Child baseball injuries are skyrocketing. Just ask Dr. James Andrews. In 1994, the American Sports Medicine Institute (ASMI) founder didn't perform a single Tommy John surgery (ulnar collateral ligament, or UCL, reconstructions) on youth baseball players. By 2008, more than a third of his UCL operations were on kids. The problem, he believes, is increased specialization—kids are now playing the same sport year-round and not just during the season. But he may have found the solution too.
Today, Dr. Andrews and his lead physical therapist Kevin Wilk are launching Throw Like A Pro. It's a mobile app that takes aim at irresponsible player training in hopes that it can preserve pitchers' arms with practice regimens, stretching exercises, and rehabilitation programs. This kind of information was previously reserved for patients of ASMI, now it's available for just $9.99.
"We're seeing Tommy John injuries occurring at a younger and younger age in the professional life," says Andrews. "It used to be they would be 28, 29, 30 years old, maybe older. Their ligament would finally have a problem."
Andrews and Wilk often ask parents and coaches why the kids don't simply rest for two months in the winter. "And they say, 'Well, we think if he takes off he'll lose the edge,'" says Wilk. "He's 12. What kind of edge does he have?"
Both Wilk and Andrews believe the increasing number of injuries stems directly from sport specialization at a young age. In 2014, adolescents are often encouraged to choose one sport to pursue, as opposed to the multi-sport programs of previous generations' athletes. Studies conducted by ASMI suggest this narrow, year-round approach is a leading contributor to UCL tears in pitchers. Andrews, a member of Major League Baseball's research committee, has been preaching the dangers of what he calls "professionalism"—a practice whereby youngsters and their coaches attack their training in the same way as the pros—for years.
"Baseball, as you well know, has always been America's sport," Andrews explains. "The type of injuries we're seeing have become so common and particularly when they start getting hurt when they're 13, 14, 15 years old. They drop out of sports. They drop out of school. They don't get a scholarship."
According to Andrews, 34 major league pitchers had Tommy John surgery in 2012. In 2013, just 12 pitchers elected for the procedure. Under three months into the 2014 season, more than 20 hurlers have gone under the knife. But Andrews doesn't think the pro game is to blame—at least not entirely.
"The epidemic of these injuries really began, even with some of these major league baseball pitchers, when they were in youth baseball," says Andrews. "Twenty-five percent of the major league pitchers right now out playing major league baseball have had Tommy John surgery. That's really unbelievable."
Some 17 million males play baseball in the United States, according to ASMI. During a study of 9-to-14-year-olds during their youth baseball seasons, the institute surveyed players and asked how many of them experienced shoulder or elbow pain and continued playing through it. Over 50 percent responded in the affirmative.
The go-to cure, for many of these players, is surgery. "I think the mindset is with some of these people is, 'Well, if I blow my elbow out I'll just have surgery. I'll be okay,'" says Wilk.
During a recent study at the Major League level, the Institute polled all 30 teams in an effort to determine how prevalent the procedure is today. A quarter of all Major League pitchers reported having had Tommy John surgery. Roughly 17 percent of minor leaguers have elected to have the surgery. The institute is adamant that surgeries like Tommy John have a directly proportional, negative affect on the longevity of professional careers.
Which is why Andrews and Wilk are focusing on fixing the system that leads to these injuries, and preventing the need for surgery. "We know that when you pitch, you're 36 times more likely to become injured if you pitch when you're tired, when you're fatigued," says Wilk.
Arm fatigue is precisely what Throw Like A Pro hopes to curb. The app provides recommendations for players of all ages, talent levels, and physical makeups as well as to coaches and families so that they might better understand the strain on kids' joints.
"They come out and they don't know how to change speeds," explains Wilk. "Every pitch is 100% intensity and that appears to be a big mistake."
The more a pitcher throws, the thicker the ligaments become. High-velocity throwers overtax their ligaments. Andrews' staff found that the redline for a UCL ligament in junior high and high school kids is about 80 miles per hour.
"When you get beyond that, it's suspect to be torn on every pitch," Andrews says. "So If a kid is throwing 90, 95 miles per hour, which they're all trying to do in high school because that's how they get drafted and get scholarships, they're all suspect to tearing their ligaments. So our best pitchers are also the ones that get used more often in more innings, extended seasons, and playoffs, get called upon by coach to pitch the next day to pitch a complete game and so they're the ones that are getting hurt. Our best pitchers are the most susceptible to injury, unfortunately."
Andrews began seeing high school and junior high school patients with "adult-type injuries" to their lower shoulder and elbow back in 2000. That's when ASMI began gathering statistics and looking for preventative strategies. But for years they only had a booklet to hand out, and hoped that the issue would come to light through word-of-mouth.
"Then I called Dr. Andrews up and I said, 'You know, I got an idea for you," says Dewar Gaines, CEO of Abracadabra Health, who partnered with ASMI to create the app. "I've talking to this guy and we're thinking about doing an App on sports medicine injuries.' The idea was, let's provide the information we've given to patients, but now let's make it available to empower the parents and empower the coaches as far as what they need to know to help reduce injury rates."
In the short term, Throw Like A Pro has identified pitchers and the Tommy John epidemic as its primary concern.
With young players growing faster, bigger, and stronger than ever, however, ASMI and Throw Like A Pro have identified ethical complications that Wilk believes will become the real issue in the near future. Citing an incident just last month in which high school senior Dylan Fosnacht threw 194 pitches over 14 innings, Wilk thinks legal liability for coaches is just around the corner.
"Now that the information is out there," says Wilk. "A lawsuit is probably right around the corner."
[Image: Flickr user Ralph Arvesen]