Epidemic Of Elbow, Shoulder Injuries

From The Sept. 7, 2012 Issue of Collegiate Baseball

By ALAN JAEGER

Special To Collegiate Baseball

LOS ANGELES — It was the perfect storm. The landscape of baseball was going through a dramatic change as elbow and shoulder surgeries were becoming a common practice in the late 1970’s and into the 80’s.

Renowned orthopedic surgeon Dr. Frank Jobe performed the first Ulnar Collateral Ligament (UCL) replacement surgery on Tommy John in 1974, and just two years later, the first rotator cuff surgery on Steve Busby.

These surgeries not only opened the door for countless players to resurrect their careers, but they also opened the door to a brand new field in the baseball community — rehabilitation.

When a player has elbow or shoulder surgery, he will typically go through a number of post-surgery, rehabilitative stages, including a healing phase, clinical work (strength and conditioning) and eventually, field work (throwing).

These stages are overseen in large part by a physical therapist or trainer, whose role is to get the player from the operating table back to the playing field.

This marked the first time in baseball history that the medical community played a prominent role in baseball operations.

It was also around this time that strength and conditioning coaches were being hired. And this influence was about to get stronger as the late 80’s turned into the 90’s.

Ironically, the medical community’s influence on baseball was happening at a time when baseball salaries and signing bonuses were rising exponentially.

For example, in the 1985 Amateur Draft, No. 1 overall pick B.J Surhoff received a $150,000 signing bonus. Five years later in 1990, No. 1 overall pick Brien Taylor received a $1.55 million signing bonus.

This was also reflected at the Major League level, where multi-year contracts were going through the roof. In 1985, the highest paid player was Eddie Murray at $2.5 million. In 1992, Barry Bonds received $7.29 million.

There was a huge paradigm shift in a short period of time as players were making significantly more money than ever before.

A baseball player’s arm (especially pitchers) took on new meaning as there was so much more at stake — and this put even more emphasis on the medical community’s role of keeping players healthy and preventing them from breaking down.

When I played baseball in the late 70’s and 80’s, I don’t remember there being a throwing program. Throwing was purely an instinctive act. It was something you just did according to how your arm felt. And not so ironically, the more I threw the better my arm felt.

But I wasn’t alone. This seemed to be a common theme among players and coaches I’ve spoken with across a number of generations and cultures.

And this makes complete sense because it is in the inherent nature of an athlete to push his or her limits — to see how fast you can run, how high you can jump and how far and hard you can throw a baseball.

The idea of someone putting a time or distance constraint on me throwing a baseball would be like someone telling me to conserve the amount of steps I walk each day so I don’t hurt my feet — inconceivable.

Thus, to my surprise, in 1996 I went to one of the spring training complexes and saw something that I couldn’t comprehend. I saw players lined up on the foul line throwing out to their partners, who were in line with cones about 60 feet away.

The players were ordered to make a specific amount of throws (or for a specific amount of time) to their partner at this increment, and then they were ordered to move back to 90 feet, and eventually 120 feet, repeating the same process.

Once this was completed, the players were then ordered to come back toward their throwing partners at 90 feet, and eventually 60 feet also for a predetermined amount of throws (or time).

In all, this program, which evidently doesn’t take into consideration that players come from different backgrounds, routines, body types and arm strength, lasted approximately 10-12 minutes, and all of the players were limited to 120 feet.

Considering that one of our pitchers was on the field that day and had spent six weeks with us prior to spring training regularly working out at distances of 300-330 feet, this was quite a shock to me (not to mention the pitcher).

This was the first time in my life I had experienced such a throwing program, and I didn’t like anything about it.

With each passing year (I’ve been to spring training for 16 straight years), it became clear to me that this throwing program had become part of the culture.

This one size fits all, 60-90-120-90-60-foot throwing program, or some slight variation of it, was what I saw at most of the Minor League spring training complexes that I visited.

I had a very hard time under-standing this concept, especially at the developmental stage of a player’s career.

And it became much more upsetting when the majority of the professional players that we trained in the off-season to throw distances ranging from 300-360-feet (a 90 mph fastball at 35 degrees elevated will travel approximately 300 feet) were losing velocity, endurance, feel and recovery period as a result of this “program” (not to mention the tremendous frustration the players had of having their throwing routine, athleticism and comfort zone taken away).

So naturally, I became motivated to find out where, why and how this “program” came into being. And for the past 16 years, that’s what I’ve done. I’ve asked questions and more questions.

I’ve talked to players from all different levels and all different nationalities including Japan and the Dominican Republic.

I’ve spoken to coaches, scouts and front office people who have been around this game for decades. I’ve spoken with doctors, trainers and physical therapists.

And the answers were confirming what I sensed all along — players were being grossly undertrained.

The research I’ve done for this particular article has helped put a face on the chronology of events that have led to the inception of the “throwing program”, thanks to the feedback from some of the top experts in the medical and baseball fields, including Dr. Louis Yocum (Los Angeles Angels and Kerlan-Jobe Center), Stan Conte (Director of Medical Services, Los Angeles Dodgers), Kevin Wilk, PT, DPT (the original Rehabilitation Coordinator, American Sports Medicine Institute), Dr. Glenn Fleisig (Research Director ASMI) and Tom House, PhD, (Pitching Coach/Performance Analyst), most of who were around prior to the throwing program’s inception.

According to Dr. Yokum and Kevin Wilk, the rehabilitation throwing program was created and devised by the medical community in conjunction with input from baseball people.

This rehabilitation throwing program was designed to last approximately 6-8 weeks (it varies based on the type of surgery and the individual).

A typical rehab program starts out very slowly and focuses on building a solid base before adding volume and distance over a period of time.

For example, a player may start out on Day One at as little as 10 feet, make 15 throws, and by the end of six weeks, may be out to 120 feet for 100 throws. Sometimes time increments are used in place of the volume of throws.

The progression of events are simply based on normal theories of training — start out slowly and build a solid base and add to this base by slowly and progressively increasing the workload (distance, volume and/or time).

This all made perfect sense. Once this post-surgery, throwing rehabilitation phase was completed, the plan was for players to return to their team and begin the “training” phase for their arm.

It was at this point that the medical staff had finished their job. Pitchers (players) were ready to be handed over to the baseball people so they could go back to their normal baseball activities. At least in theory, that’s what was supposed to happen.

But a funny thing happened on the way to the training phase of throwing.

Both Dr. Yokum and Wilk mentioned that the rehab phase is designed to get players back into shape and best position to return to their organization (school) and transition to normal throwing activity.

But somewhere along the way, the training mentality began to take on the form of the rehab mentality.

Part of this was because the rehab program did such a great job of positioning the arm to return to normal baseball activity. It could almost be seen as a means to an end.

But there were other factors involved, including:

1) Structure — Due to the structured nature of this throwing program, it was easy and convenient to implement for the masses.

2) Format — Due to its format, there was a step-by-step procedure that could be followed from Day 1 through the completion of the program.

3) Medical Backing — Because it was medically based, it had the medical community’s “stamp” at a time that the value of a player’s arm was becoming magnified.

4) Conservatism — Conservatism replaced spontaneity as many baseball coaches (pitching coaches) were concerned about losing their job if a player broke down on their watch. So it was safer to keep players at a shorter distance that was backed by the medical community.

5) The Science of Mechanics — Whether it was due to the medical influence of being anatomically correct when throwing a baseball, or simply the evolution of how athletes were being studied and trained, pitching coaches seemed to be going through a renaissance of perfecting mechanics at this time. Terms like bio-mechanics and kinetic sequencing were becoming popularized in the baseball culture, and pitching mechanics seemed to take on more of a one size fits all mentality.

The need to have perfect mechanics, which among other things, suggested that pitchers throw with level shoulders, helped strengthen the rehab protocol of capping the distance at 120 feet, because quite simply, perfect mechanics would “break down” beyond 120 feet. At that distance, it was felt that pitchers would start arcing throws and theoretically cause their front side to lift and their release point to be late.

But as you will see in the next section, throwing the ball on a line is not only a potential detriment for throwing mechanics, but more importantly, an unhealthy way to warm up the arm.

More On Epidemic Of Injuries: See the Sept. 7, 2012 edition of Collegiate Baseball.