Home Baseball Content More Than Just Pitching Mechanics: The Skinny on Stephen Strasburg’s Injury

More Than Just Pitching Mechanics: The Skinny on Stephen Strasburg’s Injury

Written on August 29, 2010 at 11:45 am, by Eric Cressey

Since a lot of folks reading this blog know me as “the baseball guy,” I got quite a few email questions about the elbow injury Washington Nationals phenom Stephen Strasburg experienced the other day.  Likewise, it was the talk of Cressey Performance last Friday – and got tremendous attention in the media.  Everyone wants to know: how could this have been prevented?

strasburg

On Thursday’s edition of Baseball Tonight, my buddy Curt Schilling made some excellent points about Strasburg’s delivery that likely contributed to the injury over time.  Chris O’Leary has also written some great stuff about the Inverted W, which is pretty easily visualized in his delivery.

invertedw

The point I want to make, though, is that an injury like this can never, ever, ever, ever be pinned on one factor.  We have seen guys with “terrible mechanics” (I put that in quotes because I don’t think there is such a thing as “perfect mechanics”) pitch pain-free for their entire careers.  Likewise, we’ve seen guys with perfect mechanics break down.  We’ve seen guys with great bodies bite the big one while some guys with terrible bodies thrive.

The point is that while we are always going to strive to clean things up – physically, mechanically, psychologically, and in terms of managing stress throughout the competitive year – there is always going to be some happenstance in sports at a high level.  As former Blue Jays general manager JP Ricciardi told me last week when we chatted at length, “you’ve only got so many bullets in your arm.”

Strasburg used up a lot of those bullets before he ever got drafted, so it’s hard to fault the Nationals at all on this front.  In fact, from this ESPN article that was published when the team thought it was a strain of the common flexor tendon and not an ulnar collateral ligament injury (requiring Tommy John surgery), “Strasburg has told the team he had a similar problem in college at San Diego State and pitched through it.”  It’s safe to assume that the Nationals rule out a partial UCL tear in their pre-draft MRIs, but you have to consider what a common flexor tendon injury really means.

medialepicondyle

As I wrote in in my “Understanding Elbow Pain” series (of interest: Anatomy, Pathology, Throwing Injuries, and Protecting Pitchers) the muscles that combine to form the common flexor tendon are the primary restraints – in addition to the ulnar collateral ligament – to valgus stress.  If they are weak, overused, injured, dense, fibrotic, or whatever else, more of that stress is going on that UCL – particularly if an athlete is throwing with mechanics that may increase that valgus stress (the Inverted W I noted above) – the party is going to end eventually.  Is it any surprise that this acute injury occurred just a few weeks after Strasburg dealt with a shoulder issue that put him on the disabled list for two weeks?  The body is a tremendously intricate system of checks and balances, and it bit him in the butt.

There are other factors, though.  As a great study from Olsen et al. showed, young pitchers who require surgery “significantly more months per year, games per year, innings per game, pitches per game, pitches per year, and warm-up pitches before a game. These pitchers were more frequently starting pitchers, pitched in more showcases, pitched with higher velocity, and pitched more often with arm pain and fatigue. They also used anti-inflammatory drugs and ice more frequently to prevent an injury.”  And, they were also taller and heavier.

valgus

Go back through the last 12-15 years of Stephen Strasburg’s life and consider just how many times he’s ramped up for spring ball, summer ball, fall ball, and showcases – only so that he can shut down for a week, just to ramp right back up again to try to impress someone else.  Think of how many radar guns he’s had to pitch in front of constantly for the past 5-7 years – because velocity is all that matters, right?

Stephen Strasburg’s injury wasn’t caused by a single factor; it was a product of many.  And, it can’t be pinned on Strasburg himself, any of his coaches or trainers, or any of the scouts that watched him.  Blame it in the system that is baseball in America today.

We already knew that this system was a disaster, though.  Yet, people still keep letting their kids go to showcases in December.  Heck, arguably the biggest underclassmen prospect event of the year – the World Wood Bat Tournament in Jupiter, FL – takes places at the end of October.  When they should be resting, playing another sport, or preparing their bodies in the weight room, the absolute best prospects in the country are pitching with dead, unprepared arms just because it’s a convenient time for scouts and coaches to recruit – because the season is over.

They’re wasting their bullets.

Now, I’m not saying that Strasburg’s injury could have been avoided in a different system – but I’d be very willing to bet that it could have been pushed much further back – potentially long enough to allow him to get through a career.  An argument to my point would be that if it wasn’t for all these exposures, he wouldn’t have developed – but my contention to that fact was that it is well documented that Strasburg “blew up” from a good to an extraordinary pitcher with increased throwing velocity when he made a dedicated effort to getting fit when he arrived at college.

My hope is that young pitchers will learn from this example and appreciate that taking care of one’s body is just as important as showing off one’s talent.

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  • Nice!

    I was waiting for you to chime in.

    Great stuff as always.

    Rick Kaselj of ExercisesForInjuries.com

    .

  • So glad you didnt say it was becuase of one thing. Shill made it seem like the “W” factor in his delievery was to blame. Most high velocity MLB pitchers have the same “W” in their delievery, including Shill. It is part of what makes MLB pitcher throw at high velocities. I believe you call it the “freak” factor why so few can do what MLB pitchers do. I am on the side of too much inconsistant throwing at young ages and also bodies not ment to throw 100+ mph and throw curveballs at such high speeds. (Wood’s 20 something K’s with that curveball) Throwing nasty curveballs with that much arm speed gets pretty dicey when fatigue comes into play, small room for error eguals high risk of injury.
    hope this gets through because it is the third and final time I can resend the same thing 🙂 hand is cramping lol

  • So very true Eric. Unfortunately, how many of these great prospects is it going to take for things to change?

  • Kaleb

    This is great stuff. Upon review of my own mechanics I was definitely an inverted w guy. I say was because I had tommy john about a year ago and have absolutely zero velocity. Went from throwing 88 to topping out at 80. When I saw Strasburg needed tj my heart sank, I pray he makes it back and doesn’t wind with us in the 17% percent club of those who don’t make it back.

  • Jim Lenkowski

    Eric,

    Is there any chance that this will actually have a silver lining in that it happened now instead of later on, namely by serving as a wake-up call for areas he needs to pay more attention to?

  • Grant Gardis

    Eric,

    I have heard many oldtime pitchers (Tommy John for one) say that kids don’t play catch enough in the off season. Not pitching, just going out and playing catch. Also, I have been told that kids throw off a mound to much and that it is hard on their arms also. Any thoughts?

    Great series of articles by the way.

  • don smith

    I’m preatty sure he had weak tight hips EC. Decent core control though.

  • John G

    @Grant: One of my biggest pet peeves as a college coach is watching my players warm up. They never throw the ball as hard as they can in warm ups. They have to be constantly reminded that they need to throw the ball hard in practice if they are going to throw hard in games. You’re not going to build arm strength unless you throw the ball hard–much like you aren’t going to build strength if you do a sub-maximal weight every time. Unfortunately it has a lot to do with how they are coached as kids.

    EC good write up. I’m not surprised that his UCL was the breaking point. This study (http://www.ncbi.nlm.nih.gov/pubmed/8784962) showed that the UCL undergoes near maximal forces at max external rotation every max pitch (UCL breaking point was measured in cadavers).

  • Great post Eric – up here in Toronto, it was announced yesterday that the Blue Jays are shutting down our young pitcher Brandon Morrow for the season after his next start…no injury, just pure prevention and management of his total pitch count and stress on his young arm. This may be a response to the Strasburg scenario, but I think there is a general movement in baseball to be a bit more careful with young arms, even once they make it to the show. It’s about time!

  • Grant, throwing from the mound is absolutley more stressful than flat ground. The body takes on much more stress because of the decelartion on a downhill plan. Extra gravitational forces are at work to decelarate the arm properly. Think of sprinting down a hill and trying to stop on the hill verses sprinting on flat ground and stopping the body. Much harder on the joints to stop your sprint on a decline.

  • Great article Eric! More evidence that when it comes to young athletes they need rest, other activities, and input from experts to avoid injuries.

  • Great point…most would blame one factor

  • I always hate to hear about a potential career-ending injury….but you’re probably right…it’s been a long time coming.

    We think we’re invincible when we’re young and don’t realize how many bullets we’re wasting. Great article!

  • Sy

    I thought it was funny when the ESPN baseball analysts were all talking about how the Nationals took all the proper precautions by sending him down to the minor leagues first, making sure he developed and wasn’t rushed up the the majors. They were acting all surprised because of all the Nationals did, and this still happened. There was no mention of what Eric talked about in the article which was how much he probably pitched growing up. Coaches and parents should be aware that pitching a baseball is a highly stressful movement to the arm. It’s more then just icing it a little and running the soreness out. If they start specializing in baseball at age 8 (which they shouldn’t) then hopefully the parents educate themselves on what kind of preparation their kid needs to go through because I guarantee their volunteer youth coaches won’t have a clue

  • Eric,

    If you haven’t already, do you care to write a post about Tim L, and why his delivery is so special and seems to cause him no problems?


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