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Is An Epidemic Among Us?

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Is An Epidemic Upon Us? Too Many Arm Injuries
By Geoff Zahn, Former Major League Pitcher and
Head Baseball Coach, University of Michigan

The last few years as I was doing Color Commentary for College Baseball telecasts, I noticed that many of the college teams we were broadcasting had at least one pitcher out for the year recovering from elbow ulna collateral ligament (UCL) reconstruction, commonly known as Tommy John surgery.  It struck me at the time to be a high level of injuries to young arms.  Recently my observation has been found to be true beyond what I first believed. After just reading an article from the “American Journal of Sports Medicine” titled “A Biomechanical Comparison of Youth Baseball Pitches: Is the Curveball potentially Harmful?” (1)  I was shocked by the increasing numbers of UCL reconstruction surgeries that the senior author of this study, Dr. James R Andrews, was doing, especially on High School pitchers. “In our own experience, the senior author (J.R.A,) reconstructed the UCLs of 119 pitchers between 1995 and 1998, 354 pitchers between 1999 and 2002, and 619 pitchers between 2003 and 2006.  Besides the increase of total surgeries during these  3

consecutive 4-year periods, there has been an alarming increase in the number (percentage) of surgeries on high school pitchers-from 9 (8%) to 61 (17%) to 201 (24%).” (1) The conclusions and clinical relevance of this study of the curveball did not surprise me.  The findings were that the fastball, not the curve ball put heavier shoulder and elbow loads on the throwing arm and that “the curveball may not be more potentially harmful than the fastball for youth pitchers”.  They then related, “This finding is consistent with recent epidemiologic research indicating that amount of pitching (emphasis added) is a stronger risk factor than type of pitches thrown.”  (1) In the three time periods mentioned spanning twelve years, there was a six-fold increase, from 119 to 619 in total UCL reconstruction surgeries, and a twenty-fold increase from 9 to 201, in high school pitchers’ UCL surgeries over that same time span.  In addition, I sense an increase in the number of Labrum tears in the throwing shoulders of younger pitchers where that injury seemed to be reserved for older pitchers who had pitched for a period of time.  There is no doubt that advances in surgical technique and the shorter times of recovery have caused more pitchers to get injuries surgically repaired and to continue to pitch.  In the past when arms would break down, pitchers would be more prone to stop pitching altogether.  Now great advances in the medical field allow many pitchers to come back from what used to be career ending injuries. What makes analysis of UCL injuries and Labrum injuries difficult is that they generally appear over time and don’t cause debilitation all at once.  My fear is that college or pro pitchers that develop these injuries actually came to college or pro ball with the problem of a frayed UCL or torn Labrum that was initiated years before.  Regardless, pitchers’ arm injuries are on the rise, and all involved in the game need to take heed and work to head off this potential epidemic.

In the last fifteen years, I believe there are new potential risk factors to look at that may be contributing to arm injuries.  At the same time, there have been many steps taken to try to limit injuries to young pitchers.  Some of those positive steps are the advent of pitch counts, research which has given a clearer picture of proper mechanics, advanced conditioning programs available at schools and sports academies and accessible over the internet, and in general, more awareness by parents and coaches of the dangers to the arm.

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