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The Top 10 Reasons (You Might Not Have Considered) For All These Elbow Injuries

The following message is intended to be rich with tongue and cheek satire, but I promise you I will take some flack for it. Mark my words, some shallow minded half wit will cherry pick excerpts and quote me as if were serious.   

Anyone who knows me understands that while I am deeply compassionate and caring, I am rarely serious.
So here goes. 

With debate on the rash of UCL injuries raging, and “experts” crawling out of every nook and cranny with what they claim to be undeniable evidence as to THE main reason for the epidemic, I thought I would chime in with a few ideas you might not have considered.   

Here are the Top 10 Reasons (you might not have considered) for all of the recent Tommy John surgeries: 

1) It’s Mariano Rivera’s Fault.

Yep. I said it. I know Mariano is baseball deity, and I am bordering on blasphemy, but let me explain.

Everyone knows that Rivera built a hall of fame career throwing one pitch — the cut fastball. He learned the pitch by accident while warming up when he was the set up man for Yankees closer, John Wetteland. It was a pitch he threw naturally and readily offered to teach to anyone. Many tried, but none could duplicate the Rivera cutter. In an attempt to copy Rivera’s success, pitchers began to develop a “poor man’s cutter” wherein they off-set the ball in the hand and applied force by slightly supinating the forearm. These days, nearly every pitcher throws a cutter or a slider, and many of them supinate, rather than pronate the forearm.

When you supinate your forearm, the muscles that flex your wrist and pronate your forearm are inhibited.

It has to happen.

It’s a concept known in neurology as “The Law of Reciprocal Inhibition”.

Whenever a muscle or group of muscles is activated, 2 nerve impulses are required. One nerve must send a signal to activate the muscle(s) you are trying to move. A second impulse must inhibit or shut down the muscle(s) that oppose that movement. For example, if you want to use your biceps to bend your elbow, the triceps must be inhibited.

The muscles that flex the wrist, bend the fingers and pronate the forearm are all vital in working together to attenuate the forces on the UCL during the pitching motion.

When you supinate your forearm as little as 25 degrees, you inhibit the flexor/pronator muscles and they are unable to assist the UCL.

Seems like everyone these is trying to throw a nasty cutter. So yeah, I’m Blaming Mariano Rivera.

2) It’s Roger Craig’s Fault

No, not the SF 49ers running back or the record holding Jeopardy champion. I mean the great pitching coach and manager who became famous for teaching his charges to throw devastating split finger fastballs. 
Again because of the amazing success of the pitch it was copied by nearly every guy who had the slightest difficulty learning the feel for a change up.
It’s a pitch that is pretty easy to learn and easy to teach.

Two muscles of the forearm — the flexor digitorim profundus, and the flexor digitorim superficialis — are also primary flexors of the fingers. 
The trouble in my view with the split finger fastball is that it puts the flexor/ pronator muscles of the forearm at a significant mechanical disadvantage

Try it.

Flex and pronate your wrist while making a fist.

Like this:

Now, with your free hand, feel the tight ball if muscle near your UCL. 

Now, shove a baseball between your first two fingers and feel the change toward flaccidity if that same muscle mass. 
Those muscles are critical in supporting the UCL. If they are placed at a mechanical disadvantage they are unable to assist in attenuating the forces on the UCL

So I blame it on Roger Craig. 

3) It’s All These New Antibiotics.

Don’t laugh.

There may be something to this. 

A few weeks ago I got a call from a guy who said he was from Minnesota and that he knew why all these Tommy John surgeries were happening. He wanted everyone to know the truth, but didn’t have the resources to get the word out. 
According to this guy, as bacteria have evolved and become resistant to antibiotics, major drug companies have created new, extremely powerful classes of medications designed to blast these stubborn bugs.

The first generation to receive these nuclear antibiotics is now approaching big league age, and according to our mystery man in Minnesota, the new antibiotics are the reason for the injury outbreak. He added that he is certain that the big pharmacy companies are conspiring to suppress the truth.  

When I hung up the phone, my first inclination was to don a tin foil hat in anticipation of an alien abduction. 

But then I Googled. It. 

Turns out, the newest class of antibiotics called floroquinolones have a significant possible side effect in that they can cause connective tissue like tendons and ligaments to weaken. Several cases of complete rupture of the Achilles’ tendon have been reported. 

The issue became so problematic that in 2008, the FDA took the following action:

FDA ALERT [7/8/2008]: FDA is notifying the makers of fluoroquinolone antimicrobial drugs for systemic use of the need to add a boxed warning to the prescribing information about the increased risk of developing tendinitis and tendon rupture in patients taking fluoroquinolones and to develop a Medication Guide for patients.

Several so-called MLB experts have noted that incidences of UCL tears appear to be higher among American pitchers than Latinos. Limited access floroquinolones in places like The Dominican Republic, Cuba, and Venezuela could explain that disparity.

I’m not sayin…I’m just sayin. 

4) Steroids in The Chicken…And the Beef

Since the 1950s, the FDA has allowed the use of “naturally occurring hormones” such as estrogen, progesterone, and testosterone in raising poultry and livestock.”  More recently, some synthetic hormones have also been approved. 

Industry critics claim that in the competitive beef and poultry markets, companies trying to gain any advantage they find are increasing dosages to their animals to help them grow bigger faster. 

This generation of pitchers has grown up ingesting steroid fed meat. Pitchers are now bigger and stronger than ever, but their ligaments and tendons have not kept pace with their muscular development. The weak link in the pitching chain is the UCL. As it is overcome by the increased forces these chicken steroid fed players can produce, the UCL yields and tears. 

5) It’s Alan Jaeger’s Fault.

No not for being the pied piper of long toss.

Despite the anti-long toss revolt created by an ASMI study reporting increased joint forces occurring during long toss as opposed to throwing from shorter distances (to which I usually pull out my smarty pants 7th grade girl voice and say, “Well, duh!”), I am still a fan of Jaeger-style long toss as a valuable off-season tool for developing ability.

It’s those damn rubber tubes…

As the number of elbow injuries has erupted, it appears to me that shoulder injuries are down. Is it a coincidence that the use of J-Bands or other rubber tubing exercises to strengthen the shoulder muscles has also become more prevalent during the same time frame? Perhaps this generation of rubber band toting pitchers are warming up and strengthening their rotator cuffs so much that the elbow has now the weak link in the kinetic chain. 
Easy now @longtoss(insertyourstate)! Don’t hate, I’m just asking a question.

6) Blame it on Dr. Jobe (God rest his soul)…and Dr. Andrews.

Through their collective genius, these two gentleman have created and refined what has been called, “the greatest procedure ever invented for pitchers.”  UCL reconstruction has saved and extended the careers of countless hurlers who would have otherwise ended up as castaways on the island of misfit arms. Return to prior level of competitive play or beyond after a Tommy John surgery is at about a 90% success rate. If Doctors Jobe and Andrews hadn’t developed such an amazing lifeline for pitchers, maybe they would be more careful and wouldn’t rip their elbows apart.

7) It’s Brent Strom’s Fault.

Current Houston Astros pitching coach Brent Strom is a good guy and good friend. But he probably has no idea of the attribution he has to the epidemic of elbow surgeries.

You see, Brent was the second guy in history to ever undergo UCL reconstruction. Of course, Tommy John was the first. Tommy John went on to have a storied and highly productive career. A look at his lifetime stats reveals a highly effective, border line hall of fame pitcher (288-231, 3.34 ERA, 2245 Ks ) 
Comparatively, Brent Strom’s career numbers are less impressive (22-39, 3.95 ERA, 278 Ks) 
If Brent had been the first guy to have the surgery, and the went on to put up his numbers, do you think today’s pitchers would be has trigger happy when deciding whether or not to try “Brent Strom Surgery”?

8) It’s Those Confounded Video Games

I think it’s safe to say this generation of pitchers has logged more hours slouched behind a video game controller than all the prior generations combined.

Unless pitchers are playing MLB2k to practice pitch selection using Perry Husband’s Effective Velocity, I am not a fan.

The profound postural changes created by prolonged gaming are obvious. In my physical therapy practice we are seeing an increase in adolescents and young adults with disc bulges in their lower backs and necks (the byproduct of a life of prolonged sitting and slouched posture). Prior to this generation, lumbar and cervical disc derangement were most common between the ages of 30 and 50. These days, younger and younger patients are showing up with what used to be considered a middle aged problem.

Due to habitually slouched postures, many of the pitchers I evaluate have significant rounding of the shoulders and forward heads. This causes the scapula to slide forward on the thoracic cage and puts the glenohumeral joint in a position that prohibits internal rotation.

I have written several blog articles about the importance of deceleration to arm health. Two critical components of deceleration are internal rotation of the shoulder and pronation of the forearm. If you can’t internally rotate, you can’t decelerate efficiently. If you can’t decelerate efficiently, you can’t protect your UCL.

9) Too Much Gatorade, Mountain Dew, and Pepsi.

These drinks, highly popular among young pitchers and video gamers, contain a chemical called brominated vegetable oil (BVO). Sounds kind harmless on the surface, but if you dig a little deeper you’ll find that BVO is banned in many other civilized countries because of severe possible side  effects.

One of the side effects listed for BVO is premature puberty. Typically in a young pitcher’s elbow complex, the weak link is the growth plate. If a pitcher ingests too much BVO, he could enter puberty early. If he enters puberty early, his growth plates close before the ligaments are prepared to handle the stress of high level throwing. Instead of breaking down at the growth plate, the young pitcher could possibly tear his UCL.

10) Fast Food Diets. No Fruits and Vegetables

Every kid loves stopping by McDonald’s or Chic-Fil-A for a quick meal after a game. Kids today don’t eat many fruits or vegetables.That’s a well known fact.

Every time you pitch, your tendons and ligaments are slightly damaged by microtrauma to the tissue. That is the source of the soreness often felt an outing. In prior blogs I have written about the value of increased blood flow through restorative functional movement to promote tissue healing and recovery from throwing.

According to many nutritional experts, colorful fruits provide essential vitamins, minerals, and antioxidants necessary for tendon and ligament healing. Vegetables also provide rich amounts of protective nutrients, including vitamin C. Red bell peppers contain more vitamin C per serving than citrus fruits and other vitamin C-rich fruits and vegetables, according to the Office of Dietary Supplements. Additional valuable sources include tomatoes and tomato products, spinach, broccoli, Brussels sprouts and green bell peppers. I haven’t seen many of those items on the menu at Whataburger.

It’s not much of a leap to link poor nutrition to lack of tendon and ligament health.  A lousy diet could place a pitcher at risk for UCL injury.

So here’s the point. 

We have definitely seen a rise in the number of UCL injuries as of late, and it seems as though every “expert” has figured out the cause.

But there are no “causes” to injury — only a series of contributors. Injuries are usually the result of a confluence of contributing factors coming together in the perfect place at the perfect time to create the perfect storm of variables.

Workload in youth baseball is probably a contributor, but so are mechanical inefficiencies, physical constraints, functional movement limitations, and dozens of other variables we may not even understand yet.

Here at the ARMory we will continue to hold the health and durability of our athletes as priority number one. We will continue to assess for all the known possible risk factors to injury, and we will develop innovative strategies for suppressing those risks.

We don’t claim to have it all figured out. We never will.

But we will continue to be on the leading edge of research and forward thinking, and we will continue to ask better questions and seek better answers. In the unfortunate event that anyone is injured, whether they are an ARMory student or not, we will be there to walk them through the healing process and get them back to the game they love.

Helping young men become GREAT men. Helping them chase their highest dreams, understanding that what they become from the journey is far more important than what they will ever achieve.

That is our passion.

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