Injuries to Pitchers

The below is a sample of some of Evan’s journalism work.

Today’s a special day because the pitching prospect that the team has been extolling for three years is finally making his major league debut. This player is going to save the team from mediocrity, maybe even send it to a World Series championship over the next decade. He can strike batters out at will with that powerful arm of his and other teams tremble in fear, wary of his potential.

He dazzles in his first start and for the rest of the year, is a beacon of hope. Fans flock to the park to see him go the distance, notching win after win. Every pitch that comes out of that arm is another step to the World Series and not one person, not even the manager, dares to consider removing him from the game. The team doesn’t make the playoffs, but everyone knows that it’s only a matter of time. The pitcher is too good to not lead them to the promised land.

Spring training rolls around the following year and as occurs every spring training, expectations run high for the team. The welcoming sun, in hibernation for months, shines on the baseball diamond, with the promise of long summer nights spent at the ballpark chowing down hot dogs and cheering on the young ace on the cusp of realization.

Then the young pitcher starts complaining of arm trouble. He’s babied in spring training and people say it’s only a precaution. The regular season comes, but he’s not himself – still good – but not the lights-out pitcher he was last year. Then he goes on the disabled list with an injury. He comes back and gets injured again as the team misses the playoffs. He’s plagued by arm injuries for the next three years and he slowly slips away from baseball, as the hopes of the team slip from playoffs to “wait ’til next year.”
Every team can think of at least one heralded prospect ended up like this. The Chicago Cubs had Kerry Wood, the Detroit Tigers had Justin Thompson, the New York Mets had Bill Pulsipher. It doesn’t stop there – the New York Yankees had Bob Tewsksbury and Al Leiter, the Seattle Mariners had Ryan Anderson and the Tampa Bay Devil Rays had Tony Saunders. The Texas Rangers currently have a minor-leaguer named John Hudgins who was abused in the College World Series in 2003. Hudgins is still feeling the effects. They had the future of their franchise in their hands and then they let the potential of the pitcher slip away, all because they rode him too hard and wore out his arm.

Glenn Fleisig, a doctor at the American Sports Medicine Institute, based in Alabama, takes it one step further. At ASMI, whose mission is to improve the awareness and treatment of sports-related injuries, Fleisig explains that injuries suffered by pitchers are due to quality of mechanics, amount of pitches thrown, types of pitches, physical conditioning and genetic make-up. He continues, saying that a pitcher cannot just deal with one of the causes of injury and ignore the others. “There are interactions between these issues,” he says.

Will Carroll, considered by many to be the injury expert in baseball and a writer on Baseball Prospectus, says that “pitching arm injuries are cumulatives. Ligaments and tendons break down and fray, labrums tear, muscles break down when not allowed to recover. It’s like driving a car too hard with bad maintenance.” Fleisig agrees, saying that most serious injuries come from the cumulatives, which, when he reviews surgical findings, always look ‘worn’. As coaches and instructors become more aware of what causes injuries, especially to young pitchers, more pitchers are finding themselves treated with kid gloves as their pitch counts have become limited.

In 1988 – which was not so long ago – 151 pitchers threw between 121-130 pitches when they started a game. Compare that to 2004, when only 11 pitchers threw from 121-130 pitches. This is a marked change, even more so when one considers that even in 1988, old-time baseball greats were complaining that pitchers weren’t throwing as much as they used to. If someone pitches 200 innings nowadays, he’s considered to have good endurance. Contrast that to the early 1900s, when pitchers routinely threw twice as many innings as that. Steve Treder’s study, featured in “The Hardball Times,” found that baseball pitchers today routinely throw 10 percent less pitches than they did in earlier decades.

This is not to say that sometimes a pitcher can go beyond his fatigue threshold. A scout for the Washington Nationals, Mike Alberts, also a hitting and pitching instructor in Worcester, Mass., mentioned that there have been times when he or other coaches have pushed a pitcher past his threshold to get a “big win.” Alberts, a former professional catcher as well, continues, remarking that he remembers “a game in college we won 14-0, and I threw a complete 134 -pitch game. I was on cruise control, so I didn’t really fatigue my body or arm. There were times when I threw 60-70 pitches in a playoff situation and my arm and body were cooked. Pitch counts depend on the situation, but as a rule they should stay within reason.”

The rule within reason has been found to be between 100-110 pitches. Baseball Prospectus, a company which does extensive statistical research on every aspect of baseball based in San Diego, conducted a study in the book titled “Mind Game” in which it looked at a chart of the number of pitches per game a pitcher threw, which focused on the 1988, 1992, 1996, 2000 and 2004 seasons. Some interesting trends are that in 1988, 60 pitchers threw more than 141 pitches, while that number is three today. Another set of pitches is dropping slowly, the 131-140 set. The watershed year was 2004 as 131-140 pitches per game decreased from 60 to 11. From 121-130 pitches, a decline from 2000 to 2004 has been noted at 56 percent. Nowadays, pitchers hover around 100 to 120 pitches. The reasoning for this marked decline has to do with simple research.

Prior to 1988, pitch counts were not kept as a statistic, so it took a while after 1988 to realize how important pitch counts were to maintaining the health of a pitcher. In 1989, Orel Hershiser, the defending Cy Young winner for the Los Angeles Dodgers, threw 170 pitches in one game. The next year, he blew his arm out. Also in 1989, 23-year old pitcher Al Leiter threw 174 pitches in a game and had arm injuries for the next three years, limiting him to only nine innings over eight games. This was two years after yet another heralded Yankees pitcher, Bob Tewsksbury, was throwing 97 mph and then blew his arm out. He topped out at 89 mph after the injury. Former director of baseball operations and interim general manager for the Cincinnati Reds’, Brad Kullman, says that there have been studies done which “found correlations between heavy workloads in years prior to turning 25 resulting in career-limiting or threatening injuries.” Leiter has since retired, bowing out after he participated in the inaugural World Baseball Classic. While he will be remembered as a solid pitcher, he could have been so much more, fans will always say.

A contributor to this data becoming available was Baseball Prospectus’ Keith Woolner, who created a statistic called Pitcher Abuse Points. Woolner found that pitchers who throw more than 100 pitches and especially 120 pitches, show a decrease in effectiveness the weeks following that effort. Pitcher Abuse Points, now charted regularly, shows which pitchers throws the most pitches in baseball past the accepted limit, which is 100.

In the last three years, Livan Hernandez of the Montreal Expos/Washington Nationals has placed in the top three for Pitcher Abuse Points. Two Cubs pitchers also have made appearances in these years – Kerry Wood and Carlos Zambrano. Wood has long been a lightning rod for those who cry against abusing pitchers, as he blew out his elbow in 1999, a year after he averaged 112 pitches a game and as many as 137 in a start. His arm injuries, contributed to by being overworked, are well documented. Zambrano, 24, has been ridden hard the last two seasons, and red flags are sprouting everywhere from his workload, as he had arm trouble in the beginning of the 2005 season. Hernandez, who just completed his age 30 season, has avoided injury in the years he has been throwing, but as Carroll explains, Hernandez is the exception, not the rule. “Pitchers that break down young don’t often make it to their age 32 or 36 seasons. Pitchers that make it to those ages are special, beyond the specialness that being a major leaguer entails.”

Carroll, Fleisig and Kullman all agree that fatigue is the more important barometer to measure, not pitch counts. Kullman says that “pitch counts are the antiquated way of attempting to measure fatigue.” Kullman goes on to explain that he means antiquated because with the current technology available, “somebody is going to come up with a much better way that will make pitch counts virtually obsolete.” Pitchers consistently suffer micro-tears within their muscles, tendons and ligaments, leading to pitchers feeling sore. This is normal, because when the body detects micro-tears, it repairs the tears, making the repaired site stronger to withstand future tears. This is the basic concept behind exercising and then resting after the exercising to allow the body to repair itself. As Fleisig goes on to explain, “pitching injuries happen over the course of time when a pitcher gets micro-tears, doesn’t have sufficient rest for the tears to completely repair and then gets more micro-tears the next time out. If a pitcher pitches past the point of fatigue or pitches with poor mechanics that apply larger loads, then he will have more tears than typical and will have his micro-tears add up to larger tears sooner.”

Every pitcher has a different limit at which point he starts experiencing fatigue. This is based on various issues, such as previous workload, build, stamina and off-field issues. The simple thing to do, according to Fleisig, is to remove the pitcher when he becomes tired. Professional baseball teams are moving towards this conclusion, as they pay close attention to visible fatigue signs to craft individualized pitch count limits. The Reds organization is attempting to change conventional thinking around baseball with regard to starting pitching and Kullman was at the forefront of it all. He oversaw a unique system in the Reds’ minor league system at the Class-A level and below. Instead of one starter going as long as he can, the Reds pull their pitchers after three to five innings and replace them with another pitcher who then goes a maximum of three to five innings. The former general manager of the Reds, Dan O’Brien, hired prior to the 2004 season, implemented this strategy. The reasoning was that if pitchers were to continually decrease in endurance to save their body from injuries, why not decrease it significantly, to three to six innings, so they can exit while their arm is fresh and bounce back quicker? “If we, as an industry, are going to continually limit starting pitcher workloads with arbitrary pitch and inning counts, why not at least get them out there one day sooner?” asks Kullman.

Critics say that this method is not utilizing the talents of a great starting pitcher correctly. However, as Kullman argues, what is the difference between a starter giving you seven to eight innings every fifth day, or five to six every fourth day? In addition, those great pitchers who can go eight innings consistently without significant harm to their career is a list so small that it can be denied in favor of the more advantageous system the Reds are slowly implementing. Kullman believes that this system should one day reach the major league level, for it will lessen the risk of the pitcher becoming fatigued, which leads to injury. University of North Florida’s Joshua Papelbon, a junior and brother to the Boston Red Sox’s young pitcher Jonathan Papelbon, says that “your arm and body can only take so much. The longer you continuously throw in a game the more and more you put yourself at risk of getting injured.”

Papelbon, 22, did not start pitching until senior year in high school, which he believes has impacted his arm. According to Bill Thurston, Amherst College’s head coach since 1966 and the winningest coach in any sport in college history, Papelbon is on the right track with his theory. “Pitchers under the age of 12 or 13 have poor mechanics as the No. 1 cause, while ages 14-18 are probably over-use, or over-load, poor mechanics, poor conditioning and preparation,” said Thurston, who is also a consultant with ASMI.

Papelbon takes care to properly warm up prior to each game and is a proponent of long-tossing, where baseball players play catch with each other, gradually increasing the distance until they are throwing hundreds of yards away. “I learned that long tossing and keeping your arm and body in shape helps you stay strong,” says Papelbon. He also believes that his pitching style, which is submarine, has helped keep his arm healthy but says his hips and lower back become sore, so he needs to keep these areas healthy as well.

Fleisig notes that there have been some specific “anatomatical realities” found about pitching mechanics that every pitcher should follow to minimize injury. The most important is abduction (the angle of the arm is lifted from the side) of the shoulder joint, which is the most effective when it is at 90 degrees. Thurston includes attempting to throw too hard too early in the season, for the arm cannot handle the sudden increase in what it is being asked to do. In addition, throwing a curveball or a slider incorrectly can impact the arm, as well as lack of game preparation.

There are also realities dealing with physics, says Fleisig, such as the “proper timing between pelvis rotation and upper trunk rotation [which] maximizes the energy passed up the body to the throwing arm. With poor trunk timing, the energy produced to rotate the trunk is not passed up to the arm and the arm must generate a greater portion of the torque.” If any of these realities are not met, it then becomes much easier for pitchers to get injured.

Colleges are becoming more attuned to these issues, as Papelbon was taught in college that legs were vital to a pitcher’s health and effectiveness. He now spends a lot of time maintaining and building his leg strength. Papelbon also believes that colleges take good care of pitchers, as they have medical trainers, planned exercises, and other precautions to ensure the player remain healthy. Colleges also take care to rest players should they become fatigued.

Common injuries among college pitchers, according to Thurston, are a lack of long-term throwing and conditioning programs, over-use (throwing too many pitches in one game), over-load (lack of recovery time), improper pitching mechanics and over-exertion. The most important element of preparation is the training done in the off-season. “You need at least a month without pitching, then be built up slowly for the season,” Thurston says.

Young pitchers need good training, for they often do not know the effective way to pitch. After Bob Tewsksbury recovered from injury, he was able to remain an effective pitcher for the Minnesota Twins, despite the drop in speed. Tewksbury started to pitch more efficiently and pitch with his smarts and not his physical ability. This is the same reason why Greg Maddux, a future Hall of Fame member on the Atlanta Braves and Chicago Cubs, has been able to remain so effective for so long.

Roland Carlstedt, the chairman of the American Board of Sport Psychology, says that if “clear reductions in performance can be established based on late inning fast-ball speed reductions and a pitching coach’s evaluation of “stuff,” then it is entirely justified to rely on [relief pitchers].” Carlstedt then goes on to explain that one thing relievers have going for them is the fact they have fresh arms – they are not expected to pitch around seven innings every five days. This is similar to Kullman’s thinking about getting pitchers out there one day sooner.

Injuries in baseball refuse to go away, not even with the evolution of the five-man starting rotation nor with pitch count reduction. However, as Kullman points out, medical technology has advanced to the point where injuries are diagnosed quicker and more specifically, allowing the pitcher to successfully rehabilitate his arm. He also believes that too much rest may contribute to injuries. An example Kullman uses is pitching one single pitch every day for 162 games. He believes that such a strategy would cause less harm and fatigue to the pitcher rather than having the pitcher throw 200 pitches every 20 days, a reason why he believes the system implemented by the Reds will be effective.

Carroll offers simple guidelines that baseball organizations should utilize to reduce injuries to pitchers. Organizations should “draft with an eye to work ethic, past injury and usage. Err on the side of caution with pitches and innings and have early and consistent instruction with focus on correct mechanics and pitching theory. The organization should also build stamina using an interval approach, abandon usage patterns and roles that don’t work and lastly, promote success.”

Alberts takes this a step farther, saying that a good pitcher needs good instruction from a pitching coach who knows mechanics, a year-round throwing program, and a general exercise program, focusing on cardiovascular exercise. “[A pitcher should] meet with someone in physical therapy and learn a complete rotator cuff strength program,” Alberts adds. A good sports doctor is also a must, for when a pitcher is injured, he needs to trust the doctor who is in charge of rehabilitation. Reading up on the subject can also be beneficial to pitchers in learning what to do and what not to do.

Young pitchers are more susceptible to injury and have to exercise caution to make sure they do not get injured. It is vitally important for a pitcher and everyone around him – from his parents to his coaches – to make sure that what is being done is keeping his arm as healthy as possible. One single game can change the course of a pitcher’s career. Baseball and its students may not be close to an answer, but they work every day to find ones. Glenn Fleisig will continue studying injuries caused by baseball to find out where the line between health and injury exists. Will Carroll will proceed with putting all the pieces together to find out how fatigue can be measured. Mike Alberts hopes to continue scouting for that perfect pitcher who never gets injured. Joshua Papelbon has plans to continue figuring out how he can remain healthy. Brad Kullman will keep implementing new strategies in the minor leagues. As he says, the Reds are working on more studies, and while nothing is implemented yet, “when it is, it is going to rock the industry. Mark it down.”

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