By STEVE KRAH
Now an Ohio State University orthopedic surgeon based in Columbus, Ohio, who has worked with New York Yankees and Cleveland Indians doctors, Frantz was back near his college town Jan. 19 for the Huntington North Hot Stove clinics as a guest of new Vikings head coach Mark Flueckiger.
Frantz spoke on several topics, including strength and conditioning, mechanics, simple physics, risky behaviors, baseball specialization and the injury epidemic.
“This is pretty new stuff,” says Frantz, who shared his knowledge and findings from studies conducted by Major League Baseball and others. “This is the best of what we know at the moment for how to keep guys healthy.
“In order to stay healthy you need that whole 180-degree arc of shoulder motion (internal or external rotation). Guys who are short on that we know, particularly in the shoulder, have 2.5 to 3 times more likely risk of suffering an injury when they start to lose that flexibility and that range of motion.
“When there’s rotator cuff weakness, that’s another risk factor for shoulder injury. A shoulder surgery for a pitcher is the kiss of death.
“Elbows we’re really good at. We now have a 97 percent return to the same level with Tommy John surgery. Rotator cuff surgery is 40 or 50 percent. It’s not great.”
When it comes to strengthening the rotator cuff, Frantz points to the Baseball Pitchers and Thowers Ten Exercise Program. It’s what former big league pitcher Jarrod Parker used for injury rehabilitation and prevention (rehab and pre-hab).
“The whole shoulder adapts when your throw and you’re overhead that much,” says Frantz. “Even the actual bone itself remodels. It does what we call retrovert, meaning it tilts back a little bit.
“The late cocking is a good thing. You get a lot generated from that. It’s not a bad thing. It’s a normal adaptation for high-level throwers over time.”
Frantz notes that elbow injuries commonly occur alongside hip and core injuries. There is an exponential increase in MLB oblique injuries in the past seven years.
Those with hip injuries also have more elbow injuries.
Throwing engages the kinetic chain — movement at one joint affects movement in another.
Frantz says body regions must be conditioned properly. He adds that there is no perfect training system.
“Every therapist, strength and conditioning coach and ‘expert’ will have their opinion,” says Frantz.
Keys to strength and conditioning include doing movements that appropriate for age/level
Well-balanced i.e.. kinetic chain and with an appropriate dosage.
Doctors have found that complete rest may be bad, too. It used to be that heart attack patients were put on weeks of strict bed rest.
“We now know that is one of the worst things we could have done,” says Frantz. “We encourage them to get up and move and lightly stress the heart a little bit.
“A lot of the strength and conditioning coaches now are buying into that philosophy. Taking three days off, just sitting there and not doing anything at all is probably worse than doing something lightly for a couple of days.”
It’s active recovery to keep things moving and loose.
Frantz says there are now many strength and conditioning programs founded in “real” science.
“It has good philosophies,” says Frantz. “It makes sense in what you’re doing and is well-rounded.
“Be careful of the programs that have marketed upon just one success story. Or it’s one pro athlete who is a freak and would have had success with anything he did. They just happen to have his or her name on this program or institution.”
In addressing mechanics, Frantz says the biggest strides made in biomechanics and pitching mechanics in general occur in youth baseball between ages 9-13.
“Interestingly, as your mechanics improve the force that’s put on your elbow joint increases,” says Frantz. “Everywhere else in the body your risk goes down.”
Frantz says that once proper mechanics are developed, there is no difference in mechanics of those with elbow ligament tears and those without.
Kinetic factors associated with pitching injury include early trunk rotation (loss of hip and shoulder separation vs. maintained hip and shoulder separation), altered knee flexion and increased elbow flexion at ball release leads to increased elbow torque.
Looking at simple physics, Frantz says there are 64 Newton meters of force generated at the elbow with each pitch (bone and muscular structures see 32 Nm and the ulnar collateral ligament sees the other 32 Nm).
“Unfortunately what we’ve shown in lab studies looking at elbows is that (the UCL) fails at 33 to 36 units of that force,” says Frantz. “Essentially every time you throw, you’re within a few percentage points of maximum strength before that’s going to break.
“That’s why you’re seeing the amount of injuries you’re seeing.”
The greatest cause/risk factor for injury is increased velocity. Other things that make for a bigger force are increased body weight and height.
MLB revealed that the percentage of pitches 95 mph or above was 4.82 in 2008 and 9.14 in 2015. Where will it be in 2020?
In this era of high strikeout totals, research shows that 18.8 percent of pitches at or above 95 mph resulted in a swinging strike with 8.2 percent for deliveries less than 95 mph.
“Velocity works,” says Frantz. “It’s not going anywhere.”
Off-speed pitch velocity has also increased.
Frantz issues a warning for high injury risk.
“Be aware of the 14- to 18-year-old who hits a growth spurt, gains 25 pounds and suddenly throws 10 mph harder,” says Frantz.
Risky behaviors include pitching with tiredness (7.8 times more likely for injury), pitching with pain (7.5 times more likely for injury), catching when not pitching (2.8 times more likely for injury), pitching on consecutive days (2.5 times more likely for injury) and playing on multiple teams at the same time (1.9 times more likely for injury).
“There’s a difference between having a little bit of fatigue and having true pain when you’re throwing,” says Frantz. “It’s difficult to isolate, particularly in younger kids.
“As guys play a lot they can get a feel for it.”
Frantz says every player’s description of pain and what they can handle is different and coaches need to know their athletes well enough to understand that.
Studies show that breaking balls have not been found to be a direct contributor to arm injury while velocity does contribute.
In players undergoing Tommy John surgery, there is no difference in the amount of curveballs/sliders thrown compared to those who stayed healthy.
Breaking balls have been showed to increase arm pain by as much as 86 percent and arm pain increases injury rates.
Pitch counts have been widely instituted at various levels since 2004.
Frantz says there is no magic number.
Pitch counts do force players, parents and coaches to stop pitching when the arm pain and tiredness are likely to be ignored.
One website resource for guidelines sponsored by MLB and USA Baseball is PitchSmart.org.
Frantz says it is well-documented that throwers in warm weather regions, where there is more actively, the incidence of injury is higher than those in cold weather places.
In looking at specialization, Frantz quoted a study by the New York Yankees doctor of youth baseball in New York state.
The average age to begin dropping sports to focus on another is 8.1 years old.
In interviewing the youth players, he learned that 84 percent wished they played more sports, 47 percent thought about quitting last season and 33 percent were told by baseball coach to stop playing other sports.
In addition, 74 percent reported an injury, 55 percent stated it wasn’t fun to play while they were hurting, 47 percent were told by a parent or coach to keep playing despite pain, 25 percent had hired personal trainers and 5 percent of parents said they would suspend grade/redshirt to gain a competitive advantage.
What’s more, players with elite coaching had an injury rate of 38 percent. The rate dropped to 7.1 percent to those without elite coaching.
Frantz says an argument for not specializing comes from current MLB players.
They have generally been found to have played more sports than current high school players and “specialized” two years later (age 14 vs. 12 now) than current high school players.
Forty percent of big leaguers say specializing at any time did not help them reach professional baseball.
What does science say on the subject?
Frantz notes there is clear evidence of improved physical, emotional and learning development when playing multiple sports.
There is no advantage in specialization before 12 years of age and a clear increase in injuries.
While there have been very little studies done on the youth injuries, studies have revealed that baseball is a relatively safe sport at the highest level. MLB has 3.6 injuries per athlete-exposures compared to 21.4 for the NBA.
Position players have greater incidence of injury and most injuries involve ligaments and tendons.
During a three-month high school season, most injuries occur during the first month.
Frantz says that many claims about weighted balls are not based upon sound science.
Weighted balls have been shown to increase velocity. But that’s with 4- to 6-ounce balls used over the 10-week period by high school and college athletes.
Frantz says there are not current protocols on how weighted balls help as warm-up or recovery tools. It’s a coaching/pitching preference.
There is no evidence weighted balls hurt or harm mechanics.
Nor has there been any study done to prove they reduce injury.
Frantz says there are plenty of myths surrounding long toss.
He has found that is does not increase arm strength.
Throwers lose about 5 percent of arm strength over the course of the season and 11-18 percent from the start to the end of the game.
Long toss may help endurance and arm speed, but does not promote proper pitching mechanics.
Motion analysis has shown significant differences and that increases when long toss goes beyond 180 feet.
There’s an even higher stress on the arm with max effort crow hop long toss.
Yes, long toss is important, but not a requirement. Many pro players never throw more than 120 feet.
It’s a balancing act between increasing endurance and arm speed vs. cumulative fatigue.
Frantz adds that long toss is helpful, but must be used in combination with downtime, good arm care and quality strength and conditioning.
“There is not one perfect long toss program,” says Frantz.
Dr. Travis Frantz, an orthopedic surgeon in Columbus, Ohio, covered many baseball topics at the Jan. 19 Huntington North Hot Stove clinics. Frantz played at Fremont (Ind.) High School and Huntington (Ind.) University. (Steve Krah Photo)