TBO.com - TBO is Tampa Bay Online

For Pitchers, Arm Injuries An Occupational Hazard

Scott Kazmir knows how fragile the arm can be after missing the first month of the season with a left elbow strain.

ADVERTISEMENT

By MARC LANCASTER

The Tampa Tribune

Published: May 6, 2008

TORONTO - Edward G. McFarland of Johns Hopkins University's sports medicine department remembers a brief debate he once had during a meeting of his peers.

It is accepted among sports medicine professionals that the human arm was not designed to withstand the stresses involved in throwing a baseball over and over again, a statement McFarland, a specialist in shoulder and elbow injuries, made at the meeting in question. But someone else spoke up in disagreement, putting forth the theory that the arm probably evolved to throw a spear, so wouldn't that be somewhat similar?

Well, perhaps.

"But if you're throwing a spear 120 times in two hours," McFarland said, "you probably have a problem."

No one has to explain to the Rays how fragile pitchers' arms can be. Already this season, Tampa Bay has seen two of its top three starters spend time on the disabled list - Scott Kazmir missing a month with a left elbow strain and Matt Garza more than two weeks with radial nerve irritation. Both of them are healthy now, but key relievers Al Reyes and Gary Glover currently are on the DL with shoulder problems.

It can be a never-ending cycle, but that's no surprise to those tasked with keeping pitchers healthy and on the field. They know that the exertion involved in throwing a baseball even once at 90 mph is staggering, and many marvel that more pitchers don't break down more often.

James Andrews, the orthopedist whose name has become as familiar to some sports fans over the years as the athletes he treats, has studied the mechanics of pitching in detail. He and his team at the American Sports Medicine Institute in Birmingham, Ala., have found that the arm has to rotate through 7,500 degrees per second to throw a baseball that fast.

"That's the fastest human motion known in sports, supposedly," said Andrews, who also serves as the Rays' medical director. "It's equal to the arm going in 20 complete revolutions, all the way around in a circle - 20 revolutions in one second. And then even beyond that it's equal to how fast the tires are going to make a car go approximately 90 miles per hour."

That force is felt mostly at the joints that support the arm: the shoulder and the elbow. And force is the operative word.

"At the time of ball release, it's like there's a force essentially pulling your arm off of your body," McFarland said. "It's really kind of amazing."

It's also unnatural to the various muscles, tendons and ligaments around the shoulder and elbow. With repetition over time, they begin to fatigue and, eventually, tear. At the greatest risk are the labrum and rotator cuff in the shoulder and the ulnar collateral ligament in the elbow - body parts that have become part of baseball's everyday lexicon in recent years.

There are ways to manage the strain, most notably by using the proper mechanics when pitching, and ensuring the arm gets an adequate amount of rest. Even so, some damage inevitably is done. Doctors and trainers who work regularly with baseball players will tell you an MRI exam of any major-league pitcher's shoulder or elbow probably will reveal abnormalities.

It's simply the price of doing business for high-level pitchers, said Timothy Kremchek, a Cincinnati-based orthopedist who serves as medical director for the Reds and is a consultant to the Washington Nationals.

"There's a lot of people that believe, and I do, too, that you only have so many pitches in your body in your career," Kremchek said.

For some pitchers, that reservoir dries up quickly. But those who make it all the way up the ladder, pitching into their late 20s and 30s at the major-league level, aren't simply the most talented, according to doctors. They're the ones whose bodies have been able to adapt to the challenges of doing the job. More than one expert invokes Charles Darwin, characterizing the weeding-out process as a survival of the fittest.

Throwing a baseball is a developmental activity, and the stabilizers in the shoulder and elbow grow stronger over time with proper conditioning and throwing.

"It's a gradual process to develop that strength," Andrews said, "and it's a process of elimination, the ones that make it."

The elder statesman of the Rays' pitching staff, closer Troy Percival, certainly would qualify as a survivor. For a decade, he was one of the most dominant relievers in the game, firing in pitch after pitch at 95-100 mph. Early in his career, he said, he would think about the potential for injury as something that could keep him from realizing his goal of playing the game for a long time. It finally caught up with him, a torn muscle in his arm apparently ending his career in 2005.

When Percival decided to mount a comeback last year, though, he took a different approach. He already has accomplished so much, he has decided to "take injury completely out of play" by putting it out of his mind altogether. His basic philosophy now is simply to pitch as long as his arm will allow.

"That's all you can do," Percival said. "If you start worrying about injuries, you've got too many outside interests coming in when you're trying to pitch out there. If you're trying to stay healthy when you throw your pitches, it's not going to do you any good. You've just got to make sure you do the work you're supposed to do to stay healthy, and then when you take the mound, it's clear your mind and go."

At some point, a player's body will tell him it's time to quit. He may break down completely. Or, he may deteriorate over time to the point that he simply can't get people out anymore - perhaps because the accumulated trauma to his arm makes him unable to get the command or velocity he used to have.

For those not ready to give it up, surgery can offer a reprieve. But there are no guarantees and rarely are such solutions permanent.

"If you have a guy who's 70 years old and he tears his rotator cuff and you fix it, he's going to stress the tendon a little bit, he may get tendinitis every now and then or irritated," McFarland said. "But baseball players, if you fix their rotator cuff, they're going right back to the same old thing that tore it in the first place."

Reporter Marc Lancaster can be reached at (813) 259-7227 or mlancaster@tampatrib.com.

Share this:

Loading Comments...

Email Print

ADVERTISEMENT