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Young Arms and Curveballs: A Scientific Twist

slottyslotty500+ posts
The New York Times, March 11, 2012

Young Arms and Curveballs: A Scientific Twist
By BILL PENNINGTON

For decades, it has been an article of faith for parents of young pitchers: Do not let them throw curveballs. The reason was simple. Contorting elbows — all in the service of ever more competitive baseball at ever younger ages — puts more strain on the joint than arms can handle.

But as the research into the biomechanics of pitching has evolved, the debate has grown more robust, and more perplexing. A recent major study shows curveballs pose no greater risk than that of other pitches. And many studies lately have shown that the greatest threat to young arms is not throwing curves but making too many pitches of any kind.

“Science is banging heads with intuition and gut instinct,” said Glenn Fleisig, the research director of the American Sports Medicine Institute, who has conducted studies on breaking balls and young arms since 1996. “For years, we told people that curveballs were bad. Then we set out to prove it. We did not prove curveballs are safe, but we could not prove they were dangerous.”

Like a pitcher and a catcher disagreeing on pitch selection, the opposing sides in the debate could not be more closely allied. Dr. James Andrews, the orthopedic surgeon to many athletes, is a founder of the American Sports Medicine Institute and has written with Fleisig some of the studies that have failed to prove that curveballs are hazardous to young arms. It has not stopped Andrews from challenging the results.

“What we found out in the lab is true,” Andrews said. “For pitchers with proper mechanics, the force of throwing a curveball is no greater than for a fastball. But that’s not what happens in reality on the baseball field. Many kids don’t have proper mechanics or enough neuromuscular control, or they are fatigued when throwing curveballs. Things break down.

“Those are the kids I’m seeing every day in my operating room.”

Little League Baseball imposed strict per-game pitch limits five years ago, but Andrews said he performed about seven times the number of arm operations on young pitchers that he did 15 years ago.

Last year, the findings of a study conducted on more than 1,300 pitchers from 8-year-olds to college students, were released by Little League Baseball, which had commissioned it with USA Baseball. Three University of North Carolina researchers surveyed the pitchers over five years, annually assessing multiple factors: number of innings pitched, kinds of pitches thrown, number of teams played for and any arm pain or injuries experienced. The answers were analyzed to judge which factors influenced injury risk. The test group included 410 Little League pitchers.

“There was no association between throwing curveballs and injuries or even arm pain,” said Johna Mihalik, who wrote the study. “It was surprising in a sense because of the conventional thinking about curveballs, but we were well aware that the studies by Dr. Andrews and Glenn Fleisig had come to similar conclusions. That’s what fueled our study.”

Stephen D. Keener, the president and chief executive of Little League International, said that deliberations among youth baseball leaders about banning, by rule, all breaking pitches had led to the commissioning of the study. When the findings did not link curveballs to injury, he said, Little League felt compelled to maintain the status quo.

“It doesn’t mean we’re advocating throwing breaking balls,” Keener said. “We don’t promote it. We just think it’s very difficult to regulate it out of the game, and there is no data to show that throwing breaking balls is at the root of arm injuries.”

Dr. Timothy Kremchek, an Ohio orthopedic surgeon who is the Cincinnati Reds’ physician and whose practice frequently treats youth pitchers, called Little League’s stance irresponsible.

“They have an obligation to protect these 12-year-old kids and instead, they’re saying, ‘There’s no scientific evidence curveballs cause damage, so go ahead, kids, just keep throwing them,’ ” Kremchek said. “It makes me sick to my stomach to watch the Little League World Series and see 12-year-olds throwing curve after curve. Those of us who have to treat those kids a few years later, we’re pretty sure there is a cause and effect.”

Kremchek said he performed 150 elbow ligament reconstructions a year, a complex operation named after the former major league pitcher Tommy John, who had the surgery when it was developed in the 1970s.

“Seventy percent of those surgeries are pitchers who haven’t hit college yet,” Kremchek said. “I ask each one the same question: when did you start throwing curveballs? And they say: ‘I was 10. I was 11.’ Sometimes, it’s 9.”

Kremchek coaxed about eight Ohio youth leagues to prohibit breaking pitches. The umpire issues a warning the first time he suspects a pitcher has thrown a curveball, slider or other breaking pitch. A second offense means the player must stop pitching.

“The mothers in those leagues are the biggest fans of those rules,” Kremchek said. “It’s not a hard call for the umpires. A 12-year-old trying to throw a breaking ball is pretty demonstrative as he does it. You can tell.”

But Keener said that rule, if enacted by Little League, would be hard to enforce across its more than 7,000 leagues.

“I applaud people for trying to do it,” Keener said. “But we often have volunteer umpires in a Little League trying to make balls-and-strikes calls and basepath calls, and it would be a very hard thing to ask them to also decide if a pitcher intentionally tried to throw a breaking pitch. What if that pitcher just has natural movement on his fastball?”

One aspect of the curveball debate, and the studies it has spawned, that everyone agrees on is that throwing too many pitches of any type is the biggest danger.

As surprised as Mihalik might have been about her study’s findings on curveballs, what alarmed her most was the number of pitches thrown.

“So many were playing for three teams at once,” she said. “And the data was extremely clear that overuse led to injury more than any other factor.”

That, too, is consistent with the findings of more than 15 years of research at the American Sports Medicine Institute, and similar studies around the country.

“Maybe asking whether the curveball is safe is the wrong question,” Fleisig said. “Maybe the question should shift to this: Are you overdoing it? Because there is no question, scientifically or anecdotally, that too much throwing leads to injury, and often it’s serious injury.”

Little League instituted pitch limits based on research conducted by Andrews and Fleisig. This season, the limits are 85 pitches a day for 11- to 12-year-olds and 75 pitches for 9- to 10-year-olds. Rules also mandate days off between pitching appearances. Other recommendations by Andrews, who is on Little League’s board, and Fleisig, who acts as a Little League adviser, include a break of months from overhand throwing and competitive pitching, a 100-inning annual limit, avoiding radar guns and barring pitchers from playing catcher.

In 2007, the first year of the Little League pitch restrictions, Tyler Richards and Kyle Cotcamp logged many innings as their Hamilton, Ohio, team reached the World Series. They also pitched for a travel team.

Two years later, Richards had Tommy John surgery. Kremchek performed the operation, as he did for Cotcamp last year.

“I just pitched way too much,” said Richards, now a high school junior who has resumed pitching.

He added: “I should have just said no. I should have rested my arm.”


http://www.nytimes.com/2012/03...?hpw=&pagewanted=all
Last edited {1}
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RJMRJMHSBaseballWeb member since 2007
What happened to the thread someone started last night on this article?

I hope this article doesn't lead dads and coaches to think it's ok to lean on the curve in youth baseball. The article says IF the curve is thrown properly. As mentioned by Andrews, how many kids have you seen throw a curve properly? Most dads and youth coaches can't teach it properly, most can't recognize proper mechanics of the curve, not can they recognize failing mechanics related to fatigue.

I talked with Glen Fleisig when he started this research. He PM'ed me with his phone number on a youth baseball discussion board. At that time from information I had from a sports orthopedic specialist family friend, I was posting properly thrown curves place less stress on the arm than a fastball due to the deceleration of the arm on a fastball is harder on the arm.

One thing not mentioned in this article that was part of the conversation is the big problem with pitching too frequently is microtears. These are microfractional tears in the arm due to the unnatural motion of pitching. Proper rest naturally heals microtears. Pitching too frequently does not allow them to heal. The tears become cummulative until the pitcher has serious arm problems. The pitcher doesn't know he has an arm problem until it's serious.
Last edited by RJM
JPontiacJPontiac500+ posts
quote:
Originally posted by dad43:
"I wish I had just said no"

If it was that easy for young pitchers...it is really up to the parents to juy sat "no"


When I was younger (probably 13-14) I was having a somewhat rough outing. As I reached pitch 130, the other team's scorekeeper asked our scorekeeper if the same pitcher was out there to throw 130 pitches or if they had missed a pitching change. My dad overheard and got me pulled immediately.

I was so embarrassed and angry that day.

I'm glad he did it. Those games are essentially meaningless, there's no reason to put anyone at risk. The way I see it, most games we play when we're young (even in HS, to some extent) are only good for us in that we're developing as players. There is no reason to risk injury or push through pain in these games, you're only going to cost yourself.
C cabbagedadHSBaseballWeb member since 2011
quote:
Originally posted by RJM:
..The article says IF the curve is thrown properly. As mentioned by Andrews, how many kids have you seen throw a curve properly? Most dads and youth coaches can't teach it properly, most can't recognize proper mechanics of the curve...


1. So, what do you all consider proper mechanics of the curve?

2. With the proliferation of the slider, how does it figure in the conversation?

3. There is also prevailing opinion that many types of CU's can be bad on young arms, i.e. the split. Which and why?

These points are often left out of these discussions, leaving them incomplete or less useful than they otherwise could be.
Last edited by cabbagedad
slottyslotty500+ posts
quote:
Originally posted by RJM:
What happened to the thread someone started last night on this article?
I just found it in "Is it time?"

I realize that the info in the article is not hot-off-the-presses and covers a topic much-discussed here, which is why I just cut and pasted it, without adding any editorial comments.
Last edited by slotty
RJMRJMHSBaseballWeb member since 2007
quote:
Originally posted by cabbagedad:
quote:
Originally posted by RJM:
..The article says IF the curve is thrown properly. As mentioned by Andrews, how many kids have you seen throw a curve properly? Most dads and youth coaches can't teach it properly, most can't recognize proper mechanics of the curve...


1. So, what do you all consider proper mechanics of the curve?

2. With the proliferation of the slider, how does it figure in the conversation?

3. There is also prevailing opinion that many types of CU's can be bad on young arms, i.e. the split. Which and why?

These points are often left out of these discussions, leaving them incomplete or less useful than they otherwise could be.
1) Ah! You're looking for trouble. I'm sorry. I will not participate. One thing I have learned on dicussion boards is when a question like this is asked the questioning person is looking to tear apart every paragraph, sentence, phrase and word that does not meet their satisfaction. I know how to teach the curve. I know what proper mechanics look like. If you don't there are plenty of sites on the web you can learn from.

2) I've never seen young pitchers throwing sliders unless it was the result of poor fastball mechanics. The slider is a nasty pitch on the arm. I've never taught anyone a slider. I would leave it to college pitchers who are more fully physically developed.

3) The only curve I've taught a kid is a 12/6. I never allowed kids to throw curves where they torqued up their arms. It's poor mechanics. Those are usually self taught kids. They experiemented until the ball broke and stuck with it.

I also taught preteens was a knuckle curve or knuckle change. It's an offspeed breaking pitch. It's about the grip and nothing else. It's thrown like a fastball.

From LL through 13U I wanted kids throwing two and four seam fastballs, a change and the knuckle curve if they could control it. The kids threw so few curves it wouldn't harm them if they were doing it wrong. A lot of 13U pitchers, includng my son couldn't throw a curve properly due to the change in pitching distance. My son was 5'2" in 13U.

What kids learned at 14U depended on their physical development. I did want them to learn properly for high school.
MB Mark B100+ posts
I know some might find this hard to believe,but my son who is 15 and a soph doesn't throw a curve. It has nothing to do with me holding him back. He is 6-4, 225 and has just thrown heat and a change. Now that he is always facing older kids would it best to learn a curve, slider or some other pitch to have a third one to throw for strikes? Thanks for input.
TPMTPMHSBaseballweb Member since 2003
quote:
Originally posted by Mark B:
I know some might find this hard to believe,but my son who is 15 and a soph doesn't throw a curve. It has nothing to do with me holding him back. He is 6-4, 225 and has just thrown heat and a change. Now that he is always facing older kids would it best to learn a curve, slider or some other pitch to have a third one to throw for strikes? Thanks for input.


All son threw before 15 was a heater, a 2 seam, CU, before collegem late HS he incorporated a slurve for an out pitch. The reason being that he really had trouble throwing CB and slider properly and I think that is what the whole idea of the article was about, the pitches may not necessarily hurt you, if thrown properly, but how many 14 yo and under can throw with perfect mechanics.

You might want to begin to incorporate another pitch for recruiting, just for show and if he is a starter. JMO.

Kudos for Kemchek for speaking up. For youth pitchers it should be about scientific evidence, but rather what makes common sense.
Last edited by TPM
C cabbagedadHSBaseballWeb member since 2011
quote:
Originally posted by RJM:
You're looking for trouble. I'm sorry. I will not participate. One thing I have learned on dicussion boards is when a question like this is asked the questioning person is looking to tear apart every paragraph, sentence, phrase and word that does not meet their satisfaction.


In this case, that could not be further from the truth. I'm not sure why you think that is where I was going. I hope I haven't put out any such posts.

quote:
Originally posted by RJM:

I know how to teach the curve. I know what proper mechanics look like. If you don't there are plenty of sites on the web you can learn from.


RJM,
I know there are plenty of sites on the web. My intention was to get some of the trusted posters on the site, including yourself, to provide some level of detail that would summarize the correct vs. incorrect way to throw a curve. I was merely trying to get this info posted on this thread, right there next to the related "warning" posts so that our readers have a complete piece of useful info - a problem and a solution as opposed to just a problem.
I believe most of our readers would feel far more confident taking away viable info from our trusted posters than they would trying to wade through the immense amount of garbage info out on the web. That's all. No traps. No hidden agendas.
Last edited by cabbagedad
J HJ H5,000+ posts
When I teach younger pitchers to throw a curveball, I attempt to keep it as simple as possible conceptually (note: I said youngER). I tell them, in layman's terms, "just turn the wrist in so your fingers are on top of the ball and throw it." I shy away from the scientific explanation when explaining it in coaching, but I'll dive into here a bit for the sake of this thread.

"Turning the wrist in" as I explain is called supination in anatomical terms. Supination is similar to walking bowlegged, for those unfamiliar. It is the act of turning the palm outward so that it is facing anteriorly. When throwing a baseball, it is the act of getting the fingers on top of the ball and the thumb behind the ball, in what is general accepted to be a curveball throwing motion. Supinating the forearm naturally eliminates a lot of the causal reactions that can create injurious movements in pitching.

A study was run back in 2009 by a group of doctors in the Elite Sports Medicine unit of the Connecticut Children's Medical Center for the American Journal of Sports Medicine. In this study they analyzed the throwing motion of 33 different adolescent pitchers, who had an average fastball velocity of 65.8 mph and an average curveball velocity of 57.7 mph. In their study, the maximal glenohumeral internal rotation (also known as the shoulder joint...the ball and socket as we most commonly know it), the varus elbow torque (the force that the elbow endures on it during the throwing motion), and the wrist flexor extension were all significantly greater when throwing a fastball than throwing a curveball. The only movement that caused greater force on the arm when throwing a curveball vs. a fastball was the wrist ulnar movement, which theoretically is more structural than acute.

The main point to note in the study was the range of motion figures for the forearm during both pitches. The ROM was 62 degrees for a curveball and 69 degrees for a fastball. That calculation alone is a major determining factor in the concluding hypothesis of the overall study- less torque means less strain. The study read as follows: "The findings based on the kinematic and kinetic data in this study suggest that the rising incidence of shoulder and elbow injuries in pitchers may not be caused by the curveball mechanics. Further evaluation of adolescent and adult baseball pitchers is warranted to help determine and subsequently reduce the risk of injury."

I realize that some of the above terminology can be confusing, so I'll try to break it down in an easier way. The study concluded that the force on the shoulder, the elbow and the muscles in the wrist were substantially less when throwing a curveball than throwing a fastball. I attribute this to the body's inability to externally rotate it's glenohumeral joint as much in supination as it does in an anatomical position. Simply, a pitcher cannot externally rotate his arm back as far when his hand is in curveball position as he can when his hand is in fastball position. That effectively eliminates some of the natural force that is created when throwing a ball, in all aspects of the arm.

I remain skeptical about teaching breaking pitches to younger pitchers because of a very important point that Dr. Andrews brings up in the article, and what Dr. Kremcheck seems to echo. A young pitcher does not have the strength or control of their body to continually repeat the appropriate mechanics of throwing a proper breaking ball. Often times younger pitchers overcompensate in other areas of the throwing motion when they feel fatigued, and the mechanical flaws that are created when doing this simply break down to the point where their throws become dangerous to the health of their arms. And, as Dr. Andrews said, "those are the kids I'm seeing every day in my operating room."

To wrap things up, I don't think the article in the New York Times brought about any type of significant new medical discovery. Most individuals that study the field already knew and understood the information that was presented in the article. What strikes me as interesting, however, is the lack of mention for alternative strengthening programs...ways to prevent the onslaught of injuries from occurring. Reducing the use of curveballs at a young age could potentially decrease the rate of injuries because of the point I echoed from the article above. However, as evidenced by the NY Times article and the study I cited from 2009, there are other significant reasons as to why arms are being hurt at an alarmingly high rate.
Last edited by J H
S Skylark100+ posts
In my years coaching little league and other travel teams I never once was able to link elbow or shoulder pain directly to throwing a curveball. The two worst cases I saw were with kids who didn't even throw breaking balls. The persistent dogmatic assertion that curveballs were dangerous didn't prevent kids from injury as numerous studies have now found. I have known for years the worst thing on the arm is overuse or improper mechanics or the combination of the two.

I know kids who cannot thow more than 2 innings and they have to ice their elbow whereas other kids can pitch a 7 inning game and their arm feels fine. Each kid is different. Each has their own threshold for fatigue and pain. Knowing how to properly condition the arm coupled with the knowledge of what to watch for as a limit is the criticle factor, not if they do or do not throw curveballs. Whats harder on an arm- a twelve year old throwing a curveball with no elbow pain or a pitcher who ices his arm because of pain after playing catcher?
P Primary10+ posts
It may be worth noting that the only arm issues my son ever had were during his 11-year-old season when a coach taught him a spike (or knuckle) curveball to go along with the FB and straight change. A well-respected pitching coach (not saying who) said that the grip forces the muscles on one side of the forearm to tighten while keeping the other side relaxed, pulling unevenly on the elbow joint. It may be the same reason some coaches don't like the cutter.
RJMRJMHSBaseballWeb member since 2007
quote:
Originally posted by Primary:
It may be worth noting that the only arm issues my son ever had were during his 11-year-old season when a coach taught him a spike (or knuckle) curveball to go along with the FB and straight change. A well-respected pitching coach (not saying who) said that the grip forces the muscles on one side of the forearm to tighten while keeping the other side relaxed, pulling unevenly on the elbow joint. It may be the same reason some coaches don't like the cutter.
Your son was taught the pitch incorrectly. The grip should have nothing to do with different forces on the muscles. Also in the preteen years kids should be throwing the fastball predominantly to strengthen their arms. In the preteen years, in most lineups there are about three hitters that deserve more than properly located (up, down, in out) fastballs.
J HJ H5,000+ posts
TPM- Pronation would be a screwball. I throw a circle change and think to myself "throw the thumb at the catcher." That creates a little downward and tailing action, similar to a 2-seam. I've never felt any discomfort throwing either pitch (change or curve...I've tinkered with a slider but not enough to hurt myself, I don't have the arm slot for it) so I don't really know from a personal standpoint. Nonetheless, the fact that there are two STRONGLY distinct camps in this discussion is, IMO, one of the beauties of the game.
J HJ H5,000+ posts
CBMDad- I believe it was a combination of things. The majority of people around me attribute it to overuse, as I threw several times on short rest for 8+ innings. But obviously there could always be other causes to the injury- mechanical imbalance, conditioning, weather, etc. I would say overuse was definitely the main cause of the end result, but I don't like pointing fingers at one thing or one person in particular for anything. And of course, maybe it was just the luck of the draw.
TPMTPMHSBaseballweb Member since 2003
I do believe that many injuries are caused by imbalance in the body. (JH and I have discussed this).

So you take a young player who has a weak core, back, not a fully developed arm mostly due to being physically immature, and put him on the mound and then compound the issue by giving him pitches that are a bit tougher to throw, more innings that he should be throwing than he is physically capable of, not enough rest, etc and you might have opened the door for disaster.

I think the whole idea is about being smart, common sense. So if you are playing the circuit for the summer and getting in lots of playing time why does he need to throw pitches that he hasn't mastered yet and may cause HIM (not necessarily others) harm?

Why do it? It can't wait until he is 14,15?
Bulldog 19Bulldog 195,000+ posts
quote:
The majority of people around me attribute it to overuse,


An ulnar collateral ligament sprain (3rd degree is complete rupture) is by nature an acute injury. A one-time deal. "Pop" and it's gone.

That's not to say that J H didn't hurt it previously, but that really it did not manifest itself until that particular movement that caused the tear.

Fatigue, increased velocity, and technique are the major culprits. Fatigue can obviously destroy technique which can set you up for failure.

And obviously the pain is in the elbow and the damage, but that doesn't mean there was anything wrong with what the elbow did. The kinetic chain including the shoulder, the core, the opposite hip, and the landing leg could be where the problem truly lies and the elbow is just the location that the pain and damage shows up...
RJMRJMHSBaseballWeb member since 2007
The kid from Phenix AL that there was such an uproar about his arm didn't pitch in high school. He was a first baseman. We could make assumptions. But we don't know for sure.

The kid from CA who struck out 18 at the LLWS was a back up catcher in high school.

One of the pitchers from PA in the LLWS is now a D1 pitcher. The stud pitcher from that team didn't play high school ball.

Dante Bichette pitched in the LLWS for FL. He was drafted and signed as a position player.

The small pitcher from MA in the LLWS served up a platter of curves with the attitude he was giving up baseball to focus on hockey after LL. He finished high school holding several scoring records from his conference. In MA that's a big deal. He plays D3 college hockey.
Last edited by RJM
S Skylark100+ posts
The dogmatic tradition continues...

People trying to make the link with youth and curve balls leading to injury is fruitless. The same can be said with trying to make the link with what age they start pitching at and later injury. It's plain and simple in my opinion- injury is caused by "overuse"!

If we can understand what overuse entails it becomes rather quite apparent that curve balls are not what injures the arm. How many youth properly warm up and stretch before throwing hard in a game? Very few. How many youth today throw enough on a frequent basis (not pitching, just throwing to train and condition arm) ? Very few. How many youth quit throwing or tell the coach to have them quit throwing when fatigue starts to set in? Very few. How many youth have very good polished mechanics? Very few. How many youth think elbow and shoulder pain is "normal" after a pitching outing? Quite a lot! How many coaches and parents believe that ibuprofen and ice is the "cure-all" for elbow/shoulder pain? Almost everyone!

The causes of pitching leading to injury is rather obvious in my opinion. Youth are not conditioned properly to pitch as much as they do. They do not warm up and stretch properly. They do not throw enough on off days to condition the arm and body. They have poor mechanics with too much emphasis on the "cookie-cutter" way they should throw and not what comes natural to them (such as arm slot). They believe ice instantly heals pain in the elbow and shoulder. They almost always pitch too much and pitch while fatigued at some point in a game.

I would like to see the correlation between all of that and youth injury.

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