Elbow injuries spur MLB to set up new study
(APR. 03, 2015 by Reuters)

NEW YORK —The plague of elbow injuries struck again in spring training with Texas ace Yu Darvish and young Zack Wheeler of the New York Mets the latest key pitchers to fall, and Major League Baseball wants to know why.

“The last three or four years, we’ve seen an increase of Tommy John injuries at the major league level,” Chris Marinak, MLB’s senior vice president for economics and league strategy, told Reuters. “That trend is certainly concerning to us.”
Propelling a baseball at speeds over 95 miles an hour, or snapping off a sharp-dropping slider naturally stresses the arm, but the rate of injury is alarming.
A survey of MLB pitchers found that 25% of them had at some point in their career undergone Tommy John surgery, named for the pitcher who in 1974 was the first to have his torn ulnar collateral ligament reconstructed.
Research has pointed to excessive stress on young amateur pitchers as starting damage to the elbow, and initiatives have been undertaken to address that with “Pitch Safe” recommendations by orthopedic surgeons.
Now the focus has shifted to examination of professional pitchers after another hike in elbow injuries with 35 Tommy John surgeries for major league players in 2012 and 30 last year.
Medical information on minor league pitchers has been collected this spring training including MRIs, range of motion data, physical exams and playing history details, Marinak said.
“The goal is to track these players over a five-year time horizon so we can watch them as they progress ... which players got hurt and which players didn’t, and try to map that back to see whether there was something predictive,” said Marinak.
In the meantime, physical therapists try to protect pitchers, and researchers have found ways to measure stresses in hopes of warding off injury.
Shari Walters, of EXOS, which uses innovative sports science and methodology to train elite athletes, has helped rehab some 100 Tommy John cases. She talked about “pillar strength” and breathing.
“It all starts with breathing. Part of our evaluation is checking their breathing mechanics,” Walters said. “A chest-breathing athlete is set up for an upper extremity injury. The diaphragm also has a role in spinal security.”
Dr Carl Nissen, who worked on an MLB grant, tested college pitchers at his lab to measure the stress from different types of pitches.
His motion studies found that curve balls and other breaking pitches put less stress on elbows and shoulders than fastballs.
“The curveball is thrown about 10 mph slower and therefore going to put less stress on the elbow,” said Nissen, founder of Elite Sports Medicine at Connecticut Children’s Medical Center.
Nissen, who placed dozens of reflected balls on his subjects and used 12 high speed cameras to measure stresses on the body during delivery of pitches, said proper mechanics was essential.
“The true shoulder turn to the pelvis ... when that’s not controlled that actually puts a huge increase in the stress on the shoulder and the elbow,” he said.
The motion tests show which pitches stress a particular pitcher’s arm the most. “Why not use the information to either change their motion or change their pitch selection?” he said.
Dr Johnny Arnouk, orthopedist in Sports Medicine at New York’s Mt Sinai Beth Israel hospital said some pitchers did not throw breaking balls properly and pitch counts mattered.
“The breaking ball is a skill and you have to learn how to throw it properly,” Arnouk said. “With higher pitch counts comes fatigue, poor mechanics and injuries.”
Dr Mark G Grossman, chief of sports medicine at Winthrop University Hospital, said damage done at a young age was a fundamental problem and referenced Dr Frank Jobe, who performed the initial surgery on Tommy John.
“To quote Frank Jobe, who I trained under, ‘some of the best pitchers never become the best pitchers because they’re overused at a young age.’”