The Doctors Speak on Elbow Injuries
The big news of the last day, at least as far as I’m concerned, is the release of a position statement by the American Sports Medicine Institute regarding the rash of elbow ligament tears requiring Tommy John transplant surgery among professional pitchers.
Most of the attention from the media has been on the Statement’s last comment that pitchers who throw harder are at higher risk of injury. However, the main take-away I took from the Statement is not exactly fresh news: the increase of elbow injuries is probably related to the fact that top young pitchers, those who eventually become professionals, throw and pitch a lot more now as adolescents than they did in days past. Thanks to traveling teams and year-round baseball in weather-friendly states like Florida, Texas and California, youngsters are more over-worked and more under-rested than ever before.
Also, the point the ASMI seems to be making is that what puts pressure on a pitcher’s elbow isn’t necessarily throwing the ball hard, but rather throwing the ball as hard as a pitcher can too often. Traditionally, the hardest throwers tended to have the longest and healthiest careers because they did not need to throw the ball as hard as they could on every fastball (and they also tended to throw a higher percentage of fastballs). Instead, pitchers with mediocre/slow fastballs tended to get hurt more because they had to throw as hard as they could on every fastball to get major league hitters out consistently.
One thing I though was strange about the Statement is that it addresses the relationship between throwing curveballs to elbow injuries (the Statement says there is not a relationship between throwing curveballs and a higher rate of elbow injuries) but does not address the relationship between throwing sliders and elbow injuries. My understanding is that curveballs increase the risk of shoulder injuries, while sliders put more strain on the elbow. I remember Giants announcer and former MLB pitcher Mike Krukow once joking on air how when young pitchers begin their professional careers their first pitching coaches ask them whether they want their shoulders to hurt or their elbows to hurt. If the pitcher says his shoulder, the young professional is taught or advised to work on his curveball, if the elbow then the slider.
It seems to me also that if the heavy use of sliders in today’s pitching is related to elbow injuries that this would explain why hard throwers have a greater risk of elbow injury. Hard throwers obviously have stronger arms than soft throwers, which means that more torque is generated when they throw pitches which torque the elbow. For some time now, fastballs and change-ups have been regarded as the least stressful pitches for pitchers to throw, because they don’t involve torque applied to the shoulder or elbow.
When I first became a major league baseball fan in the late 1970’s, the pitcher injury epidemic of the moment was rotator cuff (shoulder) injuries. You rarely hear about rotator cuff injuries today. Part of that is that surgical procedures have allowed pitchers (at least the ones under age 35) to come back from rotator cuff injuries. However, they just don’t appear to occur with the same frequency either as they once did or in comparison to elbow ligament injuries.
Is this change related to greater use of the slider relative to the curveball, or is it more a product of increased pitching by adolescent pitchers? I don’t know, and I’m a little disappointed that the ASMI’s Statement doesn’t give us a better idea.