Reducing pitcher injuries tricky task
Despite endless research, there’s still no definitive path to ensuring pitchers’ health
The Blue Jays’ front office is still not sure what to do with Aaron Sanchez. Back in spring training, it seemed a foregone conclusion the 24-year-old right-hander would — at some point in the season’s second half — be shifted to the bullpen to limit his innings and protect his arm from potential injury.
But now, that’s up in the air. They are going to monitor Sanchez for signs of fatigue — one of the only pitching-injury predictors for which there is wide consensus — and adjust accordingly. If he doesn’t show signs of wearing down, he may remain in the starting rotation through the rest of the year.
While it may seem haphazard, it’s tough to blame the team for not having a concrete plan. Nobody knows how to guarantee a pitcher won’t blow out his elbow or shoulder. Despite the best efforts of those who have dedicated much of their life to researching the topic, there is still no definitive path to ensuring pitchers’ health. We know a lot more now than we did 25 years ago — even a decade ago — but there’s still plenty of finger-crossing guesswork.
The Jays are treating Sanchez with an abundance of caution because they are afraid he will break like so many have before him. More than a quarter of the pitchers in the big leagues right now have had their ulnar collateral ligament reconstructed at least once via Tommy John surgery.
But do they know if Sanchez will be saved a similar fate? Absolutely not; others have been similarly coddled and still ended up on the operating table.
“There is no evidence that says a guy is going to stay healthy when you baby him,” says Jeff Passan, baseball columnist at Yahoo! Sports and author of The Arm, an expansive and thorough investigation of baseball’s pitcher-injury epidemic published earlier this year. “There’s just none.” Passan spent several years researching what the book’s subtitle calls “the billiondollar mystery of the most valuable commodity in sports,” and while he crafts a compelling narrative of the root causes, treatments and various attempts to solve the problem, he comes to no conclusive answer.
Meanwhile, in the face of this multifaceted complex problem, major-league teams are hoarding their injury-prevention intelligence, hoping to gain a competitive advantage on their rivals. The Los Angeles Dodgers have built what amounts to an injury-prevention think tank.
And the Chicago White Sox have kept their players far healthier than every other team for more than a decade now.
The Jays undertook their own indepth study after enduring among the most pitcher injuries in baseball in 2012 and 2013. Since then, they have had among the fewest pitcher injuries in the game. They kept the details of their study to themselves, of course.
What if, instead of competing against each other to keep players healthy, major-league teams worked together to find a solution? Could a full-scale collaboration spell the end of arm injuries?
Passan isn’t sure you could eradicate all arm injuries, but he said players are poorer served by what he calls “fiefdoms” of information that precludes collaboration.
“I think it’s wrong and I wish somebody in baseball would step up and take action on this, because it’s the kind of change that the game, frankly, needs.”
He understands why teams see injury prevention as the next competitive advantage — “The team that cracks the code is going to win a World Series because of it” — but it’s not the best way to get answers. What would be more efficient and more effective, Passan says, is a centralized MLB lab and clearing house that can undertake studies and disseminate information to all 30 teams, and vice versa.
“This is different than most proprietary information because there’s a public-health imperative here,” he said. “It’s not just how you’re able to analyze statistics. This has to do with major-league pitchers’ health and minor-league pitchers’ health and college pitchers’ health and high school pitchers’ health, and all the way down to youth-league pitchers’ health.”
There are some collaborative efforts afoot.
Major League Baseball has an elbow-research advisory committee, which meets twice a year to discuss research in the field and fund the research of others.
“We’re trying to move the knowledge forward about elbow injuries,” says Glenn Fleisig, a member of the committee and the world’s leading expert on the biomechanics of pitching.
Fleisig says that while teams do withhold certain information from each other, researchers are still collaborative.
“The nature of medicine is that doctors and scientists share results.”
Fleisig, who has spent a quartercentury studying the biomechanics of pitching, says he can’t imagine ever completely eliminating elbow and shoulder injuries from baseball. But he does believe the epidemic tide from earlier this decade can be stemmed with a combination of education, regulation and new technologies, “I do foresee getting back to previous injury levels from decades ago.”
Fleisig worked with famed orthopedic surgeon Dr. James Andrews to develop guidelines for youth pitchers that have been adopted in the U.S. and Canada. As such, when the next generation of pitchers reaches the professional level, hopefully their arms will arrive in better shape.
While diagnosis and treatment are far more sophisticated now than they were throughout most of baseball’s history when pitchers were simply told their careers were over when they blew out their arms, Fleisig said the sharp uptick in pitcher injuries started in the 1990s as a result of performance-enhancing drugs — which strengthened muscles without increasing the loadbearing capabilities of the connected ligaments and tendons — and also with the onset of specialization in youth sports and year-round baseball, which led to the overuse of teenage arms.
To eliminate overuse-type injuries, Passan says it would take not only collaboration at the major-league level, but all the way down to youth baseball and a system that tracked every pitch thrown by players of all ages.
“If we have that data I feel like it’s going to almost shame coaches and parents into not throwing their kids nearly as much. That’s what we need.”
By the time young pitchers enter professional baseball, most of them already have some kind of damage in their elbow or shoulder, Passan says. “That’s just wrong. “That is one of the huge problems these days — that no matter what pro ball does with these kids to try to keep them healthy it’s almost like they were lost before they even arrived.”
Fleisig also sees potential in new technologies, such as the so-called “Tommy John sleeve,” a piece of wearable technology developed by Motus Global that uses sensors to monitor the stress on the elbow’s ulnar collateral ligament. The company claims the product is being used by 27 major-league teams and that it is the first tool “aimed specifically at combating UCL tears.”
These are all incremental steps forward, inching toward the goal. But there’s unlikely to ever be a tidy, singular solution.
“That’s the confusing part about all of this,” Passan says.
“There are outliers. There’s no magic bullet. It’s what makes this subject so exciting and so frustrating at the same time.”