Solving the pitcher’s elbow – baseball’s epidemic of injuries

In 1974 Dr Frank Jobe and a pitcher with an injured elbow combined to change baseball forever.

The ulnar collateral ligament (UCL) lives inside the elbow. A torn one? Bad news for one whose task in life is to hurl an object at great speed.

Replacing it requires a tendon from somewhere else in the patient’s body, lacing it through holes drilled in the arm bones. A patient without a suitable tendon will receive one from a cadaver, with luck (and long rehab) bringing life to an arm and rebirthing a career.

That first reborn pitcher was Tommy John. The surgery that bears his name has been increasing drastically in recent years, and not just for professional players. While surgery figures will increase along with the availability of that procedure, it is startling to read that one-quarter of pitchers in MLB today have a Tommy John scar on their elbow.

That was part of the blurb for The Arm by Jeff Passan, baseball journalist for Yahoo! Sports, who spent 3½ years researching baseball's arm wreckage.

Speaking from New York before the book's launch, Passan told The Irish Times that when he started on the project "the idea was to try and figure out what's causing this. By the end of it though, it was more to inform and educate people that this is happening. Because if I knew what was causing this – if I figured that out – I'd be a millionaire."

The velocity of the average major league fastball rose by 3.1 miles per hour between 2002 and 2015, according to data from Fangraphs and Baseball Info Solutions. The slider was up by 3.6mph, the curveball by 2.9mph.

Even the changeup, akin to the slower ball in cricket, has increased by four miles per hour. Pitchers have become more specialised, throwing fewer pitches but going all out on every one rather than saving it for the big moment.

The best publicly available resource for Tommy John surgery rates at the professional level is maintained by Jon Roegele, with the 1,193 entries (as of today) sourced from media reports. A significant proportion have taken place in just the past few seasons, adding up to many millions of dollars in lost availability.

Does speed kill arms? Well, we don't completely know. Sports injuries writer Will Carroll said "it's a force on the arm, and it's a repetitive stress. So it's just too logical, though we don't have a perfect one-to-one relationship."

Cause and effect

Finding precise cause and effect is not easy when it comes to precisely understanding the thrashing, torque-filled forces involved in every major league pitch along with their toll on the body.

“We think guys are throwing the same [in a lab], but they’re not. They’re not warming up the same, the adrenalin’s not going, you don’t get the stressful innings” said Carroll.

The Tampa Bay Rays and an undisclosed second team have signed up to something new and potentially revolutionary. The Kinatrax system involves rigging a series of high-speed cameras around the ballpark, recording the pitcher’s delivery at between 300 and 1000 frames per second.

That game footage takes a day to analyse, producing a pitcher’s kinematic skeleton and precise throwing motion for each pitch. No electrodes, no markers on the body.

"We don't require any co-operation from the pitcher at all" said Kinatrax president Steven Cadavid. "It's completely passive technology."

New super-technologies such as Statcast and Kinatrax “won’t be on high school fields”, says Carroll, “and that’s where velocity is really measured by the scouts”.

Tommy John surgery is on the rise among the young and reading Passan’s book it’s hard not to be struck by the sections on America’s child baseball industry.

Hunger for validation

“The US Specialty Sports Association . . . ranked 30 four-and-under teams in 2015, as in preschool-aged. The hunger for validation in youth sports never ends, and it’s exceeded only by someone else’s hunger to commodify it,” wrote Passan, himself the father of a young boy.

When asked about that passage he said the practice “is just so detrimental for these kids who have no idea what they’re going to be until they’re 15-16-17 years old, and we’re talking about four-year-old teams. How they can do that with a straight face or a clear conscience, I don’t quite understand.”

Perhaps there were learnings to be had in Japan, another baseball hotbed. But Passan found no miracles there. If anything the damage being done to young arms was worse.

He highlighted his visit to Dr Naotaka Mamizuka, a spinal surgeon who takes time every week to treat young baseball players with hurt arms.

“For four straight hours children are coming in. And they’re missing teeth, and they have fractures in their elbow from throwing, that was just one of those moments where you sort of question why they even bother.”

Pitching wins championships. Raw velocity at a young age will put dollar signs in many eyes.

“I think there’s a glory complex in the United States when it comes to youth sports that I did not sense in Japan,” said Passan. “I think in Japan it is more of a cultural and a respect for culture and tradition that they don’t want to break, whereas in the United States it’s stars in their eyes disease – they can’t help themselves.”