Breaking Pitches and Broken Pitchers

My pal Nick, a.k.a. the Clubhouse Lawyer, called my attention to a study published in the July-August 2002 American Journal of Sports Medicine regarding youth pitchers and injury. The study found a significant correlation between the number and type of pitches thrown and the rate of elbow and shoulder pain in youth pitchers.

According to the press release (I have not read the actual article), the AJSM followed 467 pitchers ages 9-14 for one season. Data was collected via pre- and post-season questionnaires, postgame interviews concerning injury and performance, and pitch count logs; pitcher videos were used to analyze proper mechanics.

The study found that 15% of all pitching appearances resulted in shoulder or elbow pain (joint pain, not muscle soreness). Curveballs increased the risk of shoulder pain 52%, and sliders increased the risk of elbow pain 86%. Ouch! Intriguingly, the use of a change-up lowered injury risks for both elbow injury (12%) and shoudler injury (29%), though it’s not clear from the press release whether that’s in combination with breaking pitches or as an alternative. As for pitch counts, the correlation between pitch count and elbow pain was not statistically significant, but “there was a significant relationship between an increased number of game pitches and the risk of shoulder pain.” The authors of the study note that the risk of breaking pitches “is magnified for the prepubescent athlete because the growth plates in the elbow and shoulder joints are still open and are more susceptible to stress-related injuries.”

These results are interesting for their quantification of injury risks, but not surprising. “[I]ncreased number of game pitches” equals high pitch counts, and high pitch counts are where we presume most pitching-related arm injuries come from–specifically, the accumulation of microtrauma from the repetitive pitching motion. The risk of breaking pitches on young arms is (one would hope, at least) conventional wisdom.

The study obvioiusly has implications at the big-league level, but it’s important to note what it does and doesn’t show. Nick and I had a lively back-and-forth email session on this, which I’ll re-run here.

Jay: Most interesting for the quantification of injury risks, but hardly a surprising result–it’s right in line with the conventional wisdom that throwing breaking pitches before the arm is fully developed is a bad idea.

Nick: I think what’s most fascinationg about this study, is that it implies that the seeds of destruction (or at least major arm injury) are planted before major league scouts ever lay eyes on a pitcher. Perhaps when drafting pitchers, organizations should do background checks on little league, junior high, and high school pitching history of potential draftees. It would appear from this initial study that poor use of pitchers at the adolescent level has much more to do with major injury risk than overuse at the professional level. I look forward to more studies on the subject.

Jay: Implies is the important word. We can speculate all we want, but we don’t know what comes of THESE 9-14 year olds–how many of them are still pitching several years later, whether they sustain injuries or what kind.

In this study, we’ve got young kids, we’ve got breaking pitches, we’ve got pitch counts, and we’ve got increased injury risks. We don’t have a link to whether THEY are at risk for further injury later, or what kind of injury.

I suspect a good many of the ones who get hurt early fall by the wayside before they ever get to high school or college ball, and the ones who make it that far do so because they didn’t get hurt in their adolescent years. I don’t think you see too many high school or college pitchers who survive consistent abuse. 15 year olds who need rotator cuff or Tommy John surgery don’t make comebacks.

Nick: Clearly this is very much an initial study. You’d think the Major League Baseball would have a vested interest in serious medical studies on the links between pitch, type, pitch count, and injury rates in all age groups. What this study suggests, and what clearly needs further in depth study, is the link between abuse of adolescent pitching arms and the likelihood of major injury to adult pitchers. With the amount of money at stake, you’d think MLB would want to more about pitching related injuries than “it’s an unnatural stress on the arm, a certain percentage of career ending injuries is to be expected”. Then again, look who’s running the show.

Jay: You’d think they’d have an interest. But with all of them rocket surgeons piping up on the management side during the current labor situation, it seems pretty clear that the likes of Bud Selig, John Moores, Tom Hicks, Drayton McLane, David Glass, and Jeffrey Loria need Mapquest and a military-precision GPS system to find their own […] asses. Expecting them to extrapolate the link between adolescent pitching arms and major league contracts is like expecting the family mutt to take over the responsibility of managing your stock portfolio.

Of course, it’s tough to dig too deeply into the implications of a study for which I’ve only read a press release. While the results aren’t quite the smoking gun needed to indict current big league managers who abuse the arms of promising young hurlers, they do shed some scientific light on the situation and offer a promising avenue for further research. I’ve sent away for a copy of the full article, and I’ll report back if I glean any further wisdom from it.