Welcome back readers. After a nice summer break (only wrote one blog), I’m back with a blog that I’ve been eager to write. I do apologize for the length, but writing this blog was as much for me as it is for you. Before my fingers hit the keyboard, I watched a webinar about the epidemic of arm injuries within the baseball pitcher population. Even if you’re just a casual Toronto sports fan, you may have heard about the Toronto Blue Jays’ young pitcher, Aaron Sanchez. He’s 24 years old, and is in the latter stages of his first full season as a starting pitcher in the major leagues. He’s been dominant all year, currently boasting a 13 wins, 2 losses, 2.88 ERA, 1.16 WHIP, and a career high 162 innings pitched. Don’t worry if you don’t know what those statistics mean. They’re great! Recently, the Jays decided to skip some of Sanchez’s games so as to decrease the load on his body. Their plans for the last month of the season isn’t clear, but we expect the Jays to skip another of his starts so he doesn’t log too many innings this season. The plan for Sanchez has evolved from shifting him into the bullpen midseason, to shutting him down altogether, to the more recent plan of simply skipping some of his starts so he’s able to pitch in the playoffs.
I make mention to reducing his load. Why did I use the word load? Load refers to the accumulation of physical stress on a body part. When talking about injuries, I often cite the following equation:
INJURY = LOAD > CAPACITY
When the load exceeds the body’s tissue capacity, injury happens. It doesn’t matter if the load occurred in a single event (think: getting hit by a car) or if it occurs due to the accumulation of repetitive loads (think: repetitive strain injuries: typing, sitting, pitching). Once the load exceeds the tissue capacity, the injury happens. Simple equation. In fact, so simple that all one has to do is manipulate the equation to help understand how we recover from and prevent injuries.
Most of what we’re hearing on the radio from sports casters and news makers is about how the Blue Jays are going to manage Sanchez’s load in order to be able to have him pitch all season, including playoffs, without causing an injury.
As a Jays fan, I hope Aaron continues to pitch great and contributes to our eventual 2016 World Series victory. And, further, I hope he remains healthy and goes on to have a great MLB career. The Blue Jay organization hopes for the same. It also represents the only way Blue Jay management can escape this situation without looking like they made a mistake. All other MLB teams are watching what the Jays do with Sanchez very carefully. Watch and learn. If the Jays limit the use of Sanchez and it costs them the World Series, fans will be mad. (A similar situation occurred a few years ago when the Washington Nationals shut down their young pitcher, Stephen Strasburg. Some will argue it cost the Nationals the World Series) If the Jays don’t limit the use of Sanchez and he gets hurt, everyone will be upset. The only winnable situation is to win the World Series and for Sanchez to stay healthy.
With all of that said, it’s important that we understand more about why there is a growing concern about the apparent ‘epidemic’ of shoulder and elbow injuries in major league baseball pitchers. Not only should this interest baseball fans, but the lessons learned are applicable to every part of the body, every human, at all ages.
First, a thank you to Dr. Michael Chivers and Dr. Stephen Osterer – both co-founders of the Baseball Performance Group (BPG), chiropractors, lecturers, and all around smart people. Dr. Chivers is involved with the Functional Range Conditioning (FRC) and Functional Release (FR) team that has taught me much in the past few years. They created the group and webinar for which this blog is based. Also, a thank you to Dr. Andreo Spina – chiropractor, lecturer, developer of FRC and FR, and former classmate of mine. His teachings introduced me to the concepts of movement variability and their role in injury prevention.
For starters, let me explain that the ‘epidemic’ I’m referring to is with regards to the tearing of a ligament at the elbow – the Ulnar Collateral Ligament (UCL). When this happens in an athlete that throws (i.e. baseball pitcher), the treatment is surgery to replace the torn ligament – commonly known as Tommy John Surgery – named after a great baseball pitcher who was the first to receive this type of surgery. Nowadays, this surgery is happening at an alarming rate. Why? First, it’s important to know that this is not just happening to major leaguers. Forty percent (40%) of all Tommy John surgeries are in youth. So, before we over analyze what these pitchers are doing once they’re drafted to the minor and major leagues, we need to step back and look at what youth are doing at a young age that is predisposing them to this injury. Current protocols in place for youth include avoiding throwing curveballs before maturity, getting ample rest, and keeping the pitch counts down. In turn, Major League Baseball (MLB) follows a similar protocol. It’s NOT working! MLB has spent $1.7 Billion on injured pitchers. Wow!
If existing protocols designed to reduce LOAD are not sufficient, it is imperative we, at least, talk about ways to understand and improve tissue CAPACITY. The BPG webinar introduced me to some complicated theories, including the Dynamic Systems Theory which is a mathematics model that attempts to explain complex models in the world that take into account multiple variables: “[…] in a highly complex system like the human body all the parts affect each other in intricate ways, and studying them individually often disrupts their usual interactions so much that an isolated unit may behave quite differently from the way that it would behave in its normal context.” (Clark & Crossland) So, when we consider the pitcher’s (or anyone’s) shoulder, we have to remember the joint range of motion (ROM) can move through flexion & extension, abduction & adduction, internal & external rotation, resulting in infinite possibilities. Plus, add in the ROM of the wrist, elbow, and spine. And, we also have to factor in the pitcher’s psychological state of mind, the environment, the biochemical makeup of the human, and the tissue quality of the muscles and connective tissue.
Furthermore, another interesting update on the understanding of the human body and brain is that what happens when a pitcher pitches the ball is not controlled by the brain. Rather, it is a spontaneous movement pattern that is contingent on the tissue participating in the pitch: Bernstein’s Degrees of Freedom Problem explains that we can get “repetition without repetition” – meaning, in any movement pattern there can be an abundance of movement patterns. We never do the same movement pattern the same. In baseball, we still assume that for repeated results, we need repeated movement mechanics. This is WRONG! The perfect pitch mechanics is a myth. It does not exist. In fact, having movement variability was once thought of as a deterrent to good mechanics and results. Now, movement variability is thought of as a necessary component to good, healthy mechanics. If a pitcher throws three strikes in a row to the same batter in the same place, did he use the same biomechanics all three times? No! There are way too many variables to perfect to result in the exact same mechanics. However, the pitcher was able to get the same results! The motor cortex of the brain’s control of movement … “is organized in terms of behaviourally useful actions aimed toward a goal”. (Michael Graziano) The more varied our movement patterns become, the more layered our cortex becomes giving us more efficient and coordinated movement (Michael Chivers).
[In my office, you’ve likely heard me explain that when you need to pick something up, your brain does not coordinate the actions of picking that thing up. Rather, the brain simply tells your body that you want the thing to be picked up. It is then up to your tissue (muscles, connective tissue, environment, other variables) that determine how you pick it up. If you have healthy spinal joints and muscles, they will likely contribute to the bending over to pick the thing up. If you don’t, those pieces of your anatomy likely will not contribute.]
So, we’re working towards a solution to the baseball pitcher’s elbow injury epidemic. But, we’re also rewriting the science of injury. No longer can we rely on reducing loads, rather we have to build capacity. And, since mechanics depend on all the ‘bits and pieces’ participating in the movements, it is imperative that ‘capacity’ exists in all the pieces. It would be too simple to tell a pitcher to have a ‘stronger’ elbow. No. The pitcher needs movement variability in the wrist, elbow, shoulder, and spine. The pitcher needs to be able to vary his/her pitching mechanics so as to not overload one ‘piece’ or ‘bit’. This goes for all humans, I believe. The more movement variability we have, the less likely we’ll run into repetitive strain/sprain injuries. So, we need to build capacity in all parts of our body by incorporating more movement.
Yes, the load on the pitcher is higher these days. Once thought of as impossible, pitchers now regularly throw 95 miles per hour (mph) pitches (even 100 mph is not uncommon now). The hardest throwers used to max out at 95. Now, they’re a dime a dozen. So, with the higher demand, it is critical they develop more movement variability. Similarly, we humans never used to sit down that much. We (not me) used to work the fields and never sit down to rest other than to eat and sleep. Now, we (not me) sit all day! No wonder back pain is so common! So, just like movement variability and building tissue capacity is critical for the longevity of the baseball pitcher, it is for us too!
Perhaps you can see why this blog is so important to me. It represents one of my passions: Baseball. It also represents how I care for myself and you!