Injured reserve

Baseball Pitch

What’s your favorite sport? I’ll use baseball to answer why there’s a dramatic rise in professional sports injuries.

Recently, the New York Yankees had the best lineup in baseball — nine players plus four more. Unfortunately, they were all seriously injured and unable to play. Not surprising since all professional sports have expanding injury lists of players with preventable, non-traumatic injuries.

Baseball is no longer a game of inches, as the legendary executive Branch Rickey once claimed. Today, it’s a game of injuries. While hitting a fastball is one of the most difficult talents in all of sports, the newer, bigger, stronger players are now increasingly getting hurt, and more seriously. In just a three-year period (2005-2008) injury rates increased by 37 percent. In fact, across all non-contact sports, non-contact injuries are rapidly rising.

The reason?

Of course, the short answer is easy: Pro athletes are increasingly larger, sometimes more fit, but often unhealthy. Just think back to the pro athletes from a generation or two ago. Those individuals were lean and mean, while today many appear more out of shape.

Granted, football is brutal. But today’s so-called non-contact sports are rougher too — baseball, basketball, soccer, hockey and others are increasingly physical at all levels, including in high school where even non-traumatic injuries requiring surgery are on the rise. While a hard hit on the head or knee accounts for some acute injuries, rates of non-contact types are significantly higher. And, most are preventable.

Overuse and repetitive activities may make one vulnerable to injury, but an unhealthy body is quick to fatigue, slow to recover, and maintains neuromuscular imbalance — all increasing the seriousness of an injury from damage to muscles, bones, joints, tendons and ligaments.

Consider baseball pitchers, who rarely get into brawls, and now play less than previous generations. Yet there continues a dramatic increased incidence of injuries, including those to the elbow’s ulnar collateral ligament often treated with the spotlighted “Tommy John” reconstructive surgery. Between 2011 and 2014, these particular injuries have increased nearly three times; over 30 percent of today’s Major League Baseball pitchers have this surgery — with increasing numbers requiring a second surgery.

Surgically repaired injuries can be devastating to players and teams, and are frustrating for fans. While about 80 percent of those having Tommy John surgery return to sports, post-surgery performance can be a mixed bag.

Shoulder surgeries can cause up to half of players to retire from sport, with only 32 percent able to return to the same or higher levels of performance.

Many competitive and training factors contribute to injuries. Playing volume, warmup and recovery quality, overuse and fatigue, and increased weight. Younger players rushed through the system, pitchers throwing harder, and fastballs now hitting 100 miles-per-hour also are thought to play a role. In general, poor mechanics contribute greatly. However, these factors have become little more than traditional buzz words.

We do know that most non-traumatic injuries are preventable, yet true prevention is lacking.

Clearly the most important injury-prevention approach is maintaining a healthy body. This means avoiding excess body fat, maintaining balanced neuromuscular and hormone systems, optimal diet, and other factors that often go unchecked.

Specifically, the two most common causes of physical impairment leading to specific injuries may include muscle imbalance and excess body fat. The assessment and treatment of both conditions are essentially neglected in pro sports.

Balanced Muscles

Athletes obviously rely on great muscle function for optimal performance. Two of the most common and neglected muscle problems include:

  • Neuromuscular imbalance, which impairs mechanics. This increases the risk of injury, not only to muscles but joints, bones, tendons and ligaments.
  • Aerobic deficiency can also impair mechanics, and reduce endurance energy while promoting increased body fat.

Despite the power in most pro athletes, neuromuscular imbalance of two or more muscles is not uncommon. It’s often due to the combination of a weaker and stronger muscle impairing proper physical movement, physical trauma or even the accumulations of wear and tear. Poor recovery from training or competition, excess fatigue, nutritional imbalance, past or present head and neck trauma, and other problems can also cause or maintain muscle imbalance.

  • Consider imbalance of the shoulder’s rotator cuff muscles, impairing the function of joints, tendons, and ligaments leading to poor mechanics.
  • Shoulder rotation deficit is well described in sports, impairing throwing, hitting, and running performance — risking further injury not only in the shoulder but in other areas.
  • An example is pitching with a supraspinatus muscle weakness. This small shoulder muscle is a recognized predisposing problem to serious elbow injury.

The same phenomenon can occur in the physical body, such as the hip, knee, ankle, spine, or anywhere. But muscle imbalance can also contribute to excess fatigue and loss of power, poor recovery (short and long-term), and inflammation and pain.

While it’s common to analyze many aspects of a player’s mechanics, speed, strength or range of motion, muscle balance, vital for all effective movement, is often not assessed. This evaluation can be made by health practitioners, and sometimes trainers and coaches, knowledgeable in kinesiology and manual muscle testing.

Aerobic and anaerobic imbalance is another major problem associated not only with physical dysfunction but biochemical impairment too. Aerobic deficiency, the reduced function of slow-twitch fibers, is common in power sports that focus on speed and strength rather than endurance. These fibers, found in all muscles, help prevent injuries because they are the primary physical supports for joints, bones, ligaments, tendons. They also help the anaerobic power fibers, the most injured parts of muscle, by bringing in blood and nutrients and removing waste.

Biochemically, aerobic muscle fibers contain mitochondria, powerhouses that burn fat for endurance fuel. This long-term energy system is an unsung hero in team sports, not just for injury prevention but optimal performance over nine innings or a whole season. This fat-burning component also plays a key role in preventing the accumulation of excess body fat, the second factor contributing to high injury rates.

Excess Body Fat

Body fat is usually a neglected measure in sports, with weight or BMI being traditional assessments, albeit misleading in athletes. While high-tech equipment like DEXA scans can precisely determine percent body fat, the overfat condition can be accurately evaluated by measuring the waist-to-height ratio. In short, the waist should be less than half the height. This simple, low-cost evaluation is easily performed by trainers, coaches and athletes.

Being overfat can contribute to the rising rates of both mechanical and metabolic injuries in athletes for many reasons:

  • Increased body fat can reduce grip strength, a reflection of better body-wide mechanics, including muscle balance.
  • Waist size is directly associated with ligament and other mechanical injuries. Plus, a significant relationship in baseball players is seen between increasing fat content in the arm, and injury-related throwing mechanics. 
  • The relationship between higher body fat and shoulder and elbow mechanical imbalance are evident beginning in adolescent players.
  • Excess body fat triggers chronic body-wide inflammation, a contributing factor in non-traumatic injuries, and one that could reduce the healing of trauma. Inflammation can trigger pathological changes in tendons and other tissues.
  • Being overfat is associated with abnormal blood fats, long known to be connected to tendon injury: specifically, elevated total and/or LDL cholesterol, and triglycerides.
  • Excess body fat maintains the vicious cycle with carbohydrate intolerance (insulin resistance) and inflammation.
  • Blood-sugar abnormalities, also secondary to being overfat, are also associated with tendon and other injuries.

More serious metabolic injuries are also becoming more common in pro sports. This past spring, the Yankees had one player recovering from a stroke, and another from a procedure to unblock a clogged artery around the heart. Infections have also bugged baseball as well.

Both muscle balance and a lean body can also help prevent traumatic injuries, and speed recovery when they do occur. Collision injuries, as in many sports, are a part of baseball, and include concussions, bone fractures, hyperextension injuries to the knees, shoulder dislocations, and others.

The Fix

Recovery and repair from muscle imbalance and the metabolic consequences of being overfat can be rapidly improved through appropriate therapies. Hands-on remedies such as biofeedback can often immediately correct muscle imbalance. The necessary dietary adjustments can also quickly change metabolic impairment, reducing inflammation, increasing energy, improving blood sugar and other health features. Reductions in body fat follow over time.

Like other pro sports, baseball is a business, with each team valued in the billions. For owners, it’s more about money than creating the old image of a pastime of pleasure for fans hoping to be No. 1. Some money must be spent on health to avoid having more $20 million-a-year players spend season after season watching rather than playing. The best teams may not win, but more likely the healthiest ones will.

 

Partial bibliography

Erickson BJ, et al. Predicting and Preventing Injury in Major League Baseball. Am J Orthop. 2016;45(3):152-6.

Garner JC, et al. The influence of body composition on youth throwing kinetics. Pediatr Exerc Sci. 2011;23(3):379-87.

Maffetone PB, Laursen PB. The Prevalence of Overfat Adults and Children in the US. Front Public Health. 2017;5:290.

Maffetone PB, Laursen PB. Athletes: Fit but Unhealthy? Sports Med Open. 2015;2:24. Epub 2016 May 26.

Post EG, et al. Correlation of Shoulder and Elbow Kinetics With Ball Velocity in Collegiate 

Baseball Pitchers. J Athl Train. 2015;50(6):629-33.

Rothermich MA, et al. Incidence of Elbow Ulnar Collateral Ligament Surgery in Collegiate Baseball Players. Orthop J Sports Med. 2018; 6(4): 2325967118764657.

Scott A, et al. Lipids, adiposity and tendinopathy: is there a mechanistic link? Critical review. Br J Sports Med. 2015; 49(15): 984–988.

Wasserman EB, et al. The First Decade of Web-Based Sports Injury Surveillance: Descriptive 

Epidemiology of Injuries in US High School Boys’ Baseball (2005-2006 Through 2013-2014)

and National Collegiate Athletic Association Men’s Baseball (2004-2005 Through 2013-2014). J Athl Train. 2019;54(2):198-211.

Werner SL, et al. Relationships between ball velocity and throwing mechanics in collegiate baseball pitchers. J Shoulder Elbow Surg. 2008;17(6):905-8.

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file:///Users/philmaffetone/Downloads/Erickson-PredictingandPreventingInjuryinMajorLeagueBaseballAMJO2016.pdf

https://pdfs.semanticscholar.org/be10/2e0a8508d161a0924a3fd00f1a07dbf437cd.pdf

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