Elbow injuries continue to skyrocket among elite pitchers

2015-04-11 08:20:17 by Dr. Joe Congeni - Director of Sports Medicine, as posted on the inside.akronchildrens.org blog.

CC Flickr/Glenn Simmons CC Flickr/Glenn Simmons

With baseball buzz afoot as we anxiously awaited the Indians' home opener, there was much discussion about the increasing numbers of UCL injuries, or elbow injuries, in MLB star pitchers.

Last year, Major League Baseball reported 12 ulnar collateral tears in March alone and a total of 30 for the season. And, already this spring, we have 7 more UCL tears, including Cy Young candidates Yu Darvish and Zack Wheeler.

Many of these injuries lead to Tommy John surgery, which takes players off the field for a whopping 12 to 18 months.

Today, I spoke with 1590 WAKR morning show host Ray Horner about this injury and potential causes. Despite our efforts to try to reduce injuries through prevention education and preseason rehab programs, the numbers continue to skyrocket.

Below is an audio file and transcript of our discussion.



HORNER: Joining us live right now, Dr. Joe Congeni, Sports Medicine Center at Akron Children's Hospital. kind enough to join us on Wednesdays at this time. Joe, what do you have on your list today?

DR. CONGENI: Well, Ray, I know you're a baseball guy and ...

HORNER: Yep.

DR. CONGENI: ... a real problem, an issue ... we just can't figure out is what is it about this UCL injury, this elbow injury, that leads to the need for Tommy John surgery?

I mean ... I know you know we had, unfortunately, a banner year in 2014. Some of the best pitchers -- some of the Cy Young candidates in 2014 -- , and it's keeping right up in 2015.

This spring already, you know, Yu Darvish (Texas Rangers), Zack Wheeler (New York Mets), , guys that are Cy Young candidates.

Dr. Joe Congeni Dr. Joe Congeni

The best 3 pitchers in college baseball, the No. 1 draft choice from Stanford and Duke, and last year's No. 1 from UCLA, . He didn't sign with the Astros, he went back to UCLA and he tore his UCL and needed Tommy John surgery.

The numbers show that, uh, last year in March we had 12 UCLs and 30 for the season in Major League Baseball. And, this spring already, as of right now, we have 7 more ulnar collateral ligament tears, tears of the ligament in the elbow.

Here's an injury that we've been doing everything we can to try in the last decade to reduce. Uh, we have rehab programs, you know, preseason programs the way we do for the ACL to try to reduce the number of tears of this ligament.

We try to teach at the younger level, the youth level -- where good coaches like you are down there -- prevention, you know, pitch counts per game and per season. these young pitchers: no more than throwing 3 seasons of the year. Take at least 3 or 4 months off totally.

And despite all that, um, we continue to struggle with really high numbers of this injury that just continues to kinda go through the roof, particularly in the most elite of pitchers.

HORNER: Joe, is it the motion because it's a real unorthodox motion to pitch consistently with the way the arm goes? Does that play a big factor in this?

DR. CONGENI: That is absolutely true. And so, we've looked at a lot of things mechanically and there are a few things that people are saying that are encouraging looking at trying to change the mechanics. But overall, the mechanics that go back 100 years of pitching a baseball are somewhat unnatural, are very stressful to the elbow.

And, you know, nobody tears their UCL unless you're throwing at least 80 miles an hour. So really, this happens not in the very youngest of kids. This occurs when kids become somewhat proficient at throwing a baseball hard, over 80 miles an hour. To do that, it is somewhat of an unnatural motion, so you're right about that.

But, boy, I don't know about radical changes, but people are looking at mechanical changes and so far, not so good. We still continue to struggle with increasing numbers almost yearly of people tearing this ligament.

And remember, when you tear this ligament and have surgery, you're out for over a year. It is 12 to 18 months before players get back to pitching again.

HORNER: And some of these new pitchers like to cut fastballs and those types of things where you really go with an unorthodox delivery, really putting the stress on the elbow and such.

I know with our 13-year-old kids, we don't have them throwing curveballs at all. The only speed that we have them do is a changeup, besides throwing the fastball. Their arms just aren't ready for all that motion and that slinging of the elbow.

DR. CONGENI: Exactly. Changing speeds and throwing with command in the strike zone is what's really recommended until they get to at least high school.

So, I know a lot of people are aware of this, the education piece we keep working on and pounding in, but, uh, it's just when we get to the higher levels it just doesn't seem to be, um, adding up to a reduction, and it's really got people frustrated.

HORNER: Alright, Joe. Good stuff this morning. Thanks for the visit, my friend.

DR. CONGENI: Okay, Ray. Have a great week.

HORNER: You too. Dr. Joe Congeni, Sports Medicine Center at Akron Children's Hospital, with us.

Originally aired on 1590 WAKR-AM on April 8, 2015

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