Child baseball injuries are skyrocketing. Just ask Dr. James Andrews. In 1994, the American Sports Medicine Institute founder didn't perform any Tommy John surgeries (ulnar collateral ligament, or UCL, reconstructions) on youth baseball players. By 2008, more than a third of his UCL operations were on kids. The problem, he believes, is increased specialization that has kids playing the same sports year-round. But he thinks he might know the solution too.
Today, Dr. Andrews and his lead physical therapist Kevin Wilk are launching Throw Like A Pro, a mobile app that allows parents and coaches to access medical and training resources like never before. The app, built in conjunction with Abracadabra Health, takes aim at irresponsible player development practices in hopes that it can preserve pitchers' arms with practice regimens, stretching exercises, and rehabilitation programs--previously reserved for patients of ASMI--for just $9.99.
“We're seeing Tommy John injuries occurring at a younger and younger age in the professional life,” warns Andrews. “It used to be they would be 28, 29, 30 years old, maybe older. Their ligament would finally have a problem. Now we are seeing it in relatively young professional pitchers, in the first few years of their professional career.”
“We ask parents all the time,” says Wilk, Dr. Andrews' longtime leading physical therapist at the American Sports Medicine Institute, “'Why doesn't he just take off the two or three months in the winter?' and they say, 'Well, we think if he takes off he'll lose the edge.' He's 12. What kind of edge does he have?”
Both Wilk and Andrews believe the problem stems directly from sport specialization at a young age. In 2014, adolescents are often encouraged to choose one sport to pursue, as opposed to the multi-sport programs of previous generations' athletes. Studies conducted by the institute suggest this narrow, year-round approach is a leading contributor to UCL tears in pitchers. Andrews, a member of Major League Baseball's research committee, has been preaching the dangers of what he calls “professionalism”--a practice whereby youngsters and their coaches attack their training in the same way as the pros--for years.
“Baseball, as you well know, has always been America's sport,” Andrews explains. “The type of injuries we're seeing have become so common and particularly when they start getting hurt when they're 13, 14, 15 years old. They drop out of sports. They drop out of school. They don't get a scholarship. They end up on the street, and from there it's a downhill spiral for a lot of people. It’s become a socio-economic problem in the United States. Even when they get operated on, there's not a high percentage of return in that age group. They lose their ability to participate in the sport.”
According to Andrews, 34 major league pitchers had Tommy John surgery in 2012. In 2013, just 12 pitchers elected for the procedure. Under three months into the 2014 season, more than 20 hurlers have gone under the knife. But Andrews doesn't think the pro game is to blame--at least not entirely.
“The epidemic of these injuries really began, even with some of these major league baseball pitchers, when they were in youth baseball,” says Andrews. “Twenty-five percent of the major league pitchers right now out playing major league baseball have had Tommy John surgery. That's really unbelievable.”
The institute estimates that some 17 million males play baseball in the United States. During a study of 9-to-14-year-olds during their youth baseball seasons, the institute surveyed players and asked how many of them experienced shoulder or elbow pain and continued playing through it.
“Over 50% said that they had elbow or shoulder pain,” says Wilk. “That's kind of a staggering number. The other staggering number is just the number of surgeries. In the clinic today I had a young man come in. He's 12 years old, but he's had two elbow surgeries already, which is scary."
To Andrews, the instinct to perform surgery on such patients isn't always the best solution.
"At some point you have to say, 'Okay, is there something wrong with the system?'" says Andrews. "Because if he's lying on the table, he's got elbow pain, and he wants to play. You know what? He probably shouldn't play right now. Somebody needs to tell him, "You're not ready to play. You're hurting on the table. You certainly cannot go out there and play. You're not doing any good for anybody. Another surgery is not what's going to fix you."
During a recent study at the Major League level, the Institute polled all 30 teams in an effort to determine how prevalent the procedure is today. Twenty-five percent of all Major Leage pitchers reported having had Tommy John surgery. Roughly 17% of minor leaguers have elected surgery. The institute is adamant that surgeries like Tommy John have a directly proportional, negative affect on the longevity of professional careers.
“I think the mindset is with some of these people is, 'Well, if I blow my elbow out I'll just have surgery. I'll be okay,'” confides Wilk. “Because 9 times out of 10 it's successful. That's not really the right approach. You want to prevent surgery at all cost, and prevention is really the key. We know that when you pitch, you're 36 times more likely to become injured if you pitch when you're tired, when you're fatigued.”
And arm fatigue is precisely what Throw Like A Pro hopes to curb. The app provides recommendations for players of all ages, talent levels, and physical state not just to the individual, but to coaches and families so that they might better understand the strain on kids' joints.
“They come out and they don't know how to change speeds,” explains Wilk. “Every pitch is 100% intensity and that appears to be a big mistake. Some recent data was just put forth. When it looked at Major League baseball players with elbow surgeries, what they found was pitchers that didn't have a big range in velocity were the highest percentage to have elbow surgery. The ones that had a larger range, you know their fastball is maybe 92, but their change-up is 79, had more elbow problems. Physically your body may not be able to withstand what your mind can put forth. You're saying in your mind, "Do more, more." But your body is breaking down.”
Dr. Andrews asserts that kids today mature faster than when he was first coming up himself and that tendons and ligaments aren't keeping pace. When arms get stronger, the bones get bigger, the muscles get bigger.
“The ligaments get thicker as you throw, through all of the stages of development all the way up to the professional ranks,” says Andrews. “These young kids in high school that are high-velocity throwers are overtaxing their ligament and it won't withstand it. It goes beyond what we call its ‘redline,’ like the RPM on your car and they tear it in high school now because their bodies are more mature than the ligament is.”
In other words, the ligament is not ready to take that high a velocity. Andrews' staff found out in its research that the redline for a kid's UCL ligament ligament in junior high and high school is about 80 miles per hour.
“When you get beyond that, it's suspect to be torn on every pitch,” Andrews says. “So If a kid is throwing 90, 95 miles per hour, which they're all trying to do in high school because that's how they get drafted and get scholarships, they're all suspect to tearing their ligaments. So our best pitchers are also the ones that get used more often in more innings, extended seasons, and playoffs, get called upon by coach to pitch the next day to pitch a complete game and so they're the ones that are getting hurt. Our best pitchers are the most susceptible to injury, unfortunately.”
In 2000, Dr. Andrews began seeing high school and junior high school patients with “adult-type injuries” to their lower shoulder and elbow. “That was unusual,” Andrews confessed. “I started tracking what was happening to our young baseball players, particularly baseball players, but this has been out all over the board with all youth sports. Baseball has been the one that's really caught my attention.”
Since then, the American Sports Medicine Institute has gathered sevenfold the statistics relative to youth injuries in baseball to the shoulder and elbow. The information gathered, and subsequent preventative strategies has always been available to the Institute's patients, but has been limited until now.
“We would send the booklet out, but it was just word of mouth,” says Wilk. “One day in the clinic, I think I was talking to Dewar Gaines, our business partner. Dewar was rehabbing an ankle problem and we started talking about how to maybe treat and educate people. We kind of bounced ideas off of one another."
As the discussion evolved, the inevitable became clear: This should be an app.
"Then I called Dr. Andrews up and I said, 'You know, I got an idea for you. I've talking to this guy and we're thinking about doing an App on sports medicine injuries.' The idea was, let's provide the information we've given to patients, but now let's make it available to empower the parents and empower the coaches as far as what they need to know to help reduce injury rates.”
In the short term, Throw Like A Pro has identified pitchers and the Tommy John epidemic as its primary concern.
“It's important to all of us to do the proper research and to educate parents and grandparents, kids, coaches, and the public alike about this problem so we can try to control it,” says Andrews. “We're pretty much discovering what the problem really is. The big problem in any sport, but particularly baseball, is fatigue."
"We found in our research at ASMI that if you pitch with fatigue--event fatigue, too many pitches in a game; seasonal fatigue, too many innings in a season, or year-round fatigue--there was a 36:1 times that they could injure their throwing shoulder or elbow," says Andrews. "There's a 3,600% increase if they pitch with fatigue.”
With young players growing faster, bigger, and stronger than ever, however, ASMI and Throw Like A Pro have identified ethical complications that Wilk believes are of greatest concern moving forward. Citing an incident just last month in which high school senior Dylan Fosnacht threw 194 pitches over 14 innings, Wilk thinks legal liability for coaches is just around the corner.
“Now that the information is out there,” says Wilk. “A lawsuit is probably right around the corner."
[Image: Flickr user Ralph Arvesen]