Flawed Assumptions Holding Us Back From Real Progress In Baseball Training (part 2)

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Does this make sense?

If you want to be a great guitar player, it would be helpful to be able to play the guitar more than most people play the guitar.

If you want to be a great chemist, you should probably plan on doing chemistry stuff (whatever that means) more than the average person does chemistry stuff.

And if you want to be a great throwing athlete (pitcher or fielder), you should probably plan on throwing more than the average person throws.

This is where, in the baseball training industry, we run into trouble, and the problem stems from a pervasive flawed assumption that points to “overuse” as the primary “cause” of injury.

Baseball traditionalists and many of my esteemed colleagues in the medical profession appear to ascribe to what I call the “save the bullets” theorem.  “You only have so many throws in your arm.  It’s best to save them.”  This idea flies in the face of the laws of human physiology.  Davis’s law states that all human connective tissue (including tendons, ligaments, and muscles) will align itself to resist the stresses under which it is placed.  This means that the UCL, labrum and rotator cuff can remodel themselves to become more robust (resistant to perturbation) and more resilient (resistant to tissue failure). It also means that if we go too far in avoiding stress, we could make the tissue more vulnerable to injury – the exact opposite of our intentions.

Based on the “overuse assumption,” influencers in the baseball and medical industries have recommended and the enactment of broad-sweeping, universal pitch counts and innings limits with the noble goal of reducing injuries. These rules have been in place for nearly two decades, yet the injury rate continues to rise. Not a week goes by that we don’t get a call from an exasperated parent saying, “I don’t know how my son got hurt.  We never let him go beyond the recommended pitch count, and he didn’t throw curveballs until he was 15.” These parents have been guided like sheep into a false sense of security that one need only purchase a pitch counter to ensure reduced injury risk.

The overuse assumption fails because the injury equation is far more complex than workload alone.  In 2010 Coach Ron Wolforth of The Texas Baseball Ranch scripted a brilliant and comprehensive list of what he called “The Six Types of Contributors to Sup-Par Performance and/or pain.  On this infographic, they are listed in rank order of significance.

Your physical constraints and attributes (Type 1), you biomechanical patterns (Type 2), your tissue preparation/recovery/ramp up (Type 3), your strength training and other training related variables (Type 4), and your sleep, hydration and nutrition (Type 5), are all far more important than your workload (Type 6).

If numbers 1-5 are right, you could and should throw a lot.  If numbers 1-5 are wrong, 10 pitches may be too much for you.

We had our R&D/Analytics Coordinator, Jordan Rassmann look into MLB disabled lists reports for insight into the overuse assumption:

“The emphasis on pitch count in today’s game is meant to help prevent overuse on volume and workload for pitchers. Limiting pitch count can be effective for helping manage games strategically, but the overall assumption that it can help prevent injuries is not entirely clear. If the main reason for pitchers getting injured was overuse, then it would be expected that the pitchers that pitch more innings (i.e. starting pitchers) would exhibit more time on the disabled list. However, based on the 2017 MLB pitching stats and DL data, starting pitchers appeared to stay healthier at a much better rate than their relief pitching counterparts (special thanks to Jeff Zimmerman of RotoGraphs for meticulously collecting this important DL data). In fact, among the over 18,000 days spent by pitchers on the DL, only about 58% of it was attributed to starting pitchers, which is a much closer margin than anticipated. This is remarkable considering starting pitchers accounted for about 69.5% of all the innings pitched by pitchers on the DL this past season. If the pitchers with the highest pitch count and workload are spending less time on the disabled list than relief pitchers, then perhaps overuse isn’t as good of a predictive measure for pitchers’ safety after all. Percentage of all starters that threw at least 1 inning during the 2017 season that spent any amount of time on the DL was 40.3%. The percentage of all relief pitchers that threw at least 1 inning during the 2017 season that spent any amount of time on the DL was 28.5%.”

Another possible metric that could be used to compare the workload of pitchers to time spent on the DL is the IPDL Ratio, which (as it sounds) is simply the ratio of total innings pitched to days spent on the DL. The IPDL Ratio for starting pitchers last season was 2.81 whereas the ratio for relief pitchers was 1.72. Overall, this means that starting pitchers are providing a little more than an extra inning pitched for each day spent on the DL than relief pitchers. The higher the IPDL Ratio, the less likely a particular pitcher is to spend time on the DL. Although it isn’t a perfect metric that can be used entirely to predict the likelihood of injury, it can be used as another indicator at showing longevity and health consistency among pitchers. Obviously more serious injuries will take a larger toll on a player’s IPDL Ratio and players that were never hurt will have a ratio approaching infinity (if a player was never hurt, I’d consider just using the innings pitched for the IPDL ratio to avoid this). It’s not perfect, but it’s something that could be used to help better understand pitchers’ workload and injury history.

Shown below are charts showing the number of trips to the DL by pitchers for each month of the 2017 season. The first chart below shows this while the second chart below shows the same thing except for being separated by pitcher type (starter or reliever). It interesting to see that the majority of these injuries occur in the very beginning of the season with a peak at the very end of the season also being evident.

Great job Jordie!!

In my opinion, if we are indeed going to make progress in reducing arm injuries, we must start by abandoning the flawed assumption that all arm injuries are caused by overuse.  “Overuse” is nothing more than a trash can term we in the medical industry use far too often.  It doesn’t begin to get to the roots of the problem. The truth is far more complex.  In theory, if mobility, motor control and coordination are optimal, and if  the athlete is adequately condition and prepared, there should be no such thing as “overuse”.  As my friend, Dr. Win Chang (@shouldersphere) said in a recent e-mail exchange”

“There is no overuse, either in volume or intensity, provided that the player is prepared to face such volume or intensity.  A new 17 yo pitching 60 times at 60 mph may be “overuse “ if not prepared nor trained for such event. However, the same player, after proper training, may pitch 80 times at 80 mph with no problem. But same player if ramped  up to 90 pitches at 80 mph , may be “overuse “ because that player has not been prepared to meet higher volume.
So, it is “underprepared”, NOT “overuse”.
In our next blog, we’ll tackle another flawed assumption, that traditional “strengthening” is the key to rehab and injury prevention.

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