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March 27, 2013

Tough time for NL third sackers

Maybe there's something going around, but National League third basemen seem to be getting more than their fair share of injuries of late. Fans and fantasy owners probably are a bit panicked right now as this plague spreads.
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Posted by: Greg Simons

September 10, 2012

Protecting the pitcher: The lesson of Brandon McCarthy

I’ve always been reluctant to make it mandatory for pitchers to wear protective headgear, especially helmets, which are clunky and might not stay properly in place due to the violent nature of the pitching motion. But now, after the Brandon McCarthy situation, I’m ready to change my mind, at least partially.

McCarthy, a talented right-hander who has been part of Oakland’s surprising starting rotation, is now in stable condition after undergoing brain surgery to relieve an epidural hemorrhage, a brain contusion, and a skull fracture. Yet, he remains in a potentially life-threatening situation several days after being hit in the head with a line drive off the bat of the Angels’ Erick Aybar. Given the seriousness of his injuries, it is time for Major League Baseball to seriously consider protective headgear for pitchers.

Pitchers are fewer than 60 feet, six inches away from home upon delivery of the ball; the reaction time is incredibly small, even for elite athletes like major league pitchers. Based on a sampling of opinion from other writers at The Hardball Times, the average line drive comes back at the pitcher at about 80 to 85 miles per hour. The line drive that caromed off the right side of McCarthy’s head last Wednesday could have been going even faster, perhaps 90 or more mph. (The speed of a home run ball is generally 100 mph or faster.) Given that many pitchers are off balance and not in fielding position at the conclusion of their motions, it is unrealistic to expect most pitchers to be able to evade a line drive targeted for the head.

I’m still concerned about the awkward nature of a helmet, especially one that could shift during the process of winding up and throwing, and so could affect the pitcher's line of vision. Perhaps a better solution would be to fit pitchers with a protective liner worn under the cap. It’s true that the liner wouldn’t protect the face or the ears, but it would at least cover the top part of the skull.

Jackie Robinson wore a leather liner under his cloth cap during the '40s and '50s, out of fear that some headhunting pitchers had racist motivation. More recently, fiber or plastic liners were worn by a few position players in the 1970s: Bob Montgomery, Tony Taylor and Norm Cash come to mind as the last three players to bat without helmets. Though I’m not sure if any of the three were actually hit in the head with pitches during their careers, the bottom line is that all three escaped the game without serious injuries to their heads.

I think it’s time to do something before one of today’s pitchers has to endure what McCarthy is experiencing. Or worse. One of these days, we’re going to see another fatality related to an on-field happenstance, something that will be a tragic sequel to Ray Chapman in 1920. And right now, the pitchers are the most vulnerable people on the field; they are the ones that need the most help.
Posted by: Bruce Markusen

July 30, 2012

Chris Sale and “dead arm”

In mid-May, I wrote about Chris Sale's faulty elbow and discussed valgus stress in the elbow as it relates to sidearm pitchers. Now there are reports that Sale will be shut down for a start or two due to "dead arm." Well, I bet many of you are asking...

What is dead arm, anyway?

Dead arm is the catch-all diagnosis for a pitcher who's losing velocity and/or command of their pitches, blaming it on fatigue. Physiologically, there's not much to this diagnosis - it's a description of symptoms rather than an actual inspection on the root causes. Chris Sale's velocity has been steadily dropping over the year:



It's also worth noting that Sale threw all of 71 innings in 2011 out of the bullpen, and in 2012 he's already at 124 innings split between the bullpen and in the rotation (predominantly in the rotation, of course).

We've talked about how sidearmers are more susceptible to valgus stress due to their mechanics, and this can play a role in the so-called "dead arm" issues that pitchers experience. As pitchers throw more and more innings at game intensities, three major physiological changes occur:

-They tend to gain external rotation range of motion around the shoulder joint and lose internal rotation at the same time
-The muscle tissues in the forearm develop adhesions as they are stressed while stabilizing the pitching elbow in the delivery
-The ulnar collateral ligament (UCL) can become stretched out while holding the bones of the arm together

The first two are all but guaranteed to happen, while the third happens if the pitcher has improper force application technique (mechanics) or other issues that can lead to a UCL sprain/rupture.

Most knowledgeable trainers will stretch their pitchers into internal rotation and provide exercises that passively engage the external rotators of the shoulder to help restore ROM in IR and strength in ER without a concomitant "bounce" that happens in the late-cocking phase of the delivery to help mitigate issues with the first physiological change.


A pitcher (me) about to exit late-cocking phase

Forearm adhesions and soreness can be treated with myofascial release using items like The Stick, foam rollers, static stretching, and manual therapy from athletic trainers.

There's not much that can be done with the last change - if your UCL is being stretched or gradually torn due to poor mechanics, that requires a mechanical change and better attention to pitching arm fitness. Performing specific exercises that improve forearm rotation near the time of ball release will help, though the only real way to know is to use high-speed video to perform a biomechanical analysis on the pitcher in question to get valgus stress levels before and after changes are made to verify things are going in the direction the coaches and trainers want.

So... what's going to happen down the road?

Only the White Sox can determine how to approach this particular case. While shutting down Sale for a few starts and getting him going again sounds like a good idea, pitching isn't an activity that is easily dropped and picked up again - even if Sale's throwing bullpens and simulated games, competing in a game is a completely different activity. Pitchers throw with more intensity and cause more stress to their arms when pitching in competitive games compared to when throwing on the side - this has been verified time and time again with results being published from various biomechanical labs.

While Keith Law isn't high on Chris Sale's mechanics from the standpoint of a starting pitcher, with a guy this good, it's hard to keep him in the bullpen if he can show this kind of dominance in the starting rotation. I'd keep him in the rotation, limit his innings this year (fat chance given the AL Central playoff race), and work on slight tweaks in the off-season to address mechanical issues and build strength in his pitching arm in hopes of mitigating issues down the line.

One thing's for certain, though: Sale's precipitous drop in velocity is a real problem and highly indicative of some sort of injury to the pitching arm. Just because he's not reporting pain doesn't mean he's not injured - plenty of pitchers throw while injured though they display no symptoms.
Posted by: Kyle Boddy

May 14, 2012

Chris Sale and his faulty elbow

Chris Sale has been the subject of much discussion in 2012, as he's been jerked around from the starting role to the bullpen with reports of inconsistent velocity. To compound all of this, he's had an MRI on his elbow due to tightness, though it's been reported that it's due to normal soreness and not major injury.

Keith Law is not impressed with Sale's mechanics or the idea of him in the starting rotation:



I've asked Keith on Twitter (@keithlaw if you decide to do the same) why he thinks Sale's arm action has a higher propensity for elbow injury, but he hasn't commented on the specifics of his claims.

Sale's Mechanics: Then and now

Here are two clips of Chris Sale pitching against Oakland, both in the Coliseum. These are two different years. One clip has Sale throwing a 95 mph fastball, the other a 93 mph fastball. Both came in the eighth inning. Can you tell me which one came from 2012 and which one came from 2011?



If I hadn't cut the video, I bet I wouldn't have been able to do better than simply flipping a coin and guessing, though I might choose the clip where Sale is throwing 95 mph over the one where he came in as a reliever in 2011.

I'd be wrong. Sale was throwing 95 mph in Oakland in the eighth inning as a starter on April 25.

My point is that Sale's mechanics between 2011 and 2012 have not meaningfully changed. (If you slow the clip you can see some minor differences with the glove leg and trunk flexion, though.)

But why does Law think that Sale is an injury risk? I won't speculate on his reasons; rather, I'll discuss some scientific research that might shed a light on Sale's pitching mechanics.

Sidearmers, valgus stress, and you

Generally speaking, Sale has a fairly internally rotated humerus at stride foot contact (SFC) and, combined with his high rates of pelvic and shoulder rotation, he lays his forearm back into external rotation during arm cocking quite fast. This certainly will increase the eccentric load on the shoulder, though whether or not this is specifically injurious is debatable.

However, Sale is also a sidearmer, and research does indicate that sidearm pitchers are generally at higher risk for increased elbow valgus torque. (Source: Aguinaldo et al; ignore the "conclusion" contradiction, Aguinaldo has said it's a typo/mistake in the abstract that isn't there in the full paper. Read it here if you like). Increased elbow valgus stress is highly correlated with UCL tears/sprains, especially when combined with a more-extended elbow at ball release (which Sale does have).

The theory that sidearm pitchers are at higher risk for elbow injuries seems to hold water based on previously conducted research out there, though it's worth noting most sidearm pitchers have lower ball velocity than high three-quarters and overhand pitchers (for whatever reason). Ball velocity is obviously very highly correlated with valgus stress, so the net effect may be lowered amongst all sidearmers. Of course, Sale throws very hard, so that's not applicable to him.

Whether or not Law looked at Sale's mechanics through this type of research lens is unknown, but he's probably onto something. It should be interesting to watch Sale's velocity over the rest of the year, and beyond.
Posted by: Kyle Boddy

June 27, 2011

Quiz results: Mauer’s health

Last week I asked all of you to take a SWAG at how many of the remaining years in Joe Mauer's eight-year, $184 million pact would be healthy ones, and here is what you said:

Healthy Mauer seasons     Percentage
Zero                            2.7%
1-2                            17.8%
3-4                            39.7%
5-6                            34.2%
Seven                           5.5%

The absolute pessimists were small in number, with under three percent of you saying Mauer's healthy days are done, though over 20 percent total said he's have no more than two injury-free seasons in the next seven.

The plurality went with the middle-of-the-road choices of 3-4 years, which seems about right for an oft-injured catcher heading into his 30s.

It's good to see some optimism expressed by the roughly 40 percent of voters who foresee five or more healthy campaigns from one of Minnesota's favorite sons. (Or maybe Aaron Gleeman stuffed the ballot box.) I'd like to think just about any baseball fan, regardless of team affiliation, would hope to see as many healthy years as possible from such a talented player, but hoping and SWAGging are two different things.

Finally, sorry for not posting these results last Friday as promised. Sometimes life gets in the way of baseball.
Posted by: Greg Simons


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