Saturday, December 19, 2015

MLB’s New Frontier: No Injuries in the Game

From the USA Today. This article was too good not to share. Enjoy!

Baseball’s most renowned innovator believes the next frontier of analytics won’t be about changes to on-field performance so much as simply keeping players on the field.

“I think that everybody's looking for a competitive edge,” Colorado Rockies manager Walt Weiss said, “and that's an area where you may be able to find one.” Billy Beane, Oakland Athletics executive vice president of baseball operations, has been among the loudest voices touting injury prevention and medical treatment as the next major data-driven undertaking — and that movement is accelerating across the league as medical technology improves and the investment in player contracts increases.

Training and nutritional programs are individualized based on baseline physical evaluations, as well as a player’s age, position and handedness; further customization takes the calendar — offseason, spring training, early season, late season — into account.

Radar systems track a pitcher’s velocity and release point to gauge fatigue. Elbow sleeves log the strain of every throw. Functional movement screenings are routine tests. Biomechanics data can be delivered in real-time. Medical research papers on the epidemiology of common baseball injuries and based on a league-wide injury database are nearing publication.

In November, after an injury-ravaged roster fell short of an expected playoff berth, the Washington Nationals introduced a revamped medical staff and first-of-its-kind advisory board with new executive director Harvey Sharman, who oversaw the medical program at Leeds United, an English soccer club where analytics are more in use. At the press conference, general manager Mike Rizzo called it “maybe the next Moneyball,” summoning the imagery of the book that made Beane famous.

Mets head team physician Struan Coleman, an orthopedic surgeon at New York’s Hospital for Special Surgery, said research is in the works about the risk factors and corresponding preventive muscle strengthening exercises to avoid injury absences. Someday, that could result in better elbow protection and Tommy John surgery prevention.

“That’s the kind of thing that we’re working toward,” Coleman said, “and I think we’re going to get there.”

In an industry where revenues approach $10 billion, the average salary exceeds $4 million and the first $400 million player may be just three years away, there's ample motivation.

Prevention, not treatment

James Andrews, the internationally regarded orthopedic surgeon, founded the American Sports Medicine Institute in 1987 and, along with Ph.D. research director Glenn Fleisig, have helped revolutionize the field. The mission has always been about injury prevention and recovery, but in 2002, they had a revelation.

“We looked in the mirror and said that we’re really doing a lot more on the treatment side than the prevention side,” Fleisig said.

At that January’s annual baseball injuries seminar at ASMI, Andrews announced that their biomechanics lab was open for all business — in other words, that teams were encouraged to send all pitchers for testing, even the healthy ones, and not just those rehabbing injuries.

Around that time, Oakland A’s pitching coach Rick Peterson sent a few young pitchers — Tim Hudson and Barry Zito, among others — for analysis in February. That November, Zito won the American League Cy Young Award. “That was good for business,” Fleisig said.

Ball clubs are far more proactive now in tracking pitcher data. Peterson — who is fond of saying, “In God we trust; all others must have data” — is now director of pitching development with the Baltimore Orioles and has all of his minor league pitchers tested.

“The Orioles pitching development program is based on research and science from Dr. Andrews and Dr. Fleisig,” Peterson said, “and our motivation is to fully help every pitcher in this organization to bridge the gap between potential and performance.”

The company KinaTrax has developed 3D motion-capture technology to replicate the work of ASMI’s biomechanics lab in major league ballparks. KinaTrax is in discussions with 17 clubs; the Tampa Bay Rays will be the first to install the system, which dovetails with the progressive ethos of the organization’s medical and training staffs.

“They stay innovative — they are constantly at seminars,” Rays manager Kevin Cash said. “They are constantly trying to learn. They don't get in the mold, well, I've been doing this for 15 years and this is how we did it then. They challenge themselves daily to provide the most for our players.”

Motus Global uses small motion-sensor chips embedded in small pockets of compression clothes to track swing and throwing mechanics. The elbow sleeve measures torque in Newton meters while also logging arm slot, arm speed and a shoulder’s external rotation. Motus is used by 27 of the 30 major league clubs. (Fleisig sits on its board.)

The TrackMan radar that powers MLB’s StatCast data collection also plays a role in injury detection and rehabilitation.

“We know teams will shut players down if they see certain changes,” TrackMan Baseball general manager John Olshan said, adding that, conversely, some clubs will hold back a player in rehab until their pitching measurements reach a certain threshold: “They might not know why that’s happening, but they know that somehow the player is compensating.”

ASMI has also been at the forefront of instituting pitch counts in Little League and endorsing other safer arm-care guidelines through Pitch Smart, a joint effort of Major League Baseball and USA Baseball. With elbow injuries rising, that movement has received universal embracement.
“I watch TV — politics or sports — and how often do you say something and everyone agrees?” Fleisig said.

Rest, recovery, and ‘fingerprints’

The No. 1 cause of injuries is fatigue which, Cincinnati Reds medical director Tim Kremchek said, leads to a staggering 500% increase in their likelihood. Fleisig said a pitcher’s fatigue is often marked by stride shortening and elbow lowering. Th
ose changes can be nearly imperceptible to the naked eye, hence, all the tracking technology.
“When you fatigue, your biomechanics change,” said Kremchek, a leading Tommy John surgeon.
Many medicals staffs previously reacted to injuries and only gave lip service to the realization of baseball’s marathon season. That’s why, Coleman said, the HSS team made a big push on prevention by instituting more rest and recovery days in 2007 which, he said, “substantially” reduced the number of days Mets players missed to injury from one year to the next.

Diagnosing injuries early is essential to avoid worsening. That requires vigilance by the whole staff, as well as having a player’s healthy medical records on file, too.

“Each player has his own signature, baseline motion and strength analysis,” Coleman said. “It’s like a fingerprint.”

Starting with those thorough examinations, medical staffs can work on prospective studies by following players longitudinally.

“If someone has, say, decreased range of motion in their hip,” he said, “are they more likely to have a hip injury or a hamstring injury during the one season, during five seasons or in 10 seasons?”
Coleman said there’s been recent progress in reducing the number of shoulder injuries, due to heightened understanding of the joint’s mechanics, the need for stretching the posterior capsule to avoid internal impingement and improved MRI resolution to detect inflammation.

Medical teams have grown from a doctor and a trainer to dozens of physical therapists, trainers, strength and conditioning coaches. Minnesota Twins manager Paul Molitor, a Hall of Fame player from 1978-1998, said teams didn’t even have weight rooms when he started playing.
“We have gone from — when I started with the Reds 20 years ago — cursory physical examinations in the spring and letting him play,” Kremchek said, “to now individualized, customized programs from them. It’s very sophisticated.”

Among the advances, Kremchek said, are increased use of ultrasound to view muscles dynamically rather than static MRI images and more natural healing approaches. Especially in younger athletes, he said he’s less apt to use cortisone than platelet-rich plasma (PRP) or stem-cell therapies.
“We are very, very proactive in these types of regenerative medicine,” Kremchek said.

The statistics of baseball performance have been so finely studied and dissected that it’s becoming harder to find differentiating factors, so clubs are turning further attention to the field of sports medicine to minimize one particular statistic: disabled list stays.

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