matt-harvey-rehab-lead

Overuse and fatigue, culprits on TJ surgeries

“Overuse,” especially in childhood, and fatigue are the main factors in the rise of Tommy John surgeries in baseball the last few years, Dr. James Andrews told Vox reporter Joseph Strombgerg (Vox, June 13).

“If they’re playing with fatigue — either from too many pitches in a game, or too many innings in a season, or from pitching year-round competitive baseball — you have 600 percent increased chance that you’ll injure your shoulder or elbow,” he said.

Matt Harvey, Bobby Parnell and Jeremy Hefner all underwent Tommy John surgery during the last year.

In 2014, to date, 15 pitchers underwent the procedure, which follows 19 in 2013 and 36 in 2012.


In regards to how teams handle news about injuries, Andrews said most teams prefer to be quiet.

“Teams, in general, will put out as little information about an injury as they can get away with,” he explained. “They may call something a knee sprain, when it’s a complex injury of the knee ligaments. And a lot of times, the press wants a diagnosis immediately, and you just don’t know.”




35 comments
metjetnet
metjetnet

Great discussion.

From all that I'm reading, there seems to be a number of factors that I see intertwined to create today's high-profile TJ epidemic. The overall heading seems to be "Pressure." From:

1) The radar gun. You now pitch to the gun. Voices rhapsodize on 95-100 mph pitches, and mourn someone's "topping out" at 90-94. GOD FORBID, you even ATTEMPT to get guys out at 89 mph or lower. Leading to…

2) Constant max effort. Pitchers are best served when varying their approaches and mixing up their speeds & locations. Baseball's a game of deception. But due to #1) above, staying at 75%, using few pitches, then "dialing it up a notch" when needed, or going to that "other gear" of lore has been replaced by being "consistently in the mid to high 90s" as a metric of value & superiority.

3) One size fits all scouting/drafting. They've decided the perfect pitcher's frame. Scan the recent draft list & see all the strapping 6'2" to 6'5", 215 lb. to 230 lb. RHPs. This tells you they're trolling for big, strong frames for timely "power pitcher" delivery to MLB in 2-4 years time, during which their deliveries will be refined, smoothed & systematized for optimal speed & repetition. Disappearing from the game are the small guy, the light guy, the quirky delivery, the oddball pitch -- no matter HOW effective he/it may have been on the playing levels they were scouted on. We no longer scout pitchers; we breed them.

3) 24/7/385. All of the HOFers noted on this thread grew up in an era of seasons (baseball/swimming in the summer, football in the autumn, basketball/skiing in the winter, baseball/tennis in the spring). Each sport works different muscle groups, so over the course of the year, your entire body gets worked well, creating overlapping physical benefits for the next sport. This also allowed your HOFer to throw 200-300 innings each summer, then rest all winter, ready to repeat the process each year. Yesterday's 3-sport star now focuses intently on one sport, committing to it only "to give himself the chance to Make It." The body never recovers. It soon becomes a field that's been overly farmed for one crop for too long a period & is now barren.

4) 24/7/385 (Media division). HOFers had a local paper that covered baseball until the end of the WS in early Oct., then each other sport for its season, then no more until the next. Today's youth are inundated with every sport & every nuance, nook & cranny of every sport, 24/7/265, from major news outlets, web sport sites, team sites, twitter accounts, in a non-stop lava flow of fiery writing & fan angst. There's no break, no off-season and no rest for any player anymore -- due in large part to the immoral amount of money sloshing around all Sport today.

5) Rotten parenting. Any parent who pushes their kid into a sport to "make it," before that child has matured adequately is, simply put, a bad parent. Any parent who doesn't harness their child when their child's zeal can prove harmful to their health, short or long term, is, simply put, a bad parent. In Little League many decades ago, my dad coached our team of 11 & 12 yr. olds. We were mostly goof-offs. But our star pitcher was just that.  This 12-yr.-old had a ton of talent -- the most dominant of our small town league. Nice kid, too, but nervous. Found out why very soon. His leather-lunged dad sat in the stands, haranguing him on every pitch. I stood at 1B, watching this kid shake visibly on the mound from the pressure. Got so bad, my dad banned his dad from our games -- told him that his boy would never play again if he ever showed up again. Not surprisingly, the kid was fine from then on... My dad may not have been much but he was a giant that day.

dabo
dabo

Did Dice K, Moyer, Maddux or Glavine ever have TJ surgery?

Shawn Sparks
Shawn Sparks

All you guys rattling off the names of HoFers who threw a ton of pitches are missing the point. They made the majority of all those pitches as adult professionals.  Not a single one of them threw in a fall travel league game as a 12-year-old after already having pitched in summer little league and a middle school season before that.

It basically comes down to a given pitcher being allowed "x" number of pitches over a course of a career before a damage threshold is reached.  They can either use the bulk of them over a pro career, or they can blow through most of them before their 20th birthday. Also, the earlier they throw more of those pitches, that number "x" comes down because they're stressing immature anatomy as opposed to mature anatomy, and there's no way to teach a pre-adolescent consistent & solid mechanics because their neuromuscular system simply isn't up to the task. Nobody's dumb enough to put a 7-to-11-year-old on a serious weightlifting program, but throwing a baseball as hard as possible off of a mound for 10 months straight?  Sure, why not? 

And yes, there's plenty of research to support that, but the people running these youth leagues don't want to hear it.  I was part of a free, well-publicized seminar a couple of springs ago to share and discuss some of this information with youth leagues in the area, and literally no one showed up: not a single league official, not a single coach, not a single parent of a child playing ball.

Just curious...whatever happened to the windup?  Gone are the days of Koos, Matlack, Seaver? 

Walter Johnson? Nolan Ryan? Tom Seaver?

Doubleday
Doubleday

If it's just overuse and fatigue, Satchell Paige would have needed six Tommy John surgeries.  I think it's the weight room.  Pitchers used to be lean, not muscle bound.  Look at Bartolo - not lean, but no muscle.  In the immortal words of Greg Maddux, "You can't tear fat."

David Graf
David Graf

I think it's due to the fact that pitcher's don't use a wind up anymore.

Chris Kujawa
Chris Kujawa

That nurse does not look like she expected to have her picture taken.

MetsFan1962
MetsFan1962

It appears that somebody needs to take a better look at a pitchers conditioning and how the ball is thrown. The various pitches like curve, slider, breaking pitch . . etc, all require certain arm actions that may be harmful to some and not harmful to others. 

Ben Fortney
Ben Fortney

Does anyone have data on arm injuries in Japan? Those guys are physically smaller, but throw an insane amount of pitches from high school until they retire.

grillruben
grillruben

I feel like the biggest factor no one really mentions is the fact that these guys due to new innovations in exercise science are just too muscular and big for their own good.

Macacawitz
Macacawitz

I absolutely believe that it's a combination of deluded parents and the unscrupulous, for profit "dream peddlers", that are largely responsible for the epidemic numbers of arm injuries.  In the past a kid would be well into high school before he/she focused on a particular sport; now you have crazed parents who are grooming their "elite" level 8 year old's for careers in the majors.  Having little Johnny or Janie play one sport twelve months out of the year is a recipe for disaster, sadly it's become all too common. 

Peter Weintraub
Peter Weintraub

Listen - the rise in Tommy John surgeries isn't due to overuse or misuse from childhood. Back in the day prior to this surgery or the notion of a restrictive pitch count even existing, pitchers would throw out their arms in high school or prior, weeding out those with poor throwing mechanics that leaves them more susceptible to injury. If we weren't so restrictive with kids early on and focused on emphasizing proper throwing mechanics, these elbow injuries wouldn't be so prevalent at the professional level.

metsfanman
metsfanman

Hope Torres isn't next because he's sure being overused.

Sean Grogan
Sean Grogan

How come no one talks about how hard these guys are throwing? I read a great article on how pitchers don't know how to "pitch" anymore, but rather we have a generation of Hard Throwers. The crop of pitchers today just lean back and fire at 100% for most of their games. I think that consistent High Velocity (ie. averaging more than 50% fastballs that are over 94 mph) has a much larger effect on the TJ Epidemic than does the overall pitches or innings pitched. Bartolo Colon and Tim Hudson are guys that are great examples of the dying breed of "Natural Pitchers" ie. guys that are smart enough to know that most games they can cruise at 75-85% on their pitches because you don't NEED to ramp it up constantly if you're getting swings and misses with an 89mph fastball...I think if pitching coaches today taught Pitchers more situational physicalities (ie. when to throw your hardest, when to tone it down, when to just let it fly, etc) you would see a great reduction in injuries because it doesn't matter if you're a starter or a reliever this epidemic has impacted all pitchers across the league. I'm not saying these guys are any smarter or dumber than previous pitchers, but just as it has gone with ALL sports, due to increases in nutrition, training, technology etc. you are seeing larger, bulkier pitchers than you did 25-30 years ago (Just look at the pictures of guys like Doc!) and that added weight on these frames who are literally flinging their body at the plate definitely has a much larger impact on the muscles, ligaments and joints then we care to believe. If these guys are going to get bigger and bigger, then someone has to tell them that they don't always have to throw harder and harder!

wingo43
wingo43

@dabo How about Bob Gibson, Tom Seaver, Steve Carlton, Don Sutton, Ferguson Jenkins, Nolan Ryan, Juan Marichal and Gaylord Perry?

Shawn Sparks
Shawn Sparks

@dabo Not that 4 examples prove a point among hundreds, but Moyer and Glavine were multi-sport athletes in high school, so we know each of their developmental years included a few months of not pitching. All of the guys you listed utilized multiple off-speed pitches and relied on savvy more than speed (Dice-K still being in the present tense, of course).  Can't find any info confirming whether or not Maddux played multiple sports, but he's also coincidentally the softest thrower of the bunch.

wingo43
wingo43

@Shawn Sparks Yeah, but those guys were still throwing close to or over 300 innings/year.  At least well over 200.  Remember when Marichal and Spahn started and completed a 16 inning 2-1 game?  LOL.  No relievers pitched.  


That said, I think what you said is a big part of it.  Though many old school players will say that the key to staying healthy is to throw more often, as opposed to, for instance, lifting weights (which I think is the biggest cause).

Shawn Sparks
Shawn Sparks

@Ben Fortney "From high school" is an important phrase there.  Here in America, you have kids--and it's usually the true talents with a shot at making it to pro ball--throwing a high volume of pitches over the course of a year at much younger ages than that.

Shawn Sparks
Shawn Sparks

@Macacawitz Bingo.  It's not just baseball, either.  Baseball's getting all the attention because there's not much leeway between "injury" and "surgery" in an elbow.  For every Tommy John surgery, there's also a young basketball player or soccer player sitting out 6 weeks while a stress fracture or foot issue more traditionally associated with middle-aged weekend warriors heals up.

Shawn Sparks
Shawn Sparks

@Peter Weintraub You're probably on to something.  Thing is, it's those kids with the better mechanics and livelier arms end up carrying the load when coaches & parents start treating every game like it's life or death during tee-ball.  That kid who's not so great won't ever see the mound in the first place.

Better mechanics is no doubt better at putting off injury than bad mechanics.  The only problem I have with what you're saying is that there's a minimum age at which you really teach good, repeatable mechanics.  Practice can only take you so far when you're dealing with the nervous & muscular system of pre-teen.  There's a reason there are no 4th graders in the Olympics.  Kids are kids, they're not just smaller adults.

nncyel
nncyel

@Peter Weintraub Interesting hypothesis, but just that, a hypothesis. Do you have any evidence? 


Explain how Matt Harvey's throwing mechanics are improper. Or any of a number of pitchers who've gone under the knife. Perhaps Straasburg's mechanics were off, but Harvey is like a Tom Seaver clone - great mechanics - but he still blew out his elbow. 

Shawn Sparks
Shawn Sparks

@Sean Grogan People are talking about it. Throwing at a maximum velocity is a stated risk factor along with year-round baseball and too many pitches thrown as a youth.


One of the more fascinating ideas tossed out for consideration on MLB Network's recent Tommy John roundtable was the notion of removing the mound from the early levels of youth baseball.  Taking away pushing off the rubber and throwing down hill would a) reduce the amount of stress on the immature elbows and b) emphasize correct throwing mechanics prior to pitchers arms being exposed to that level of stress.  You could have them start throwing off of a low mound as pre-teens then steadily increase the height until they're throwing from a regulation mound in high school.

Lee Lewin
Lee Lewin

@Sean Grogan I see what you are saying, but this is so far from the truth though. Here is a list of All-time tommy john surgeries for MLB players. Please provide me with a list out of this of players who just rear back and throw the ball as hard as they can. You will find it in the minority. 


http://mlbreports.com/tj-surgery/

metsfanman
metsfanman

@Sean Grogan I think you may be on to something. After all, TJ surgeries have increased despite efforts to limit innings for pitchers, with pitcher's whose innings were limited including Strasburg and Harvey still needing Tommy John (and also being very hard throwers). 

Shawn Sparks
Shawn Sparks

@Lee Lewin @Sean Grogan First off, the "pure hard throwers" are a minority of pitchers, period, so of course they'll be in the minority of any list.

Secondly, that list is of everyone who ever needed the surgery at any point in their careers, including for example a 4-pitch thrower like Smoltz who pitched for 12 years before his number came up.  Arrange that list according to how long each guy pitched in the majors before going under the knife and see what happens.