Pitchers who throw with 100 percent effort and at higher velocity are at greater risk of suffering the type of elbow injuries that lead to Tommy John surgery, the American Sports Medicine Institute said in a position statement Wednesday.
The statement drafted by Dr. Glenn Fleisig, research director of the ASMI, addressed several misconceptions about elbow injuries and included nine recommendations to help prevent what it called the "epidemic" of ulnar collateral ligament injuries among professional pitchers.
"The best professional pitchers pitch with a range of ball velocity, good ball movement, good control, and consistent mechanics among their pitches," the statement said. "The professional pitcher's objectives are to prevent baserunners and runs, not to light up the radar gun."
Miami Marlins ace Jose Fernandez recently joined Arizona's Patrick Corbin, Oakland's Jarrod Parker and A.J. Griffin, Atlanta's Kris Medlen and Brandon Beachy, and Tampa Bay's Matt Moore among a group of 20 major league pitchers to undergo Tommy John surgery since the start of 2014.
The Kansas City Royals received a scare this week when hard-throwing right-hander Yordano Ventura experienced pain in his elbow, but an MRI showed no structural damage and Ventura is expected to miss only one start.
The rash of arm injuries has become so pronounced that commissioner Bud Selig said recently that he's "almost afraid to pick up the paper" because of all the bad news.
"I'm very worried over the fact that it's happening with so much regularity, over and over," Selig said at the MLB owners' meetings earlier this month. "We have some great young arms, and it's very sad."
The ASMI statement said the amount of pitching among adolescents and fatigue both contribute strongly to elbow injuries at an early age.
"Other risk factors may include pitching on multiple teams, pitching year-round, playing catcher when not pitching, poor pitching mechanics, and poor physical conditioning," the statement said.
In their research, the investigators have not found a strong connection between throwing the curveball and elbow injuries.
Dr. James Andrews, founder of the ASMI, is quick to add a word of caution when interpreting that data.
"These studies were largely based on throwing in a biomechanical lab setting with ideal mechanics," Andrews said. "Kids don't typically have the neuromuscular control to properly throw a curve. If you add in fatigue, they're even likelier to have poor mechanics and end up with an injury."
Andrews says he still encourages delaying throwing a curve until physical maturity has been reached or, as he says, "Until a kid can shave."
Researchers also determined that lowering the mound would have no effect on reducing the frequency of UCL injuries, and found no difference in the rate of elbow problems among pitchers from the United States and Latin American countries.
Among its recommendations for professional teams, the ASMI urged pitchers to optimize their mechanics to ensure using the whole body in a coordinated sequence, stressed that pitching coaches need to watch for signs of fatigue on the mound, and emphasized the importance of "open communication" between pitchers and the coaching and medical staffs.
The doctors also cautioned pitchers against taking part in winter ball because "the UCL and body need time to recover and build strength."
"Exercise, rest, and nutrition are vital for a pitcher's health," the statement said. "Performance-enhancing drugs may enable the athlete to achieve disproportionately strong muscles that overwhelm the UCL and lead to injury."