Not much elaboration is needed when discussing the widespread baseball phenomenon we call the Tommy John Epidemic. With the rates of Tommy John Surgeries in Major & Minor League Baseball spiking in 2015, and the current media spotlight on pitching injuries (including a highly-acclaimed investigative book looking into the “Billion-dollar industry that is pitching”) the emphasis placed on attempting to remedy the state of arm health today cannot be understated.

Unfortunately, it does not seem that anyone quite has a legitimate answer for the question of how to solve this problem. We’ve seen pitch counts and inning-limits developed at both the professional and amateur levels. We’ve also seen a growing stance by sports-medicine professionals condemning early-specialization and year-round pitching/baseball. Despite this shift toward restrictions and education, it seems that Tommy John surgeries – and upper extremity injuries in general – are swelling in the face of most medical professionals, both in the amateur and professional ranks.

Surely, it may take 5-10 years before we see these precautions and paradigm shifts in education manifest themselves as reduced injury rates, as the cessation of overuse and early-specialization won’t lead to acute changes in injury, but chronic changes as the athletes grow older and progress through their careers.

But, what if there is no change 5-10 years from now? What if we are wrong? Or, I should say, what if we are partly wrong? For that reason, combined with the fact that we don’t have a whole lot to go off of in terms of mitigating risk factors, I feel that the devil’s advocate stance should at least be considered, and question must be asked – are we nearing our physical limits for the throwing velocity of a 5 oz baseball?

Before I continue, let me be very clear (or as clear as I can be given how little we actually know) about my stance on Tommy John, overuse, etc… Put briefly, I believe that:

• The health of the pitcher’s arm, elbow, and upper extremities is dependent on innumerable factors, including (but not limited to) chronic stress, acute trauma, accumulation of innings, lack of recovery, physical preparation, mechanics, etc. To place blame on any one or couple of factors for the rise of Tommy John would be completely underestimating the complexity of the topic.
•  With the above being said, I believe that overuse at a young age, in conjunction with the high rate of specialization in baseball, may be causing structural changes to the elbow and upper extremities that lend themselves to an increased risk of upper extremity injury down the road. Although this isn’t the only culprit, I personally believe it is one of the prevailing factors.

Many have argued that the extreme overuse of our youth arms is the only factor that has “changed” in the last 20 years or so, thus this must be the exact reason for the current epidemic. But, this is where I’d argue that velocity too has changed.

Understand that, while there was no travel baseball 100 years ago for the 20th century children to play year-round, there was still a lot of baseball being played. But, pitching was different back then. The job of the pitcher in the early 1900’s was to deliver a hittable ball to the batter. In fact, in the dead ball era, the batter told the pitcher where he wanted the ball. Mechanics were different, velocities were lower. Even as time progressed into the modern era, velocities still weren’t what they are today.

In fact, even in recent years the average velocity of the Major League fastball has crept up steadily. Just this week Aroldis Chapman tied the record for the fastest pitch ever recorded during the “Statcast Era” at 105.1 mph … 3 times!

Not to mention the velocity at younger ages. Observationally, it seems as though these are sky-rocketing. I know that when I was in high school, some 8-10 years ago, hearing that a pitcher threw 95-100 mph seemed more like a mythical tale or hyperbole. Today, high-grade radar guns (often times hundreds of them honing in on a select pitcher at a showcase event) read 95-100mph more often than we ever thought was possible for amateur athletes. Stephen Strasburg’s 100 mph (collegiate) fastball was once-in-a-generation in 2009. In 2016, 100 mph doesn’t even guarantee the first overall pick for a pitcher.

World renowned orthopedic surgeon Dr. James Andrews and the ASMI have called 85 mph the “red line” for amateur pitchers, where throwing with greater velocity than that will lead to an increased likelihood of elbow injury. This makes velocity out to be a double-edged sword. Great for getting batters out, great for getting paid, potentially bad for arm health and longevity.

What can we attribute this statistically proven rise in professional velocity, and observationally seen increase in amateur velocity? The first reason is heavily tethered to other factors that are theorized to contribute to the risk of upper extremity injury – overuse and specialization. Both of these factors contribute to anatomical and physiological adaptations that can increase throwing velocity (such as humeral retroversion), as well as mechanical proficiencies that can do the same. In other words, the earlier and more you pitch, the better you can possibly become (and more likely you are to experience chronic injury. Again, double-edged sword).

The other reason, though, is where I will play devil’s advocate. The goals of a strength and conditioning professional are injury reduction and performance enhancement. We strive to make the body resilient to the stresses occurred during sport, but also to enhance the body’s ability to produce greater force at higher rates of speed more efficiently. In this way, strength training can help improve performance by helping the athlete express the greatest amount of power capable of the body, through the most efficient ranges of motions and movement quality possible.

But, what if this is part of the problem – part of the reason for the epidemic? Where once strength training was taboo for even professional pitchers, it is now a vital part of the process for big leaguers and high schoolers alike. Thus, the athletes are stronger and more powerful, and oftentimes at younger ages they are expressing these qualities in the form of highly-efficient mechanics and big-money radar gun readings.

As the epidemic worsens, it is the norm for most strength & conditioning professionals (myself included at times) to counter overuse (at least philosophically) with greater physical preparation. We want to prevent injury, right? So, we must train harder – working to move better and more efficiently.

It’s moving better, more efficiently, and more powerfully that also leads to higher performance. Without any scientific literature at my fingertips now, I wonder if, although we have (for example) improved trunk and shoulder stability, optimized kinetic chain sequencing, and improved leg strength and power all in the name of efficient and safer movement, maybe this isn’t all good. In other words, maybe safer and more efficient movement with enhanced/amplified performance outputs is still more stressful on the upper extremity than slightly less efficient and “less safe” mechanics with lower outputs.

A crude example would be to think of a kid who has what we deem “inefficient” mechanics and throws the ball at a max velocity of 72 mph. Meanwhile, a kid of the same age with more precise/acceptable mechanics throws the ball at 85 mph. With all else being equal, is the 72 mph going to place enough stress on the arm to cause significant damage with sub-par mechanics, as compared to a higher velocity arm with above-average mechanics? I’ll leave that up to a biomechanist to examine in a lab setting, but it is an interesting question to ask nonetheless.

One last example to clarify my thoughts:

Think about the difference between a street-legal car that is all tuned-up (for example, a Honda Civic) versus a NASCAR race car.

While the Honda Civic you just tuned up may be faster than most cars, and you tuned it up yourself in your garage (not exactly professional grade), you may not need to take care of it too often to maintain its amateur “racing” ability. As long as you get it’s oil changed, it is going to run for a long time. On the other hand, consider a NASCAR vehicle. It is professionally manufactured and professionally maintained, yet it still requires constant tune-ups and fixes. Driving at speeds nearly double what your Civic could reach, tons of stress is placed on the car. In fact, NASCAR engines, which are already expensive and complex, are oftentimes used at their near-limits for a whole race, and thus must be broken down and rebuilt at the conclusion of the race, if they don’t blowout during the race itself.

While the Civic may not have been professionally built or tuned like the NASCAR, it still may last 250,000 miles because it isn’t pushed to its limited often. The NASCAR, on the other hand, is pushed to its brink all race long, thus even its professionally designed and installed engine and components need to be repaired and replaced frequently, and often they completely break down on their own during performance.

Now think of the less-trained, raw, and moderately utilized pitcher as the Civic, and the high-performance, elite, machine-of-a-pitcher as a NASCAR.

The high performance pitcher has been training for years, has efficient mechanics, and throws hard. He strength trains to get the most out of his muscles, he throws weighted baseballs to get the most out of his arm and to dial in his arm action, and works with a top-notch pitching coach who utilizes high-speed video to help develop the most effective and efficient mechanics possible for that athlete. While this leads to increased performance outcomes (high velocities), could it also in turn create a more stressful impulse for the upper extremity overall?

The paradox of pitching, of course, is that what makes for an elite pitcher often makes for a higher risk of injury. If you don’t want to get hurt, don’t throw hard and don’t throw often – but also don’t expect to be a great pitcher either.

***

Am I saying that strength and conditioning is actually bad for the throwing arm? Of course not. I am a strength and conditioning coach after all. But, the question that I am begging is this:

Of course we (myself included) are all fairly convinced that overuse and specialization are a major part of the problem, but by enhancing performance and efficiency of movement, could we also be pushing toward the physical limit of our own capabilities?

Ultimately, this is all just conjecture; talking points built around observations. So, before you burn me and my “ideas”, know that these aren’t my ideas at all. Rather, just another way to look at and discuss the current state of pitching and arm health.

Respectfully,

RJF