There is little doubt that the Angels have been particularly affected by the UCL crisis. This season alone the UCL count at the Major League level includes Ohtani, Ramirez, Lamb, Wood, Middleton and Richards. Consider that Tropeano, Heaney and Skaggs are all back from Tommy John surgery to repair UCL injuries. This is a substantial list and is not complete since it does not include the minor league pitchers within the organization that have succumbed to UCL injry. So, the question arises - are the Angels snake-bit or is there some Organizational negligence involved?
Angel's GM Billy Eppler stated yesterday in a press conference regarding the Richard's injury that he "hasn't found a common thread that suggests that the maladies are linked or triggered by negligence by the club." Eppler went on to say, "[w]e have not found a correlation....in some instances we've had players that come into this organization from other organizations that have had pre-existing UCL conditions. Generally, when you have pre-existing conditions, those can resurface. In other scenarios, we've had young players that have had tremendous velocity spike. When players encounter a velocity spike like that, it creates additional valgus load, which is the load put on your elbow while throwing. While velocity is a good thing, and the number one predictor of success, it's also a contributor to injury. Darned if you do, darned if you don't."
While I like and respect Eppler, I felt the need to dig a little deeper into the issue rather than just accepting his statement at face value. Unfortunately, I have no access to the members of the organization who could answer many of the questions that have formed in my mind (since I am not a believer in bad-luck). Thus, my goal is not to take Eppler to task in denying organizational negligence. My goal is to lay out some of the facts related to UCL prevention to raise the bar on our colelctive knowledge of cause and prevention. By doing so, I hope we all can be more educated as fans and hopefully be able to ask respectful and meaningful questions of the organization.
Prevention of injury to the UCL focuses primarily on addressing the risk factors for the injury. I have done some research (the primary articles are referenced below at the end of this post) and it is from this research that the following is gleaned.
1. PITCHING MECHANICS
It is pretty clear that the primary predicting factor for UCL injury is pitching mechanics. Pitching mechanics that decrease valgus stress on the elbow are key to preventing strain on the UCL. The UCL resists valgus stress during the pitching motion - cumulative microtrauma leads to UCL tears and failures. Thus, the more valgus stress on the pitcher's arm, the more likely the UCL is being strained beyond its capacity. In time this strain leads to tearing and finally failure.
Five parameters that have been shown to decrease valgus stress include leading with the hips, hands on-top position, arm in throwing position (elbow at max height at stride foot contact), closed-shoulder position and stride foot toward home plate (rather than stepping towards another target and having to torque to throw the ball on target). Others have described this as (1) lowering the shoulder abduction angle at front foot strike, (2) keeping the arm at the scapular plain from cocking into maximum external rotation and (3) increase shoulder range of motion while keeping the elbow at 90 degrees.
Others studying the issue have described the pitching deliveries that create the most valgus stress leading to UCL injury as (1) sidearm and 3/4 sidearm delivery, (2) early and late trunk rotation, (3) high and low shoulder angle, (4) arm behind and at scapular plane and (5) limited shoulder range of motion and full shoulder range of motion.
The bottom line of all of this is that there are specific mechanics that are associated with increasing valgus stress and therefore strain on the UCL leading to injury. These are relatively easy to identify and certainly any pitcher demonstrating these mechanics should be viewed at at-risk for UCL injury - particularly if they throw at high velocity. Any organization savvy in UCL injuries and pitching mechanics should be able to identify high-risk versus low-risk pitching motions. In other words, UCL injuries are not random or caused by bad luck - they are predictable by analyzing and studying a pitcher's mechanics.
This should come as no surprise - high pitch velocity is associated with UCL injury and the need for surgical intervention. During late cocking and acceleration phases of pitching, the increased stress on the elbow can cause tearing of the UCL.
As Eppler said, while pitching velocity has become the "number one predictor of success" it is also one of the main causes of the problem - particularly if pitchers adversely change their mechanics to achieve higher velocity. With all the young players chasing scholarships and MLB contracts/money - velocity has become a focus for developing pitchers. Unfortunately, unless proper mechanics are emphasized, it is also a predictor of UCL injury - particularly with improper mechanics.
High velocity and poor UCL mechanics are the top predictors of UCL injury. Pitchers who throw 95-plus with poor mechanics can be predicted to develop UCL injury and likely require TJ surgery at some point in their career. Ohtani and Richards are just current examples of this - again it is not bad luck - it is predictable.
3. POOR CORE, SHOULDER AND HIP MUSCLE STRENGTH AND RANGE OF MOTION
Maintaining strength, stamina and range of motion in the hip, shoulder and core muscles has been demonstrated to limit the potential for UCL injuries. These muscles can all be strengthened and kept limber by a regular and carefully monitored strength and conditioning as well as stretching routine. Hip, leg and core strengthening as well as rotator-cuff and scapular strengthening exercises and stretches are extremely important in preventing UCL injuries. Additionally, the literature suggests strengthening the flexor mass of the throwing forearm.
The literature suggests a regular strengthening and stretching program including the "sleeper stretch", "modified sleeper stretch", "cross body stretch" as well as a strengthening program focused on scapular stabilization and shoulder strength. Maintaining normal range of motion, scapular control and shoulder strength decreases the stress on the elbow and decreases the risk of UCL tear.
These are issues that one would think (and hope) are well known to the Angel organization. Certainly the trainers and strength/conditioning coaches at all levels should be fully aware and knowledgeable on these issues and these programs should be overseen by top experts in the field of UCL injury prevention. Every coach and trainer at every level of the Angel organization should be aware of the most recent research and developments in this area.
4. PITCHING YEAR ROUND
The literature discussing the UCL crisis in baseball all reference the fact that baseball is now being played year-round and pitchers are not getting a break from pitching. In days long ago, upcoming baseball talent would play baseball only during baseball season and then not play during the entire off-season. Now, baseball is played year-round even at the professional level with winter league and various other leagues that keep pitchers pitching without a break. This is done in the name of developing players but doing so fails to allow micro-tears in the UCL to naturally heal which can then lead to partial thickness or full tears of the UCL.
DISCUSSION AND THOUGHTS
The overriding message from the literature on UCL injuries is that they can be prevented or at least the risk of same can be minimized. If we rule out bad-luck, I think it is reasonable to conclude that the Angel organization has not made UCL prevention enough of a priority. It is unknown what Eppler is doing in this regard currently since it takes time to make headway throughout the organization - but certainly UCL injury prevention does not seem to have been something that prior management took too seriously. Richards and Middleton were both homegrown and if you look at their mechanics, it is pretty obvious that they were not coached in a manner to emphasize minimizing UCL injury. Their mechanics made UCL injury more of a "when" than an "if".
Pitching mechanics should be more than teaching how to gain control, gain velocity and throw strikes - proper UCL mechanics should be emphasized organizationally. This should be overseen by experts in the field and all coaches at all levels in the organization should be familiar with proper UCL mechanics.
Organizationally, the Angels need to commit themselves to prevention of UCL injuries to the fullest extent that is possible. That means scouting needs to search out pitchers with proper mechanics, mechanics should play a part in identifying pitchers to draft, player development needs to be familiar with proper UCL mechanics and teach them while developing young pitchers in the organization, strength and conditioning needs to be aware of the proper UCL protocols for weight training, stretching and range of motion. Experts in the UCL field should probably be hired (if they have not been already) to ensure that at all levels of the organization, proper mechanics, training and conditioning are made a priority. Other organizations have made such commitments and it is clear the Angels need to do the same.
Eppler mentioned that the Angels have taken some risks on players with prior UCL problems. That is obviously a risk that can and will be taken by almost every MLB organization since many of these players can be obtained at a low cost. So, those are low-cost, high-risk players (think Lamb and Ramirez) whose UCL mechanics are unsound and the decision is made to sign them anyway. It should be understood (predicted) that the UCL bug is likely to affect these players so they should not be a focal point of off-season planning.
Finally, a bit of commentary. If MLB scouts and GMs would make proper UCL mechanics a priority in pitching evaluation, then pitchers with bad mechanics (regardless of talent) would either go undrafted or fall to lower rounds. If this were to happen, coaches at lower levels would start emphasizing proper UCL mechanics over velocity and these injuries could be minimized throughout professional baseball. Everyone is chasing the almighty dollar. However, promoting velocity as the golden-goose without emphasizing proper UCL mechanics is irresponsible at all levels of baseball. Scouts and GMs could have a positive impact at little league and high-school levels if their draft-day decisions were guided by proper UCL mechanics.
Most of the information utilized for this Fanpost comes from the following articles.