Staying well-armed ... Young pitchers are increasingly at risk of injury

I pitched for Arizona.  I was drafted and then had an career ending accident skiing.  I have coached at every level other than MLB/MiLB.  Still do so today.  I also founded the largest "program" in the midwest.  I know James Andrews personally and am very involved in the AMSI where science of the game is very unveiling nowadays.  Everyone has their opinion, you are welcome to yours but I wonder how many (true numbers) young players you have first hand knowledge of, as in true involvement, to have such a firm opinion???

 

I know many pitchers that have been in the show, or still are, and each and every one of them knows they are different than the next in minor ways mostly.  Then again there are those few that go against the grain and have success too.  That does not mean that is the norm though.  For every 1 kid you suggest to develop a curve at such a young age that may get away with it without injury, just how many do you think it will harm?  Andrews is THE top Tommy John surgeon and I am sure you have not been to his house and had the discussions I have detailing how the numbers for younger surgeries have grown 400% in the last 6 years.  I guess the whole AMSI is wrong spending money in research to find the reasons for such increase.  The number one reason IS developing deception pitches, mainly a curve and slider, at too young of an age.  It is recommended to not develop these until your growth spurts ( growth plates) fuse together which mostly means 15/16 years.  That is when you start "developing it".  

 

Bum, you sound like one of those dads who started his kid out really young, wanting to be stand out at 9 in league ball.  I am uncertain what that proves at that time but you apparently have gotten away with it without injury.  That does NOT make you right.  I am happy for your son that he is injury free but will turn a blind eye and deaf ear to your reasoning going forward.

Excuse me, overuse is a big factor in youth pitchers today also, especially factoring in that deception pitches are thrown more than FBs.  Thats because of poor fathers and poor coaches, the kid doesnt know any better other than what is told to him.

and one last comment, change ups are NOT the least thrown ball in MLB.  Where do you get such naive information?  Wow.

He watches on tv.

Bum Jr. was a reserve outfielder at nine.  Smallest player on his team and probably still is but good enough to be drafted twice.  Didn't pitch (except for a few innings) until 13.  Has been long-tossing ever since.  And it wasn't ME that said the change-up was the least used pitch.. that was Skylark.  Stop the personal attacks, Coach. 

Holy shiznit folks, I said of the 4 main pitches in professional baseball- the fastball, slider, curve, changeup, that the least thrown of those 4 main pitches is the changeup. I think eveyone can agree with that.

The ASMI says that curveballs do not cause arm injuries:

http://www.nytimes.com/2009/07...aseball/26score.html

“I don’t think throwing curveballs at any age is the factor that is going to lead to an injury,” said Glenn Fleisig, the chairman of research at the American Sports Medicine Institute in Birmingham, Ala."

 

The issue appears to be that curveballs lead to pitchers being more successful at young ages and then they get overused:  http://usatoday30.usatoday.com...pitching-study_n.htm

"Part of the confusion is that the pitchers that throw curveballs tend to be the ones that throw a lot," ASMI research director Glenn Fleisig said Wednesday. "So it's hard to separate those factors. But when you do separate them statistically, the pitchers who pitch too much are the ones who got hurt, whether they throw a curveball or not."

 

It's far more likely that Dr Andrews does more operations today because the operations work better today.  40 years ago the number of operations would have been 0.  Over the years, the success rate has gotten higher (90%?) so the risk/reward calculaton makes sense.  It used to be if you were a 14 year old kid, and you injured your UCL, you just found another sport (parents aren't going to pay for an expensive operation that has a very low chance of success).  Dr Jobe put Tommy John's chances of pitching again at 100-1: http://www.jhutriplehelix.com/...edicine-bryan-kohrs/    Now, you can get an operation that can more than likely fix the issue.  That's likely the main reason why Andrews would be doing more operations.  I would imagine that the number of open heart surgeries in the 1920s was pretty low, but it's a lot more common today (risk/reward due to increased success rate).  It's a logicial fallacy to assume that just because there are more operations today the problem is getting worse. 

 

 

 

 

 

Except for the fact that Dr. Andrews himself says the problem is getting worse.

 

When I met Dr. Andrews, he told me very bluntly that the number one source of arm injury, bar none, is overuse. Everything else is a distant second. There are, of course, many contributing factors to overuse. But it's #1.

 

There is nothing kinetically wrong with throwing a curveball, as proven time and time again by medical research. I would be wary to teach a young pitcher to throw breaking pitches, however, because lesser-developed bodies struggle repeating mechanics when fatigued. When a pitcher begins compensating for a lack of "stuff" (for lack of a better term) by altering his mechanics, that's when things can go wrong. Young pitchers don't know how to properly cope with the necessary adjustments on the mound, and that is why the principle of breaking pitches being bad for the arm has been developed.

 

And by the way, for those following along, it is completely incorrect to say that 80% of MLB pitchers tip their pitches at some point. 

 

Skylark, data about the information you give is not difficult to find on the Internet. I'd urge you to not rationalize by saying "I think everyone can agree". Because no, actually, everyone can't agree. From 2003-2011, more changeups were thrown than curveballs, by a significant margin. The 2012 season was the first in 11 years to see more curveballs than changeups league-wide. Perhaps that would be a good research project for you...to hypothesize why that may be the case. As I said, raw data is the way to go.

mcloven,

the article you are quoting from is 6 years old and based on data older than that.

The first post in this thread includes the following from the same Dr Fleisig:

 

"Fleisig, though, said no curveball is safe. He recommends a pitcher learn a fastball at age 8, a changeup at 10 and a curveball at 14. All other pitches – such as a slider or split-finger fastball – should not be introduced until high school.
 

A study of young pitchers in Alabama showed statistically that kids who threw curveballs had a higher chance to have elbow pain," Fleisig said."

 

Also, the initial information posted in this thread and in many articles is  not just the reporting that there are more TJ surgeries. The important element to the articles for the parents of baseball players aged 8-16 is the increasing numbers and percentage of the totals being performed on kids...those age 16 and under.While the totals are increasing, the percentage of those age 16 and under is increasing much more rapidly.

infielddad, I don't believe that the ASMI has done any other study on curveballs since the one I cited.  Also see this, which relies on the 2011 University of North Carolina study that said overuse and not curveballs causes issues: http://www.littleleague.org/As...s/media/UNCStudy.pdf

 

The percentages of TJ surgeries aren't relevant.  Again, as any surgery gets more successful, it will be a more recommended course of action by a physician.   If it wasn't successful, the risk/reward wouldn't be worth it.   So yes, percentage-wise, there will be more 16 and under pitchers getting the surgery than there was, because the surgery has a more well-defined successful outcome.  If it wasn't successful, no one would recommend it for a kid, and then the percentages would be lower.  [What percentage of nonprofessional athletes/kids would undergo a surgery that costs tens of thousands of dollars and involves a great degree of rehabilitation,, if it had only a 1 in a 100 chance of fixing the injury versus a 9 in 10 chance?  As the result becomes more sure, the percentages opting for the fix become higher.  A greater percentage of surgeries does not mean a greater percentage of problems...it could just indicate a better/"more certain" solution for the same number of problems.] 

 

I'm quite sure that teenagers hurt their arms in the 40's, 50's and 60's too, but the percentage of TJ surgeries then was 0% because they just stopped pitching/playing baseball since there was no successful "fix" for them.    I have no doubt that Dr. Andrews has seen a huge increase in surgeries on both a percentage and raw number basis, because the "cure" gets better and better as the surgery and rehab is refined and improved (allowing kids who would be out of baseball to continue). 

mcloven,

To suggest the research comes to one clear conclusion, and rationalize the number of TJ surgeries on baseball players age 16 and under can certainly be argued.  While it won't matter with our son, it might be important for those with son's age 8-16 to appreciate the entire picture is anything but clear cut.

In 2011, the National Athletic Trainers Assn did a lengthy analysis and position paper on youth sports and injuries.  The article found that youth baseball was studied more than any sport and they incorporated all the ASMI work and that of Dr. Fleisig and Dr Andrews.  It also included the comparative assessments of the various articles leading that organization to a recommendation as follows:

 

"Parents and coaches should restrict the use of breaking pitches in order to prevent pitching-related arm injuries.²⁰ If an individual pitcher can throw breaking pitches on a limited basis and remain symptom free, then it may be allowed; however, if the use of this pitch precedes the development of any throwing-related symptoms, it should be immediately terminated and the athlete should seek medical attention."

 

While this thread, as do most, ends up focusing on the elbow and TJ, the far more problematic area is the shoulder, where more than one article reports an association of pain and curveballs..  Shoulder surgery, especially for labrum tears does not have anywhere near the success rate of the UCL/TJ procedure.  In 2008, a Phillies team orthopedist conducted a study and found that about 25% of players with shoulder surgery recovered to be able to compete and succeed at the pre-injury/surgery level.

Finally, because of the focus on the UCL/TJ, we also fail to factor growth plate injuries in young players in the equation and discussions such as this.

I fully realize there are Dad's and others who post about their son throwing curveballs, sliders and the like beginning at age 10 and without any problems.  Again, I also realize most think the TJ/UCL repair works every time.  It does not.

Having a son who is now coaching in college, my perspective is looking at this over a very, very long time in terms of baseball.  When our son's are playing little league, it seems like nothing could be better.  That is true until HS. That is then true until college and beyond.;

One constant which I think Dr Flesig and Dr Andrews agree upon is that arm and shoulder injuries and surgeries result from cumulative, long term stress, strain, wear and tear.  We cannot see it. Often times, our son's cannot feel it or conceal from us that they feel it.  Even when they feel it, they don't appreciate what it might be.

I take 3 things from this thread which I believe parents of HS and pre-HS age players should appreciate: 

Young players and pitchers especially are being diagnosed in greater numbers and at younger ages with repetitive stress injuries from playing baseball.

Overuse is the main culprit but by no means the consensus only culpable aspect, especially for the shoulder.

Parents need to educate themselves more than ever about the risks of injury while their sons are young and over the long term and how those risks project when baseball gets really fun and the most exciting for our sons(IMO) which is HS, college and Milb.

 

Jh,
Like I said, the changeup is theast thrown out of the 4 main pitches. 80% only applies to the changeup not other pitches. If you think that a large majority of professional pitchers dont tip their changeups somewhere in their delivery, then go ahead and believe it. My eyes dont lie.

The part I find most interesting is that the load on the elbow happens well before release not at the moment of release. So, why the misunderstanding of what a pitchers arm and fingers is doing at the release point versus the previous stage? ASMI research shows the pressure greatest when the forearm becones parallel to the ground just at the moment when it begins its acceleration into release. So, how one is gripping a ball at this moment has no impact on the elbow but rather how much stress and pressure is acting on the ligament in the acceleration phase.

Huh?

 

I said this:

"From 2003-2011, more changeups were thrown than curveballs, by a significant margin."

That is based on Pitch F/X data you can find very easily on FanGraphs. It took me about 20 seconds. The raw data proves your eyes wrong.

As I previously stated, I plan to tell my superior with the MLB organization I'm working for that the technology that they use is completely archaic. Skylark's eyes tell us the complete opposite of what the research and kinetic analysis tell us, so of course, he's right.

Any "tipping" done by a professional pitcher will be quickly exploited and reflect in a pitcher's stats.  These men talk and share.  The pitcher, not a dummy himself, would himself quickly realize this (geesh.. why am I suddenly getting pounded?) and correct the problem.  I believe there is always "tipping" to some degree but the pitchers at the professional level are experts at hiding it and their pitching coaches constantly monitor this.  Corrections are made on an ongoing basis.

 

BTW folks, I believe we can all agree curveballs should not be thrown at the little league age.

From what I have researched, on average, the changeup is thrown less than breaking balls. The slider or hard breaking ball is the most thrown offspeed pitch in professional baseball.

 

Yes, it is. And from 2003-2011, the changeup was second, the curveball was third. What's your point?

You still have to factor in a batters ability to put pitch in play knowing whats coming. As things are, professional pitchers, just as college and hs, dont have pinpoint control with the changeup. According to statistics, the changeup is most used in a 1-0, 1-1, 2-1 count when it is most probable that a fastball  is coming.  Breaking balls are used more to finish batters off and record an out. We all pretty much know these things though. I think you yourself can agree that it is hard, even for professional pitchers at all levels, to throw the changeup with exactly the same arm and trunk speed. Perhaps its a mental block, not quite sure why, but pitchers have difficulty throwing the changeup all out with excellent arm speed and same follow through, arm slot, etc. What do the best mlb changeup pitchers all have 8n common? They all can duplicate mechanics, arm and trunk speed to that of their fastball mechanics, arm and trunk speed. I have yet to meet any pitcher who has actual pinpoint control of their changeup. The best just keep it in the dirt to shins not knowing really where it goes side to side.

Skylark, what you say validates my whole argument against focusing on the changeup in h.s.  It is without a doubt the most difficult pitch to command, and if you're saying the average MLB pitcher can't do it so much less so for a h.s. pitcher.  My point exactly.  (But you're wrong, of course, the average MLB pitch CAN command it.)

 

The fade, the depth, the arm speed, the count knowledge, these are things that a 17 year-old cannot comprehend.  Or if they comprehend it cannot develop it against advanced hitters.  So play with the change in h.s., just know that at the next level it's a different pitch. 

 

Focus on the fastball in h.s. and develop a breaking pitch so as to get the opportunity to play at the next level.  If you can't develop a hard, well-commanded fastball the other pitches are trickery meant for J.C. ball. 

 

(Nothing against J.C. ball, it serves it's purposes.  Generally for pitchers to develop more velocity, a quality breaking pitch, academics or a combination of these factors.) 

 

Once you're 20+ the nuances of the changeup (your current B.P. fastball) will be revealed.

I doubt the average mlb pitcher can "command" his changeup. As far as I understand it, command means "placement" and generally speaking, not very many mlb pitchers can "place" their changeup.

There are times (few of course) when my son's changeup is working good enough to be his out pitch in games. Its just so difficult to be consistant with it. Son doesnt throw hard enough yet (mid 80's)  to have an overpowering fastball and thus why he has worked hard on his breaking ball. He has really refined his breaking ball to be his go to out pitch. Years ago I was of the philosophy that developing the breaking ball sooner rather than later would eventually lead to lower pitch counts and thus less "overuse". Our hs team keeps stats and guess what? Last year he led the team in least pitches per inning at right around 15.  I did some research and found that that number was actually slightly below mlb average (16). Our team average for pitches per inning is around 17. If my math is correct, my son pitched 200 less pitches last season compared with team average because he has worked hard on commanding 2 pitches (fastball, breaking ball). Some may argue that the breaking ball is dangerous on young arms, and for some it may be, but saving son from throwing 200 extra pitches in a 4 month span, in my opinion, outweighs that risk because I am limiting the number 1 factor of "overuse". Pretty much every pitcher overuses their arm at some point in a game, season etc. Pitch counts came into being to thus limit overuse.

That all said, my son is really focusing this year on the elusive changeup. His philosophy, his goal is to lower pitch counts per inning which we both believe is the ultimate factor that leads to overuse.

TCWPreps - I'm guessing you were just looking to put up an article which I think had great value on pitching and this spun off on a very different path.  Oh well, thanks for trying.

This.  A properly thrown curveball isn't a problem for pitcher at any age.  The problem is that many kids either don't learn to throw a curve properly or they rely on it so much that they develop injury problems due to fatigue. 

 

Wklink- Agreed. As a college pitcher I've watched video of myself in the past and noticed a mechanical difference as my outings grew longer and my fatigue grew higher. I am no expert, but I'm fairly certain a 12 year old doesn't have the muscular buildup or biomechanically capacity that I do. If its difficult for a college pitcher, its most likely infinitely times more difficult for a young pitcher. 

if the kids builtp arm strength as they go thru youth ball the arm problems would greatly diminish

 

IDK why some are getting so defensive?  

 

IMHO, it was very informative that all should be able to learn from so they can make the best decisions with their children.

I agree but the operative word here is if. 

 

Kids have two problems with their wiring that makes getting them to do what is needed to build up arem stength difficult

 

Most, but not all kids,(and we are talking about kids) find the exercises and bandwork needed to build up arm strength boring.  Just like T drills are boring but essential to a hitters development doing the little things are pulling teeth to a majority of kids.  They can be boring, especially if they do it every day.  There isn't some immediate payoff for all of this work and an 11 year old is very now centered.

 

The other problem is that the average 11 or 12 year old has no concept of injury like most of us old farts.  We have a concept of it because, well be have screwed ourselves up.  We can preach to our kids all day about how 'if you don't do this or don't do that you are going to pull or tear something' but until it happens they have no real concept.  Unfortunately then it is too late. 

 

I could get into more, like the fact that most coaches at the 14U level (and many beyond it) have no idea what a true arm strengthening program is or how parents have no idea of what they should be doing for their kids early on if they want to pitch.  The vast majority of kids at the 14U level don't even pick up a baseball until February or March. 

The problem here is that you all are putting too much emphasis on the arm.  The arm is only one small part of the entire process.  Expose young players to other activities that incorporates the entire body. I agree, they have no idea how to work out properly, but you can teach simple pylo and bandwork and it should not be position specific becase at very early ages they should be playing different positions, as well as other sports.

Skylark you crack me up.   You argue that ml pitchers can't command the change up yet your son will be using it to cut down on overuse?   Why not just pitch to contact and let the  defense take over?
BTW how is recruiting coming along for your son?  Where will sign with a college program or head off to play proball?

Mlb pitchers cant command the changeup. They may be able to control it (throw fir strikes) but generally they cant place their change wherever they want to.

TPM, THERE are counts when a changeup gets desired results and yes that literally translates to lower pitchcounts. You know, we had this conversation years ago about strategy to lower pitch counts. I chose to teach kid the breaking ball and how to command it. 5 years later he leads his hs and legion team in lowest pitch count per inning. He also leads in first strike percentage and leads in percentage of strikes thrown. As far as I know, that is the philosophy to pitching to contact. You want swings, you want them to swing, you just dont want solid contact. Can he improve? You bet and that is why working on the changeup is coming into play.

He is not yet sure where he will play his college ball. Several schools are watching him. Truthfully we havent shopped him around much at all. This summer and fall we will do that.