USA TODAY US Edition

Spring sees Tommy John spike

Pitcher’s el­bows at higher risk of in­jury in camp

- Mike Vorkunov @Mike_Vorkunov Spe­cial for USA TO­DAY Sports Sports · MLB Baseball · Baseball · Tommy John · Florida · Arizona · Boston Red Sox · Boston · Pawtucket Red Sox · Cy Young · Cleveland · Cleveland Indians

Along the Florida coasts and in the heart of Ari­zona, Ma­jor League Base­ball teams are pre­par­ing to start spring train­ing. Camps soon will be pop­u­lated by hun­dreds of play­ers ready to start prepa­ra­tion for the 2017 sea­son. And when pitch­ers and catch­ers of­fi­cially re­port, they will be­gin the weeks-long shut­tle to ready their arms for open­ing day.

It is a rite of spring, and for those in­volved in keep­ing those pitch­ers healthy, the first few days of spring train­ing are a cause of se­ri­ous worry.

“The first week of camp, for us in­ter­nally in base­ball, is al­ways the worst week of the year,” says Mike Reinold, a for­mer head trainer for the Bos­ton Red Sox.

As base­ball puts in­creas­ingly more scru­tiny into how to pro­tect arms and lower Tommy John rates, it has con­sid­ered pitch counts, in­nings thrown and many other fac­tors, but anec­do­tal and em­pir­i­cal data show that spring train­ing is a prob­lem of its own. To keep pitch­ers off the dis­abled list and op­er­at­ing ta­ble, teams first must nav­i­gate the land­mines of Feb­ru­ary and March.

Over the last five years, 27% of Tommy John surg­eries have oc­curred in March and April, ac­cord­ing to Jon Roegele’s Tommy John data­base. It is a stag­ger­ing num­ber when put in con­text with the rest of the year. Last year, 26 of 81 to­tal surg­eries were un­der­gone in those two months and just 32 over the last six months of the year. In 2015, there were 38 in Feb­ru­ary and March and 43 from July 1 on. In 2014, there were seven more Tommy John surg­eries in the spring than there were from July through De­cem­ber.

It puts an uneasy tint to the next few weeks. It is good to see base­ball again, but there is a fore­bod­ing sense that more pain and surg­eries are on their way.

Some of the surg­eries, ex­perts say, are un­avoid­able. They are the result of an off­sea­son of hop­ing by teams and play­ers. Pitch­ers who felt pain and dis­com­fort in their throw­ing el­bows at the end of the 2016 sea­son will go un­der the knife be­cause an off­sea­son of rest and re­hab did not do them enough good.

But there are plenty of new in­juries, too, and they come from the stress of spring.

“It’s a com­bi­na­tion of the busi­ness, the phys­i­ol­ogy, the biome­chan­ics and just the sit­u­a­tion of who’s mak­ing the de­ci­sions,” said Eric Cressey, a trainer who works with pitch­ers, in­clud­ing for­mer Cy Young Award win­ner Corey Klu­ber, in the off­sea­son. “That’s the chal­leng­ing thing about base­ball is there isn’t that one easy thing we can do to mod­ify stuff.”

Still, the pre­scrip­tion to curb the in­jury rate seems to cen­ter around two changes — one that could break through base­ball dogma and the other a change in phi­los­o­phy.

Alan Jaeger, a long toss guru, sees the way ma­jor league teams ap­proach their bullpen sched­ule as a se­ri­ous is­sue. The norm, he says, is for pitcher to throw a bull- pen ses­sion ev­ery other day, try­ing to build up his arm and en­durance quickly enough to pitch in ex­hi­bi­tion games by early March and then to be around the 90-pitch thresh­old in April. He thinks it makes lit­tle sense.

“That could be the sin­gle big­gest prob­lem with an arm break­ing down — the first 10 days,” Jaeger said. “That’s how im­por- tant it is.”

Tak­ing just one day off be­comes a bru­tal stress on the arm, he says, es­pe­cially when pitch­ers are ex­ert­ing them­selves to try to im­press and make the team. Cressey and Reinold agree that hav­ing one day off be­tween throw­ing ses­sions, whether it’s a bullpen ses­sion or live bat­ting prac­tice, is not in a pitcher’s best in­ter­est.

And, Reinold notes, with pitch­ers throw­ing harder all the time, it puts more force on el­bow. Pitch­ers who reg­u­larly throw in the mid-to-high 90s are at greater risk.

“You’ve got to ques­tion why tra­di­tion is tak­ing prece­dent over a mod­ern-day ap­proach to pitch­ing,” Reinold said. “I don’t want to come across as be­ing a con­ser­va­tive viewpoint. Times have changed, and we’re throw­ing harder.”

With­out an ex­tra day, at least, for the arm to re­cover, Jaeger says, the arm does not get to re­con­di­tion and build strength. Which leaves it ham­pered.

“The first 10 days are not mod­ern,” Cressey said. “It’s just dif­fer­ent. There’s too many guys try­ing to make the club. There’s too many guys throw­ing re­ally, re­ally hard nowa­days that it’s prob­lem­atic and prob­a­bly un­nec­es­sary. But it’s some­thing that I feel like is just hap­pen­ing be­cause of tra­di­tion.”

Mov­ing away from such a com­pact sched­ule, Jaeger says, would be ben­e­fi­cial for pitch­ers. It also would break from tra­di­tion, though he has no­ticed that some teams have al­ready made a change. Just as vi­tal would be putting pitch­ers on an in­di­vid­u­al­ized reg­i­men in­stead of a cook­iecut­ter ap­proach.

With in­creas­ing knowl­edge that ev­ery pitcher and ev­ery arm is dif­fer­ent, treat­ing ev­ery­one the same way no longer makes sense.

“What it all comes down to: Are you go­ing to adapt to what the play­ers are do­ing to be what they are,” Jaeger said. “Or are you go­ing to op­pose it?”

Ev­ery pitcher has a dif­fer­ent off­sea­son train­ing pro­gram, and teams, they say, should re­spond to what that pitcher needs and what has worked for them in the past.

For in­stance, Cressey says he pushed Klu­ber’s work­load back this off­sea­son be­cause of the long and ar­du­ous sea­son he had with Cleve­land as the Indians made a World Se­ries run. Teams should be just as re­spon­dent in spring.

“I don’t think the so­lu­tion is to make spring train­ing longer — the sea­son is al­ready long enough,” Cressey said. “I think it’s more just a mat­ter of in that early stage of spring train­ing maybe just ta­per­ing back a lit­tle bit on how much bullpen stuff is ac­tu­ally tak­ing place. Maybe not bring­ing guys along so quickly. ... I don’t think we need to cod­dle base­ball guys — I think we’ve done enough of that — but I do think there’s a place for mix­ing stress so it’s not al­ways off the mound.”

“You’ve got to ques­tion why tra­di­tion is tak­ing prece­dent over a mod­ern-day ap­proach to pitch­ing.” Mike Reinold, for­mer Red Sox trainer, on pitch­ers’ spring train­ing throw­ing sched­ules not be­ing ad­justed to guard against in­jury.

 ?? TONY GU­TIER­REZ, AP ?? The Red Sox’s Carson Smith de­vel­oped el­bow dis­com­fort early in the 2016 sea­son and had Tommy John surgery in May.
TONY GU­TIER­REZ, AP The Red Sox’s Carson Smith de­vel­oped el­bow dis­com­fort early in the 2016 sea­son and had Tommy John surgery in May.

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