Releasing Tommy John’s Grip on Pitchers

It’s about that time, isn’t it? The short period of time where we notice the rash of elbow and shoulder injuries to pitchers and look for answers in the usual places, like Tom Verducci’s columns (never mind that the Verducci Effect has been thoroughly debunked) where the “experts” are interviewed and say some variation on the following:

  • Travel ball is evil
  • Showcase ball will cause you to kill your arm, damn those people at Perfect Game
  • Latin players grow into their velocity
  • Americans put too much focus on velocity
  • etc

Let’s not forget: If a pitcher is going to be injured, it is most likely at the beginning of the year. The reasons for this aren’t necessarily clear, but as Dirk Hayhurst pointed out in his latest book, when he hurt his shoulder in the gym, he was tempted to nurse it to the beginning of Spring Training and hope to blow it out on the mound there so medical insurance would be picked up by the team. It is not inconceivable that this is a significant contributor. Additionally, players are often allowed to do whatever they want in the offseason by their teams, and are not given specific workouts to train their arm. I’ll always remember Matt Diaz doing P90x in the 2008-2009 offseason, which is probably one of the worst possible “training” (I use the term loosely) methods you can employ for a baseball player. A lack of a sound throwing program with specific prehab exercises probably contributes to both the velocity drop at the beginning of the year (in addition to weather of course) as well as increased risk of injury in the early months of the year.

So, with all that out of the way, let’s cover some major talking points.

Youth Pitchers are Overused

Tim Lincecum - Young Age

This is a trope that generally covers the “showcase baseball is more risky than Little League” as well as the “pitch counts / adequate rest is important” line of argumentation. Most of these arguments lately are based off of a longitudinal 2011 study done by the University of North Carolina (pdf, web) which indirectly surveyed youth, high school, and college pitchers across the country from 2006-2010 (HS players 2007-2010, college players 2008-2010).

ASMI also released a ten-year longitudinal study (pdf) in 2006 that concluded that pitching more than 100 innings in a calendar year increased the risk of serious injury to the pitching arm. However, like most longitudinal studies, sample size and retention rate dropped off very quickly:

ASMI Sample Size

The University of North Carolina study was cited by many publications, including USA Today, which concluded:

The study found the primary cause of such injuries is overuse.

Researchers went on to say that curve balls were not more likely to hurt a pitcher’s elbow than any other type of pitch based on the data from this study. Fortunately, they published their summarized data for review:

Pitch Data

Er… overuse is the primary injury factor here? Like Russell Carleton concluded based on statistical analysis of MLB pitchers, it’s actually prior injury that best predicts future injury. And furthermore, the second-highest risk ratio was throwing sliders, according to the data! Higher innings pitched and showcase pitching both fall below use of the slider AND the curveball (thrown at a later age).

Now, pitch counts seem to be effective at reducing injuries to youth athletes, and that’s certainly a cause I can get behind. It is my opinion that pitch counts need to be instituted at the youth level to avoid abuse by parents, even if these pitch counts are overly conservative.

So, is overuse a real problem? I have no doubt that some coaches and parents out there abuse their kids by leaving them in games too often. However, the 30th pitch of the inning and the 30th pitch of the game in the third inning aren’t the same stress-wise, and this is a factor that should hopefully be understood by coaches and parents alike. But outright blaming showcases and select teams for the rise in pitching injuries is irresponsible, considering none of these studies controlled for the ability of the pitchers in question – of course the pitchers who throw hard and are more effective tend to do more showcases, and this effect can be very large.

Which brings us to our next point…

Kids Throw too Hard

Lance McCullers

In Tom Verducci’s latest article in Sports Illustrated, he talks at length about how youth pitchers are overused and how velocity is at a premium, which leads to more injuries to the pitching arm. He quoted an anonymous international scouting director, who said:

Latin American pitchers are allowed to grow into their velocity. It’s a common story to sign a guy throwing 84, 85 [mph] who eventually winds up throwing in the 90s. Michael Pineda is one. You’re looking for someone with a good, athletic body who can throw the ball around the plate and has a feel for spinning the ball. The velocity comes in time, with training and better nutrition and physical growth. Here? The statistics don’t lie. We need to look elsewhere around the world to learn a better way. It’s time.

Really? The same Michael Pineda who missed three months in the minors during the 2009 season with a non-specific elbow injury and later had invasive labrum reconstruction surgery, requiring him to miss all of 2012 and most of 2013? The same Michael Pineda who averaged just about 95 MPH with the Seattle Mariners and has now “grown into” an average velocity of 92.5 MPH with the Yankees?

Verducci continues the cherry-picking, noting:

Go back to 2002, which featured a strong first-round high school draft class that included Zack Greinke, Cole Hamels and Matt Cain. None threw harder than 94 mph as seniors. All of them have thrown more than 1,500 innings in the big leagues.

Greinke never threw harder than 94 MPH as a senior? Perfect Game shows he threw 94 MPH during the winter after his junior year of high school, and John Sickels noted something entirely different in his ESPN column during the 2003 summer season:

Greinke is an excellent overall athlete, who was mostly a position player before his senior year in high school. He moved to the mound full-time a few months before the ’02 draft, and showed stunningly quick development. Greinke’s fastball has been clocked as high as 96 mph, though it’s more usually in the 90-93 mph range. He hits spots with it, and isn’t afraid to throw inside. His curveball and changeup are already above-average pitches.

Hamels broke his humerus bone his junior year of high school, which limited his velocity and dropped his draft stock to the middle of the first round. So even if he was topping out at 94 MPH, there would have been extenuating circumstances on why he didn’t throw harder considering he missed an entire year of development. But Verducci was verifiably wrong once again according to mlb.com:

Hamels returned to go 10-0 with an 0.39 ERA his senior season, impressing the Phillies with his 94-96 mph fastball and plus curve and change.

By the way, all the experts that say playing multiple sports is good for an athlete may enjoy this bit of anecdotal fun:

Apparently the 18-year-old would run through a truck to play for the Phillies — a parked car to be exact. Hamels smacked into the back of one playing street football with friends. He injured his arm then but did nothing about it. Three weeks later, he broke the humerus bone in his throwing arm while pitching in a game.

(I happen to think playing multiple sports is a good thing, too – but for psychological reasons and not “scientific” ones that are trotted out there all the time.)

Matt Cain did not, in fact, throw over 94 MPH as a high school senior – reportedly topping out at 92 MPH. However, once he was allowed to “grow into” his velocity in professional baseball, he fractured his elbow while pitching in 2003, just one year after the draft.

Jonah Keri’s post on the topic at Grantland started off a bit more realistic, quoting some solid research presented by Dr. James Andrews:

“The big risk factor is year-round baseball,” Andrews said. “These kids are not just throwing year-round, they’re competing year-round, and they don’t have any time for recovery. And of course the showcases where they’re pitching for scouts, they try to overpitch, and they get hurt.”

I can’t disagree with that – playing games and pitching competitively year-round is ridiculous and should be immediately stopped. I advise all of my warm weather clients to tell their winter ball coaches to kindly stuff it while they rest, recover, and train hard in the weight room or play a second sport.

But then Jonah quotes another anonymous AL executive who seems to be totally clueless about cause and effect:

“The rise of Perfect Game baseball and other summer travel baseball has dramatically decreased the off time for younger players. Kids are traveling all over the country from 8 years old on, and playing year-round. Colleges are recruiting younger and younger, and kids feel like if they don’t compete in every summer or fall event, they will lose their chance for exposure. That kind of exposure also leads to kids absolutely airing it out at max effort. When the section behind the plate is loaded with recruiters and scouts, kids absolutely take it up a notch and try to throw it through the backstop. The damage that is being done early can’t be undone by managing workloads once pitchers get into pro baseball.”

So… how is this Perfect Game’s fault, exactly? College and professional teams are the ones sending scouts to these events! If they were so concerned with keeping kids healthy, they would decrease the incentive to attend the events by not sending representatives of their teams. PG is only responding to market forces by providing events, and it’s a stretch to blame them specifically for decreasing the amount of time off, anyway.

PG - WWBA

Look how much we care about these kids’ arms!

Dr. Andrews goes on to say:

“It used to be that we didn’t see these injuries until they got into high-level professional baseball. But now, the majority of the injuries are either freshmen in college, or even some young kid in ninth, 10th, 11th, 12th grade in high school. These young kids are developing their bodies so quickly, and their ligament … isn’t strong enough to keep up with their body, and they’re tearing it.”

It’s true that the majority of the injuries happen early in the year as well as early in a pitcher’s developmental cycle, but to say that it’s wholly because their bodies are developing so fast ignores a whole host of other variables we’ll get to later in this article – such as massive ignorance of training principles amongst amateur baseball coaches.

Dan Jennings – GM of the Miami Marlins – said:

“Back in the day, you’d be pitching melons in a field, doing things with your hands — that’s how you built strength, from your elbows to your fingertips. Because of the new strength and conditioning programs, that’s been taken out. By the 10th grade, you’re told to focus only on football, or only on baseball; kids no longer play multiple sports. You get these specialized regimens where you build large muscle groups, but not the small muscles around the rotator and UCL. The large muscles get developed so large that when you try to decelerate, you can get badly hurt.”

Of course, Jonah interviewed a strength and conditioning expert in the field of baseball like Eric Cressey, Ron Wolforth, or if those two were busy, maybe me, right? No. Not a single interview appears in the article with an athletic trainer that is well-known for training amateur players with a good record of health like the aforementioned people I listed. I highly doubt we were all so busy we couldn’t be reached via email or phone call – I know that I didn’t get pinged before this article went up!

Our field got thrown further under the bus with no chance for rebuttal by an anonymous executive, who said:

“I think what has happened is that, due to improved training and instruction, pitchers throw harder. Joints and related connective tissue are put under greater stress from the increased velocity. Many claim that they can reduce injury with ‘their program.’ There is no evidence to support those claims. I am afraid, in fact, that many of these programs — several of which are well designed — actually increase injuries. The conundrum is that they also improve performance.”

First of all, this is a completely ridiculous statement with no evidence presented in favor of it – unfortunate, consider Jonah Keri used to write for Baseball Prospectus, a website that highly values falsifiability and thorough research.

Secondly, I have done internal studies on our training program of our amateur and professional talent, and when comparing our data with longitudinal studies and surveys done at appropriately matched levels, Driveline Baseball athletes are far less likely (2+ SD) to suffer a major arm injury (defined as missing competitive baseball for 8+ weeks; usually surgery) than your average athlete. I am sure that the athletes at Cressey Performance training under Eric Cressey and Matt Blake have similar – if not better! – records at keeping their athletes healthy, yet at least I was not contacted to give my side of the story, and I highly doubt Eric or Matt passed up on a chance to chime in with their experiences on such an important subject matter.

Four Camera System

Let me take a moment to state that at Driveline Baseball, injury prevention is the NUMBER ONE most important lens that all training is filtered through. Our private training facility has some of the most sophisticated equipment you can possibly find, and I can absolutely guarantee you that no other private pitching development facility in the world has the scientific tools we have to evaluate pitchers. We use multiple high-speed cameras in a markerless biomechanics laboratory that can calculate both kinematics and joint kinetics, a four-camera synchronized system to subjectively evaluate pitching mechanics, a database of major league pitchers with correlated planar kinematics and injury histories to compare our pitchers to, wearable athletic EMG sensors to measure muscle activity under the skin during maximum effort throwing with no degradation in performance/velocity, and force plates to measure ground reaction forces of various activities – not to mention high-end EMS recovery tools like the Marc Pro, equipment from Oates’ Specialties, and custom-manufactured and designed implements like Driveline PlyoCare Balls.

So while I can’t speak for others (though I have a good feeling that the aforementioned people care a LOT about preventing injuries), I am doing a whole hell of a lot to analyze and study the pitching delivery to help cut down on injuries to our pitchers, and I don’t really appreciate the blanket statement handed out by baseball executives hiding behind an anonymous snippet throwing the strength and conditioning community under the bus like we’re a bunch of idiots who don’t care about the future health of our clients. Furthermore, it’s quite irresponsible of Jonah Keri to not get this side of the story from noted representatives of our field, a fact I have pointed out on Twitter which garnered no response.

The real problem is probably a bit more involved, but what’s clear is that teams are not electing to draft weak arms and hope to develop them – they still go for the hardest throwers possible in the top rounds. Of course, they’re absolutely correct to do so, considering that fastball velocity is the number one best predictor of strikeout rate and success at the MLB level:

Being able to bring the heat is a very important factor in a pitcher’s success. Being able to crank it up a notch typically improves a pitcher’s run prevention abilities, and losing a notch hurts his effectiveness. Starting pitchers improve by about one run allowed per nine innings for every gain of 4 mph, and relief pitchers improve by about one run per nine innings for every gain of 2.5 mph.

ASMI’s Risk Factors for Shoulder and Elbow Injuries in Adolescent Baseball Pitchers (Olsen, Fleisig, et al AJSM 2006) was heavily cited in Verducci’s article to damn fastball velocity. The study had numerous flaws, including self-reporting of injury factors for control groups and injured groups (groups who are hurt are FAR more likely to report negative things about their coaches and previous throwing programs, and this factor was not controlled for) but was still a mostly well-designed study with very interesting data. Using a multivariate analysis of the data yielded far more interesting conclusions than the cherry-picked conclusions from the abstract:

Multivariate FB Velo

So despite the fact that Verducci (and Fleisig, to a lesser extent) blamed fastball velocity as a huge factor, it is actually in fact the least important factor in the multivariate analysis. And where did the 85+ MPH marker come from? It seems to have been subjectively chosen as a “high-velocity” marker.

Regardless of the origin of the “velocity limit,” if we simply accept the number given, throwing harder is fourteen times less relevant to predicting injury than pitching with arm fatigue on a regular basis, and half as relevant as pitching year-round (greater than 8+ months per year, a good number considering winter ball is the usual culprit here).

Uneducated, Ignorant, and Malicious Coaches are the Real Problem

HS Pitching Coach

If you play baseball, let me ask you a question: What would your pitching coach say if you asked him to cite his favorite research paper on pitching injuries?

Let me guess: Nothing. Or you’d be benched.

This is the real problem. Coaches at all levels simply don’t care about educating themselves on thrilling topics such as kinesiology, biomechanics, and research. The gold standard for coaching at higher levels of baseball is the fact that the coach played professionally or at a high college level, as if this is some good way to evaluate someone who will have a large role in keeping your arm healthy. It is, of course, the best example of falsely appealing to authority.

Let’s just pick a random well-known article on baseball pitching that is fairly important, such as Comparison of shoulder range of motion, strength, and playing time in uninjured high school baseball pitchers who reside in warm- and cold-weather climates (web). This paper by Kaplan, Elattrache, et al (AJSM 2011) talks about the soft tissue differences in pitchers who reside in warm weather climates compared to cold weather climates, concluding that athletes who competitively pitch year-round in warmer climates tend to have increased shoulder range of motion (ROM) and poorer shoulder external rotation strength. It’s fairly basic stuff to most decent trainers and coaches out there, but even a concept like this requires a coach to:

  • Read the paper
  • Understand the implications for increased total ROM of the throwing shoulder (perhaps GIRD?) and decreased ER strength (deceleration weaknesses?)
  • Figure out the best ways to counter these negative adaptations (specific stretching? passive external rotation strengthening? more time off?)
  • Deploy it effectively with his pitchers
  • Monitor the changes in soft tissues and ranges of motion
  • Evaluate his corrective exercise program and follow up with improvements

Keep in mind that this is for a SINGLE well-understood adaptation that happens with throwers of all ages and has wide-ranging implications on keeping arms healthy (let’s not even get into the elbow, hips, core, etc), and understand that the vast majority of pitching coaches (95%+?) don’t even do this. Your average pitching coach has never heard of Eric Cressey, Ron Wolforth, Lee Fiocchi, Matt Blake, Randy Sullivan, Jim Wagner, Kyle Boddy, or any other progressive baseball coach out there who cares about sports science, and expecting the average 14 year old to keep up on graduate-level kinesiology isn’t exactly fair.

Anti-Intellectualism is the Real Issue

Moneyball

Of course, this is nothing new in America – the dislike for intellectual behavior is well-established in this country and is perhaps most strongly present in the sports world. Consider how long it took Bill James and Pete Palmer to have their ideas adopted by most of professional baseball and you will come to the stark – and sad – realization that true player development (and injury prevention) is even further behind today than where James and Palmer started decades ago.

Since amateur coaches aren’t going to reverse their trend any time soon, it is unfortunately up to the athlete and parent in question to educate themselves and to fight back against disruptive and dangerous behavior by baseball coaches at large. Coaches that do not understand kinesiology and the importance of a proper training and throwing program must have kids taken out from under their wing; parents (and kids, sadly) must stand up to them and refuse to let their arms be abused, even if it means being labeled “uncoachable.”

Stop blaming velocity, pitch counts, and other weakly relevant factors. The number one issue is and will remain uneducated and willfully ignorant coaches that allow these things to continue. Focusing on the symptoms rather than the cause won’t solve anything.

How to Protect Your Curveball

I was recently in Spring Training with the MLB team I consult with, watching a few pitchers throw, when a Pitching Coordinator came over and remarked to another pitching coach that pitchers need to throw high fastballs to protect their curveball. I asked the coordinator to expand on his statement, and he explained the tunneling theory of keeping the high fastball in the same tunnel as the middle/low curveball to increase deception – that fastballs located outside of the tunnel can’t adequately “protect” the deception of a pitch with a hump in it.

As most know, I’m on board with tunneling theory, and we teach it all the time at Driveline Baseball:

Drew Rasmussen Overlay

However, I have never heard it referred to as “protecting your curveball.” I loved it! The phrase makes complete intuitive sense, and the pitchers on the MLB staff in question loved the idea and immediately grasped the concept. This is huge, because we in the nerd/sabermetric community tend to overcomplicate concepts for fear of diluting their meaning – however, simplifying the truth is possibly the most important gap to bridge when it comes to applicable use on the field.

Of course, this phenomenon had already been discussed by my former co-writer, Josh Kalk…

Ted Lilly and High Fastballs

Josh Kalk wrote about how he theorized Ted Lilly threw below-average fastballs up in the zone to protect his curveball in an outstanding Hardball Times article – Pitch sequence: High fastball, low curveball. In the article, Josh illustrated the difference between a fastball that protects a curveball:

Protected FB / CB

And a curveball that is so far outside the fastball’s tunnel that pitch recognition becomes much easier:

Average FB CB

Tons of words can be written on pitch tunneling (and will be in my upcoming book!), but this is a great graphical representation of the pitch tunneling theory as well as a bitesize phrase – “protect the curveball” – that makes a lot of sense!

Mechanical Improvements Through Training

Too often you see guys trying to “change their mechanics” through use of video and a pitching instructor who helps them along, but the reality is that unless the athlete is at such a low level of proficiency, these lessons don’t usually stick. Since an athlete tends to retain the same throwing mechanics throughout his life (which is why you need to stress arm strength, arm health, throwing – not pitching – mechanics, and limited breaking ball use at a young age), making an overnight or short-term change isn’t feasible.

Tim Lincecum - Young Age

Looks familiar, yeah?

Case in point – I was talking to one of my high school pitchers who has been training with me for 14+ months, and he’s gone from 70-71 MPH (crow-hop) to 90-93 MPH (indoor mound velocity) in that time frame. His mechanics have drastically changed over that time period, and while he was resting in-between sets of ballistic mini-medball throws, I asked him:

“How many words do you think I’ve said to you about your pitching mechanics?”

He sat there and thought for awhile, and responded:

“Probably less than thirty.”

I figured that was about right. I don’t talk to most of my clients about pitching mechanics maxims or theories unless they specifically ask, and the client in question isn’t very good at making small changes on the fly – he needs programming that overrides his internal motor patterns to reinforce better concepts. That means throwing with weighted baseballs, wrist weights, constraint drills, and slowly integrating them back to his mound pitching mechanics after we nail them down in his flat ground max intensity throws.

Often times, putting a kid on the mound is the LAST thing you want to do as a pitching coach. They start focusing in on the target whether or not you tell them you don’t care about their accuracy, they subconsciously remember 10+ years of failure and frustration when toeing that white slab, and they break down. You have to remove all those obstacles and get them in a mindset of simply throwing once again to remap their motor patterns.

Effective training programs will account for this and will design drills and throwing exercises to slowly remap a pitcher’s delivery while building power, speed-strength, and endurance.

It’s not one or the other. It’s both!

By |February 24th, 2014|Mechanics, Training|1 Comment

Should Youth Pitchers Throw Curveballs? Probably Not.

The debate on whether or not youth pitchers should throw curveballs rages on, and on, and on. Studies to seem to show that breaking balls are no less stressful on the elbow and youth pitchers who throw curveballs don’t seem to be more likely to have surgery or retire from pitching due to pain, so what’s the deal?

Despite the inconclusive kinematic/kinetic and longitudinal studies done on breaking balls, Dr. Kremchek (a well-respected sports orthopedist) strongly disagrees:

“They have an obligation to protect these 12-year-old kids and instead, they’re saying, ‘There’s no scientific evidence curveballs cause damage, so go ahead, kids, just keep throwing them,’ ” Kremchek said. “It makes me sick to my stomach to watch the Little League World Series and see 12-year-olds throwing curve after curve. Those of us who have to treat those kids a few years later, we’re pretty sure there is a cause and effect.”

Unfortunately, the answer isn’t so black-and-white. There is a real sampling issue here in that pitchers who throw breaking balls (or throw harder than average) tend to be more successful, and therefore they are used more. Youth pitchers who throw a large amount of innings in a calendar year – especially year-round baseball in the warm weather states – ARE more likely to be hurt, by a huge factor! However, we know that overuse is a real problem when a pitcher is young; that doesn’t help us answer the question on whether or not youth pitchers should throw breaking balls.

Youth Pitchers

 

So why do I think youth pitchers shouldn’t throw curveballs?

Their Neuromuscular Control is Underdeveloped

Have you ever seen a 10-year old kid run into a table at full blast for no reason, cutting his head open and requiring stitches? Or watch them trip over their own feet while walking down the street? The young body is undergoing huge physiological changes in a multitude of domains, and on top of that, the motor control center isn’t very good at coordinating all these changing areas of the body. Just when the body has a map to follow, the map detours wildly off path, forcing the brain to rewire everything once again.

Wildly changing mechanics in pitchers who already throw hard is a great way to injure the athlete if he is not enrolled in a solid arm care / arm strengthening program (such as one outlined in The Dynamic Pitcher). Recently the 11U Showtime team I train (with continually dwindling numbers) have been introduced to the standard supinated grip curveball with the “pull-down the lampshade” mechanics by their pitching coach.

Instead of analyzing the pros/cons of teaching a curveball that way (see my article for more details including high-speed video – Young Arms and Curveballs), I think that most instructors and pitching coaches have never taken video of their pitchers and done a spot check of their pitching mechanics when comparing their fastball with their breaking ball. The video below is an overlap video shot at 120 frames per second, and this was AFTER I instructed the pitcher to try to maintain similar mechanics between his fastball and curveball:

Overlay Kinematics - FB vs CB

Does that look particularly consistent to you? Didn’t think so.

My issue with teaching breaking balls to youth pitchers is simple: You expect a kid who can barely tie his shoes the same way to learn complex motor control patterns and hope to repeat it on a regular basis? This on top of the fact that developing good velocity, repeatable mechanics, and a base of arm strength are more important than breaking balls for even elite high school pitchers – much less youth pitchers!

It all stinks of trying to “win now” when development should be the primary goal.

For fun, here’s what one of my clients (Drew Rasmussen, class of 2014 – Oregon State commit) looks like when throwing his change-up against his slider (two of the most different possible pitches you can pick):

Drew Rasmussen Overlay

You can barely tell that’s an overlay video until the ball separates or you check the follow-through. Now compare that to the youth pitcher above. Easy enough?