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The Watering Hole: What's with all of these injuries?

April 17, 2014

By Michael Waterloo
Of The Spirit

Any athlete knows the risk of stepping on to the playing surface.

It is, after all, why many fans say they don't feel sorry when an athlete gets hurt, because they know the risks, and they get paid handsomely for it.

But this past year, the injuries seem to be coming at an alarming rate, especially when it comes to the NFL and MLB.

In 2013 alone, there were 61 recorded ACL tears in the NFL.

Joan Niesen of The Denver Post, calculated that 2,589 players appeared in at least one preseason or regular-season NFL game this past year.

After doing the math, that equates to 2.4 percent of NFL players suffering the injury.

The percentage may seem minute, but in fact, it's alarmingly high.
Now, one can point the finger and say that because of the increased enforcement from the NFL on not targeting the head, that the ACL and other knee injuries are the result.

OK, that's fine.

But if we switch gears and look at baseball, a non-contact sport, what's up with all of the Tommy John injuries, and less notably, the wrist (Hamate) injuries?

According to Jon Roegele of The Hardball Times, there have been 22 Tommy John surgeries — not counting the possibility of Josh Johnson ending up next in line — for baseball players since Feb. 18 of this year.

Of those 22, 13 were in the Major Leagues.

Can the causes of Tommy John surgery (ulnar collateral ligament reconstruction) be traced back to youth baseball?

What about the wrist injuries that we've seen so much lately, and why aren't they discussed as much?

For answers, I reached out to ESPN injury analyst Stephania Bell.
Oftentimes, when a pitcher is on the mound, he will hear or feel a "pop."

What exactly causes a pitcher to know that he needs the Tommy John procedure?

"We hear that sometimes, but more often than not, it's far less dramatic. Discomfort, the inability to locate pitches, the feeling that they have nothing on the ball when they release it, those are the hallmark signs," said Bell. "That should send the athlete to have the problem investigated...and it's not always dire. There can be other sources of elbow pain, especially in younger athletes, so that should not be the first thought on everyone's mind."

In doing my research, I've noticed that there's the thought going around that pitchers can actually gain velocity after their surgery.

It's nothing but a myth, right?

"Yes, it's a myth but it turns out that myth may be unknowingly perpetuated by players who have undergone the procedure. A recent study of MLB pitchers who have had the procedure found they believed their velocity improved after undergoing TJ surgery, but their actual numbers were lower. It's important to qualify that. They may have seen a drop in velocity just prior to their injury (which we are also now learning may be a signal something is about to go wrong), so after surgery they may improve from their immediate pre-injury low point," said Bell. "But chances are they are not improving their career high when it comes to velocity. They're probably more efficient in their pitching after surgery not only because the damaged tissue has been addressed but because they have taken a year off and rehabbed their entire body, including their core and their legs, which may help them drive the ball and, ultimately, feel as if they're throwing harder."

Well, because of myths like that, it can come off as if Tommy John surgery can have its distinct advantages.

Players like Stephen Strasburg and Adam Wainwright are two of the recent pitchers who have continued to have terrific careers despite going under the knife.

Has it changed in the past decade or so that undergoing the surgery can be seen as a positive for players, even those at the college or high school level?

"It's SO important that kids (and their parents and coaches!) understand that this positive is a myth. And they need to understand the realities of rehab. It's 12-16 months. Not everyone recovers (although there is a high success rate), and it's a huge undertaking and commitment," said Bell. "The surgery should only be done if an athlete cannot function in his role and he plans to continue playing. It should NEVER be done because he thinks he will become a better pitcher."

OK, so any athlete can get injured at any time, but with the unnatural motion of throwing a baseball, it seems as if pitchers are more likely to get hurt, especially with the velocity they are throwing at.

With that being said, why are teams shelling out outlandish contracts to pitchers like Clayton Kershaw (seven-year, $215 million) and Justin Verlander (seven-year, $180 million) despite knowing the risks?

"Ha! That's truly the million-dollar question. Why? Pitching is unnatural for the arm. More pitchers entering the Big Leagues have been pitching since they were kids (probably too much and without enough downtime each year) making them even higher risks," said Bell. "There are surely some market economics in play here, because as long as one team is willing to pay, other teams have to match, or they'll lose the player. But you're asking a question that has to be on the minds of many."

Moving on to the wrist injuries, which the majority are caused by the shape and function of the Hamate bone, according to Will Carroll, lead writer for sports medicine for Bleacher Report, it's not as an extensive recovery, but there is a 6-8 week recovery window, on average.

"The scar creates shape changes in the complex network of bone, cartilage, tendons and ligaments. It could be that or many other things. They are small and very interrelated," said Carroll on the impact that scar tissue buildup has in the recovery process. "It's temporary. Most overcome it after a short period of power loss."

Is it the power that is affected, or is it the overall ability to hit, too?

"There are so many types of wrist injuries that depending on what the athlete is dealing with specifically, both can be affected. Arguably, more difficulty hitting typically translates to a power deficit. With Hamate injuries (post-surgery, since the standard is typically a surgical procedure to remove the fractured fragment), players have often told me they feel some irritations/soreness at the surgical site initially, and that can affect the way they grip the bat," said Bell. "That usually resolves within a couple weeks, and the power deficit doesn't last long."

But why is it that we don't hear much about wrist injuries?

People get nervous about a pitcher who has shoulder stiffness, or a running back who has has knee issues, but why not a batter with wrist injuries?

"Probably because they're all over the map in terms of what the actual structure is (again, not all wrist injuries are the same), how severe the injury is and therefore how much (or how little) it affects the athlete," said Bell. "While we know that a chronic or severe injury can do real damage to a hitter, rarely do we know out of the gate just how significant the problem is going to be. Traumatic injuries to the wrist in baseball, the kind which would make us more nervous about a player's future, are relatively uncommon."

For a baseball player, would either the Tommy John surgery or wrist history change the way they are perceived when it comes to free agency then?

"I think the entire medical history is always evaluated in the context of the particular individual and measured against his talent. Obviously, the more trips to the DL, the more chronic the problems, the more concern. A history of TJ surgery has not typically been a huge discouraging factor, given the high success rate, especially if that pitcher has proven he has been able to return to his prior level of performance, or even better in some cases (i.e. moves from college to minors post-surgery)," said Bell. "There appears to be a slight rise in the number of revision (2nd) surgeries recently so it will be interesting to see if the level of concern changes over time. Right now though, with 1 in 4 major league pitchers having undergone TJ surgery, teams would be significantly narrowing the talent pool if they avoided them entirely."

 

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