Are the Reds doing all they can to prevent elbow injuries?

The answer, as it does for every major league club, depends in large part on how they view the problem. Do the Reds believe elbow injuries are primarily caused by workload or by pitching mechanics? The best answer to that question has changed in the past five years.

Have the Reds kept up?

Profound change is occurring everywhere in baseball. A new analytical approach began to take hold about ten years ago. Moneyball was published in 2003. Baseball Between the Numbers: Why Everything You Know about the Game is Wrong came out three years later. The new outlook focused on isolating player contributions with innovative statistics and developing better ways to think about roster composition, lineups and in-game strategies. Today, baseball organizations have bought into those concepts to varying degrees.

But new understandings have also arrived in the area of health and injury prevention. A separate revolution in measurement and analysis has developed throughout all professional sports in just the past two or three years. And it has huge implications for ulnar collateral ligament (UCL) injuries.

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The new approach on health and injuries involves monitoring and measuring various physical aspects of players during practice and games. Players can be fitted with biometric sensors that produce real-time reports. That data allows experts to often pinpoint injury risks ahead of time. A wide range of variables are being measured, including speed, hydration, sleep, hormone level, muscle fatigue, exertion, Vitamin D level and stress, among others.

As a general rule in decision making, more information is better than less. If they choose to, front offices can use this biometric data when evaluating player contracts and potential trades. Managers and trainers can gain insight in how hard to push players in practice and games. Coaches can work with players on correcting their mechanics.

But when it comes to elbow injuries and avoiding Tommy John surgery, teams first have to make a fundamental change in the way they look at the problem.

Workload Rules: Outmoded Thinking

For years, big league clubs have focused on pitcher workloads as the answer to arm injuries. Teams have adopted strict pitch count limits for individual games and rigid rules for how many innings a healthy pitcher will throw. These policies begin in the minor leagues and follow the player through development and on into the major leagues.

For example, the local team appears to be preoccupied with how to handle the innings count of their young pitchers. Will they shut down Raisel Iglesias and Michael Lorenzen? Will they send Robert Stephenson to instructional ball to build up his innings? Teams — and not just the Reds — have become fixated on workload rules as if they were divine edicts.

You would expect that the ever-more-restrictive regimes would have reduced the number of UCL injuries. But the opposite has occurred. The Washington Nationals became notorious for limiting Stephen Strasburg’s innings during a postseason drive. Then the young right hander still ended up needing Tommy John surgery. Chase Whitley, a 25-year-old pitcher for the Yankees, had TJS this spring even though he had never pitched more than 70 innings in a season or thrown 100 pitches in an appearance. For all the emphasis, workload rules don’t seem to be working.

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It turns out that research backs up those anecdotes. Regulating workload isn’t as effective as believed. Pseudo-science like the Verducci Effect (concerning innings limits) has been discredited. That whole business about not allowing otherwise healthy pitchers to increase their workload by more than 30 innings from one year to the next? Mostly bunk. New studies show little correlation between workload and injury.

If the latest research fails to back it, why do teams continue their devotion to workload limits? It’s the perfect solution for the uninformed. The rules are easy to understand, the steps are simple to implement and it has the patina of statistical rigor. And following external rules takes human judgment about individual pitchers out of the picture and, more importantly, out of question.

Ironically, workload regulation may be counterproductive. Under-training carries its own set of risks. Limits on workload may produce arm muscles that are not as developed as they could be, so the pitcher’s arm may be insufficiently prepared for stressful situations in games. Careful overload in training can make the arm capable of handling bigger tasks. New research from Northwestern University indicates that stronger arm muscles can help protect ligaments at the elbow.

Pitch and innings limits also have the perverse effect of encouraging pitchers to throw with more violence to achieve higher velocity. If a pitcher knows he’s going to be used for no more than 1 inning or 100 pitches, he’ll throw harder when he’s in there, risking more damage.

Teams must undergo a paradigm shift away from simplistic and largely ineffective workload strategies.

Motion Analysis

How should major league teams approach prevention of UCL injuries?

Instead of treating workload restrictions as the silver bullet, teams should pay close attention to pitching mechanics and data analysis. The study and measurement of arm motion offers great rewards, particularly in allowing a deeper understanding and insight into stress placed on shoulders and elbows during the act of throwing.

Biomechanical evaluations have been conducted on thousands of pitchers at all levels, from youth pitchers to professionals. They accurately measure and calculate the efficiency of the delivery motion. The test results produce three-dimensional data that allows analysis of body angles, joint velocities and timing mechanisms. The evaluations can be used to reduce the risk of injury or re-injury.

For example, when pitchers raise their throwing elbow above their shoulder before moving the ball into the loaded position it’s a red flag. Sports injury expert Will Carroll puts it like this: “Biomechanical evaluations could help teams and doctors figure out which pitchers are exerting forces that could cause them trouble.”

Major League Biomechanics

Are major league teams taking advantage of this new insight?

Some are and some aren’t.

The Seattle Mariners require every pitcher to undergo analysis of their pitching motion each year to identify mechanical risks. They target pitchers with issues in their delivery and work with them on specific metrics, like release points or arm angle, for 3-6 weeks in the spring if necessary.

The L.A. Dodgers announced earlier this year they have partnered with Kitman Labs, an Irish company that has had success using biomechanics and computer-based programs in Europe preventing injuries in soccer and rugby players. Kitman collects data on Dodger players. The club hires personnel qualified to interpret it. The Dodgers have started to collect detailed biometric measurements at the minor league level.

Stan Conte, who is the Dodgers VP of Medical Services explains the idea: “You set these marks and if a player is having an issue with a lack of motion or strength — and we know that because we can measure it two or three times per week — the program will alert you. If we have the right system, biometrics can tell us there is a slight decline before he gets injured.”

Don’t assume that only big-budget teams can afford biometric analysis. It isn’t money that limits participation, it’s openness to new, modern ideas. Science comes a lot cheaper than injuries. The Milwaukee Brewers were the first team to have all their pitchers undergo biomechanical analysis. They were the only team in MLB to have no Tommy John surgeries on their major league pitchers for 5 years. At first, the Brewers and Baltimore Orioles were the only two teams doing full analysis on all their pitchers.

The Pittsburgh Pirates understand the edge that maintaining pitching health can provide for small market teams. While they don’t publicly reveal their practices, it’s known they target pitchers with large frames and aggressively monitor the health and mechanics of their pitchers. Early adopters of biomechanics  — Milwaukee and Pittsburgh — showed significant reductions in pitching injuries.

In the future, Big Data will play a large role in injury prevention in all major sports. Billions of lines of data will be available on everything from throwing motions to hamstring fatigue to heartbeats. For organizations willing and prepared to take early advantage of it, data science will be a powerful tool enabling decision making about injuries, training regimens, playing time and roster construction. It will be a massive edge for those who use it compared to those who don’t.

Back to the Reds. We don’t know for sure how much the Reds use biometric analysis for their pitchers. Will Carroll says that only about half of MLB teams do full evaluations. We do know the Reds are one of only three major league teams that don’t even use advanced elbow sleeves to measure stress. Given that, it seems unlikely they are taking advantage of modern full-body analysis. It would be great if someone in a position to ask them about it would, and report on it.

Are the Reds taking advantage of the latest ways to collect vital information about their pitchers’ health and injury proneness?

It sure would be smart if they did.

10 Responses

  1. Craig Z

    I can understand to a degree not wanting to jump right into every new technology, data use, etc. But when most of your competitors are doing something and it seems to be working, I can’t understand to feet dragging. And how long before the players association starts demanding these type of studies to help prevent injuries?

    • shawndc04

      You’re wrong about the Strasburg scenario. He was injured in his rookie season and had Tommy John. The Nationals were not in a pennant drive. His innings were limited during the 2012 run by the Nationals, i.e.,when he was coming off the TJ surgery.

      • Shchi Cossack

        That does bring up an interesting addendum to preventing injury, and that is rehabbing from an injury. The topic doesn’t specifically focus on rehab issues, but the analysis and data used to prevent injury should be useful in monitoring recovery and strengthening during rehab.

      • Steve Mancuso

        Yes, it’s important to distinguish those situations when it comes to workload limits. There are solid reasons for treating recovering arms different from healthy arms. That’s what is going on with Matt Harvey and the Mets right now, as Harvey is recovering from TJS.

      • Steve Mancuso

        You’re right about 2012, that was after his surgery, which was in 2010. I was mixing up my recollection of how they had babied him with innings limits and pitch counts prior to his 2010 injury.

      • greenmtred

        Steve: A very impressive piece of research and writing. Many have noted that pitchers used to pitch many more innings than they do in the modern era, and it seems that velocity is much higher now than it was even a few years ago. And it also seems, as you have documented, that throwing very hard for fewer innings does not reduce the likelihood of injury. Thanks for the excellent article.

  2. big5ed

    I think that computer may melt down trying to analyze Jumbo Diaz. A whole lotta shakin’ going on.

  3. WVRedlegs

    Great series of articles Steve. Excellent information. Two things that jumped out at me, other than the Reds are way behind the learning curve in their jurassic front office, was 1) the chart that showed the yearly number of TJ surgeries leaped above 30 in 2003 and started climbing quickly. And 2) the NU study that “indicates that stronger arm muscles can help protect ligaments at the elbow.”
    This begs the question, has MLB’s banning the usage of performance enhancing drugs, like steroids and HGH, had a significant effect on pitchers’ elbow injuries? I ask this because it has been mostly pitchers that have got caught by MLB’s drug detection system since its inception. And the Mitchell report came out in 2003. Many pitchers have said that the HGH helped with speeding up tissue healing in between outings. Could the banning of HGH have had a counter-productive effect on pitchers’ elbows?

  4. Nick Doran

    Great series of articles Steve.