Baseball Pitchers and Arm Injuries

18-33 Baseball Pitchers and Arm Injuries

Nancy Benson: We're fast approaching the first milestone of the Major League Baseball season--Memorial Day, when we can start to get a good feel for the teams likely to compete until the Playoffs. Fans are tallying the statistics that are so much a part of the game-- wins, losses, on-base percentages... and unfortunately, season-ending injuries. One or two stars lost for the year can be the difference between a World Series championship and not even making the Playoffs. And no players are more likely to be hurt than pitchers.

Passan: There are upwards of 30% of major leaguers now who have Tommy John scars on their elbow and honestly, I think that’s going to pale compared to future years.

Benson: That's Jeff Passan, baseball columnist for Yahoo! Sports and author of the new book, The Arm: Inside the Billion Dollar Mystery of the Most Valuable Commodity in Sports.

Passan: Major League Baseball this year is going to spend upwards of $1.7 billion on pitchers just in the major leagues. That doesn’t count the ones that it signs in the draft or sign internationally via free agency and that number really was the impetus behind this book. I asked myself a question, at the time it was $1.5 billion, and it was how could baseball spend $1.5 billion on something it doesn’t understand?

Benson: Baseball may not understand the alchemy that makes a front-line, injury-resistant pitcher, but Passan says it's not for lack of trying.

Passan: They’ve tried all sorts of different things. They’ve tried throwing more, they’ve tried throwing less, they’ve tried piggy-backing players, which means pitching them only a couple innings at a time to start the game and then bringing in a second starter. They’ve tried limiting the number of pitches that are thrown, not just in a game but in an entire season and it is a culture of fear these days in baseball because the money is large enough that if a player gets injured it feels like you are positively wasting not just the salary that he’s being paid but any opportunity cost and any opportunity of getting surplus value out of it.

Benson: Some teams are investing big money in trying to find the secret. But even gurus who know everything about the mechanics of pitching can't guarantee that the team's star closer won't blow out an elbow ligament.

Passan: If there is somebody out there like that, baseball teams will pay a lot of money for him or her to do that. You think about it, injury prevention is the holy grail. If we are able to teach somebody from being injured, that team will win at least one World Series because the margin of error is so much greater then. They can go out and draft pitchers who have higher upside and keep them healthy theoretically. And if you know you’re not going to miss with pitchers, maybe you take greater risk with hitters going for higher upside guys there too.

Benson: "Tommy John surgery," named after the first major league pitcher to undergo the procedure in 1974, is officially known as ulnar collateral ligament reconstruction. It requires surgeons to transplant a tendon from a player's wrist or leg into his elbow, to replace the torn ligament. According to Major League Baseball, 15 to 30 pitchers per year have undergone the procedure over the past few years. In 12 months, the player may be back on the mound. In 18 months, they may be back to full strength.

Passan: Those 18 months, though, are filled with the most grueling mental and physical rehabilitation an athlete can imagine and the mental part of course is tougher than the physical part because you’ve been playing baseball your whole life, it is what you love to do and your livelihood is taken away from you with the truth that you may never get back. 80% of people return to their previous level of competition but the number isn’t nearly that who return to their previous level of achievement and those that think that Tommy John surgery is just a sew and go procedure, it couldn’t be further from the truth.

Benson: Even so, one major league manager told Passan that tommy john surgery was like a root canal--no big deal. Maybe we can expect big league players to go through it as part of the job, but what about kids? Passan says pitchers on the local high school team are at risk, too.

Passan: When you hear that between 2007 and 2011, 56.8% of Tommy John surgeries were on 15-19 year olds, you tend to get a little bit alarmed. The population that’s coming into professional baseball right now, having gone through the year-round baseball that’s emphasized, which leads to five times likelier an arm injury than those who don’t play year-round. And the fact that they’re participating in showcase events, which emphasize higher velocities, they either have scars on their elbow or their arms are ticking time bombs. So the idea of a healthy 18 or 19 year old is almost an anachronism at this point.

Benson: Still, major league teams aren't scared away from those kids. Passan says over the last few years, perhaps a half dozen kids have been drafted in the first round and signed million dollar contracts despite having had Tommy John surgery or needing it.

Passan: They’re not scared off by it and I don’t quite get that. The lifespan of a new ulnar collateral ligament tends to be anywhere between seven and 10 years. So the idea that this kid is going to spend at least a couple of years in the minor leagues before he comes up, the chances are good that he’s going to get hurt when he’s in the big leagues and going to need a second Tommy John surgery which doesn’t have anywhere near the successful return rate as the 80% of the first time.

Benson: But most frighteningly, these days, it doesn't even start with teenagers. Talented kids who are even younger often play on several teams, and may pitch far more than their arms can stand.

Passan: There was a study that came out recently from Japan on 62 9-12 year olds are 42% of them had damage seen by an MRI to their ulnar collateral ligament and I believe it’s 63% of the pitchers have damage to their UCL. These are little kids, these are third and fourth and fifth and sixth graders and if they are starting that young there, then they’re certainly starting that young here as well. And, you know, I’m coaching eight and nine and 10 year olds this summer on my son’s team and I’m in charge of pitching, first year they’re going to be pitching this year and it scares me to death.

Benson: Passan says pitch limits for growing kids make sense. The young kids he coaches will never throw more than 30 pitches at a time and the count will go up as they get older. But surprisingly, Passan says low pitch limits on major leaguers don't make much sense. He says the arms of professionals ought to be able to take it. Often, managers are too cautious.

Passan: If a pitcher goes over 100 pitches in any outing, it’s like there should be Congressional intervention and some of these arms are well capable of handling 120+ pitches in a game. I just think that we are so stuck inside of this culture of fear with baseball that it’s tough to embrace a culture of knowledge that allows us to better understand what’s going on.

Benson: The solution, Passan says, isn't in the major leagues. It's in youth leagues where kids are pushed far too hard, too soon.

You can find out more about Jeff Passan's book, The Arm, through links on our website, radiohealthjournal.net. Our production director is Sean Waldron. I'm Nancy Benson.