Monday, April 14, 2014

Dr James Andrews and the Epidemic of Torn UCL's

   Dr James Andrews was a guest on Sirius XM radio's "Power Alley" yesterday, discussing the supposed glut of torn UCL elbow ligaments that major and minor league baseball has seen over the past several seasons.
   It was an interesting interview from one of the pioneers of the procedure, to say the least. You can read our summary of the conversation, or listen to the link at the end of the article.

   Tampa's Matt Moore is the latest pitcher facing the prospect of Tommy John surgery to repair the damaged ligament.  In the last month, the Braves lost starters Kris Medlin and Brandon Beachy and reliever Cory Gearrin to the procedure.  Oakland ace Jarrod Parker, Arizona's Patrick Corbin, and Detroit's Bruce Rondon have also undergone the surgery in the past year.
   19 pitchers had the surgery last season, including All Star game starter Matt Harvey of the Mets, who also just lost closer Bobby Parnell to it as well. Top prospect Dylan Bundy of the Orioles is in rehab after having surgery last year, and the Pirates just lost their top pitching prospect Jameson Taillon to a torn UCL last week.
   On the Blue Jays front, top prospect Roberto Osuna is currently rehabbing from the operation, and is expected back late in August at the earliest. In 2012, Kyle Drabek (for the second time), Drew Hutchison, and Luis Perez all blew out their elbows and had the surgery, as did minor league catcher A.J. Jimenez.  Other minor league pitchers in the organization who have had a TJ performed recently include Johnny Anderson, Scott Copeland (twice), and Danny Barnes.
   So, what does Andrews attribute this rash of injuries to?
  He doesn't consider this rash of injuries an anomaly, but as part of a larger trend.
In the interview, he claimed that the most frequent visitors to his office of late are high school players, especially those who top 85 on the radar gun.  The developing ligaments and tendons of a young pitcher just can't stand up to that kind of stress.  On top of that, with more and more American high schoolers playing ball year round and in multiple leagues, there isn't sufficient time for rest and recovery from pitching, which, as we detailed in an eariler post, is an unnatural act.  He also cites poor mechanics among young pitchers (the risk of UCL injury drops starting at about age 23, depending on the individual) as another factor.
   Andrews also says that he doesn't believe that there is a miracle cure for the injury,  but he feels that it can be limited by having high school pitchers throw less, and by developing more effective treatments for the injury.  Andrews has started adding stem cell therapy during the procedure, which helps enhance the pitcher's healing.  Trouble is, it's hard to study its effectiveness, because most pitchers who undergo TJ want it, and no one wants to be in the control group.
   Andrews did acknowledge that there is some hope for Platelet-Rich Plasma therapy, which we also researched and wrote about here,  as a means of rehabbing the injury and avoiding surgery, but not enough study has been done to determine its efficacy.
   Interestingly the Sirius XM hosts didn't ask Andrews his opinion about the weighted ball program, which many teams, including the Blue Jays, have implemented throughout their organizations.  Thus far, the program, which was originally developed to strengthen the shoulder, lessening stress on the UCL, has had good reviews, but it tends to be lauded more for its velocity increasing than for its injury prevention.  Clearly, more research and study are needed - if researchers can find a sizeable enough control group.
   Our belief is similar to Andrews: given the stakes involved for highly touted high school pitchers, UCL injuries almost seem inevitable. The young arm can't take the abuse that pitching year round with a radar gun in mind involves.  It's a matter of human physiology.  Thus, major league teams are often drafting damaged goods without knowing it.  About all a club can do with a high school draftee is to minor his pitch counts religiously, and refine a prospect's mechanics to minimize the risk to the elbow.  Pitchers need to have strong core and lower body musculature in order to further reduce the exposure of that elbow joint, as well as good flexibility, and the athleticism to consistently repeat a proper delivery.  It's not just the arm that throws the ball - it's the lower body and core that create the buildup of potential energy that allows the body to propel the arm forward.  Some think that a certain body type creates the ideal pitcher - the long, lean, athletic type.  The Rays and the Jays have focussed on drafting and developing those type of pitchers, although the Rays top pitching prospect,  Taylor Guerrieri had TJ surgery last July.  And when you think of successful pitchers from the past, Roger Clemens doesn't fit the lean part, and Pedro Martinez wasn't exactly long.
   As we have discussed before, if we ran a minor league system, we would make core and lower body work part of a daily regimen for all pitchers at all levels, as well as work to strengthen the shoulders. Come draft day, we would try to factor in the workload pitchers we were considering have undergone. We would also adhere to guidelines like the Cubs', who won't allow a pitcher who has thrown at least 25 pitches in an outing to throw again for the following 24 hours, with longer enforced rest periods for higher pitch counts.  The Blue Jays, wisely, removed Alberto Tirado from his last start after throwing 33 pitches in the first inning, likely to protect his arm.
   This doesn't address the fact that UCL damage is cumulative, and much of it seems to be done before a young pitcher even graduates from high school.  MLB needs to research this issue further, and educate kids, parents, and youth baseball organizations that more has to be done to protect these developing athletes.  Maybe radar guns only get used for high school seniors, and leagues need to co-ordinate and share information about their athletes, as more and more are doing in the case of concussions in other sports. Parents should be warned about the risks of high pitch counts, the radar gun, and the need for adequate rest for their kids. Granted, as long as pro contracts and college scholarships are at stake, this will be hard to do, but in the case of MLB, it should be viewed as protecting a long term investment.

Dr Andrews interview can be heard here
Our earlier post about minor league pitcher abuse points can be found here.
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