The Board

Paul Arden wrote: ↑Sat May 06, 2023 11:04 am I think the front view of this would be quite different.

What’s causes these tears and the surgeries that follow?

When the arm is cocked back, there’s a large — what we call — varus torque. See, if I push your arm back, you feel the elbow here. [Fleisig has me put my arm up in a 90 degree angle, then he pushes my forearm backward. Even with a gentle push of a few degrees, it doesn’t take long before this starts to hurt.] In this position, it’s 100 newton meters of torque. A bowling ball weighs 12 pounds, let’s say. If you put a bowling ball in your hand, imagine what your elbow would feel like. That would not be 100 newton meters. One hundred newton meters would be 60 pounds. Five bowling balls. Picture five bowling balls of force. That’s the stress of that instant in the elbow.

Because of the arm speed or because the pitcher has his forearm cocked that far back?

The arm speed. Your body’s going forward and your arm’s whipping back. This is the torque, the rotational force, to stop your arm from whipping back and get it going forward. The ulnar collateral ligament, which is the Tommy John ligament, is stressed here. If you bend an elbow like that, the UCL provides about half of the resistance. So this tiny ligament in a pitcher’s elbow has to withstand 55 newton meters. When we try to test the UCL in cadavers, it breaks at 32 newton meters. So in a way, that’s saying that on every single pitch, your ligament should break.

RECOMMENDATIONS FOR PROFESSIONAL PITCHERS AND TEAMS FOR REDUCING RISK OF TOMMY JOHN INJURY

Optimize pitching mechanics to ensure using the whole body in a coordinated sequence (kinetic chain). A biomechanical analysis is recommended, as it provides objective data to the pitching coach, strength coach, and pitcher. A biomechanical analysis can also serve as a baseline for re-evaluation later in the pitcher’s career, after performance improvement or after return from injury.

Vary speeds for each of your pitch types. This will not only reduce the overuse on the elbow, but also can be an effective strategy. The best professional pitchers pitch with a range of ball velocity, good ball movement, good control, and consistent mechanics among their pitches. The professional pitcher’s objectives are to prevent baserunners and runs, not to light up the radar gun.

Open communication between a pitcher and his professional coaching and medical staff is paramount. The pitcher’s elbow and body are living tissue. Pitching and training create small tears in the tissue; rest, nutrition, and hydration repair the tears. A pitcher and his team should have a plan, but that plan needs to be monitored and sometimes adjusted depending on how the pitcher feels. Specifically, the pitcher should keep his trainer or coach up to date about any soreness, stiffness, and pain. That way when there is an issue, the player and team can consider rest, modified activity, or examination from the team physician to allow the elbow to heal and avert serious injury.

The pitching coach needs to watch for signs of fatigue on the mound. This could be seen in-game as well as in bullpen sessions.

The team trainers, coaches, medical staff, and front office must share knowledge in a holistic approach to minimize the risk of injury.

Flat-ground throwing drills and bullpen sessions should not always be at maximum effort. Reduced effort will allow for physical fitness and technique without adding undue stress to the UCL.
Take off at least two consecutive months each year from all throwing. During this “active rest” period, you can do other physical activities and exercises, as well as continue proper nutrition. The UCL and body need time to recover and build strength, so the concept of annual periodization should include adequate rest from pitching.

Exercise, rest, and nutrition are vital for a pitcher’s health. Performance-Enhancing Drugs (PEDs) may enable the athlete to achieve disproportionately strong muscles that overwhelm the UCL and lead to injury.

Pitchers with high ball velocity are at increased risk of injury. The higher the ball velocity, the more important to follow the guidelines above.