MLB Network press release on “The Pitching Dilemma”

 I reawakened this blog to highlight some of the panel discussions on the MLB Network Roundtable Show for Saturday, May 10. This release has information on experts on what is wrong with the way young pitchers are developed. Here is the release:


Expert Panel Headlines MLB Network Roundtable: The Pitching Dilemma

On Widespread Pitching Injuries in MLB This Season


Bob Costas Moderates Panel Discussion with Dr. David Altchek, Tom House, Jim Kaat,

John Smoltz & Tom Verducci


Exclusive One-on-One Interview with Dr. James Andrews & Costas

Covers the Current Prevalence of Elbow Injuries in Youth Baseball


                May 8, 2014 – With 17 Major Leaguers having undergone Tommy John surgery so far this year, MLB Network assembled an expert panel to examine the prevalence of elbow injuries among MLB pitchers and what it means for the future of the game. In MLB Network Roundtable presented by Delta Airlines: The Pitching Dilemma, Bob Costas moderates a roundtable discussion with Hospital for Special Surgery Co-Chief of Sports Medicine and Shoulder Service Dr. David Altchek; pitching expert Tom House; Jim Kaat, who pitched more than 4,500 innings and 180 complete games in his 25-year career;1996 NL Cy Young Award winner John Smoltz, who had Tommy John surgery in 2000 and finished his career as the only pitcher with 200 wins and 150 saves; and MLB Network insider Tom Verducci, who has covered the topic extensively.

Costas also hosts an exclusive one-on-one interview with orthopedic surgeon Dr. James Andrews, one of the foremost authorities on Tommy John surgery, to discuss his latest research on the biggest risk factors for elbow injuries among young pitchers before they reach the Major League level.

            The one-hour program airs this Saturday, May 10, immediately following MLB Network’s 1:00 p.m. ET telecast of the Minnesota Twins at Detroit Tigers game, and on Sunday, May 11 at 8:00 p.m. ET. A clip from the program is available here and quotes from the program are transcribed below:


Dr. James Andrews on what causes elbow injuries:

“The basic thing that parents out there and coaches and players alike need to know is if you throw with fatigue at a young age – in high school, for example, or youth baseball – you have a 36-to-1 chance of injuring your shoulder or elbow. … Fatigue could be event fatigue, seasonal fatigue or year-round fatigue, so it’s a big problem.”


“What we really found out is that [high school patients] only had one week off each year from competitive baseball and that one week was – you could guess what – between Christmas and New Year’s. So they’re playing year-round baseball – that’s the number one risk factor in youth baseball.”


“If you take a coat hanger and you bend it enough times, what happens? It breaks clean, and then of course that injury didn’t begin with that last bend, it began with all of those multiple, multiple bends. It’s a developmental ligament and the stress that it will take is only about 80-miles per hour, so our high-velocity throwers in high school – unless they’ve got great genetics – are really suspect to really injure their ligament along the way.”


On what can be done to prevent future elbow injuries:

Tom House: “We’re designed to throw on flat ground. … What happens to kids today? They pitch too much year-round and they don’t throw enough. … They only time they throw is in a practice or a game, and the pitcher’s are [throwing] off the mound. … Let them play on flat ground. Let them throw stuff, throw anything. Stay off the mound except for game day, throw as much as you can on flat ground the rest of the time.”


Jim Kaat: “I had pitched nine innings against [Tommy John] in Chicago and the next day I’m at the mound throwing. Not pitching, [but] exercising. He’s running his laps and he said, ‘What are you doing? You pitched nine innings. You can’t do that.’ I said, ‘Well, I throw every day. It will rust out before it will wear out.’ Well, when he had the surgery, he called me and said, ‘Guess what Dr. [Frank] Jobe told me to do?’ He got his wife in the backyard and played catch every day. Throw a little more – I think that’s one thing that’s lacking.”


On the recent increase in Tommy John surgeries:

Dr. Andrews: “It’s really depressing to go in and see the number of high school kids coming in with this injury. At this point in my career I’m probably seeing more high school kids with a ulnar collateral ligament injury than I am with college and pros.”


Dr. David Altchek: “It’s a constant struggle in terms of trying to treat any of these athletes conservatively with this injury.”


John Smoltz: “A lot of those [success rate] numbers that we see are a little skewed – they make you want to grasp something. They want to say, ‘If you’re going to make it to the big leagues, follow these guys who were successful.’ But I had my surgery after 2,400+ innings in the big leagues [and] I knew how to get back to the big leagues. I feel sorry for the Single-A, Double-A players.”


Tom Verducci: “As more people get the surgery – we know that’s happening – that means that more people don’t come back.”



Discussion was typical. Everyone had his own preconceived notion and nobody moved. Costas spoke of a greater synthesis among the medical community, training experts and coaches, but at that very table, all of these “camps” talked right past each other – and I don’t even think they noticed.
Two points:
One: The question was posed – I think by Costas: is there really a problem? Are we simply looking for things we didn’t used to look for? Are we seeing things we weren’t able to see before; and are we saving arms we just never would have attempted to save before? Nobody had an answer here. Nobody disputed the notion that it may have always been like this.
And Two: Dr. David Altcheck “threw cold water” on the notion that all of the extra, non-pitching throwing that is done in Latin America which is similar to the way things used to be in the United States, is something we should learn from. He said the elbows from Latin America are worse off than the ones here.
The discussion ends with a consensus (at the table) that there is a huge problem – and kids need to be doing a lot more non-pitching throwing like in Jim Kaat’s day.
What a waste of time.

I have been involved in baseball all of my life. I have discussed or listened to discussions concerning “Tommy John” injuries with many involved in MLB including Dr. Andrews. I was deeply impressed with the comments made by Jim Kaat. I had the opportunity to follow two young pitchers from the time they were 10 years old through now. Both are 23 and pitching college baseball and both had TJ surgery while in High School. As youths neither were ever over pitched nor played year round. As sophomores both were starting pitchers and usually threw no more than five innings per game with pitch counts normally in the 60 t0 85 range. James was primarily a fastball pitcher that threw 92 plus while Matt threw mostly breaking balls with a fastball in the low eighties. The two had never had any sign of arm trouble and always played in the field until they became pitchers on the high school varsity team as sophomores. From there on the basic workouts other than games were bullpen sessions and long toss but not daily. I agree with Mr. Kaat that pitchers should continue to play; take ground balls in the infield and throw daily. The two young pitchers were and still are very talented and capable of playing in the Majors but they will likely never get the opportunity. After becoming pitcher only Matt had TJ surgery his junior year of high school. James had a slap tear in his shoulder his junior year. Matt pitched his senior year and again was not over used but only pitched. James did not pitch again until his first year of college. Today Matt has had to start throwing side-arm in order to continue pitching. James, in his first college start had pitched four innings of hitless ball in 19 degree weather. After setting in the dugout for almost an hour while his teamed rallied he went to the mound to warm-up for the 5th inning. His first warm up pitch the UCL snapped. Trying to be brief here, what I am trying to say is: The two young men were opposite style pitchers, did not play year round and were not over pitched. Both seemed to develop arm problems when they became only pitchers. I have watched major college coaches, whose names I will withhold though they do not deserve to be protected, throw a young pitcher 160 pitches plus in 20 degree weather or ask a pitcher to pitch Saturday after having thrown 8 innings on Friday. It’s deplorable and an abuse of these young men. I believe the resulting injuries were the due to the young pitchers arms not being physically strong enough to handle the work load. Today most pitchers are pitchers only and their arms are not properly developed. All muscles, ligaments, tendons and the bones to which they attach have be developed equally. If one part of the structure is not as strong as the other then the structure must compensate or collapse. Throwing with only a pitching motion will not develop the arm as a whole. Throws made on flat ground, throws from various angles such as over hand, ¾, sidearm, with full extension, or with quick snaps. All of the different angles and motions strengthen the arm as a whole and complete structure is less likely to fail. A weakness in any part of the structure may be the underlying cause of most injuries

I am not sure how MLB will ultimately effect the dilemma of signing a pitcher with “damaged goods” when the local programs and travel teams (for the most part)do not stress the proper fundamentals:

1. Throwing Mechanics
2. Proper Warm-up and Cool down Activities
3. Proper Rest and Hydration
4. Daily Throwing Programs
5. Off-season Training

Additionally, I have seen so many organizations speak about inning restrictions, pitch counts, and number of days a pitcher needs to rest between pitching. Here is an idea to consider; only allow a pitcher to pitch for one team during an active season. The player can play for as many teams as he wants, but can only pitch for one of them – no exception. This concept would allow the player to develop his pitching at a pace that might increase his ultimate longevity to pitch while giving him more opportunities to develop his other baseball skills at the same time.

Finally, the old timers of the world, guys like Jim Kaat, Bob Gibson, and Nolan Ryan, threw a ton of innings because they had great non-pitching day throwing regiments that probably did not start when they became professionals. Players can throw everyday, but can not pitch everyday. Functional throwing is a great way to build muscle development and proper sequencing.

Thanks for the comments. I’d like to see more research on the subject. Does the problem tend to skew American? Can “Latin America” be thrown into one category, or are pitchers from some countries less likely to develop problems than others? The idea of limiting kids to pitching for one team or pitching x-months out of the year (a pitcher from April to October but only a position player for the rest of the year) has merit, but how will that be controlled. But who controls this? With youth sports leagues, not just in baseball, the reaction to any kind of oversight or any kind of standards is to splinter off into other leagues.

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