Further evidence that when you hear "inflammation" mentioned as the "diagnosis", you need to look further into what is causing the inflammation. Ervin Santana ’s MRI revealed a sprain of the right Medial Collateral Ligament - also known as the Ulnar Collateral Ligament (UCL). This ligament is the primary stabilizer of the elbow when it is flexed, and when sprained, creates laxity about the inner portion of the elbow with throwing.
It has not been revealed how major of a sprain this is, but early indications are that it is minor (probably a Grade I+), and that Santana is already feeling some better. Plus, he will be allowed to start playing catch later this week, so long as his elbow is feeling better. A ligament injury of this nature takes about 6 weeks to heal.
Manager Mike Scioscia has pretty much ruled Santana out for the opening week of the season, and feels that the current injury should not have lasting effects once the season starts. Said Scioscia, "We’ll slow him down, let the stuff in his elbow calm down, and go from there. We don’t anticipate that it’s the sort of setback that will cost him an appreciable part of the season."
There has been some concern that Santana had thrown more innings in the Dominican Winter League this past off season than was initially reported. While most accounts had Santana throwing only 6.2 innings, teammate Erick Aybar said he had thrown 16 innings. Santana logged 219.0 innings last season, which was a career-high, while he had thrown 182.1 the season prior (combined MLB/AAA). According to Fangraphs pitch selection data , he had largely stopped using his curveball and decreased his changeup use in favor of nearly a 10% increase in slider usage. It is anyone’s guess if this has anything to do with his current situation, but it is interesting enough to note.
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16 Comments
Great explanation as always. We had Ervin Santana on our ‘risky pitcher’ list (http://razzball.com/20-risky-pitchers-for-2009/) specifically because of his overreliance on the slider in 2008.
Two questions:
1) If you could rank pitches based on their potential for injury, what would it be? Slider, curve ball, split finger, cutter, fastball, changeup, knuckleball?
2) Any guidance on why pitchers who throw a lot of cut fastballs seem to lose arm strength? Abbott, Avery, and Loaiza come to mind…
As far as potential for injury is concerned, the volume of pitches thrown has more to do with injury risk than anything. Force/velocity of pitches is another major risk factor.
There have been studies performed by some of the best Doctors in the country that show statistical insignificance between various pitches when it comes to joint loads at the elbow.
It is important to realize, however, that just because a study shows “statistically insignificant” results of pitch type/joint loads/injury risk, it does not mean that there is absolutely NO relationship. This is one of the flaws of research methods.
A frequently-cited research article by Fleisig et al (2006) even admits in the conclusion of the article that: “The increased forearm supination and increased wrist motion from radial to ulnar deviation may or may not increase tension and injury risk in specific soft tissue, but such analysis was beyond the scope of the current study.”
Why is it, then, that we always hear teams talking about bringing pitchers back after injury and having throw fastballs and changeups first, then breaking pitches - usually with the slider being the last pitch introduced???
My belief is that you have to take into account forearm/wrist position, increased activity of individual muscle groups (i.e. finger/wrist flexors), and the types of grips and releases for each pitch.
For example, most pitchers grip their sliders firmly with the middle finger, with the ball leaving the middle finger at release, while utilizing a supinated forearm position at release.
Plus, in the cocking phase, the supinated forearm position of a slider grip, combined with the eccentric contraction of the wrist/finger flexors at the medial elbow, could realistically contribute to overuse injuries to the elbow - more so than other pitches.
I would probably rank in order of injury risk:
1. Slider (due to forearm/wrist position and grip using middle finger)
2. Cutter (a hybrid fastball-sliderish pitch)
3. Fastball (due to velocity/force of pitch and the frequency of its use)
4. Curveball (mostly due to forearm/wrist position)
5. Forkball
6. Changeup (looser grip, slower velocity)
7. Knuckleball (low velocity pitch)
In addition, Fleisig et al did admit that because the slider-throwing population in their study was so small, that kinetic differences might have been seen to be significant with greater sample size.
The main thing I see with this study is that it calculates gross (resultant) joint loads using inverse dynamics. It really does not address changes in ligament tension that results from changes in forearm/elbow and wrist positions. In other words, it is a scientific estimation, not a surefire method to detect injury risk.
In addition, the researchers did admit that there may be other biomechanical factors such as “ball grip and forearm tension” that could not be detected with the methods of the study. This is what I was talking about in my previous in comment #2 above.
They did report that the slider produces greater horizontal adduction torque at the shoulder.
Cutters combine a slider-like grip with the velocity similar to a fastball, which probably has something to do with it.
Wow. Great explanations. I’ve been really skeptical about the cutter given the impact it seems to have on pitchers’ velocity. A number of the risky pitchers happen to have high cutter %s (Lester, Litsch) and it now increases my suspicion of Halladay who seemed to resurrect his K ability last year with a fierce cutter.
A fastball is worse than a curveball? It’s just hard to believe. Wouldn’t a 100% fastball pitcher be better off than a 50/50 fastball/curveball pitcher?
Fastballs are thrown with the most force and intent, and are thrown with greater frequency. Look at Joel Zumaya, who threw 82% of his pitches as fastballs (avg 97.5 mph!!). Although, everyone is different in their mechanics/delivery/anatomy, etc…
I mean Papelbon threw 81% fastballs and he was relatively healthy, so I don’t think you will ever be able to say “Pitcher X throws a ton of fastballs so he is going to be more injury-prone than Pitcher Y.”
Gotcha. Just feels like the guys who throw the hard 12-6 curve ball often end up hurt - Ben Sheets, AJ Burnett, Bedard - whereas the guys who threw a mix of fastballs, splitters, and changes stay healthier. Although it does seem that non-power lefties throw the lollipop curve which seems less wearing on the arm (like a Zito)
Re: Zumaya, relieving is a different animal. I find them impossible to predict.
I find it very strange you list fastball as one of the more damaging pitches. The frequency it is thrown should have no bearing on how damaging an individual pitch is. It seems like a logical fallacy.
Also, most pitchers try to have the same arm action for each pitch otherwise it’s easy to tell what they are throwing. Changeup and fastball should look identical and even the hard curve should be the same.
It is not just the velocity that makes a fastball injurious, but it is the force generation needed by the various shoulder muscles at various points in the motion (to either accelerate or decelerate the limb). The sheer volume of the pitch also plays into this. If you do this for 60-80% of your pitches, the cumulative stress adds up. Most would agree that a fastball certainly is more taxing than is a changeup.
As far as the various pitches, the difference isn’t so much in the “arm action” as it is with the position of the wrist and forearm throughout the pitching motion (for elbow problems), especially at release and after release.
Wow, great discussion. As a former rag-armed pitcher, I agree with the assessments that a fastball is more injurious than a properly thrown (emphasis on properly thrown)curveball. Although arm speed should be the same for all pitches, the force required for a fastball in comparison to other pitches taxes those muscles to a greater extent. And sliders kill elbows, plain and simple. Whenever someone can pitch for a long time throwing sliders and avoid injury (Randy Johnson), I am always amazed. Good stuff…..
The reason I mentioned about volume was in regards to ranking which is most injurious.
For example IF we determined that a hard curveball was 10% more damaging (for one pitch) than a fastball
then:
80 FB & 20 CB would be 80pts of abuse + 22 pts of abuse. Equalling 102.
80 CB & 20 FB would be 88pts + 20pts equalling 108.
In this case a high volume of Fastballs actually means less damage.
Volume is only relevant after determining which causes the most damage.
ps:from what I’ve heard the slider is the worst for the elbow and the hard curve is worse for the shoulder. With the changeup being the easiest on the arm and fastball next. Excluding the knuckle of course.
A lot of ifs…I suppose the entire scenario depends on how hard a fastball is thrown, how slow/fast a curveball is thrown, etc. What if we found that throwing a “hard” curveball was 10% less damaging than fastball.
There are so many variables involved, there would be no way to really quantify (with certainty) which pitch is worse.
You have to also take into account individual factors such as joint laxity, ligamentous laxity, muscle weakness/tightness, neuromuscular control of the Scapular stabilizers and rotator cuff (timing and coordination of contraction/movement). All of these factors will be different for individuals, and hence, pitches could be more or less “damaging” for individuals based on these factors (and other factors).
This is why I can’t accept abuse points as gospel.
Sliders typically are worse for the elbow, though research has not concluded that to be “significant.”
What we do know if that fastballs are thrown a lot - and thrown very hard in most cases. If you a huge volume of any physical activity with significant force, the tissues/structures will be taxed. Given that the shoulder joint sustains deceleration after release of around 500,000 degrees per second/squared, you can see how this would be injurious.
Throwing a fastball is “one of the fastest human movements observed in any physical skill”, with nearly 15,000 inch-lbs of shoulder external rotation force according to Dillman et al.
Pappas et al reported peak angular velocity of 9,198 degrees per second with shoulder internal rotation.
I agree there are many ifs. And I only see abuse points as a basic guideline.
When I hear “the fastball is thrown very often” I want to reply “so what”. But it would sound rude and not convey my meaning.
If a pitcher throws 100 pitches in a game and they are all fastballs is that more harmful than throwing 100 pitches and they are all curveballs? I’m not sold on that.
I suppose it depends…are we talking Barry Zito curveballs, or Josh Beckett curveballs? Does the pitcher have a previous history of injury?
Volume is a big deal - whether it is innings pitched, pitch count, ratio of FB/CB/SL, etc…
It is not just the volume, but the volume combined with the ridiculous force required to perform the activity. See post #14.
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