A risky business

eam Research
Title: BASEBALL '03 PREVIEW: Fragile: Handle WIth Care / Arms weren’t designed for throwing a baseball

Date: 3/27/2003; Publication: Newsday; Author: Chuck Culpepper

Newsday

03-27-2003

BASEBALL '03 PREVIEW: Fragile: Handle WIth Care / Arms weren’t designed for throwing a baseball

By Chuck Culpepper. STAFF WRITER

ARM STRAINS

A ligament and four muscles went out one night. They ambled into one of the
rougher neighborhoods they could encounter, a maj- or-league pitching mound.
Sufficiently loosened up, feeling pretty good, they’d get used - for the
fleeting glory of championships and the American glory of a yard full of sexy
sports cars and gas-drunk SUVs.

They didn’t much care that people found entertainment and escape and even
stress reduction while viewing this “pitching” business. In fact, they grumbled

  • especially the ligament. Bad enough when somebody uses them to throw a
    baseball on level ground; harder still with precision at 80 to 100 mph and the
    added body-weight force of throwing from a foothill.

Of all the numerous body parts summoned for the coordinated sequence of
motion - the kinetic chain - required for the “art” of pitching, these muscles
and this ligament incurred the most physical risk. In a true case of adding
insult to injury, doctors called them weak links in the body structure.
Sometimes, in the case of the ligament, doctors would just yank them out,
coldly replace them with a tendon, belittle them by saying they resembled
"spaghetti" and toss them away with yesterday’s scrub gloves.

Nice planet.

The human arm endures a particular brand of non-violent trauma when
pitching. It’s a race between damage and recovery, built on the backs of these
four muscles and one ligament as they labor through the evening.

“These guys are paid to abuse their arms, and the guys who can abuse their
arms and recover are the ones who can make a lot of money,” said former
major-league pitcher and pitching coach Tom House.

The ligament hailed from the elbow, a hinge region featuring limited
flexibility. The four muscles hailed from the rotator cuff in the shoulder
area, a ball-and-socket on your body map. They all resembled “pink, squishy
stuff,” in the kindly lucid words of Dr. Glenn Fleisig of the American Sports
Medical Institute in Birmingham, Ala.

They’d come out of this nefarious mound neighborhood covered in
multitudinous tiny tears that show up on medical pictures rather like sunspots

  • dark, angry-looking splotches. Specialists would say they’d endured
    "micro-trauma," which appeased them none; they weren’t much on semantics.

Start in the pitiable elbow, which, for starters, roundly loathes the
innovation called the slider about as much as anybody loathes anything. It’s a
strain to help out with the fastball, yes, and it’s a bear to aid with any
breaking ball because the pitch adds twisting and untwisting to the already
linear push. Some sadist thought up the slider. The slider’s about as welcome
as gout.

So as this ulnar collateral elbow ligament plays ball, you might say it’s
as if somebody’s hitting it repeatedly with a ping hammer - not a sledgehammer,
just with a minor, repetitive thumping.

Granted, it has help from other ligaments, but it’s the ligament
ringleader, the one Tommy John shredded in the early 1970s before he had the
surgery that became known as Tommy John surgery.

At the apex of stress for this chief ligament, the pitcher has turned
toward the batter and has sort of moved forward to deliver the ball. At the
instant the pitcher’s palm faces skyward, the ligament has its most trying job.
Or, wait: Some say it’s during the notorious flyout of the forearm. Whatever,
given that a ligament consists of soft tissue traveling from bone to bone, it
has about two choices in the matter.

It can: A) pull forward like a rope or a string, or B) refuse to pull
forward like a rope or a string.

In which case, it pops.

Because hardly anybody knows much of anything about pitching - especially
the starry-eyed parents of non-voting-age youth-league pitchers - imagine, now,
a chorus across America. To narrate, here’s Mike Marshall, former Dodgers
reliever extraordinaire and four-decade student of this stuff: “I mean, as we
speak, they’re popping like popcorn across the nation.”

When the pop pops, it pops not because of one pitch, but because of a long
accumulation of serial micro-trauma. As it weathers the rather brutish evening,
the elbow ligament typically separates or loosens itself maybe one-eighth to
one-quarter of one inch. The tissue gets bruised and used, nipped and ripped.
It’s torn. It’s stretched. It’s full of minute ruptures. It’s subject to what
they call “subtle bleeding,” as if the subtlety of the bleeding should provide
a whole bale of comfort. Lactic acid holds a little lactic-acid convention in
its midst. It has undergone core-temperature elevation, which sounds a little
like Hades. Seeking sympathy, it has yanked maybe a few fibers away from the
bone. It has become inflamed.

The ligament benefits nada from the rising stock prices of
anti-inflammatory pharmaceutical companies. Take a medical picture, and you’d
find the tears "hotter, of a different color, interspersed, like sunspots,"
House said.

Now, the shoulder typically separates one-quarter to one-half an inch, but
at least we’re dealing mostly with muscles. Muscles enjoy work - at least after
you’ve budged off the couch and started working them.

To imagine the toil of the shoulder, imagine somebody pulling on it, and
pulling on it, and pulling on it, and pulling on it, as if pulling on your
earlobe, all evening long. Or, if you’d like other imagery, try someone putting
their foot in your armpit and trying to pull it out of the socket.

Gently.

In the shoulder, the ball’s larger than the socket, rather like a golf ball
on a tee, so the muscles take charge of the stability issue. In the common
choreography of pitching, to which Marshall, by the way, objects firmly,
there’s this business of rising onto your hind leg like a stork. There’s the
body falling forward while the pitching arm moves backward. The arm pointed
toward second base, the body toward home.

The shoulder merely can sort of pull the arm along. The poor subscapularis
muscle, among the four, particularly dislikes this. Through the game, the trunk
of the body continually requests that the shoulder accept all this energy,
then transfer it to the arm.

The shoulder might scream briefly, but it usually lacks the capacity to
tell the trunk to get lost.

The supraspinatus muscle, at the top of the shoulder, particularly loathes
when the arm moves around sideways, but at least if the usable strength and the
functional strength and the mechanics combine to make some biomechanical
sense, muscles can strengthen from use.

The other two muscles of the rotator cuff, also key to pitchers, are the
teres minor and infraspinatus. The ligaments and muscles of the major leagues,
if they could talk, could tell parents a thing or two. For instance, they know
their major-league pitcher probably didn’t throw breaking balls until well
beyond puberty, because those things ruin a young arm. They know there probably
wasn’t a lot of year-round pitching, none of this youth winter league
business. Took time off, paid attention to pitch counts.

Later, in adulthood, they can tell you if preparation has prevented damage
from a coup d’etat. They might liken a cautious thrower between starts to the
two-drink social drinker who feels no hangover, with the incessant thrower
resembling the eight-drink fool with the banging headache, which in this
metaphor has nothing whatsoever to do with David Wells. Or, like Atlanta’s John
Smoltz, they might posit he’s added mph later in life through the wonders of
surgery, as if that entails any empathy for our poor, downtrodden ligament.

Or, like “The Rookie” of non-fiction movie note, maybe he felt pain the old
way he threw, then found a new way. Or, as Marshall opines after his careful
cogitation, maybe there’s a way to throw that jibes more with the body, that
doesn’t mandate so much pain and rest, that belies the conventional wisdom of
pitching being an “unnatural act.”

Baseball people labeled his whopping 106 appearances during his Cy Young
Award year of 1974 as the stamina of a physical freak; Marshall credits careful
study and adjustment.

Says he feels like Columbus amid the flat-Earth types.

Speaking of explorers, by the time our fab five (one ligament, four
muscles) returns to the dugout from the micro-trauma - all micro-tears and
subtle blood and fiber pulls and lactic acid and sunspots, like some bar fight

  • the gang needs some triage. The pitcher’s arm might throb gently or even feel
    as if it’s glowing. Ice assuages the micro-tears. Some aerobic work flushes
    the lactic acid, which explains why Randy Johnson met reporters on a stationary
    bike this spring training.

They breathe a bit more the day after that, courtesy of aerobic and
anaerobic work, maybe some resistance training. The body imports blood.
Benevolently sends oxygen. Supplies nutrients. Growth hormone visits the areas
with intent to heal.

The day after that, most guys, if they’re wise, undergo more intense
training. This flushes out old junk, brings in new. Clears embattled zones
somewhat. A good number of the micro-tears can recover, becoming more micro.

If a guy doesn’t throw on Day 2, he does on Day 3, but not necessarily from
the wretched mound. The arm nears reasonable healing. A less intense workout
might follow on Day 4, with no mound work and the number of lingering
micro-tears depending on matters such as nutrition and mechanics and prudent
habits.

The next night - or day, in north Chicago - the cruelty resumes, the
pitcher walks out, the crowd cheers, and you can, with certainty, tell the one
about the ligament and the four muscles, how they went out one night.

Oh, no.

Not again.

Inside the Arm

The Rotator Cuff

The rotator cuff is a group of tendons connecting the humerus (upper arm bone)
with the scapula (shoulder blade). It consists of the tendons of four muscles:
supraspinatus, infraspinatus, teres minor and the subscapularis. The tendons of
each muscle fuse together and wrap around the front, back and top of the
shoulder joint. The rotator cuff works to raise and rotate the arm, stabilizing
the shoulder joint. Rotator cuff tears can affect any of the four muscles, but
most commonly the supraspinatus tendon.

The UCL

The ulnar collateral ligament (UCL) is located on the medial side (inside) of
the elbow on the small finger side of the arm. It is composed of three bands:
the anterior, posterior and the transverse. The UCL attaches on one side to the
humerus (upper arm bone) and on the other to a bone in the forearm. The
anterior band of the UCL is the arm’s primary restraint from stress to the
elbow. The largest stresses in the elbow are those forces that cause twisting
and bending of the elbow, such as when throwing a baseball.

Hey Chin,

What’s your point?

I’ll disagree with the author’s original premise that arms aren’t designed for throwing a baseball. It would be better restated that arms aren’t designed for throwing a baseball in the way we currently teach it. In these past three years of discussion that’s been my primary point. Here’s yet another one that backs my point: http://ajs.sagepub.com/cgi/content/abstract/35/1/23

Can anyone read this abstract and think that it doesn’t at least start pointing to the conclusion that mechanical failure due to fatigue and overuse is a myth? The real issue is mechanics and very few seem to understand what actually causes pitching-arm injuries. The mechanics we currently teach is what causes them.

Until we modify mechanics to keep the ball hand from slamming downward and backward while the torso continues to rotate forward we will never stop the UCL and front-of-shoulder injuries. It’s that simple. If you look at the footage of Juan Marichal on this website, tell me what’s different mechanically about how he throws. Guys like this wouldn’t get a look today, yet he’s a Hall of Famer. Some of the clues to eliminating elbow and shoulder injuries are found in his mechanic as opposed to Prior and Gooden.

I’ve been too busy to engage in this for a while and honestly don’t have much time right now. Here’s some evidence that back my statements: my son has now thrown, daily, for over 32 consecutive months. No injury. Just getting stronger and more proficient. And he uses a very different mechanic. I’ll see if I can get him and some others to post a few things here and you can ask them some questions.

–Coach45/Bill

edited to add content

One more thought. There is ZERO documentation, that I can find, describing micro-tears. We don’t biopsy tissue from live athletes. I think this concept is nothing more than a theoretical construct designed to explain something we don’t understand.

[quote=“Coach45”]Hey Chin,

What’s your point?

I’ll disagree with the author’s original premise that arms aren’t designed for throwing a baseball. It would be better restated that arms aren’t designed for throwing a baseball in the way we currently teach it. In these past three years of discussion that’s been my primary point. Here’s yet another one that backs my point: http://ajs.sagepub.com/cgi/content/abstract/35/1/23

Can anyone read this abstract and think that it doesn’t at least start pointing to the conclusion that mechanical failure due to fatigue and overuse is a myth? The real issue is mechanics and very few seem to understand what actually causes pitching-arm injuries. The mechanics we currently teach is what causes them.

Until we modify mechanics to keep the ball hand from slamming downward and backward while the torso continues to rotate forward we will never stop the UCL and front-of-shoulder injuries. It’s that simple. If you look at the footage of Juan Marichal on this website, tell me what’s different mechanically about how he throws. Guys like this wouldn’t get a look today, yet he’s a Hall of Famer. Some of the clues to eliminating elbow and shoulder injuries are found in his mechanic as opposed to Prior and Gooden.

I’ve been too busy to engage in this for a while and honestly don’t have much time right now. Here’s some evidence that back my statements: my son has now thrown, daily, for over 32 consecutive months. No injury. Just getting stronger and more proficient. And he uses a very different mechanic. I’ll see if I can get him and some others to post a few things here and you can ask them some questions.

–Coach45/Bill

edited to add content[/quote]
Im not making any point. I dont need to the articles speak for themselves. Im sharing information that I believe has merit, you obviously dont, thats good too.

Go ahead modify! Just think after people have been throwing objects of one thing or another for 100’s of years you just may be the guy that changes it for the better!!! Good luck and more power to you BUT in the mean time I gotta go with whats out there and what I have seen for the last 45 years.

Beyond that if you do not think that everytime somebody throws a baseball there is inherent risk for injury than go ahead, although history will probably prove you wrong. Mechanics aside people that have pitched extremely long and injuiry free careers are few and far between. Most pitchers have and will suffer some sort of pathologic problem the longer they throw, again history is on my side not yours. Have there been pitchers who have had injury free careers, of course. Is it the norm? Of course not. You obviously think that mechanics are a pitchers saving grace. In SOME CASES you may be right but if you honestly think that this is the correct answer for everything related to pitching or even if mechanics in itself is any more important than every other aspect related to high level pitching, well here we go again… YOUR NUTS…TOO!!! So again go and reinvent the wheel, when YOU get it right Ill be the first in line to buy and guzzle your koolaid. For now I guess Im just going to force myself to believe and learn from what the very best baseball ortho people in the world are saying instead of “coach 45”.

As far as my point, read the articles I personally think the points are pretty well made. In the end pitching a baseball is a risky business with a high potential for injury REGARDLESS of mechanics. If you believe differently thats GREAT by me, could NOT care less does not affect me one way or another. I choose to teach a more rounded approach myself. Where mechanics are a important issue but still only part of the whole deal. Working on mechanics alone endlessly will you get you nowhere faster than it will if you work the total package.

Beyond your question as to a point? IM not trying to make any point. Im sharing some good articles, nothing more. I am however pretty sick of you people claiming mechanics alone are the panacea, thats B.S. and you know it, WHOS MECHANICS??? THats the real question who is your perfect model??? Im gonna guess its MIKE MARSHALL or perhaps his “duped crusader” Chris Oleary, at any rate I dont care. Ill continue to watch what the best in the world are doing and continue to PREPARE the people I come in contact with to be the very best they can be while trying to harness all potenital and NOT get caught up in something that shares a great deal of flexibility and CHANGES from person to person. BY the way is that a fiddle or a violin?? SEE what I mean???

Coach 45,
The effect of microtears has been seen under microscopes many, many times and the cumulative effect has been seen during surgery many, many times.

I know, we didn’t really go to the moon either.

[quote=“CADad”]Coach 45,
The effect of microtears has been seen under microscopes many, many times and the cumulative effect has been seen during surgery many, many times.

I know, we didn’t really go to the moon either.[/quote]

CADad,

I’m a huge fan of the space program. One of my uncles, a Navy carrier pilot, was invited to apply for the astronaut program early on. And another uncle was the lead troubleshooter for SDI. I’m not a conspiracy theory guy.

If you’ve got documentation on micro-tears I’d love to see it. I’ve looked and can’t find any.

Coach45