November 9, 2016

Study Shows Connection Between Fastballs & Tommy John Surgery


In baseball’s enduring struggle to understand the root cause of the Tommy John epidemic, there have been many losses and Pyrrhic victories. All that’s missing is an actual answer, leaving teams to digest correlations and presumptions. This month, more data came out that will only further muddy the conventional wisdom about pitching and what causes injuries while doing it.

A study in the Journal of Shoulder and Elbow Surgery found that while raw velocity does not presage future elbow issues, there is a connection between increased fastball usage and eventual Tommy John surgery to repair broken down ulnar collateral ligaments.

“MLB pitchers who pitch a high percentage of fastballs may be at increased risk for UCL injury because pitching a higher percent of fastballs appears to be a risk factor for UCL reconstruction,” the study concludes.

The study leads to another wrinkle to Major League Baseball’s attempt to curb its own problem. While it does not prove any causation, the research does give teams another data point to consider in how to handle its pitchers. And it could shed a light in how teams interpret new information and use it to guide their practices.

No team is potentially more affected by this, in theory, than the Mets. Their pitching staff throws more fastballs than any other. Already, three of its starters have had the surgery early in their careers.

The study found that throwing fastballs more than 48 percent of the time was a “significant predictor” of injury, having studied 83 pitchers over the previous eight years who had Tommy John surgery. This year, 26 starting pitchers are at or above that threshold. Complicating the matter is that the fastball is a bedrock pitch for most pitchers.

But using this study to change pitching habits at the major league level seems to be a non-starter for them or for any team. Especially if the results don’t create a blinking red light that shows a danger.

“On our level, it’s you gotta go out there and get outs and be successful and do the best you can for yourself and for the team,” Jim Henderson, a Mets reliever, said. “Whatever’s working, just continue to do it.”

Instead, studies like these might have more use at lower levels of the sport. Henderson, 33, and in his fourth major league season, isn’t going to change now, but he believes that starting in high school or the minors, something could be done to mitigate the possible damage done to elbows in the future. Dan Warthen, the Mets pitching coach, takes the same approach, saying that pitchers already in the majors will make the pitches they need, while younger hurlers can be better prepared to guard themselves.

That no one new piece of information leads to transformational change is not surprising. There is no succinct clarity so far in the attempt to save pitching elbows. Every team has its own approach and even a study like this one has its own questions. While it adds to the conversation, it does not prove a causation.

Glenn Fleisig, the research director at the American Sports Medicine Institute -- started by famed orthopedic surgeon Dr. James Andrews -- notes that the study doesn’t account for mechanics, or some other factors.

“Previous works by me and others have shown two fastballs of the same speed with poor mechanics are more stressful than good mechanics,” he said. “I think this study by itself is a small part of the puzzle. You also have to look at the pitchers’ mechanics -- which is the purpose of the pitching coaches and biomechanists. So not all fastballs are the same.”

Yet, when new information arises, it’s worth looking into. The Mets, according to assistant general manager John Ricco, will check with their doctors and discuss it internally. Warthen will sometimes confer with Fleisig for outside counsel. They won’t jump at any single study but will evaluate it.

It’s a different process than the Nationals seem to have. Mike Rizzo, their general manager, says the club is more reliant on its own work. He prefers the work done by his analytics staff and by the new medical department installed this offseason -- keeping data enclosed and allowing Washington to track the study from start to finish.

And there is the wait for the long-term study already underway across Major League Baseball, in conjunction with the players association, that began last year and is testing and monitoring minor league pitchers over a five year window in hopes of getting definitive reasons for elbow injuries and its causes.

“It’s going to be an interesting study for a lot of years,” Warthen said. “Everybody’s going to have a philosophy. Everybody’s going to have an idea of what causes Tommy John. I just think the guys are bigger, stronger, faster and we’re seeing high-end velocity all over the league right now.”