbow and can be worn during a live game. The mThrow provides real-time measurement of arm speed, release point, angles of the elbow and shoulder and arm torque at a rate of 1000 frames per second. The data can be read on a smart phone app.

Sleeve

The sleeve’s primary purpose is to allow teams to identify when pitchers show dangerous and correctable mechanical problems in their delivery. By doing this mThrow lets clubs get ahead of problems. It can provide warning signs that aren’t easily visible by the naked eye, even with players who are pitching well.

Measuring the load on the elbow – what the sleeve measures – isn’t the same thing as directly measuring stress on the UCL, because muscles and bone take up workload in varying amounts. But if the mThrow identifies an area of possible concern, the team can follow up by having the pitcher undergo a full biomechanical analysis.

The mThrow also has practical, competitive applications. It measures arm and elbow fatigue during a game, which helps managers spot tiring pitchers by identifying small drops in arm slot. The Motus Sleeve can also show if pitchers are tipping pitches by variations in their arm motion.

The sleeve may also offer valuable information to teams about how to manage workload. Preliminary data from mThrow wearers shows that long-toss throws of over 180 feet actually place more stress on the elbow than in-game pitching. Long-toss is often used as part of warm-up and rehab programs. Also, mThrow data shows that short-distance bullpen sessions produce comparable stress. That means in-game pitch counts aren’t as important as total throws, including pickoff attempts and between inning warm-ups.
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Major league teams were slow to play ball with mThrow. The problem wasn’t cost, as the sleeve is inexpensive, especially relative to injuries. But it represented something new and that meant organizations resisted the idea at first.

A few teams tried it and saw benefits. Then more clubs joined the mThrow bandwagon. Last November, nine teams partnered with Motus Global on a study during the Arizona Fall League. Pitchers from the Astros, Dodgers, Mariners, Orioles, Pirates, Red Sox and Yankees wore sleeves and went through comprehensive big data biomechanical analyses. The Reds were not one of the participating teams.

25 major league teams signed up to use the sleeve this year in spring training and the Motus website boasts that 27 teams in total are using it. According to an industry injury expert, the Reds are one of the tiny handful of teams who aren’t.

Conclusion

Complex problems – and the UCL epidemic is one – generally require complex responses. No single action is a panacea. The solutions may dent the rosters of youth baseball travel teams and the wallets of orthopedic surgeons, but pro-active policies would protect the health of young men. These steps include changing recruiting and scouting practices, adopting targeted conditioning programs for arm muscles and implementing big data biomechanical analytics. Relying simply on overuse rules, like pitch counts and innings limits, is quickly becoming out of date.

We know that UCL injuries threaten a steep competitive toll on every baseball club. Teams have a strong self-interest in adopting the cutting-edge (and cutting-prevention) solutions that are out there. The smart, open-minded organizations will.

One thought on “BROKEN ELBOWS: Prevention

  1. Prevention… Probably the most important part of this series. Great series so far Steve.

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