I'm a doctor. You don't have any idea what you're talking about.

I am a doctor (both an MD and a PhD) and while I think that while there is a problem in general with arrogant doctors mouthing off in public about topics of which they have little knowledge, they certainly don't have a corner on that market. As my handle states I have 4 kids and, as I practice adult radiation oncology, I defer to my wife, a pianist of all things, to more effectively than I handle  their childhood ailments. 

The problem with pitching, IMHO, is that we don't know what is the root of the rise in arm trouble. I would again defer to those who know better than I such as the guys at Florida/Texas Baseball Ranch, Dr. Andrews, kinesiologists studying this scientifically, etc. to help figure this out. It however makes sense to me that a more fluid use of the core would protect the arm from excess wear and tear, and I cringe when I see "inefficient" fast pitchers put their arms at awkward angles and visibly stress their arms.  I think as we apply kinesiology to pitching and find ways to better use the legs/ butt/ core to generate power we will see a drop in arm trouble but that is purely an educated guess. 

As long as colleges keep accelerating the commitment process, particularly for young teens throwing hard, kids (and their parents and coaches) will strive early for velocity. I would like to know what percentage of kids in the top 95th percentile in velocity at say age 15 are in the top 95th at age 20, and those who are 50th at age 15 in the 95th at age 20. These types of stats would be interesting and potentially instructive. Perhaps the sabremetrics gang can tackle these early predictive data - perhaps they already are working on it?

Although I was never a fan of his pitching delivery, Mike Marshall's work on arm injuries seems to me to be as close to 1st principle application as anything I have seen published. His explanation of the methodology of injury seems pretty reasonable. However, I feel that teaching the player the basics of the curveball early allows him to develop proper movement patterns before he is easily able to generate enough power to seriously injure himself. I restrict velocity to about 2/3s the average fastball and I discourage full extension of the arm while throwing the curve. I also feel curveball use should be limited to no more than 10%. Elbows are known to be pretty soft until 15-16. Pronation is important to limit damage. Generating weak contact is the best way to make the game fun for everyone and keep the pitch count low. That requires fastball location and the ability to change speeds. Of course the threat of the curveball can make the fastball that much more effective in pitcher's counts.

Not to hijack the thread, but the discussion has me wondering:  How many of your sons ice their arms after pitching when their arms are not sore?  Mine does not, mainly because I read a couple of medical journal articles (which I thought were--at the time at least--the latest word) suggesting that icing actually limits healing if you aren't trying to bring down inflammation (soreness).  Blood flow is greater when an arm isn't iced, so not icing is supposedly therefore best.  But icing still seems to be the norm for most pitchers in my vicinity.

I have no medical training. I've just spent years as the dad of a young pitcher (now in HS) reading whatever I can about arm care. It's maddening how many opinions are out there. We all want to keep our kids healthy, but doing so for pitchers seems like flying blind much of the time. 

roothog66 posted:

cabbagedad posted:

real green posted:

SultanofSwat posted:

I think probably nobody knows what they are talking about when it comes to 'what makes the UCL tear'.

Everyone is now counting pitches, and icing, and chanting to the gods, and ... 'injuries are on the rise'.

Well the fact that 1000's of players can now throw over 90 compared to a few who could a 20 years ago might have something to do with the injury rise???

OK, so with that said, here's a different take... 

-far more players getting instruction on mechanics that allow them to maximize their ability to throw harder.

-far more players can now throw over 90. 

-injuries are on the rise.

Does that mean that maybe good mechanics can be dangerous?

Don't be so quick to jump on the notion that injuries are on the rise. The only proof offered is a rise in the rate of TJ surgeries. A rise in the rate of a particular treatment method cannot be logically used as proof of an increase in injuries. It is like saying a rise in artificial transplants proves an increase in heart disease. It just means that the surgery has become more accessible and more common. That's all that statistic proves - a ride in the use of TJ surgery.

Yeah, Root, got it.  I've been along for the ride for almost all of the "injury on the rise" debates here.

 I was just doing some extrapolation on the comments of  Sultan and RG, somewhat toungue-in-cheek, somewhat to provoke different thought processes.  Sort of a backwards angle to the argument that we may be engineering and refining our throwing mechanics so well, we may be getting to the point where we are able to throw full throttle... and, like a race engine, can only run so long wide open.  Sorry, we're getting away from OP topic.

cabbagedad posted:

roothog66 posted:

cabbagedad posted:

real green posted:

SultanofSwat posted:

I think probably nobody knows what they are talking about when it comes to 'what makes the UCL tear'.

Everyone is now counting pitches, and icing, and chanting to the gods, and ... 'injuries are on the rise'.

Well the fact that 1000's of players can now throw over 90 compared to a few who could a 20 years ago might have something to do with the injury rise???

OK, so with that said, here's a different take... 

-far more players getting instruction on mechanics that allow them to maximize their ability to throw harder.

-far more players can now throw over 90. 

-injuries are on the rise.

Does that mean that maybe good mechanics can be dangerous?

Don't be so quick to jump on the notion that injuries are on the rise. The only proof offered is a rise in the rate of TJ surgeries. A rise in the rate of a particular treatment method cannot be logically used as proof of an increase in injuries. It is like saying a rise in artificial transplants proves an increase in heart disease. It just means that the surgery has become more accessible and more common. That's all that statistic proves - a ride in the use of TJ surgery.

Yeah, Root, got it.  I've been along for the ride for almost all of the "injury on the rise" debates here.

 I was just doing some extrapolation on the comments of  Sultan and RG, somewhat toungue-in-cheek, somewhat to provoke different thought processes.  Sort of a backwards angle to the argument that we may be engineering and refining our throwing mechanics so well, we may be getting to the point where we are able to throw full throttle... and, like a race engine, can only run so long wide open.  Sorry, we're getting away from OP topic.

 

I agree with this 100%!  When it comes to throwing I too believe MANY more players are running over the red line.  

Than the question becomes, do you run it full throttle at the risk of blowing the engine to win the race?  Especially, knowing you can rebuild the motor if it fails.  

As  I currently look up to watch Sam Dyson throw 96 in relief for the giants and not even blink an eye.  

Heck 5 years ago I would have been on the edge of my seat watching every pitch in awe.  Today it's the norm.

Now, pirates closer Rivero throwing 100, and I have never even heard of him.  

Chico Escuela posted:

Not to hijack the thread, but the discussion has me wondering:  How many of your sons ice their arms after pitching when their arms are not sore?  Mine does not, mainly because I read a couple of medical journal articles (which I thought were--at the time at least--the latest word) suggesting that icing actually limits healing if you aren't trying to bring down inflammation (soreness).  Blood flow is greater when an arm isn't iced, so not icing is supposedly therefore best.  But icing still seems to be the norm for most pitchers in my vicinity.

I have no medical training. I've just spent years as the dad of a young pitcher (now in HS) reading whatever I can about arm care. It's maddening how many opinions are out there. We all want to keep our kids healthy, but doing so for pitchers seems like flying blind much of the time. 

One guys opinion.

We iced briefly when my son was about 11-12. Then we stopped for much the same reasons as you stated. For the elbow I believe the MEAT protocol promotes healing more than the RICE. The shoulder is probably a different animal. The low vascular nature of the ligament requires actions that promote blood flow to the region.

When eleven my son had a very mild strain from overthrowing while goofing around. After a visit with a PT friend, I did some research on different protocols. We picked the meat protocol and consulted with the PT practice to get their opinion. Within 8 days all discomfort was gone. He has never had any discomfort since. Purely anecdotal, I know.

Ted22 posted:

Chico Escuela posted:

Not to hijack the thread, but the discussion has me wondering:  How many of your sons ice their arms after pitching when their arms are not sore?  Mine does not, mainly because I read a couple of medical journal articles (which I thought were--at the time at least--the latest word) suggesting that icing actually limits healing if you aren't trying to bring down inflammation (soreness).  Blood flow is greater when an arm isn't iced, so not icing is supposedly therefore best.  But icing still seems to be the norm for most pitchers in my vicinity.

I have no medical training. I've just spent years as the dad of a young pitcher (now in HS) reading whatever I can about arm care. It's maddening how many opinions are out there. We all want to keep our kids healthy, but doing so for pitchers seems like flying blind much of the time. 

One guys opinion.

We iced briefly when my son was about 11-12. Then we stopped for much the same reasons as you stated. For the elbow I believe the MEAT protocol promotes healing more than the RICE. The shoulder is probably a different animal. The low vascular nature of the ligament requires actions that promote blood flow to the region.

When eleven my son had a very mild strain from overthrowing while goofing around. After a visit with a PT friend, I did some research on different protocols. We picked the meat protocol and consulted with the PT practice to get their opinion. Within 8 days all discomfort was gone. He has never had any discomfort since. Purely anecdotal, I know.

I am surprised there have not been more posts on this topic.  To ice or not to ice, along with long distance running, are two of my favorite topics.  In third place, running poles to "flush out" lactic acid comes to mind.

Never been a fan of ice outside of acute injury.  Icing probably helps lessen immediate pain and discomfort from swelling, but actual healing does require blood flow, the more generally the better.  I've heard mention that swimming is thought by some to be the best exercise during recovery from pitching, although others argue that it places too much strain on the shoulder (assumes freestyle stroke).

If your arm doesn't hurt and isn't sore, why would you ice it?

My son will be a junior at a D1 this fall.  PO now, but growing up he was a SS/C/P and played every inning of every game.  Would play SS, then P....heck, sometimes SS/P & C all in the same game.  He played as many games as he could find, rec, travel, etc....sometimes 7 days/week.  Never iced one time....and has never had any type of injury.  I can remember 3 or 4 times total where he may have had a bit of a sore arm during a busy week, but those where in junior high when he was about 4'6 and 70 lbs....lol.   All of his college teammates ice after games, regardless of how much they threw.  He will throw 100 pitches, grab his stuff, jump in the car and head home.  Maybe he's just been luck, I don't know....I'm NOT a doctor

If I could point to one thing I've done for my son's pitching that mattered the most, I would, without hesitation, say that it was when he stopped icing and I purchased a MarcPro. Three years ago we changed to estim and it has been invaluable. The MarcPro is extremely expensive. I have bought other, much cheaper estim devices. They are obviously inferior and eat 9v batteries regularly, but they do get the job done. 

My son also uses the estim device before warming up to pitch. It actually cuts the number of bullpen throws he needs to feel loose by 75%. He also uses it in between innings while he's pitching to keep the blood flowing. Of course, it's only anecdotal, but he hasn't experienced soreness in his arm or shoulder in over three years whereas he used to have bicep soreness after pitching on a regular basis.

My son didn't usually ice.  He was not overused. ... hardly ever pitched except in Spring.  He also has the TJ scar.  Go figure.

SultanofSwat posted:

My son didn't usually ice.  He was not overused. ... hardly ever pitched except in Spring.  He also has the TJ scar.  Go figure.

And we are back to NO ONE KNOWS, and DEPENDS ON THE KID.

roothog66 posted: Don't be so quick to jump on the notion that injuries are on the rise. The only proof offered is a rise in the rate of TJ surgeries. A rise in the rate of a particular treatment method cannot be logically used as proof of an increase in injuries. It is like saying a rise in artificial transplants proves an increase in heart disease. It just means that the surgery has become more accessible and more common. That's all that statistic proves - a ride in the use of TJ surgery.

What people should be saying is: “The number of REPORTED” pitching injuries is on the rise.”

If there was a MLBPA in place back in the 1800’s, and the medical profession had the same capabilities as it does today, I’m betting large sums that a lot more injuries of all types would have been reported and treated as well.

FourKids posted:…As long as colleges keep accelerating the commitment process, particularly for young teens throwing hard, kids (and their parents and coaches) will strive early for velocity. I would like to know what percentage of kids in the top 95th percentile in velocity at say age 15 are in the top 95th at age 20, and those who are 50th at age 15 in the 95th at age 20. These types of stats would be interesting and potentially instructive. Perhaps the sabremetrics gang can tackle these early predictive data - perhaps they already are working on it?

 I’m sure someone in the sabremetrics gang somewhere has his/her fingers in that pie. The problem though is, there’s so little valid data to work with. Not only is there no way to identify where a player lies on the velocity chart because not all players have a recorded velocity, there’s no way to tie those velocities to injury because not all injuries are reported or treated. Then there’s always the push back on progress from old timers in the game who turn off as soon as they see the word “statistic” show up in the conversation.

With regard to Tommy John surgeries, I think you also have to consider the rise in the amount of kids playing travel ball as opposed to rec ball.  Sure, there are more kids getting injured, but there are also a lot more kids playing a lot more games than they used to.  I'm willing to bet with the huge growth in AAU basketball that there are a lot more knee injuries in basketball than there were 10 years ago.  Kids didn't used to play 6 straight weekends of competitive basketball in the summer like they do now.  I know a lot more kids that have gotten injured in AAU after playing 6 games in 3 days than I do kids who have gotten hurt in HS with 2 games/week.

roothog66 posted:

If I could point to one thing I've done for my son's pitching that mattered the most, I would, without hesitation, say that it was when he stopped icing and I purchased a MarcPro. Three years ago we changed to estim and it has been invaluable. The MarcPro is extremely expensive. I have bought other, much cheaper estim devices. They are obviously inferior and eat 9v batteries regularly, but they do get the job done. 

My son also uses the estim device before warming up to pitch. It actually cuts the number of bullpen throws he needs to feel loose by 75%. He also uses it in between innings while he's pitching to keep the blood flowing. Of course, it's only anecdotal, but he hasn't experienced soreness in his arm or shoulder in over three years whereas he used to have bicep soreness after pitching on a regular basis.

Interesting...  I have seen stim used in physical therapy (a lot), but have never heard of it for recovery or warm up.  Does anyone here know about any data on this (or have another anecdote, for that matter)?  

(Yeah, I know the plural of "anecdote" is not "data"; but I'll take the best info I can gather.)

I believe when it's all said and done there will be decided two issues result in arm injuries. It will be overuse and hitting the physical limits of tolerance for an arm..

The way travel ball operates has a lot to do with overuse if not managed properly. A kid starts pitching in a 50-80 game travel season starting at 9u. There's an age group for every year. A quality pitcher is going to pitch a lot every year from 9u to 18u.

When I played LL it was from 10-12. Players had to make teams. Even the worst teams had competent players. I didn't get to pitch until I was twelve. Then I moved up to Babe Ruth ball. Once again everyone had to make a team. Even the worst team was competent. I didn't get to pitch at thirteeen. I pitched at fourteen and fifteen. This process repeated itself in Legion ball. I did get to pitch a little mop up as a sixteen year old. I started at seventeen and eighteen. Junior high and high school were short seasons similar to those anywhere today. I pitched as a ninth grader, junior and senior. Given all the years my all star teams won states and went to regions summer ball was about thirty games between the season and all stars. It wasn't until Legion we started playing fifty, sixty games per summer.

I essentially pitched five years of summer ball (12, 14, 15, 17, 18). A kid today will pitch as much before he's physically developed and only fourteen years old in 14u. Three of my five pitching season were when I was a reasonably developed fifteen years old or older. Essentially, I didn't pitch until I was twelve, had a year off, pitched two years, had a year off and pitched two more years. 

On my worst day my arm was tight due to pitching with two days rest. I once pitched the last game of junior high (9th grade) on Wednesday and Opening Day of Babe Ruth ball on Saturday. Back then no one knew it could be an issue. MLB pitchers did it in the World Series.

The only kid I know who totaled his arm was a pitcher who started throwing sidewinder breaking balls when he was eleven in LL. It involved a lot of arm torque. The pitch broke sideways about twenty inches. I remember swinging and missing at a pitch in LL that was headed dead center of the strike zone that hit me.

Our Legion team had a loaded pitching staff. He was the only one with arm problems even though his curve was corrected in high school. Actually he never had arm problems until Legion ball post senior year. The damage had been done. One game i was in the outfield while he was pitching. It sounded like thunder and the kid was on the ground screaming. His arm broke in two places. He PG'ed a year. Then he had an awesome freshman college season. Pitching that summer his arm broke again.

roothog66 posted:

If I could point to one thing I've done for my son's pitching that mattered the most, I would, without hesitation, say that it was when he stopped icing and I purchased a MarcPro. Three years ago we changed to estim and it has been invaluable. The MarcPro is extremely expensive. I have bought other, much cheaper estim devices. They are obviously inferior and eat 9v batteries regularly, but they do get the job done. 

My son also uses the estim device before warming up to pitch. It actually cuts the number of bullpen throws he needs to feel loose by 75%. He also uses it in between innings while he's pitching to keep the blood flowing. Of course, it's only anecdotal, but he hasn't experienced soreness in his arm or shoulder in over three years whereas he used to have bicep soreness after pitching on a regular basis.

Chico posted:

Interesting...  I have seen stim used in physical therapy (a lot), but have never heard of it for recovery or warm up.  Does anyone here know about any data on this (or have another anecdote, for that matter)?  

(Yeah, I know the plural of "anecdote" is not "data"; but I'll take the best info I can gather.)

The best source of info I can give you as it relates to pitching is driveline baseball.  Kyle has worked a LOT with the MarcPro.  Go to his site and read the blogs and other info on the MarcPro.  My son has one as well as does his D1 team.  I just don't think he uses it to its fullest effect.  I know he doesn't use it before throwing, even though I have encouraged him to read up on it and to do so.  It is kinda difficult when you are in college as you typically have a program in place that they expect you to use.  I can only assume if you want to do something different, a sit down with the PC and trainer could result in you being allowed to do some different things, especially if you have done your homework and can give them good reasons why you think it would work and then if success follows.