Wednesday, April 23, 2008
RT Staff Note: A reader sent us a copy of an article from the Houston Chronicle yesterday and it talks about the pervasive injuries from pitchers that play year round baseball. It's more than that in our opinion. It's about common sense. The reason why we praise travel ball on this site is because the truly great travel ball clubs have a plan. They have a rotation. They know the value of rest and conditioning and the risks involved in too many pitches in a week. A top rated travel team will have 6 or more starting pitchers and closers...minimum. Any less than that is irresponsible. If your son is being approached by a travel team, the first thing to ask is the number of pitchers they carry. Too many dads want their son to be the showcase pitcher..But at the ages of 12, 13 and 14, it means absolutely nothing...$5 plastic trophies are useless and won't get them into college...especially if the player is overused and gets injured. Your responsibility as a parent is to make sure your son is part of a rotation...not part of your vicarious vision of stardom. Don't agree? Then read below.
Tommy John surgery is rising among young pitchers
By SAM KHAN JR.
Nathan Eovaldi knew something was wrong. For all the pitches he had
thrown in his young life, his arm never felt like it did after this one
on March 13, 2007.
"I threw a slider, and something didn't feel right," said the Alvin High School senior righthander. "It wasn't a horrible pain, but when I threw it, I felt a tingling in my arm, and I could just tell something was wrong."
Two months later, the Texas A&M signee underwent surgery to reconstruct the ulnar collateral ligament in his right elbow, otherwise known as Tommy John surgery.
It may sound drastic, but what was once a last-ditch procedure to save a professional player's arm is now becoming more commonplace at all levels — including high school.
Eleven months after the procedure, Eovaldi is back on the mound competing with his Yellow Jackets teammates. He is both a picture of a successful recovery and a sign of how the procedure has been mastered.
But he is also a symbol of a larger concern.
While rates on UCL surgery are not tracked nationally, some of the area's and country's top surgeons said they've seen a significant increase in the number of high-school-aged players having the procedure.
"I would say over the last five to seven years, (the rate) has doubled," said David Lintner, an orthopedic sports medicine specialist who is Eovaldi's doctor and also serves as the Astros' team medical director. "And it goes up steadily every year."
Dr. James Andrews, one of the nation's most respected orthopedic surgeons, has also seen a spike in the number of high school pitchers he has performed the procedure on.
In a three-year span from 1996-99, Andrews performed Tommy John surgery on 164 pitchers, 19 of whom were high school aged or younger. From 2004-07, that number had jumped to 588 pitchers, 146 of whom were high school or youth league players — a seven-fold increase.
"Without a doubt, it's an issue," said Glenn Fleisig, the Smith and Nephew Chair of Research at the American Sports Medicine Institute, which was founded by Andrews. "The numbers are staggering in adolescents. More and more high-school-aged kids are having the surgery."
The big question: Why is a procedure once used mostly on college and professional players becoming more prevalent in kids who can't legally vote?
There are many factors, including how much a pitcher throws, what type of pitches he throws and whether he has good mechanics. But one factor stands out as the main culprit.
"Without a doubt, the No. 1 statistical cause (of UCL injuries) is overuse," Fleisig said. "In our studies, when a pitcher regularly threw with arm fatigue, he was 36 times more likely to be in the surgery group as opposed to the non-surgery group. That's the strongest statistical correlation in any study we've ever done."
High school coaches agree pitchers are throwing too much these days — and it starts before their high school careers. With the warm weather in Houston, the high school season is just one part of an elite pitcher's year. Such pitchers often play with select or travel teams in the summer and sometimes in the fall, leaving little time for rest.
'Crazy' year-round play
"(Year-round play) has gone off the charts," Alvin coach Mike Rogers said. "Years ago, it used to be that you played Little League, and then you went to basketball and football. Now you have 8- and 9-year-olds playing winter league and summer league. It's crazy."
Fleisig said year-round play is one reason high school pitchers may eventually require the surgery.
"Kids get more specialized, playing all year round, but that's what got them here," Fleisig said. "With so many pitches thrown, their total pitch count is now what a 25-year-old man used to have."
Eovaldi said he began pitching at a young age.
"I started pitching when I was 8 or 9," he said. "It was just fastballs, though. I've been a pitcher ever since then, for about nine or 10 years."
He said he rarely experienced pain — aside from customary postgame soreness — until that March game against Brazoswood. Once the UCL tears were discovered and the decision to have the surgery was made, Eovaldi wasn't nervous. In fact, he was somewhat excited about the procedure, which was performed by Lintner.
"I was ready to get it, recover and get back into it," Eovaldi said. "I read up on it. Doctors have really mastered the surgery. All the pros recover. It's just about being patient for that full recovery before you get back out there."
Timeline for a full recovery is normally about 12 months or longer, though pitchers can often throw again before then. Eovaldi, for instance, has been competing with the Yellow Jackets for much of this season, but he has been on a strict pitch count and hasn't fully regained his original velocity.
Lighting up the gun
"Before surgery, the highest I hit on the radar gun was 96 (mph), and I was consistent with 90-94 (on my fastball)," he said. "Now, the highest I've hit is 94, and I've been pretty consistent from 88-92."
Eovaldi is one of a handful of players in the area to have recently had Tommy John surgery. Mo Wiley, a senior at Mayde Creek, underwent the procedure in late March. The 18-year-old righthander, who is a University of Houston signee, had the procedure in hopes he could return in time to play as a freshman with the Cougars in the spring of 2009. His procedure was also done by Lintner.
"Luckily, most of the players understand that it can take a year to get back to pitching," Lintner said. "But every teenager thinks they'll heal quicker than everyone else ever did."
While the number of surgeries has increased over the years, so has the rate of full recovery. It's a much more reliable procedure now, and Fleisig said a recent study he conducted shows athletes who have UCL reconstruction come back to the same or a higher level 80-85 percent of the time.
"Yes, more kids are getting hurt, but now that we have a reliable surgery, people will have it because the recovery rates are good," Lintner said. "Ten years ago, it was almost a coin flip whether a pitcher would get back. It was just a salvage operation out of desperation. Now we expect upward of 85 percent getting back to being able to pitch."
Still, athletes can take preventative measures to help them avoid the injury. It starts with monitoring how much they throw — weekly and annually.
"The older they are, the more they can throw," Lintner said. "A teenage pitcher should not be going over 100 pitches once a week, generally speaking."
Rest is another important preventative measure. Most doctors agree pitchers should take a minimum of two to three months off from throwing.
Back off on the curves
Also, doctors recommend pitchers not throw breaking pitches (curveballs or sliders) until they are ready — normally after they've reached puberty.
But parents and coaches at all levels also have to take responsibility.
"Dads thinking (their sons) have to win at all costs at 9, 10, 11 and 12 years old to win those championship games (at tournaments) — all that means nothing in the big picture," said Mark Wiley, Mo Wiley's father. "They are fun years, but they all mean nothing compared to (the high school) level. It's not worth risking your son's arm to win a tournament at all costs."