Is the UCL problem even solvable?

Genome editing, genetic engineering, synthetic UCL's, Nolan Ryan Clones...

Great question.  It'll be interesting to see if our resident medical people contribute.  Not an expert just a dad but one thing I have heard is that  besides strengthening the shoulder you want to strengthen the core and get it to do more work on routine throws.  By that I mean a SS, for example, may have one throw a game that needs to be all arm. The rest of the time he can get his legs and core behind the throw, and the stronger he is there, the less stress there is on the arm.

JCG posted:

Great question.  It'll be interesting to see if our resident medical people contribute.  Not an expert just a dad but one thing I have heard is that  besides strengthening the shoulder you want to strengthen the core and get it to do more work on routine throws.  By that I mean a SS, for example, may have one throw a game that needs to be all arm. The rest of the time he can get his legs and core behind the throw, and the stronger he is there, the less stress there is on the arm.

 

 

I'm not sure that is true, the stronger the core/legs are, the more stress put on the arm?

I'm not challenging you, just saying I don't know.

I'm not sure a stronger core takes away stress from the arm. Given the same throwing velocity that is true but the guy with the stronger core will also create more passive forces on the arm so that in the end it probably is about the same (although the guy with a stronger core will throw harder). 

Go44dad posted:

JCG posted:

Great question.  It'll be interesting to see if our resident medical people contribute.  Not an expert just a dad but one thing I have heard is that  besides strengthening the shoulder you want to strengthen the core and get it to do more work on routine throws.  By that I mean a SS, for example, may have one throw a game that needs to be all arm. The rest of the time he can get his legs and core behind the throw, and the stronger he is there, the less stress there is on the arm.

 

 

I'm not sure that is true, the stronger the core/legs are, the more stress put on the arm?

I'm not challenging you, just saying I don't know.

No problem. Just a discussion.  

But 2 recent data points.  My 2017 was working with a PT who made pretty much this exact point (assuming it was relayed to me accurately.)  And I just saw a video of kid doing IF work at Stanford Camp 2, and the coach doing the analysis voiceover said that he wasn't getting his legs behind his throws enough.

Working legs and core may, if that is all you do, and if that indeed allows for greater velocity, may work the other way by allowing greater arm speed and putting more stress on the elbow.

There are, I believe, 10 distinct muscles that cross through and support the ucl. Strengthening these muscles requires some very specific work, though. The more developed these muscles, the more support they provide the ucl and the more arm speed the elbow can withstand. Some of these wouldn't even at first glance appear to effect the elbow. I'll give you an example. I (and others) have noticed that pitchers will tend to have a tightness problem in the forearm for a time before the ucl gives and they need TJ surgery. This precursor, however, seems to go largely unnoticed in MLB. I often see a pitcher go on the DL with a "forearm strain" only to come off the DL and the next injury is the elbow. There seems to be some correlation between muscles in the forearm giving out and future ucl problems, perhaps from a decreased amount of muscular support.

Certainly, stronger legs and core (along with proper use of that strength) will allow for one to throw with more velocity with the same effort from the arm.   It is certainly an interesting topic for debate as to whether this may result in more stress due to the ability to generate more force.  I can only claim Holiday Inn Express status on that one.  

Regarding OP's "different mechanics" reference, we have had some success with helping kids coming into our HS program with arm issues and mechanical flaws.  We have been able to make adjustments and, in some cases, reduce the arm discomfort, including elbow pain.   Usually, the problem is some combination of finding a natural arm slot, correcting sequencing, using the lower half properly or not throwing across the body. 

The other side of the coin is that, yes, throwing hard does put a lot of stress on the elbow and does often lead to injuries.  Sometimes the difference comes down to genetics.  So my conclusion is a resounding yes.. and no.

Fatigue is a key factor.  Muscle fatigue can affect mechanics and also the muscles holding the joins together under stress / torque conditions. Once the muscles you have worked on so hard start to fatigue and you continue to throw at top velocity, you are at a greater potential for a strain.  The strain can be from lack of proper mechanics or from the joint muscles being fatigued.  Lack of strength, conditioning, and flexibility can cause any number of strains in any body area.  You can also over develop one part of the muscle, raising your risk of injury.  The SS example is a good fatigue example.  Comparing a position players infrequent hard throw to a pitchers 100 hard throws, you can see how fatigue can set in differently. If you are a pitcher, working the core hard, and are not doing the same with the upper body (not talking about rubber bands and stabilizing muscles - you need that as well), you are bound to have issues.  You will generate too much torque on the elbow as you have mentioned.

The only true way to virtually eliminate UCL injuries is to avoid throwing a baseball at all costs. 

Short answer: Probably not completely solvable, but definitely reducible. But until baseball decides it wants to do something about it and actually address the problems, no it won't be fixed. 

There is also fatigue in tendons and ligaments that cause damage (as in normal cellular damage from working out).  Typically if you have enough rest between workouts, cellular damage is repaired to a point that you did not know it was there before.  If you do not adequately recover, cellular damage is still evident and will get worse as you continue.  Repeat the cycle enough times without proper rest or nutrition and anyone can have injury.  Genetics will play a big role in how strong and elastic your tendons and ligaments will be.

Greatly increasing roster sizes and putting very strict pitch count limits in place could possibly help reduce UCL injuries.   If players were only allowed to throw 35 pitches once every 5 days and weren't allowed to play another position besides DH during their rest days, I would bet there'd be a lot less injuries.  

That is a very extreme notion, I know, but I'm fairly certain it would work.   You'd have a heckuva lot less kids playing youth baseball if you did that though....obviously.... having said that kids would still get hurt from throwing too much in between their pitching outings

I am from the camp that its all part of the kinetic chain. Which begins with the foot and ends with release of the ball. The arm is only there for the ride. Strong legs and core  and stable shoulder along with proper mechanics are needed to prevent injury but how many players are prepared for that at a very young age.  While the intent should be to throw hard, if you are throwing hard with just your arm, you will eventually have issues.

I was told once by a very well known pitching coach if everyone had perfect mechanics there would be no pitcher injuries, but not everyone can teach those mechanics and not everyone is in agreement on what perfect  actually consists of.

I would assume that most pitchers who hurt their ucl have an excellent core strength and kinetic chain, since pitchers who don't have one usually don't throw very hard.

mlb pitchers use their body very well and their tear their ucl all the time. I think the throw with your body to save the arm is a nice idea but mostly a myth.

There are many in HS, college, milb who need TJS that you dont hear about and they all dont throw hard.

TPM posted:

There are many in HS, college, milb who need TJS that you dont hear about and they all dont throw hard.

 

I'm Not saying that using the body and throwing hard increases the injury risk but apparently it doesn't lower it either. Soft tossing pitchers get injured too but at the MLB level fire ballers have a higher injury rate statistically.

3and2Fastball posted:

Greatly increasing roster sizes and putting very strict pitch count limits in place could possibly help reduce UCL injuries.   If players were only allowed to throw 35 pitches once every 5 days and weren't allowed to play another position besides DH during their rest days, I would bet there'd be a lot less injuries.  

That is a very extreme notion, I know, but I'm fairly certain it would work.   You'd have a heckuva lot less kids playing youth baseball if you did that though....obviously.... having said that kids would still get hurt from throwing too much in between their pitching outings

This extreme notion might work, however, it would lengthen the game to change pitchers every 35 pitches. This would go against the current trend to look at ways to shorten the game.

My son threw hard, hit 98. He never had TJS.    Not without minor injury but no TJS. There are many who throw hard who dont have TJ. IMO, I think the damage occurs for most in HS.

Fireballers move quickly through the system. Years ago all of these young guys fireballers would still be in milb.

I just read somewhere the average player in ml is 4 years. That is an old stat, probably due to TJS and shoulder surgery it would be higher.

JMO

Bottom line is, I think it comes down to genetics. What we are talking about with all the pitch limit rules and days rest and talk of mechanics, is a theory of minimizing risks, not eliminating. At some measure of force, anyone's UCL will tear. For some it is a lower force, for some it is a much higher force. 

Sure, there are things that may help increase the amount of force put on the UCL. Mechanics will help and the musculature around the UCL will help take some of the stress away from the UCL. But if that point is reached, it will snap. The pitch limits and days rest proposals address the musculature around the UCL. As a player tires, those muscles will lose some of their ability to absorb some of that force. The more tired a pitcher is, the more of that force is taken by the UCL. 

The mechanics, I believe, help as well. However, the best mechanics vary from pitcher to pitcher especially in terms of arm slot, but all the way up the kinetic chain as well. Finding that perfect chain of events for each pitcher is very tough to do. 

But, like I started this response with, it really comes down to genetics and what that individual pitcher's "breaking point" is. The rest are just ways to hopefully minimize that risk. UCL tears will never completely go away, as long as pitchers pitch. 

TPM posted:

My son threw hard, hit 98. He never had TJS.    Not without minor injury but no TJS. There are many who throw hard who dont have TJ. IMO, I think the damage occurs for most in HS.

Fireballers move quickly through the system. Years ago all of these young guys fireballers would still be in milb.

I just read somewhere the average player in ml is 4 years. That is an old stat, probably due to TJS and shoulder surgery it would be higher.

JMO

They say that pitchers now Peak much earlier, they basically lose velocity from day 1 they come to the Majors. however of course they also throw much harder.

so they do Peak earlier but they also come in better trained (travel ball, pitching coaches, strength Training since they are 14) which probably shortens the Need for MILB time.

maybe this also means that many pitchers who would have had their career end in the minors due to injury and never to be heard off will make it to the Majors and get injured there.

roothog66 posted:

Working legs and core may, if that is all you do, and if that indeed allows for greater velocity, may work the other way by allowing greater arm speed and putting more stress on the elbow.

There are, I believe, 10 distinct muscles that cross through and support the ucl. Strengthening these muscles requires some very specific work, though. The more developed these muscles, the more support they provide the ucl and the more arm speed the elbow can withstand. Some of these wouldn't even at first glance appear to effect the elbow. I'll give you an example. I (and others) have noticed that pitchers will tend to have a tightness problem in the forearm for a time before the ucl gives and they need TJ surgery. This precursor, however, seems to go largely unnoticed in MLB. I often see a pitcher go on the DL with a "forearm strain" only to come off the DL and the next injury is the elbow. There seems to be some correlation between muscles in the forearm giving out and future ucl problems, perhaps from a decreased amount of muscular support.

I think there is something to the example Roothog said about the forearm tightness. My son, who had TJ in spring of this year. Talked about how his forearm was "hot and tight" the inning before he tore his UCL. Of course he didn't tell anyone until he was being looked at by trainer after he had already tore it. He has very specific arm exercises he has to do to build up his muscles connected to the UCL as part of his rehab.

I, also, think it has a lot to do with how hard you throw. He never had any arm issues growing up nor in HS. Truly didn't have any until he tore it but he had increased his average velo over time and had a significant jump in that area between summer after freshman year in college and when he hurt it in February of Sophomore year. Roughly 3 MPH on average velo according to coaches

Do pitchers still do the bucket of rice workout? I think I remember that from the 70's and 80's. Seems like Ryan and Clemens did that for their arms. I've never heard of a kid doing it though.

Stafford posted:

Do pitchers still do the bucket of rice workout? I think I remember that from the 70's and 80's. Seems like Ryan and Clemens did that for their arms. I've never heard of a kid doing it though.

Not so much, but still do a lot of forearm work with weights - pretty much the same goals. There are some starting to come to the conclusion that building the forearm is extremely important to protecting the ucl.

Very few non-pitchers have TJS. Many young OFers throw 90+ with a crow-hop and never have elbow problems. The forces on the elbow "look" similar, so I have to surmise that the main difference is repetitions and recovery time.

Has anyone read a study that has determined where in the pitching sequence the UCL is getting stressed? Late cocking phase seems obvious, but do they really know? How much of that stress/rotation is in the shoulder joint at late cocking? How much stress at ball release, when those forces are trying to open up the elbow joint and stretch the UCL?

I hope Nolan Ryan has made arrangements for his UCL to be studied after he's gone.

In some cases, it might just be luck, or it might be genetics, or both. Kevin Greene played 15 seasons in the NFL and never had a major injury or knee surgery.

Stafford posted:

In some cases, it might just be luck, or it might be genetics, or both. Kevin Greene played 15 seasons in the NFL and never had a major injury or knee surgery.

I would say luck is less of a factor in baseball (pitching specifically). Football knee injuries are more of the single catastrophic event variety, where as UCL tears generally come after years of micro-tears and lengthening. But genetic research is a rapidly growing field, so I'm a little more optimistic that something can be done to "improve" the UCL from that front.

MidAtlanticDad posted:

Very few non-pitchers have TJS. Many young OFers throw 90+ with a crow-hop and never have elbow problems. The forces on the elbow "look" similar, so I have to surmise that the main difference is repetitions and recovery time.

Has anyone read a study that has determined where in the pitching sequence the UCL is getting stressed? Late cocking phase seems obvious, but do they really know? How much of that stress/rotation is in the shoulder joint at late cocking? How much stress at ball release, when those forces are trying to open up the elbow joint and stretch the UCL?

I hope Nolan Ryan has made arrangements for his UCL to be studied after he's gone.

When the doctors do a post mortem study of Nolan's UCL, don't be surprised if it slaps the doctor around the lab.

Go44dad posted:

MidAtlanticDad posted:

Very few non-pitchers have TJS. Many young OFers throw 90+ with a crow-hop and never have elbow problems. The forces on the elbow "look" similar, so I have to surmise that the main difference is repetitions and recovery time.

Has anyone read a study that has determined where in the pitching sequence the UCL is getting stressed? Late cocking phase seems obvious, but do they really know? How much of that stress/rotation is in the shoulder joint at late cocking? How much stress at ball release, when those forces are trying to open up the elbow joint and stretch the UCL?

I hope Nolan Ryan has made arrangements for his UCL to be studied after he's gone.

When the doctors do a post mortem study of Nolan's UCL, don't be surprised if it slaps the doctor around the lab.

He may not even have one!

TPM posted:

Go44dad posted:

MidAtlanticDad posted:

Very few non-pitchers have TJS. Many young OFers throw 90+ with a crow-hop and never have elbow problems. The forces on the elbow "look" similar, so I have to surmise that the main difference is repetitions and recovery time.

Has anyone read a study that has determined where in the pitching sequence the UCL is getting stressed? Late cocking phase seems obvious, but do they really know? How much of that stress/rotation is in the shoulder joint at late cocking? How much stress at ball release, when those forces are trying to open up the elbow joint and stretch the UCL?

I hope Nolan Ryan has made arrangements for his UCL to be studied after he's gone.

When the doctors do a post mortem study of Nolan's UCL, don't be surprised if it slaps the doctor around the lab.

He may not even have one!

Sure he does. And it will be wearing a cowboy hat!

Just take Advil. That's all that Nolan needed.

My 2016 was just diagnosed with a UCL tear.  TJ coming up in two weeks.

He really didn't have any of the risk factors, except that he threw relatively (but not remarkably) hard (mid 80s).  Pitching innings were pretty low (8 in the fall, 12 in the spring, 15 in the summer).  Went to three showcases and two college visits over the past year.  Hadn't gone over 65 pitches in an outing in at least a year.  No short turnarounds that would violate PitchSmart.  Mechanics relatively clean - had some issues with repeatability and timing like most really tall kids do (he's 6-7).  But nobody (including the 3 ex-MLB pitchers he's worked with) had ever pointed out any mechanical flaws as being potentially detrimental to his arm.  And he was a multi-sport athlete (football & basketball) that had been in a structured, supervised weight-training program for almost 7 years.

Saw his velo starting to fade back in June.  When I asked him if his arm was okay, he just said he "wasn't feeling it today."  Later it became that his arm "felt a little off." And then "didn't feel right."  But never any pain.  I asked.  Repeatedly.  And no inflammation.  I looked.  Often.  (I was getting a bad vibe about the whole thing.)

Until 3 weeks ago in Ft. Myers.  That's when he said he first felt pain, but not on every pitch.  Finished the inning, which was immediately followed by a lightning delay, during which he told his mother and coach that his arm hurt.  They shut him down instantly.  Noticeable inflammation the next morning.

Initial exam, doctor was almost positive that it was just a muscle strain in the flexor/pronator bundle.  Only ordered MRI as a precaution because he is a pitcher.  MRI came back as a complete detachment.  (FWIW - Based on our experience I don't buy the "forearm strain as a precursor" theory.  In our case the actual tear presented as a forearm strain, but by the time there was pain, it had already happened.)

Everyone stunned - coaches, teammates, us - because he doesn't really fit the profile since he had such a low-mileage arm (he wasn't overused at any age by anyone's reasonable definition that I've ever heard) and was a multi-sport athlete (there goes the Smoltz theory).

The only plausible theory we have heard as to why it happened to him is that because of a recent huge growth spurt (mass, not height - he went from 193 in November to 235 in May) and the general strength training program he was on, his newly developed big-boy muscles simply overpowered the ligament before it had a chance to catch up.

Frustrating, because we are really not sure what we could have/should have done differently.  Thankfully, college coach is going to redshirt him and team trainer will oversee rehab.  And he has a good support network, including a coach, a former travel ball teammate, and a college teammate that have all gone through it.

Mr B, sorry to hear about your son. Best advice that I can give is to get the surgery done ASAP by a reputable surgeon:

1) He will be in pain and arm in sling. Better to get past some of that stage before college starts.

2) He will be that much further along and better chance of success in Spring of 2018.

yeah, sorry to hear about that... don't know if it makes it better or worse that seemingly every precaution was in place.  Glad to hear he has support at his school.

mrbumstead, So sorry this happened. If you have any questions my son is going thru rehab right now. He tore his is mid February and had the surgery March 5. Just started throwing about 3-4 weeks ago

RedFishFool posted:

Mr B, sorry to hear about your son. Best advice that I can give is to get the surgery done ASAP by a reputable surgeon:

1) He will be in pain and arm in sling. Better to get past some of that stage before college starts.

2) He will be that much further along and better chance of success in Spring of 2018.

Can't quite get it done that quick - he moves in Saturday.  Classes start next week.

But he's scheduled for a 2nd opinion/surgical consultation in two weeks with Dr. Cain at Andrews.  If they concur with diagnosis, surgery will be next day.

College coach doubles as an academic advisor.  He said professors will work with him to keep him from getting off track.

The good news is that he will have about 18 months to be ready for 2018 season.

MRBUMSTEAD - my sympathies re your son and here is hoping for a full & quick recovery

Question:  what were his pitch counts like when he was younger?  From age 10-13 did he pitch a lot?   Did he throw more than 80 pitches in an outing several times a season between ages 12-14?

3and2Fastball posted:

MRBUMSTEAD - my sympathies re your son and here is hoping for a full & quick recovery

Question:  what were his pitch counts like when he was younger?  From age 10-13 did he pitch a lot?   Did he throw more than 80 pitches in an outing several times a season between ages 12-14?

Thank you 3/2.

When he was 10-14 he was rather uncoordinated due to his height, which translated into him being rather wild on the mound.  Consequently, he didn't run up many high pitch-count games, though he did have some high-pitch (25+ pitch) innings.  I honestly don't remember him ever going over 70 pitches until his sophomore/15U year.

When he was 12U, he did have a bout of Little League elbow that forced us to shut him down in mid-April.  (No evulsion. Just inflammation.)  But he had only pitched 3 times up to that point in the season, so that wasn't overuse either.  Tried to come back in late May - first game back had a recurrence while playing outfield.  Only PH/DH/EH for the rest of that season.  Didn't pitch off a mound again until around Christmas.

Doctor told us that because of his size at that age (IIRC he was about 5-7 125-ish) that he was probably just throwing too hard for those unfused growth plates.

chefmike7777 posted:

mrbumstead, So sorry this happened. If you have any questions my son is going thru rehab right now. He tore his is mid February and had the surgery March 5. Just started throwing about 3-4 weeks ago

Thanks Chef.  May take you up on that.

MRBUMSTEAD - thanks for your reply.  UCL injuries are baffling.   It seems like you can do everything right and still tear it.