How Can Pitchers Avoid ‘Spike’ In Tommy John Surgeries When Baseball Returns?

Experts In The Field

With the expectation of baseball coming back, doctors are concerned about the risk. And while doctors have spoken on the risks involved with COVID-19, this isn’t the particular risk they’re talking about. Pitchers, who have been quarantined like the rest of us, are trying to get back in tip-top shape quickly, which will likely bring an increased risk of arm injuries like ulnar collateral ligament (UCL) issues. This type of injury can ultimately result in Tommy John surgery.

Ron Wolforth has experience when it comes to pitching. He’s written five books on it, his Texas Baseball Ranch blends technology with non-traditional approaches that bring increased performance, and 64 of his clients since 2003 have been drafted. Dr. Chris Ahmad, an orthopedic surgeon at the New York-Presbyterian/Columbia University Medical Center, is also no stranger to the pitching injury. Ahmad teaches at Columbia University, serves as the head team physician for the Yankees, and for more than 20 years has performed Tommy John surgeries.

“The coronavirus pandemic may very well indirectly cause a spike in Tommy John surgery because of intense enthusiasm, lack of ideal conditioning, poor mechanics, faster than usual ramp up and avoidance of symptom communication,” Ahmad wrote on Medium earlier this month. “Everyone who is involved in baseball and is willing to recognize this threat can improve these modifiable risks and help their players avoid Tommy John surgery.”

How can pitchers avoid serious arm injuries? With major league players being some of the most well-compensated players on the field, this is literally a million-dollar question. In order to properly prepare for the 2020 season, pitchers will have to focus on several layers of safety, starting now. Part of the problem is the different levels of preparedness. Some pitchers had access to a facility and were able to throw to live hitters occasionally, while others haven’t been able to.

Preparing Safely

Dr. Rand McClain, who has a sports medicine practice in Santa Monica, California, says it will be fascinating to watch this process of preparing.

“It may end up teaching us something good or bad,” McClain said. “We’ve been channeled into this idea that the only place to work out is on the field or in the gym, in groups. Not to sound like an old geezer, but in my generation, they were just building gyms. You learned your sport and got your fitness outside the gym. The options are there. It’s more about the execution.”

Frank Velasquez, Allegheny Health Network director of sports performance, shares that sentiment. Velasquez was also the Pirates’ strength and conditioning coach from 2003-12 and knows plenty about baseball-specific training. During the pandemic, Velasquez has been helping athletes out of AHN’s two sports performance centers. Velasquez, regardless of major leagues or not, the starting point for an athlete is routine.

“Something Monday through Friday that keeps you regimented,” Velasquez said. “You’re getting up. You’re going to do this or that. You’re going to have lunch. You might take a nap. You have family time. We don’t want ’em just floating away like a ship at sea.”

”Going fast with a return to baseball is like tailgating the car in front of you at high speed.

Dr. Chris Ahmad

When it comes to the pros, they’re used to a routine. Specifically, they need to be focusing on what they’re doing during that routine. For Wolforth at the Texas Baseball Ranch, it’s focusing on soft tissue to keep it “robust and resilient”. To do this, he has pitchers throw weighted balls or use wrist weights. Wolforth also utilizes special equipment.

“Preparing your soft tissue for competition is really a physiological thing,” Wolforth said. “Soft tissue needs to have a time for adaptation to prepare for these stresses.”

If the athlete is lacking in space, they can always slowly increase how hard they throw a ball into a screen or net. They can also tie a sock around their wrist with a ball in it, throwing that.

“Although it’s not perfect, the soft tissue of the shoulder and elbow doesn’t know if it’s throwing at 15 feet or 300 feet,” Wolforth said.

Wolforth also focuses on a variety of levels when crafting his routines. For example, two days should be heavy, pushing the envelope days. Three should be medium work, while two should be light work. Light work would be warming up, doing something quickly, then calling it a day.

“That allows the soft tissue to actually adapt to the stress you put on it,” Wolforth said.

Other Factors

Another important factor that Ahmad shares in his Medium post? Honesty. If anyone is experiencing pain in their arm, they need to say something. Since his post was geared toward any level of athlete, he shared advice for parents watching their kids train. Ahmad says parents should watch for over-icing, habitual massaging of the elbow or NSAID abuse—all signs of potential soreness.

“Going fast with a return to baseball is like tailgating the car in front of you at high speed,” Ahmad wrote. “You simply don’t have time to respond when driving 76 mph with two feet separating you and the car ahead. A high-speed crash can ruin your career. This is especially true in bad conditions such as night time, rain, winding slippery roads, etc. If we slow down, we dramatically improve safety. When conditions allow, we speed up and avoid injury.”

Velasquez adds that the focus shouldn’t just be on physical health. While he believes proper sleep, nutrition, and hydration are important, he emphasizes doing sport-specific movements. Instead of having players run for a specific time or distance, Velasquez suggests completing base running circuits.

“I don’t want the first time for those guys to run the bases to be at spring training,” Velasquez. “That just increases the risk of an injury.”

Another focus during training should be reassuring players. The athletes will not be performing at 100% right away and that’s okay.

“I don’t expect ’em to dot a gnat’s ass right now, and they shouldn’t either,” Velasquez said. “They’ll get a few weeks with their own coaches and a more intense regimen, where they can hone in.

“But with there still being a question mark on when they’re going back, I tell them, ‘Don’t use all your bullets now. I don’t want you to report to camp with shoulder tightness.’ ”

Article originally posted on Pittsburgh Post-Gazette by Jason Mackey.