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Baseball is a chore. Among major American professional sports, MLB has the longest season: 162 regular season games. Last year, due to the coronavirus pandemic, the 2020 season was cut short, which to many seemed like a good thing. This would lead to a longer rest period and hopefully fewer injuries. However, it seems that the opposite has happened. Already, just a few months after the start of the 2021 season, injury lists are on the rise. Statistics have shown a 30% increase in injuries so far. Usual suspects such as UCL elbow injuries and ACL knee injuries have emerged as expected, but the overwhelming increase is in strains and sprains.
Strains and sprains often refer to muscles and tendons. UCL and ACL refer to ligaments. This anatomical difference can be significant. Ligaments are like little cords that hold bones together. The UCL helps stabilize the internal elbow joint when throwing. ACL stabilizes the knee joint for cutting and pivoting. Muscles, on the other hand, are fleshy structures made up of fibers that can be stretched or, if they are too far apart, torn. It can happen even at the microscopic level. Tendons are what muscles transform so that they can attach to and move bones. These can also be stretched or torn. When muscles or tendons are stretched or partially torn, they are not necessarily repairable with surgery and can take a long time to heal, turning into throbbing injuries that come back repeatedly throughout the season or career. athlete.
Baseball is a predominantly one-sided sport, which means that you engage in certain activities with only one side of your body under heavy loads. The throw, for example, requires only one arm. Hitting affects opposite sides of the body in unique ways. The step count was designed to prevent Tommy John elbow surgeries and has its roots in preventing overuse injuries. Unfortunately, there is some limitation inherent in their calculation as they do not take into account warm-up throws and training throws. Now some coaches are starting to wonder if the same rules could apply to hitting. Can a player swing the bat too much?
Muscles also differ from ligaments in that ligaments are a static structure. You can’t warm them up as much as you can a muscle. Preventing injury to ligaments tends to focus on limiting stress through them. Body mechanics play a big role in this, which is why so many teams have looked into motion analysis video capture for their launchers. Based on the position and acceleration of the body, the stress on different joints can be calculated. Preventing muscle injury, however, may be more about performance cycles and proper warm-ups than peak loads on a static structural ligament. With the rule and schedule changes combined with the intermittent stop and start of the 2020 season, some players may have lost their very keen pace and therefore their bodies, despite the extended rest, may not have been properly warmed up for the workload of the current season.
A recent study on lower limb muscle tension in Japanese baseball players was published in the Orthopedic Journal of Sports Medicine. In the study, researchers looked at 55 muscle strains on a professional baseball team between the 2006 and 2015 seasons. They also looked at MRIs of player injuries. 60% of muscle injuries were localized in the hamstrings. Among the injuries studied, the MRI predicted how long the players were away. Lower-grade strains took four to five weeks to return to play, while players with higher-grade injuries took 10 weeks to return.
In 2012, researchers published a study on abdominal strain in major league baseball from 1991 to 2010. At that time, abdominal muscle strain accounted for 5% of all baseball injuries on the disability list. These muscles appear to be most active on the front side of a pitching stroke, and on both sides of a batting torso stroke. At least 92% of these injuries were strains of the oblique or intercostal abdominal muscles. 44% of the injured were throwers. Even then, the authors warned that an upward trend was observed from 1991 to 2010, particularly for early season injuries in March and April. 12% of these players would sustain a new injury to the same muscle and more than half (55%) would sustain a new injury in the same season. The overall injury rate also increased 22% in the 2000s compared to the 1990s.
The areas of muscle injury prevention have traditionally focused on flexibility, fatigue, core stability and strength. The concept of flexibility is something that everyone is taught even at an early age in physical education classes. Actual sports studies have been contradictory in preventing flexibility-based muscle tension, but those that show a difference focus on preseason muscle flexibility, which in baseball may indicate that spring training affects the first months of the season. Fatigue has a lot to do with endurance. Too little time spent building up the body’s energy reserves can lead to early fatigue. But the reverse can also be true. Overworking or overtraining can lead to decreased performance and earlier muscle fatigue.
Stability refers to core stability and using the whole body to perform activities, which is especially true with pitchers. The term kinetic chain was coined to describe the generation of energy from the ground up, traveling through the legs, trunk muscles, torso, and eventually out of the arm. Like a boxer, much of a pitching power actually comes from the legs and hips. Finally, strength is a staple of any athlete training routine, but one aspect that is sometimes overlooked is eccentric exercise.
While most weightlifting focuses on compressing the muscle to shorten it and bring the bones together (think bicep curls), eccentric exercise may be more important in preventing injury. This happens when the muscle fibers are activated, but the muscle belly lengthens and the weight slowly moves away from the body. This further recreates the scenario where a muscle is used to stabilize or slow down the body, such as in following a throw, pulling upwards when sprinting towards a ball, or stabilizing the back side during a swing.
Traditionally, despite an increase in injuries in baseball early in the season, the injury rate has generally leveled off, with the lowest levels seen in September. Even in 2015, the abdominal injury rate for MLB players appeared to be dropping compared to 2011. Yet at the same time, the abdominal injury rate for minor league players tended to increase. Minor league players tend to have a less structured schedule than major league players. Perhaps the recent increase in abdominal injuries reflects the timing and training irregularities that major league players are not used to seeing. As organizations and players are better able to resume their pre-pandemic routines, as much of the rest of the world hopes to do, they may also be healthier.
Jonathan Gelber MD is a surgeon and sports medicine specialist. He is the author of Tiger Woodss Back and Tommy Johns Elbow: Injuries and Tragedies That Transformed Careers, Sports, and Society
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