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. With the 22nd annual “Injuries in Baseball” course starting Jan. 29 in Orlando, Fleisig chatted with BP about the growth of ASMI, warning signs for pitching injuries, and the challenge of generating awareness among major league teams.

Baseball Prospectus: What first attracted you to working at ASMI and studying biomechanics in general?

Dr. Glenn Fleisig: Like many people out there, I had dreams of being a major league player as a kid. After a while it became apparent that I was stronger in the classroom than on the baseball field. I went to MIT, majored in mechanical engineering, and figured I’d devote my life to being a mechanical engineer, building cars and playing softball on the weekend with friends. This was 1983, and at that time MIT had a biomechanics lab in the mechanical engineering department. I had to do my senior engineering project, and my friends were working on fluid dynamics, heat transfer, things like that. So I walk into the biomechanics lab, and I see someone working on breaking down a golf swing. I didn’t know you could use these principles to apply to sports and people’s movements playing sports. So for my senior paper I worked on the mechanics of the golf swing.

I told the professor in charge of the lab that I wanted to get a job in this field; he laughed and said there weren’t any. An intern from MIT had gone out to the Olympic training center in Colorado to do some biomechanical work, so I decided to do the same thing. When I got there, I was just some college kid who’d walked off campus, right into the center of media attention for the ’84 Olympics. We were testing rowers, archers–USA Today, CBS, newspaper people would show up every day–it was quite exciting obviously. From there, I approached Dr. Chuck Dillman–he was the director of the biomechanics lab and my first mentor–and said: ‘I like the idea of looking at sports through biomechanics, but my particular interest is baseball. What can I do to do this for a living?’ He said I’d have to meet this up-and-coming young doctor named James Andrews. The Olympic committee and Andrews had put together a joint effort, a course called “Injuries in Baseball,” and Dr. Dillman suggested there might be some potential there.

BP: So you met with Dr. Andrews…how did that first meeting with him go?

Fleisig: I talked to him as the Olympics were winding down, and we hit it off right away. He said he had a vision of setting up a sports medicine center to understand and prevent injuries in sports. Because this was just 1984 though, the timing wasn’t right. He hoped to see awareness spread a bit before he could get started. So I went on with my life in mechanical engineering, didn’t talk to him at all until Thanksgiving 1986, when the phone rang. I picked up, and he said “Are you ready now?” I was in the Masters program in mechanical engineering at Washington University in St. Louis at the time, but I dropped that pretty quickly and went to work with Andrews in Birmingham, Ala. Basically from 1987–when he started ASMI–to today, I’ve been working under Dr. Andrews. I took a few classes at UAB to complete my Masters, and I worked as a researcher at ASMI from ’87 through ’89. At that point Andrews decided we had to move this forward and hire a big-name biomechanist. I was confident in myself, but didn’t have the experience at the time. So we hired Dr. Dillman. He stayed until ’91, then when he left I became research director and later got my PhD in biomechanical engineering. Since then we’ve been working to build ASMI into what it’s become today.

BP: How does the study of biomechanics apply to baseball, and to pitchers in particular?

Fleisig: The purpose of biomechanics is simply combining biology and mechanics–applying the laws of physics to living systems, people or animals. So when we do biomechanical analysis of athletes, we do it for two reasons: 1) to reduce stress and the risk of injury; and 2) to improve performance. Because of that philosophy, baseball pitching is an obvious area for us to analyze. With pitchers you get a lot of injuries that are self-induced, that happen though repetition of the same mechanics, which leads to injuries. That’s different from say, an NFL running back, who’s more likely to get hurt when other players hit him, being in the wrong place at the wrong time. With a batter in baseball, the risk of injury is far less, and you’re more focused on performance than injury prevention.

So you get to pitchers, and we’ve been fortunate enough to analyze over 800 pitchers in our lab, from the smallest youth league pitchers to the big leagues, from healthy to previously injured. From this research, we’re able to form databases to see what healthy pitchers do. Once we’ve built databases, we have two goals. The first is adding to the body of knowledge on the topic, which means giving the course every year, talking to medical professionals who treat baseball injuries, publishing scientific articles, and getting information out to people who treat baseball players. Second, trying to help pitchers who come to ASMI themselves. Before we can ever do an evaluation on a pitcher, we’ll have done thorough studies, had our research peer reviewed, do further analysis, then apply our conclusions. That way by the time they get here, we’ll hopefully have a good idea of how to approach all kinds of different mechanical flaws and problems.

BP: What are some of the most common faults you’ve seen among pitchers over the years?

Fleisig: When a person pitches a baseball, he uses what we call a kinetic chain, which is a coordinated sequence of body motion, what in sports you’d call “coordination.” The top pitchers aren’t doing anything exceptionally well, there’s just no weak link in the chain. For example, we’re interested in looking at elbow and shoulder injuries. One thing we find is when a pitcher lands with his foot too far open–for a right-handed pitcher that would mean his foot was too close to the first-base side–he increases the stress on the front of the elbow and shoulder. Incorrect hip and leg action will lead to increased force higher in the chain. Younger pitchers often don’t properly use the strength in their hips and the lower part of the body. So they swing the leg open, land too early, and the energy from their legs and trunk gets passed to the trunk too early, before the arm’s ready for it. So when the arm is ready for it, that energy’s already dissipated. The arm ends up providing all the force, more than it’s able to handle.

Another flaw is when a pitcher drifts too early. A young pitcher may have a tendency to lift the knee towards the batter rather than lifting it straight up. That gets the legs moving before the arm is ready. You end up with similar strain to what you’d get with the first flaw. Another one: When a pitcher takes his arm out of the glove, the elbow should bend at 90 degrees. If you bend more or less, that’s a bad sign. What happens is once the arm is bent back, the palm’s facing the sky and the elbow’s bent 90 degrees, from that position the upper trunk can rapidly rotate to face the batter. If the bend is more than 90 degrees, the arm ends up closer to the head than it should be, and the pitcher needs to apply extra force to allow the elbow to catch up. If it’s less than 90 degrees, the injury risk isn’t as great, but you’ll most likely have lower ball velocity, which becomes a performance issue.

The worst is when you keep repeating a flaw in the delivery. What we’ll often see are pitchers who bend their elbow out too much, who stick it out too far forward, like when you’re throwing a dart. From there, you end up putting too much of the burden on the elbow extending, rather than properly rotating the shoulder. The irony is that you’re not thinking about this as you’re doing it. You may have that dart-throwing mechanism down already, and you already have pain in the elbow; the body’s telling you this is the way to take strain off the elbow, and it just ends up causing more pain.

BP: Of course if you talk to any pitching coach, he’ll talk about how he doesn’t want his pitchers thinking about keeping the elbow bent at 90 degrees, or landing a foot at exactly this or that point…how do you work with pitchers to make the process seamless and automatic for them?

Fleisig: Well first of all, the best time to convince a pitcher to change his mechanics is in working with those that come here in rehab situations. They’ve had some kind of breakdown, they’re making their way back, and they’re getting assessed. At that point, mentally, physically, or both, they’re most amenable to changing their mechanics, with the help of their coaches. Unfortunately, where we’re trying to have the biggest influence is before injury occurs. And unless you have a coach who’s really committed to learning more about injury prevention, you’re not likely to see too many healthy pitchers show up here.

We view our role as identifying what it is that they’re doing wrong, and noting methods for improved safety and performance. We don’t view our role as implementing those suggestions. We see ourselves as a tool to coaches and doctors. The same way that an MRI doesn’t correct a problem, it just identifies what it is–that’s us. So basically we’re trying to provide information to coaches about what the situation is with a given pitcher–this guy’s arm comes around too late, which is a shoulder injury waiting to happen–that kind of thing. The biggest measure of success for us if when the pitcher works with his coach or doctor and makes the necessary improvements. We try to be realistic about suggestions too. An elite major league pitcher may have a pretty good, but perhaps not optimal set of mechanics, but we may for the most part leave him be. It’s rare that we see someone who has no flaws at all.

BP: You talked about finding coaches and instructors who may be proactive about preventing injuries before they happen. Who are some of the coaches you’ve worked with, who have shown this kind of mentality? How did you get started hooking up with major league teams in the first place?

Fleisig: We were just looking at a major league pitcher here or there, most of those coming through referrals to Dr. Andrews. Then Rick Peterson called me about four years ago–I knew him from back in the late 80s when he’d started communicating with Dr. Andrews while he was in the White Sox organization. So four years ago he was involved with ASMI as the A’s pitching coach, but he said he wanted to step up the relationship. Since then, for the last three years or so we’ve analyzed a bunch of Oakland A’s major league and minor league pitchers with Rick. He’s had some success working with them, although obviously it helps that they’re good pitchers too.

We have representatives from just about every team come to the (Injuries in Baseball) course, and that’s attracted other teams. We also had a town meeting-type event about two years ago with representatives from 25 of the 30 teams showing up. We tried to give them an idea of where we’re coming from; that ASMI is a non-profit, that we have this source of knowledge, and that we have the ability to help prevent injuries by assessing pitchers. We basically said, “OK MLB, how can we help you?” There’s a lot of money being spent on pitchers, and in the meantime teams are ruining pitchers’ careers by misdiagnosing injuries and failing to fix mechanical problems. All the teams there were very much in agreement; they realized that they’re having to deal with too many expensive injuries, and that ASMI can help preserve the health of their pitchers, and the end result can be saving money and winning more

BP: So what’s the next step once you’ve got their interest?

Fleisig: We asked ourselves, how do we implement a program to help these teams out? We asked them for thoughts, if they’d want a system where all of MLB uses ASMI and there’s one uniform model. They said they’d rather approach us team-by-team, which makes some sense if you think about it, since Major League Baseball is one organization, but each club is obviously in competition with one another. So the A’s continued with us and really became the model of how we can help: sending pitchers to us, having the pitching coach–in this case Peterson–come down to work with us, pick up new techniques and implement our suggestions. The next couple of teams to officially announce were the Red Sox and Indians–they’re both sending us pitchers, this off-season and hopefully in the future too. Now that Rick has gone to the Mets, the Mets are planning to use us as well. We’ve also talked to Billy Beane, and they want to continue to use us. Besides that, we’ll work with some individual pitchers here or there–the Rangers and Royals sent some recently.

Looking at the teams we’re talking about–the A’s, Red Sox, Indians–it’s not a coincidence that their front office approach tends to be more scientific, more analytical, for everything from the scouting of players to sports medicine and injury prevention.

BP: You mentioned Peterson being your contact when he was in Oakland. Is it usually the pitching coach who contacts you, or someone else from inside an organization?

Fleisig: With the Red Sox and Indians, it was actually the director of player development both times, Ben Cherington for the Sox, John Farrell for the Indians. It makes sense that they’d be the drivers for this kind of thing, since young pitchers especially can be at risk.

BP: What might the set-up look like when a pitcher comes in? Who’s looking at him, and what kind of reports are you sending back to his coaches and his team?

Fleisig: It often starts with a referral from Dr. Andrews or another doctor. A pitcher complains of arm pain, doesn’t have any tears, but may be mechanically overloading himself. Or it can be a pitcher who got injured a year ago, and the team wants to see if he’s likely to get reinjured. Two coaches that really helped us get going, Rick Peterson and Dewey Robinson, along with another pitching coach from the college ranks, Bill Thurston, worked with myself, Dr. Andrews, and years ago, Dr. Dillman. We’d stand there, watch the pitcher, and from watching the same person, we’d see different things. Rick would say ‘look, he has no balance.’ Dr. Andrews would notice the load on the elbow. I’d say something about improper sequencing. Once we started talking to each other we could come up with a complete diagnosis. Biomechanics is really a multi-discipline approach; you’re looking at a pitcher not as a physics equation, but rather taking a holistic approach and working on injury prevention and performance improvement at the same time.

When a team sends a pitcher down, we send a report back to the person who made the referral. The report has numbers in it, but also photos and high-speed video of the pitcher in different positions. The pitching coach doesn’t have to be there during data collection, only afterwards, to talk about results. We want to make sure the technical side is covered and the research is scientifically-based, but also practical.

Coming soon, Part II, with a look at the strain of different pitches, the health risks of big vs. small pitchers, and injury risks among different age groups.