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Chat: Dr. Glenn Fleisig

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Welcome to Baseball Prospectus' Thursday May 13, 2004 6:00 PM ET chat session with Dr. Glenn Fleisig.

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Dr. Glenn Fleisig is the Smith and Nephew Chair of Research at the American Sports Medicine Institute, an organization founded by noted orthopedic surgeon Dr. James Andrews dedicated to improving the understanding, prevention, and treatment of sports-related injuries through research and education. Fleisig has worked closely with players and coaches at all levels, from youth leagues to the big leagues, teaching performance optimization and injury prevention methods. You can read Dr. Fleisig's two-part Q&A with Baseball Prospectus' Jonah Keri here and here.

Dr. Glenn Fleisig: Hi everybody, It's a pleasure to be on this chat. As the research director at the American Sports Medicine Institute, I help ASMI in it's mission to improve the understanding, prevention, and treatment of sports-related injuries through research and education. I figure today's chat will be about understanding, preventing, and treating baseball injuries. For more info - and perhaps thoughts for a question - click on the Q&A links above. Let's get started.

chirodocMetsFan (Wheaton, IL): I am a pitching instructor at the Chicago White Sox Academy in Lisle, IL, and have a question regarding the lead arm of a pitcher. A fellow pitching instructor and I have opposing teaching methods in regards to the lead arm in a pitching windup. Do you advocate tucking the arm through to create shoulder rotation and arm speed or leaving the arm out in front of the body while throwing? Thank you, Greg Wheaton, IL

Dr. Glenn Fleisig: Greg, I’ve been involved in this exact controversy, when talking with Dr. Tom House and Bill Thurston (Amherst College), whom I consider to be two of the top pitching coaches in the world. Tom teaches leaving your front arm out and moving your trunk forward to it, while Bill teaches bring your lead arm into your side to rotate your trunk. As a good diplomat, I’ve explained to them that BOTH theories are correct! At ASMI, we’ve quantified the biomechanics of about 1000 pitchers – from youth league to Major Leagues – with our motion analysis system during the past 15 years. The truth is that when a good pitcher pitches, his front arm and trunk move close together when the trunk rotates to face the batter. You could say that the front arm moved back to the trunk or that the trunk moved forward to the arm, it’s all relative. As an analogy, picture a subway train (i.e. “the trunk”) moving forward down the tracks and a man (i.e. “the elbow”) walking towards the back seat in one of the cars. An observer in the train would say that the man moved back to the seat, but an observer outside watching the train go by might say that the back speed moved forward toward the man. The bottom line is that the lead arm needs to be tucked in at the side in order to rotate the trunk fast enough, just like a figure skater pulls in her arms towards her trunk to spin faster. Whether a coach teaches pull the arm in or pull the trunk forward is up to the coach as to whether “feel” will get his pitchers to do the right motions.

AaronD (delmar): is tom glavine's early season Reniassance for real or will his ERA climb back up to no. 4/no. 5 starter territory? and on that same note, will al leiter be able to continue his early season success?

Dr. Glenn Fleisig: Aaron,

I’m playing in my first Fantasy Baseball league this year, and Glavine and Leiter are both on my team. My expectation is that their early season success is indicative of good complete seasons. The reason I say this is my knowledge about how excellent a pitching coach Rick Peterson is. As many of you know, Peterson and the Mets brought about a dozen of their pitchers to our ASMI lab in Birmingham before this season to assess their pitching mechanics. Rick has been working with us here at ASMI since he was a minor league instructor with the Birmingham Barons in the late 1980’s.

The Mets brought young pitchers like Looper, Kazmir, and Peterson to Birmingham, not the veterans like Glavine, Leiter, and Franco. The philosophy is that it is more effective to modify mechanics of younger pitchers. The Mets’ veterans will also benefit from Rick Peterson. Rick gets a lot of deserved credit for his mastery of pitching mechanics, but he is also a master of the mental game of pitching. This includes the psychology of pitching as well as game strategy. Game strategy, for example, utilizes knowledge about batters’ past tendencies and performances against certain types of pitchers and in certain types of situations. Overall, Rick Peterson will greatly improve the pitching of any team he coaches.

By the way, for you parents and coaches out there, ASMI and Rick Peterson are working on plans to reach a broad audience of amateur pitchers. This may include instructional schools, instructional DVD’s, booklets, etc. Stay tuned…

Chris (Norwalk, CT): Hi Dr. Fleisig, What do you make of the rash of serious injuries to Kansas City's young pitchers (Ascencio, Hernandez, Snyder)?

Dr. Glenn Fleisig: The KC Royals are another team that ASMI works with (in fact, two of these three were analyzed at ASMI’s biomechanics lab and at least one of them had surgery from Dr. Andrews), so I know some information about their organization. There are no guarantees in this business, and the injuries to Asencio, Hernandez, Snyder seem serious. The good news is that Royals’ head trainer Nick Swartz is one of the best in the game so hopefully their rehabilitation will be effective.

Mike (Hershey, PA): In these days of modern medicine and new medical breakthroughs, it's amazing how pitchers now throw 200 innings and all of a sudden you see "possible arm breakdown alerts." Can it be explained how great pitchers of yesteryear like Walter Johnson, Cy Young, Christy Mathewson, Lefty Grove, Warren Spahn go their whole career without arm injuries, yet alone pitch upwards of 350 innings a year? Thanks.

Dr. Glenn Fleisig: This is an excellent question, Mike.

It is hard to compare pitching today to pitching 50 to 100 years ago, as many things have changed. Today’s athletes in baseball and all other sports are in much better physical condition, which allows their body to be pushed much closer to it’s breakdown limits. There are other possible factors, such as number of pitches thrown per inning nowadays compared to back in the “Good Old Days.” Also, way back when, pitchers might have coasted more often, just putting the ball over the plate without full effort. Furthermore, for every Cy Young or Christy Mathewson it is unknown how many pitchers burned out.

Let’s re-focus this question to today’s pitcher only. The question then becomes what are the real and imaginary breakdown alerts for a pitcher today, and why. The answer has many components and is not exact. Number of pitches thrown (not just innings) is one factor, but so are quality of mechanics, types of pitches used, physical conditioning, throwing history (how much pitching and throwing has been done during the athlete’s life), and other factors.

Some expert should write a book about this topic. In fact, someone has. I highly recommend the new book called “Saving the Pitcher” by Baseball Prospectus writer Will Carroll. The book is available at online and local book stores.

jschmeagol (carlisle,pa): what has changed in the Tommy John rehab/surgery that has made recovery so much quicker?

Dr. Glenn Fleisig: I’m not sure that the Tommy John rehab/surgery is necessarily quicker, but I do know that the success rate has improved. Our data shows that pitchers need about 9 to 12 months to completely return to their full level. The advancements have come from improved rehabilitation protocols. Unfortunately we are now seeing large numbers of pitchers receiving this surgery from Dr. Jim Andrews at our center and from other surgeons as well. The silver lining on this increased number of patients is that Kevin Wilk, PT, and others have conducted clinical research on the rehabilitation so that the rehab methods have improved from the experience.

Now that treatment of these injuries has improved, the next step is to improve the PREVENTION of these injuries. All elbow and shoulder pitching injuries result from repetition and overuse. A good starting place is for youth pitchers and coaches to follow the recommendations of USA Baseball. The USA Baseball position statement can be found at www.asmi.org.

Martyk (Naperville, Ill.): Dr. Fleisig, My 17 yr. old son suffered a linear fracture of the olecranon while pitching last Sept. MRI's showed no damage of the soft tissue. He was immobilized in a cast for 6 weeks, rehabed at physical therapy until full ROM was regained, and followed Dr. Tom House's throwing protocols for rehabilitation. As of this past weekend, he still has not participated in pitching due to a continual pain at the point of origin. The radiologist beleives he may still may have a non-union. I have not seen many occurrences of this nature in the big leagues, so there is not much data for me to research. What can you tell me about healing times or something we may have missed? Thank you.

Dr. Glenn Fleisig: Martyk,

Unfortunately a non-union of this type of fracture is not uncommon in baseball pitchers. What concerns me most about the way you wrote your question is who was mentioned and who wasn’t. Certainly a radiologist and physical therapist are important in the diagnosis and rehabilitation of this injury. Also, as I mentioned before, I consider Tom House, Ph.D., to be one of the best pitching coaches out their; however his throwing program should be coordinated with the physical therapist, not serve as rehabilitation by itself. My main concern is that you didn’t mention an orthopaedic surgeon, who should be the MAIN GUY for this type of injury. You need to bring your son to an orthopaedic surgeon who was trained at an “accredited sports medicine fellowship.” If you are looking for one near Naperville, IL, I can highly recommend Dr. Giri Burra at the Parkview Musculoskeletal Institute in Joliet, IL. If you are looking for a top doc in any other part of the U.S., let me know.

RC Cook (Carrollton, TX): Do you have any opinion on the effectiveness of the "tandem starter" system (used by the A's and Rangers' A-ball affiliates) as a possible method of injury prevention? I've seen it mentioned that the Rangers are another new team to ASMI- what services of yours have they used, if any?

Dr. Glenn Fleisig: Yes, the Rangers have started to use our services. The services we are referring to here are biomechanical evaluation of healthy pitchers. The purpose of this service is to identify mechanical inefficiencies that might increase the risk of injury or reduce performance. The Rangers, A's, Mets, Indians, Red Sox, and Royals are among the teams that have sent healthy pitchers to ASMI recently. I anticipate more teams will follow suit.

For more information, click on biomechanical evaluations on www.asmi.org. GUESS WHAT? This service is available not only to your favorite Big Leaguers, but also to pitchers from youth league on up!

In regards, to the question about "tandem starter" system, someone needs to submit to me a specific description of what we're talking about.

Aric (Oakland, CA): I was listening to Gary Huckabay speak a couple of weeks ago, and he talked about the Oakland As system that they call 'prehab' for pitchers, and how they had used it on guys like Ted Lilly with some success. What is the prehab regimen?

Dr. Glenn Fleisig: “Prehab” is an excellent word, as it shift the focus away from rehabilitation AFTER injury to prevention BEFORE injury. Personally I’ve met more than my share of athletes over the years in rehabilitation and I’m glad to be working now with more and more baseball players and teams trying to prevent injuries instead. The first baseball person I ever heard say “prehab” was Tom House, but Rick Peterson talked about it extensively when he was with the A’s prior to this season.

Prehab can include many different topics. When Peterson talks about prehab, he refers to mental preparation, physical conditioning, and mechanics. For mechanics, several of the A’s pitchers (Zito, Hudson, etc.) have come to A’s to have their biomechanics analyzed, but Lilly was not in this group. The pitching coach uses results from biomechanical analysis to design programs for individual pitchers. Prehab also includes other mechanical drills from the pitching coach, physical conditioning from the strength coach, and mental preparation.

Nutrition, supplements, and other issues can also be considered.

The bottom line is that the pitchers with the best results are the ones who are on the active roster, not the DL.

Anthony (NY): Just finished reading "Saving The Pitcher." Do you agree with Will Carroll that most pitching coaches "don't have a clue about pitching"? How many major league pitching coaches, in your experience, stress proper mechanics, particularly with regards to the hips?

Dr. Glenn Fleisig: Will Carroll travels around and meets pitching coaches and others, while I just meet the ones that come to me. Therefore, he probably has a better read on the overall population of pitching coaches than I do.

I can tell you that many of the pitching coaches that work with ASMI are knowledgeable about pitching mechanics and all are receptive to exchanging thoughts and learning. I can't really speak about the ones that don't come to ASMI, because I don't know them.

This leads to a strong point that I'd like to make. The key to a successful biomechanical analysis is the coach. It doesn't matter what the biomechanist finds if the coach doesn't understand the results and doesn't utilize the results. Therefore, when dealing with the pros, ASMI focuses on the relationship with the pitching coach.

For the younger athlete, we work with either the coach, parent, or athlete - whoever is the person who will be working with the pitcher on his mechanics.

bokosox13 (RI): How would you rank pitches in order of most unhealthy to least unhealthy for a pitcher to throw?

Dr. Glenn Fleisig: If you look at the research section of www.asmi.org, you will see the summary of a study where we tested the biomechanics of college pitchers throwing their various piches (fastball, curveball, slider, and change-up were studied).

What we found was that shoulder and elbow forces and torques were about the same magnitude among the fastball, curveball, and slider, and significantly less in the change-up. The mechanics of the fastball and slider were similar, while the change-up had slower arm and body motions. The curveball had different trunk and forearm mechanics than the other three pitches.

What we conclude from this is that the curveball is not necessarily more stressful than the fastball, but it is potentially dangerous for a young pitcher because he is applying the stress while trying to master a different set of mechanics than the fastball.

In another study, we followed about 500 youth baseball pitchers during a spring season. We found in that study (also explained on the research section of our website) that the young pitchers who threw curveballs or sliders were more likely to experience shoulder or elbow pain.

Guidelines for when young pitchers should start to throw different types of pitches in competition are shown in the USA Baseball position statement (linked on to www.asmi.org).

One thing we teach is that a boy shouldn't use a curveball until he shaves. It sounds silly, but what we mean is that a curveball should be avoided until the bones are strong and the growth plates in the end of the bones have prettymuch closed (usually near puberty). Young pitchers should learn a good fastball first, with good mechanics and control. Next, he should add a change-up as his off-speed pitch.


As far as the pros go, we have no evidence to show that the curveball or slider are any more or less dangerous than a fastball.

Certainly the change-up is a safe pitch at all levels.

Dr. Glenn Fleisig: Guys, it's been great. - Glenn Glenn S. Fleisig, Ph.D. American Sports Medicine Institute Birmingham, Alabama glennf@asmi.org


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