Ulnar collateral ligament tears continue to devastate the ranks of both Major League and Little League Baseball, with the total number of UCL reconstructions climbing almost every year for the last two decades, according to research published in the Orthopaedic Journal of Sports Medicine.
Sports medicine stakeholders are hopeful the implementation of workload management and the active dissuasion against single-sport specialization at a young age will mitigate the UCL problem in the future, and wearable technology promises to yield a greater amount of data than ever before. These and other advances seek to make the Tommy John epidemic a thing of the past.
Becker's Spine Review spoke with Neal ElAttrache, MD, of Los Angeles-based Cedars-Sinai Kerlan-Jobe Institute; Steve Jordan, MD, of Gulf Breeze, Fla.-based Andrews Institute for Orthopaedic and Sports Medicine; and Will Carroll of Motus Global — a wearable technology company that caters to athletes — about the prevalence of UCL tears in baseball and the emergence of wearable technology.
Mitigating the epidemic is no easy feat, and the latest attempt to do so in youth athletics is being made through workload management and the active encouragement against single-sport specialization, which Dr. ElAttrache and the American Orthopedic Society for Sports Medicine are emphasizing in advance of the upcoming season.
"It all has to do with exposure and with trying to decrease the repetitive nature of the specific tissue," he says. "If you have a kid playing one sport year round, the same physical moves are going to be occurring, so those specific tissues unique to that sport will be at risk."
Overexposure and overuse on a young arm wears down the UCL. By limiting workload and taking stress off the arm, the muscle has a chance to normalize, Dr. Jordan says.
"What we can look at is the overall body of work suggests taking three months off a year [which] is important," Dr. Jordan says.
Dr. ElAttrache cited expanded starting rotation as an example of managing workloads in professional baseball. At the turn of the 20th century, professional baseball teams carried two to three man rotations and compiled monstrous innings counts. Teams saw the value an expanded rotation would have, and “the teams with the 4 man rotation started winning everything,” he says. This year will be among the first times a professional team will try a 6-man rotation, as the Los Angeles Angels are expanding their rotation to accommodate two-way player Shohei Ohtani. Dr. ElAttrache said the reduced workloads could prove to be greatly beneficial.
However, there is a developing fear in sports medicine around increased velocity. The sport is evolving and young pitchers are hitting velocities unheard of for their age groups. Dr. ElAttrache says 15-and 16-year-old pitchers are regularly throwing in the high 80 mile per hour range, with some 17-year-old pitchers hitting the low 90s. That level of velocity paired with raw mechanics is a recipe for disaster.
It's a fear echoed by Mr. Carroll and Dr. Jordan. "You see too many kids going out there on a well-intentioned program but they didn't have the base," Mr. Carroll says. "What works for Michael Kopech throwing 107 mph, is not the same as what [works for] this 12-year-old who needs to gain 20 pounds, get his core solid and learn where his arms are. But he's doing the same program."
Being part of the solution
Mr. Carroll recently retired from a career reporting on sports medicine to serve as Motus Global’s media relations director. Motus is one of several companies creating wearable technology for athletes, and it is among the most recognizable. He joined Motus because it gave him "a chance to stop talking about injuries and start doing something about it. I want to see less injuries across all sports and at all levels and with Motus, we have a real chance to make a real change."
Motus has several offerings for baseball players that track every aspect of a player's game, among them is the Motus Sleeve and the Motus Baseball. But instead of just developing the technology and selling it, Motus is using its tech for research.
Recent research conducted by Washington, D.C.-based Medstar Georgetown University Hospital's Sameer Mehta using Motus sleeves compared collected data to a player's acute-to-chronic workload ratio. The data found athletes were 15 times more likely to be injured when their ratio increased more than 30 percent.
Motus is in the midst of conducting a three-year study, first reported on by SportTechie, in which a team of Little Leaguers, 12 years and under, were outfitted with Motus technology. Mr. Carroll says the reasoning behind the study was simple. "The question we want to ask is what would happen if we took the most advanced tech, the most advanced approach and the same kind of people," he says.
Dr. Jordan believes wearables will make workload management easier.
"If you see a drop in pitch velocity or a drop in spin rate, that's a sign that something is going on," Dr. Jordan says. "Wearables can be used to monitor overuse and changes in kinematics on a daily basis along with the outside monitoring of variables like spin rate and ball movement."
While wearable technology is slowly breaking into the MLB, the University of Indianapolis was among the first in the country to fully buy-in. After arm injuries derailed the Greyhounds' 2016 season, the team embraced wearables, and Mr. Carroll believes the results will spur other teams to embrace the technology.
"They're using it for pitching, they're using it on their fielders — which we don't normally see — and they're using it on their hitters. Their team is ranked right now and they've had no arm injuries," Mr. Carroll says.
Above all else, wearable technology could possibly mitigate the Tommy John epidemic. "We can't get to zero, but we can get to less. One less is good. One arm we save is good," Mr. Carroll says.
It's a sentiment echoed by Drs. ElAttrache and Jordan.
"We are getting a lot of data. It's about analyzing the data and [seeing] how we can relate that to injuries and injury prevention." Dr. ElAttrache said. "...[Mr. Carroll] is right, the future is in the data."