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March 14, 2005

An Ounce of Prevention...

Keeping Young Arms Healthy

by Dave Haller

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When I came aboard BP as an intern, I didn't understand that living a few hours from Will Carroll might make this more of a hands-on experience than I'd expected. Apart from a fragile shoulder and elbow, my experience in sports medicine, orthopaedics and baseball-related injuries had been limited. Any medhead acumen I possessed came straight from Will, his Saving the Pitcher, and "Under the Knife." When Will presented me with the offer to visit a major league surgeon, one of the most renowned in the world, I couldn't turn down the chance to learn more.

Beacon Orthopaedic Clinic

Last year, Will documented his visit to Beacon and his introduction to Dr. Tim Kremchek, the team doctor for the Cincinnati Reds and now for the Washington Nationals. Beacon's ornate entryway invited us into a rotunda that almost felt like a Cooperstown display. Large statues constructed from broken bats, cases full of patient-signed balls, bats, helmets, spikes and jerseys, and more plasma TVs than Circuit City seemed to console the sad-looking teens and college athletes waiting around with thick slings and braces bundled around their arms.

One artifact struck me: on the wall hung an autographed photo of Jose Rijo, sitting alone in a chair on the field in spring training, right arm ensconced in several yards of thick fabric that wrapped around his torso with a fat cigar in his mouth. With the help of Dr. Kremchek, he cringed his way back to the big leagues after a five-year absence and threw 94 innings for the Reds between 2001 and 2002. In a twisted sort of way, Rijo's image at the secretary's desk provides hope to the most shredded arms in the Midwest. If Jose Rijo can make a comeback, then maybe you can, too, you ligament- and labrum-deprived teenager. (Rijo is now a special assistant to Jim Bowden in Washington, as is the recently-retired Barry Larkin. Much more of this and they'll replace that script W with a wishbone C.)

This is the hub of sports medicine in Cincinnati. Ken Griffey Jr. has spent long, grueling hours at Beacon. So have Austin Kearns, Scott Williamson, Tony Womack and Larkin. Tommy John--the procedure, not the man-has found a safe haven here, as players both professional and amateur from across the region bear down on this building for treatment. We didn't get to tour the facility, the operating and rehab rooms, the recovery area that can serve as a hospital for patients, the indoor parcel of Astroturf, the millions of dollars worth of equipment, the closets of scalpels and forceps. Or their snack rooms. With all the patients waiting around, maybe they were occupied. Then again, the back entrance, specifically constructed to allow players a private entryway, away from other patients and more importantly, media like us, might have been working.

Dr. Kremchek's public relations assistant welcomed us and then met us in the parking lot so we could follow her car to the adjacent facility. "A team doctor with a public relations staff," Will mused, "now there's something you don't see every day."

Apparently, the operating table at Beacon is just a few feet away from a built-in pitcher's mound. "I'll tell them, 'My goal is to get you from here to there,'" Dr. Kremchek would later explain.

Ignition Athletics Performance Group

A brief zigzag through the neighborhood led us to the new Ignition facility, a 21,000 square-foot building that was established just last year. One of Ignition's founders, Troy Merckle, showed us around.

The facility is built around a multipurpose plot of Astroturf that is used for drills, instruction and clinics. There is a lounge with a one-way visibility window so parents can watch their kids without pressuring them, a post-rehab therapy center, a running track, Hammer Strength® weight equipment, Fitnex® high-speed treadmills, a SpineForce® stability trainer and Cellu M6® tissue elasticity system both made by LPG. There is a massage room and a basketball court. Everything is state-of-the-art. Any kind of training an athlete could possibly desire is offered: speed and agility, sport-specific, skill-specific, core strength, dietary and more.

The scope of Ignition's market is broad. Plenty of professional athletes have used and/or endorsed their services and training, including NFLers Anthony Muñoz and Gus Frerotte. During our tour a small group of middle schoolers were getting personal attention from trainers. Ignition's focus on "maximum performance through proper training"--particularly through technique and technology--seemed to be their M.O. This staff could probably turn Montgomery Burns into a specimen.

"It's prehab taken to a whole new level," Will exclaimed excitedly, using the term coined by Tom House nearly 20 years ago. We knew that pro players were using the facility, but we also saw what appeared to be a 10-year-old girls soccer team working with plyoballs.

After the initial tour, we retreated to their "pro players lounge." Aptly named, in fact, as Zach Day and his wife walked through the door a few minutes later. Day is a native of nearby Harrison, Ohio, and spent the bulk of the winter training at Ignition. Many players have personal trainers in the winter, but the holistic attention delivered by Ignition gives him an edge. Using a progressive training regimen on a team typically associated with old-school baseball principles is not without its challenges. "Physically, I can't keep up the demands of what I've done this winter over the course of the season," Day said. "Baseball breaks you down, but with what I've learned and what they've passed on to the staff in Washington, I feel better heading into this season than I have in the past."

Day missed the season's final two months in 2004, and he hopes his improved training will sustain him and equip him with new ways to protect his arm. As a sinkerballer who induces plenty of contact and ground balls, he discussed his differences from teammate and capital-H horse Livan Hernandez. "Livan can throw at 70 percent and still get batters out, and that allows him to work deeper into games. Most guys can't do that. He can work at 88, 89 [mph] and then when he needs a strikeout, crank it up to 94."

"For me, I need to be a bit fatigued. It really helps the sinker," Day said. "What I don't want to do is hit the wall again. As a pitcher, I don't want to get bulked up. I need to be more about stamina and recovery, so the team here has been able to personalize things whether it's workouts or nutrition. It's really an advantage over what I've done in the past."

After we let Day go, Merckle led us back into the Ignition training facility. The newest toy in their repertoire, the High Speed Video room, is the reason we came. Tucked away in the back corner of the building is the biomechanical athletes analysis laboratory. Eight cameras stationed around the room pick up reflected light from electrodes fashioned on a suit made of Spandex, or something similar.

From these signals, an image is built by computer software to enable the Ignition staff (or a personal coach or trainer) to evaluate an athlete's motion. In our case, a pitcher would actually stand on the built-in mound and throw a few pitches into a strike zone-shaped net. The resulting three-dimensional video can be viewed from several angles and analyzed by pitching coaches or anyone else to look for mechanical flaws, providing an exceptionally powerful tool to promote injury prevention.

The technology has been around for several years--it reminded me of how modern sports video game graphics are developed--but rarely has been used for this purpose. Even Little Leaguers are starting to use the system, though pragmatically, access might tend to be limited to the "travel team" populace (an imaging session typically runs around $400). Hopefully, as the technology becomes more common, it will also become more affordable and therefore accessible to more players.

At the professional level, this investment should be more widely embraced. Only one other majorleague team currently has implemented this motion analysis technology, but it's expected to make huge inroads in the game soon. "In five years, I think 20 teams will have a similar system," Merckle speculated. Ignition paid $200,000 for theirs, according to a Cincinnati Enquirer article.

Dr. Kremchek joined us after we had explored the motion-analysis machinery. He was an enthusiastic man, stirred by a passion to educate baseball players, coaches, parents and trainers to treat arms sensibly. It's little wonder; last year alone, he performed 120 Tommy John surgeries, including at least 20 on young patients, some under the age of 13. By definition, each one of those is a completely preventable injury.

Will and Dr. Kremcheck quickly connected on the subject of their passion: pitching. "One problem about this field is that some people have a competition mindset," Dr. Kremchek explained, "but the thing is, we should be working together to inform everyone. It's in the best interests of the game of baseball to collaborate, to share this information. Education is the key to prevention."

Even BP's body of readers, involved in all facets the game, has significant sway. The abuse of pitchers at all levels must end, and so must the subsequent praises they receive for being "gutsy." Will quoted from Saving the Pitcher: "[S]ome players who might be the next Clemens, Johnson, or Prior are on a high school or college field somewhere...and their elbow is sore. They've been overworked, undertrained, and are tired."

"That's right!" Kremchek exclaimed. "Jim Andrews always says he's trying to put himself out of business and that's true. If we can prevent rather than fix, that's the ideal and that's what's going to make the game better. It's one thing to do this for the Reds or the Nats; it's much, much more important to do it for the kids of Cincinnati or Indianapolis."

While the state of the art video facility couldn't be demonstrated due to some confidentiality issues, this system is very similar to the one used by the National Pitching Association. This new video system allows for multiple views, comparison of different pitches side by side, and as shown above, uses a "skeleton" generated by the video rather than the "stick figure" that many are used to seeing. A similar system is being used by a MLB team at spring training, taking video of each pitcher in the organization, both for analysis and for baselining some of the younger pitchers.

On the drive back, Will and I exchanged personal injury stories. Many of us, many of you, have been directly affected by the medical incompetence that plagues a majority of t-ball, Little League, high school and college baseball diamonds. Many of our playing careers, no matter the caliber, were wickedly derailed not because we didn't know how to treat our sore arms, but because we didn't know how to prevent sore arms in the first place. Progress is underway, but the newer research must be shared with the masses.

For medheads everywhere, from Will Carroll to Dr. Kremchek, it starts with the kids.

--

David Haller is a Baseball Prospectus intern. He can be reached here.

Related Content:  DR,  Year Of The Injury,  Trainers

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