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TJ article on ESPN.com

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#1 Heezy1323

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Posted 25 April 2014 - 01:26 PM

I'm certainly not a frequent poster on TD, but really enjoy the site/commentary/etc. There was a nice article today on ESPN.com that many have likely already seen regarding the incidence of Tommy John surgery this year. I thought it had a nice discussion of factors that come in to play and the current research in the area. There had been some discussion in the forums previously regarding this topic and I thought others may find the article interesting as well.

http://espn.go.com/m...y-john-epidemic

#2 tobi0040

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Posted 25 April 2014 - 01:35 PM

I'm certainly not a frequent poster on TD, but really enjoy the site/commentary/etc. There was a nice article today on ESPN.com that many have likely already seen regarding the incidence of Tommy John surgery this year. I thought it had a nice discussion of factors that come in to play and the current research in the area. There had been some discussion in the forums previously regarding this topic and I thought others may find the article interesting as well.

http://espn.go.com/m...y-john-epidemic


I enjoyed the article as well. I wish someone would publish some data on how much more a pitcher today pitched in youth/threw breaking balls versus pitchers 10 or 20 years ago. I think they are on to something, but it would be nice to have some data.

#3 Heezy1323

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Posted 25 April 2014 - 01:56 PM

I enjoyed the article as well. I wish someone would publish some data on how much more a pitcher today pitched in youth/threw breaking balls versus pitchers 10 or 20 years ago. I think they are on to something, but it would be nice to have some data.


I agree 100%- that would be extremely valuable research. Unfortunately it is almost impossible to do... (this idea is similar to an idea for a project I was working on that I just wasn't able to get off the ground). 10-20 years ago very few people were paying attention to pitch counts (even less to the type of pitch). Today, most youth leagues have pitch counts, but few if any keep track of type of pitch. I think one difference is that years ago pitchers were more likely to throw more pitches in an outing (importance of pitch counts was not as well understood) but also less likely to play year-round baseball. It would be difficult to get an 'apples-to-apples' comparison. During my time with Dr. A, about 35% of the TJ's we did were on high schoolers. Crazy.

#4 Hosken Bombo Disco

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Posted 25 April 2014 - 02:14 PM

Kids were discouraged from throwing sidearm or three quarters, as that was bad for your arm. Had to be overhead. It was established fact that curveballs were bad for your arm. Four out of five doctors recommended Lucky Strikes at one point, too.

I don't know what's being taught today as far as pitching mechanics but I'd love to find out if anything is. Hopefully the kids just throw however it feels natural and do it in moderation.

#5 blairpaul715

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Posted 25 April 2014 - 02:14 PM

Sorry, I didn't read article, but my take is that, weighlifting puts more strain on arm(shoulder and elbow)........people don't throw anymore today than yrs ago, actually less IMO.........and in my day(im 50) kids threw curveballs and everything else. Guys 30 yrs ago or 40, were starting 45 games a yr, throwing 300 plus innings......altho most didn't throw more than low 90's, today you pretty much have to throw at least low 90's, but most of that can be attributed to strength thru weighlifting and other exercise routines.

#6 blairpaul715

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Posted 25 April 2014 - 02:17 PM

The ironic thing to what I just said is, that Tommy John certainly didn't look the part of a strong athlete, but IMO it isn't all because of weightlifting, just the weightlifting is a major contributor.

#7 Heezy1323

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Posted 25 April 2014 - 02:24 PM

I don't think it is the weightlifting specifically, but the fact that all the weightlifting makes you stronger- allowing you to throw harder which places more stress on the elbow/shoulder. There is pretty good data that fastballs place the most stress on the elbow, followed closely by sliders. I agree that pitchers probably throw less today than years ago. This is where the idea of a cumulative effect of throwing comes from. Nolan Ryan wasn't pitching 12 months a year on 4 different teams as a youngster.

#8 Lefty74

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Posted 25 April 2014 - 03:58 PM

I don't think it is the weightlifting specifically, but the fact that all the weightlifting makes you stronger- allowing you to throw harder which places more stress on the elbow/shoulder. There is pretty good data that fastballs place the most stress on the elbow, followed closely by sliders. I agree that pitchers probably throw less today than years ago. This is where the idea of a cumulative effect of throwing comes from. Nolan Ryan wasn't pitching 12 months a year on 4 different teams as a youngster.


I agree with your comments about weightlifting. We have a son pitching in college and the training they do is incredible. He's gained 25 lbs in 1.5 years and most of it is due to pitching specific lifting. They do not focus on heavy lifting, but rather improving their explosiveness. This leads to the additional strain and as stated in the SI article, you never know when something is going to give. The pitchers or yesteryear were, for the most part, not allowed to do any sort of lifting.

#9 Taildragger8791

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Posted 25 April 2014 - 04:21 PM

It feels like the injury rates nowadays are so high that without TJ surgery we wouldn't even have any elite pitchers left. It's almost a rite of passage that a pitcher will have it at some point, especially the power guys with wicked breaking balls. I'm sure that's not really the case, but that's definitely the sense I get watching top-tier pitchers go down year after year.

#10 Thrylos

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Posted 25 April 2014 - 05:08 PM

Hate to say this, but this article is a prime example of making a hypothesis based on incomplete data and then look for root causes, but when you really look at the data, the big picture is different. What do I mean? Here is the data (from that writeup) that they use to formulate their hypothesis (actually more like a thesis, since they are presenting it as a fact.)

Tommy John surgeries by year (MLB players only)
2014 - 16*
2013 - 19
2012 - 36
2011 - 18
2010 - 16
2009 - 19
2008 - 18
2007 - 20
2006 - 18
2005 - 16
2004 - 12
2003 - 15
2002 - 13
2001 - 12
2000 - 13
Source: Baseballheatmaps.com
*Yankees RHP Ivan Nova and Rangers LHP Pedro Figueroa are scheduled to have surgery


The problem with this is that a. they are not normalized (i.e. 16 surgeries over 100 total pitchers is much bigger percentage than 30 over 1000) and not normal data in an epidemiology study (because this is what this is trying to be) is not acceptable and b. the sample size is not noted (related issue.)

Here is the normalized data: (The first column is theirs, then the total number of MLB pitchers each season and then the % of MLB pitchers that season who had TJ surgery)

2014 - 16* (437 total pitchers = 3.7%)
2013 - 19 (679 total = 3.0%)
2012 - 36 (662 total = 5.4%)
2011 - 18 (662 total = 2.7%)
2010 - 16 (635 total = 2.5%)
2009 - 19 (664 total = 2.8%)
2008 - 18 (651 total = 2.8%)
2007 - 20 (666 total = 3.0%)
2006 - 18 (635 total = 2.8%)
2005 - 16 (606 total = 2.6%)
2004 - 12 (632 total = 1.9%)
2003 - 15 (612 total = 2.5%)
2002 - 13 (609 total = 2.1%)
2001 - 12 (591 total = 2.0%)
2000 - 13 (606 total = 2.1%)

If you ignore a couple of outliers and the incomplete this season that pushes down the total n (that are not significant anyways based on the sample size of 600-650,) the TJ incident has been around 2.5% +/- 0.5%.

I'd love it if I were able to make a serious business case for a 0.5% deviation over a sample of 650 ;)
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#11 biggentleben

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Posted 27 April 2014 - 08:21 PM

I would never support purely blaming weightlifting. A big part of it is in general that baseball trainers believe that they cannot learn anything from any other sport, for some reason. Greg Shepherd called baseball the "last frontier of common sense weight training" 15 years ago, and I've not experienced or heard anything that has shown change in that. Oblique injuries are a lot more common now, and a lot of that has to do with improper focus on specific training rather than whole body training. Heck, the power in a swing or pitch is primarily from the bottom of the butt to the bottom of the rib cage, but look at the guys who seem to hit the weights at the professional level - they focus completely on their arms, chest, and shoulders.

I would put a few key factors into why we "see" more TJ surgery: 1) Incredibly more media coverage and interest in fantasy baseball leading to a lot more knowledge about the surgeries. Thrylos' numbers show that while the numbers are higher the last three seasons, they're not drastically higher than 15 years ago. 2) Increased focus on velocity. A guy who tops out at 90mph is seen as a "soft-tosser" in the modern game. It's interesting to consider whether Jamie Moyer would have ever gotten a chance in the modern game at all, let alone until he was old enough to get AARP mailings. Focus on velocity has reduced the focus on proper mechanics and training as long as the arm can generate high-end velocity. 3) Increased utilization of breaking pitches and overall pitch counts at a young age. A pitcher on an American Legion team when I was that age would pitch roughly 15-20 games if he was really good in the course of a summer. Now there is high school, traveling games, showcase events, etc. One anonymous pitcher in a recent draft estimated that his total pitches thrown (he was a 4-year college pitcher) was in the range of 30,000 pitches in his lifetime to that point with roughly 10,000 of those being non-fastballs. The pitcher was cited as a control and command fastball/changeup pitcher in the podcast I heard on these numbers, so his non-fastball count was likely quite low compared to many other pitchers.

I don't see this reversing as most people don't really see an issue here. They want the 95 mph throwing starter with three offspead/breaking pitches as well, and it's hard to see with current baseball training that focus on heavy early workload and focus on velocity would lead to any change in arm health for pitchers.
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#12 Sconnie

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Posted 27 April 2014 - 09:12 PM

I'm certainly not a frequent poster on TD, but really enjoy the site/commentary/etc. There was a nice article today on ESPN.com that many have likely already seen regarding the incidence of Tommy John surgery this year. I thought it had a nice discussion of factors that come in to play and the current research in the area. There had been some discussion in the forums previously regarding this topic and I thought others may find the article interesting as well.

http://espn.go.com/m...y-john-epidemic

Good discussion fodder, thanks Heezy. Keep it up.
The discussion has been interesting, but sample size jumps out at me. Tommy John surgery is frequently administered as a treatment for repetitive motion related injury, correct? The ligament ruptures as a result of repetitive motion. How many pitches as the pitcher thrown in their career? It could be entirely plausible that the ligament has a half-life and the "epidemic" is coincidental.

#13 a-wan

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Posted 29 April 2014 - 02:13 AM

The decrease in the, "Just rub some dirt on it" mentality, the increased use of MRI, the increased use of specialists such as Dr. Andrews and the increased awareness of injuries are just a few reasons why surgeries maybe more frequent. Or maybe the MMR vaccine. It causes autism, right Jenny McCarthy?

#14 BigTrane

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Posted 30 April 2014 - 01:02 PM

Hate to say this, but this article is a prime example of making a hypothesis based on incomplete data and then look for root causes, but when you really look at the data, the big picture is different. What do I mean? Here is the data (from that writeup) that they use to formulate their hypothesis (actually more like a thesis, since they are presenting it as a fact.)


You clearly have a command of numbers- I do not- so here's an interesting question:
What is/was the % of free agents to go down with TJ? % before throwing a pitch for their new clubs?

Media is always suspect #1, but they are just competing with money to drive a storyline.
Imho- love to see the real numbers.
Feel free to pile on about Suzuki.

#15 Heezy1323

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Posted 30 April 2014 - 01:21 PM

I would never support purely blaming weightlifting. A big part of it is in general that baseball trainers believe that they cannot learn anything from any other sport, for some reason. Greg Shepherd called baseball the "last frontier of common sense weight training" 15 years ago, and I've not experienced or heard anything that has shown change in that. Oblique injuries are a lot more common now, and a lot of that has to do with improper focus on specific training rather than whole body training. Heck, the power in a swing or pitch is primarily from the bottom of the butt to the bottom of the rib cage, but look at the guys who seem to hit the weights at the professional level - they focus completely on their arms, chest, and shoulders.

I would put a few key factors into why we "see" more TJ surgery: 1) Incredibly more media coverage and interest in fantasy baseball leading to a lot more knowledge about the surgeries. Thrylos' numbers show that while the numbers are higher the last three seasons, they're not drastically higher than 15 years ago. 2) Increased focus on velocity. A guy who tops out at 90mph is seen as a "soft-tosser" in the modern game. It's interesting to consider whether Jamie Moyer would have ever gotten a chance in the modern game at all, let alone until he was old enough to get AARP mailings. Focus on velocity has reduced the focus on proper mechanics and training as long as the arm can generate high-end velocity. 3) Increased utilization of breaking pitches and overall pitch counts at a young age. A pitcher on an American Legion team when I was that age would pitch roughly 15-20 games if he was really good in the course of a summer. Now there is high school, traveling games, showcase events, etc. One anonymous pitcher in a recent draft estimated that his total pitches thrown (he was a 4-year college pitcher) was in the range of 30,000 pitches in his lifetime to that point with roughly 10,000 of those being non-fastballs. The pitcher was cited as a control and command fastball/changeup pitcher in the podcast I heard on these numbers, so his non-fastball count was likely quite low compared to many other pitchers.

I don't see this reversing as most people don't really see an issue here. They want the 95 mph throwing starter with three offspead/breaking pitches as well, and it's hard to see with current baseball training that focus on heavy early workload and focus on velocity would lead to any change in arm health for pitchers.



Couldn't agree more. Certainly there is more awareness about the injury now than 10-15 years ago- which I think is mostly a good thing. The focus on velocity is also a big one. When I see these kids with throwing injuries I ask them how hard they throw- and they ALWAYS know exactly. From a data standpoint, there is still debate about breaking pitches contributing to injury, but I think it's likely it has some importance. Overall, I think as athletes have gotten bigger/stronger over the years, these injuries are some of the side-effects. The increase in number of 'hard throwers' (however you want to define it) has been well documented. And we also know that when pitchers reach about 90 mph the amount of force placed on the UCL nears the tensile strength of the ligament. Add it all up and you get more injuries.

#16 Heezy1323

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Posted 30 April 2014 - 01:32 PM

Good discussion fodder, thanks Heezy. Keep it up.
The discussion has been interesting, but sample size jumps out at me. Tommy John surgery is frequently administered as a treatment for repetitive motion related injury, correct? The ligament ruptures as a result of repetitive motion. How many pitches as the pitcher thrown in their career? It could be entirely plausible that the ligament has a half-life and the "epidemic" is coincidental.


I don't have exact numbers, but my intuition is that you are correct. The hard part is going from 'excellent theory' to 'data-driven fact'. The example I use with patients is a paper clip. If you straighten out a paper clip and bend it back and forth 50 times, it will eventually break, right? Well, was it the 50th bend that did it? Or was it the combination of all the bends leading up to (and including) the 50th bend that did it?
I would say about 40% or so of UCL injured pitchers have an acute 'pop' and the rest have a more vague onset of elbow pain with throwing without a specific injury. The hard part is that even those that have a 'pop' probably didn't have a completely normal ligament one pitch and completely torn the next. It's proving that concept with specific data that is difficult.