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Update from Baseball Academia:
What’s New in Baseball Medical
Research
Aaron Gray, M.D. (@MizzouSportsDoc)
Assistant Profe...
Overview
• Youth Baseball Specialization
• Hamstring Injuries
• Concussions
• Tommy John (Ulnar Collateral Ligament) Injur...
Patterns of Specialization in
Professional Baseball Players
• Ginsburg et al. Journal of Clinical Sport Psychology
2014.
–...
Age of Specialization by Ethnicity
Survey
Respondents
Age began
playing
baseball
Age
specialized
in baseball
% who
special...
Climate Effects on Specialization in
Professional Baseball Players
• 59% of North American players came from “warm
climate...
Major League Baseball Injury
Surveillance System
• 2010 - MLB, players union, and minor league affiliates
reached agreemen...
Major League Baseball Injury
Surveillance System
• MLB Health and Injury Tracking System (HITS)
– Centralized database wit...
Hamstring Injuries
• Studies in multiple sports show re-injury risk of 12-31%
• 2011 – Players with hamstring injuries col...
Major and Minor League Baseball
Hamstring Injuries
• Christopher Ahmad et al. AJSM, 2014.
• Epidemiological Findings from ...
Athlete Exposure
• 1 athlete involved in a practice or game = 1 athlete
exposure
– Basically, every player in the box scor...
2011 Major and Minor League Baseball
Time Loss Injuries
Major League Minor League Total
Avg # of players
per game
14 13 13...
Time Loss Injuries by Body Part and
Injury Type
Injury Diagnosis Major
League
Number
Major
League
Percentage
Minor
League
...
Hamstring Injuries
• In 2011 - MLB & MiLB: Hamstring injury rate 0.7 per
1000 AE
• ~1 hamstring injury per 100 games per t...
Hamstring Strains by Activity
MLB # MLB % MiLB # MiLB %
Base running 31 62 154 70.6
Fielding 10 20 29 13.3
Unknown 4 8 8 3...
Time-Loss to Hamstring Injuries
12
22
30
10
26
5
21
27
25
23
0
5
10
15
20
25
30
35
1-3 days 4-7 days 8-15 days 16-30 days ...
Recurrent Hamstring Injuries
• Only reported if player had an injury in 2010 and 2011
• 20% of major league injuries were ...
Recurrent Hamstring, Oblique and
Groin Injuries
Major League Minor League
Total in 2010 Recurrent in
2011
Total in 2010 Re...
Hamstring Injury Seasonal Timing
0
20
40
60
80
100
120
140
160
April May June July August September
TEMPDEGREESORNUMBEROFG...
Hamstring Injury Prevention
Hamstring Injury Prevention
• Soccer Hamstring Injury Rates
– Recurrence rate of 22% within first 2 months
– 25% recur the...
Nordic Hamstring Exercise
Nordic Hamstring Exercise Protocol
Results
3.8 3.1
7.1
13.1
8.1
45.8
Overall Initial Recurrent
Hamstring Injuries per 100 Player Seasons
Intervention Control
MLB Hamstring Prevention Pilot
Program
• Some Minor and Major League teams started using the
Nordic Hamstring Curl prevent...
Concussions
• Gary Green et al. AJSM 2015.
• Mild Traumatic Brain Injury in Major and Minor League
Baseball Players
Concussions
• 2010 Pilot Data was collected
– 50% of concussions got better in 7 days or less
• This data led to the 7 day...
Concussions
• Injury rates were only calculated for regular season and are
per 1000 Athlete Exposures
Total MLB MiLB
Concu...
Excluded from Time Loss Calculation
• Injuries occurred less than 30 days from end of season
and they did not return
• Inj...
Time Loss Results from Concussion
• Majors
– TL HITS: Mean 11, median 8 (range 0-51)
– TL Medical Director: Mean 11, media...
Activity During Concussion
53.4
27.4
9 10.1
51.2
19.5
14.6 14.6
0
10
20
30
40
50
60
Fielding Batting Running Other
Minors ...
Fielding Concussions by Position
14.8
40.8
26.1
18.3
9.5
47.6
28.6
14.3
Pitcher Catcher Infield Outfield
Percentage of Con...
Catchers
• 7.4% of all non-concussive injuries but 40% of MLB
concussions!
Major League Minor Leagues
Player Collision 4 (...
Pitchers
• 23 concussions by pitchers
– 15 hit with batted ball and 2 in MLB
• ~750,000 pitches per year in MLB and on avg...
Tommy John Injuries
• Prevalence of Ulnar Collateral Ligament Surgery in
Professional Baseball Players
• Conte et al. AJSM...
Tommy John Injuries
• 5088 players responded
– Pitchers 53% of respondents
• 10% of players reported previous Tommy John s...
Tommy John Injuries
• Major League Pitchers
– 25% had a history of Tommy John surgery
– 86% had TJ surgery as a profession...
The Inverted W: Good or Bad?
Early Cocking Phase Mechanics and Upper
Extremity Surgery Risk in Starting Professional
Baseball Pitchers
• Douoguih et al...
• Inverted W – defined as elevated of 1 or both elbows
above the shoulder in early cocking phase of throwing
motion
Early Trunk Rotation – trunk rotation before stride foot hits the ground
and occurrence of non vertical trunk rotation at ...
Results
• 2 investigators achieved consensus on inverted-W in
88% of players and early trunk rotation in 86% of players
Ra...
Future Directions
Return from injury studies using pitch tracking, batted ball
tracking, and defensive player tracking
Questions or Comments?
Email: grayad@missouri.edu
Twitter: @MizzouSportsDoc
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Update from Baseball Academia: What's New in Baseball Medical Research

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Presented at 2015 Saber Seminar Boston, MA

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Update from Baseball Academia: What's New in Baseball Medical Research

  1. 1. Update from Baseball Academia: What’s New in Baseball Medical Research Aaron Gray, M.D. (@MizzouSportsDoc) Assistant Professor, Departments of Family Medicine & Orthopaedics University of Missouri
  2. 2. Overview • Youth Baseball Specialization • Hamstring Injuries • Concussions • Tommy John (Ulnar Collateral Ligament) Injuries • Inverted W
  3. 3. Patterns of Specialization in Professional Baseball Players • Ginsburg et al. Journal of Clinical Sport Psychology 2014. – Surveyed 708 minor league baseball players • 20% Spanish speaking not from North America • Mean age of sports specialization 15.52 years – 52% didn’t specialize until at least age 17
  4. 4. Age of Specialization by Ethnicity Survey Respondents Age began playing baseball Age specialized in baseball % who specialized after age 16 Total Sample n=708 6.2 15.5 64% White American 438 (63%) 5.3 16.5 75% African American 34 (5%) 10.5 17.2 79% Asian 10 (1%) 8.9 10.9 0% Hispanic non- American 140 (20%) 6.1 12.7 39% Hispanic American 44 (6%) 6.1 14.1 43% Other 27 (4%) 6.6 14.5 42%
  5. 5. Climate Effects on Specialization in Professional Baseball Players • 59% of North American players came from “warm climate” conducive to year-round practice – Warm climate specialized earlier (15.8) – Cool climate (17.6) • Analysis was done that determined “ethnicity and climate were both related to specialization age, irrespective to the other”
  6. 6. Major League Baseball Injury Surveillance System • 2010 - MLB, players union, and minor league affiliates reached agreement on creating a electronic medical records system and injury tracking system – Ability to track traded players • 2011 - first year of 100% involvement of all MLB and MiLB teams – MiLB ~245 clubs and ~7500 players – MLB 30 clubs and ~1200 players
  7. 7. Major League Baseball Injury Surveillance System • MLB Health and Injury Tracking System (HITS) – Centralized database with de-identified medical data from MLB Electronic Medical Record (EMR)
  8. 8. Hamstring Injuries • Studies in multiple sports show re-injury risk of 12-31% • 2011 – Players with hamstring injuries collected $30 million while disabled
  9. 9. Major and Minor League Baseball Hamstring Injuries • Christopher Ahmad et al. AJSM, 2014. • Epidemiological Findings from the Major League Baseball Injury Surveillance System • Only recorded time loss hamstring injuries occurring in a game (spring training, regular season or post season)
  10. 10. Athlete Exposure • 1 athlete involved in a practice or game = 1 athlete exposure – Basically, every player in the box score • Example of National League game • 9 players start game + 2 relief pitchers + 2 pinch hitters = 13 athlete exposures • Limitations
  11. 11. 2011 Major and Minor League Baseball Time Loss Injuries Major League Minor League Total Avg # of players per game 14 13 13 # of athlete exposures (AE) 69,076 302,744 366,886 # of players injured 541 2558 3099 Total game injuries 871 3697 4568 Injury rate (per 1000 AE 12.5 12.0 12.1
  12. 12. Time Loss Injuries by Body Part and Injury Type Injury Diagnosis Major League Number Major League Percentage Minor League Number Minor League Percentage Hamstring Strain 50 5.7 218 5.9 Adductor Strain 36 4.1 85 2.3 Oblique Muscle Strain 36 4.1 88 2.4 Hand Contusion 32 3.7 203 5.5 Leg Contusion 26 3.0 124 3.4 Concussion 18 2.1 101 2.7
  13. 13. Hamstring Injuries • In 2011 - MLB & MiLB: Hamstring injury rate 0.7 per 1000 AE • ~1 hamstring injury per 100 games per team
  14. 14. Hamstring Strains by Activity MLB # MLB % MiLB # MiLB % Base running 31 62 154 70.6 Fielding 10 20 29 13.3 Unknown 4 8 8 3.7 Pitching 2 4 14 6.4 Other 1 2 2 0.9 Catching 1 2 3 1.4 Hitting 1 2 6 2.8 Majority of base running injuries were running to first and majority of those were right handed.
  15. 15. Time-Loss to Hamstring Injuries 12 22 30 10 26 5 21 27 25 23 0 5 10 15 20 25 30 35 1-3 days 4-7 days 8-15 days 16-30 days >30 days PercentageofHamstringInjuries MLB % MiLB % Average time-loss MLB - 24 days MiLB - 27 days
  16. 16. Recurrent Hamstring Injuries • Only reported if player had an injury in 2010 and 2011 • 20% of major league injuries were recurrent • 8% of minor league injuries recurrent • Much greater recurrence rates than oblique or adductor groin strains
  17. 17. Recurrent Hamstring, Oblique and Groin Injuries Major League Minor League Total in 2010 Recurrent in 2011 Total in 2010 Recurrent in 2011 Hamstring 50 10 375 18 Oblique 44 0 148 4 Groin 34 2 100 1
  18. 18. Hamstring Injury Seasonal Timing 0 20 40 60 80 100 120 140 160 April May June July August September TEMPDEGREESORNUMBEROFGAMES Injury Rate (1 Hamstring Injury Every n Games) MLB MiLB Avg Temp
  19. 19. Hamstring Injury Prevention
  20. 20. Hamstring Injury Prevention • Soccer Hamstring Injury Rates – Recurrence rate of 22% within first 2 months – 25% recur the following season • Petersen et al. AJSM 2011 – ~1000 professional & amateur soccer teams randomized to 10 week eccentric training program followed by weekly seasonal program
  21. 21. Nordic Hamstring Exercise
  22. 22. Nordic Hamstring Exercise Protocol
  23. 23. Results 3.8 3.1 7.1 13.1 8.1 45.8 Overall Initial Recurrent Hamstring Injuries per 100 Player Seasons Intervention Control
  24. 24. MLB Hamstring Prevention Pilot Program • Some Minor and Major League teams started using the Nordic Hamstring Curl preventative exercises – 25% reduction in hamstring injuries in MLB – Decreased days lost to 14.25 days from 24 days previously
  25. 25. Concussions • Gary Green et al. AJSM 2015. • Mild Traumatic Brain Injury in Major and Minor League Baseball Players
  26. 26. Concussions • 2010 Pilot Data was collected – 50% of concussions got better in 7 days or less • This data led to the 7 day concussion disabled list • Data for this study from 2011-2012
  27. 27. Concussions • Injury rates were only calculated for regular season and are per 1000 Athlete Exposures Total MLB MiLB Concussions 307 266 41 Regular Season 277 241 36 Used to calculate time loss 207 170 31 Injury Rate 0.42 0.46 0.26
  28. 28. Excluded from Time Loss Calculation • Injuries occurred less than 30 days from end of season and they did not return • Injured toward end of spring training with more than a week until regular season game • If they participated in short season • Season ending injury
  29. 29. Time Loss Results from Concussion • Majors – TL HITS: Mean 11, median 8 (range 0-51) – TL Medical Director: Mean 11, median 9 (range 1-44) – TL Box Score: Mean 13, median 9 (range 0-60)
  30. 30. Activity During Concussion 53.4 27.4 9 10.1 51.2 19.5 14.6 14.6 0 10 20 30 40 50 60 Fielding Batting Running Other Minors Majors
  31. 31. Fielding Concussions by Position 14.8 40.8 26.1 18.3 9.5 47.6 28.6 14.3 Pitcher Catcher Infield Outfield Percentage of Concussions by Position Minors Majors
  32. 32. Catchers • 7.4% of all non-concussive injuries but 40% of MLB concussions! Major League Minor Leagues Player Collision 4 (40%) 24 (41%) Contact w/ batted ball 6 (60%) 18 (31%) Contact w/ non- pitched ball 0 5 (9%) Contact w/ pitched ball 0 0 Contact w/ bat 0 9 (3%)
  33. 33. Pitchers • 23 concussions by pitchers – 15 hit with batted ball and 2 in MLB • ~750,000 pitches per year in MLB and on avg 1-2 pitchers hit in head each year Bryan Mitchell
  34. 34. Tommy John Injuries • Prevalence of Ulnar Collateral Ligament Surgery in Professional Baseball Players • Conte et al. AJSM, 2015. • Online survey administered by certified athletic trainers for each MLB team to all MLB and MiLB players
  35. 35. Tommy John Injuries • 5088 players responded – Pitchers 53% of respondents • 10% of players reported previous Tommy John surgery – 16% of pitchers – 3% of non-pitchers
  36. 36. Tommy John Injuries • Major League Pitchers – 25% had a history of Tommy John surgery – 86% had TJ surgery as a professional • Minor League Pitchers – 15% had history of Tommy John surgery – 61% had TJ surgery during high school or college • No difference in prevalence in pitchers born in United States vs Latin America
  37. 37. The Inverted W: Good or Bad?
  38. 38. Early Cocking Phase Mechanics and Upper Extremity Surgery Risk in Starting Professional Baseball Pitchers • Douoguih et al. Orthopedic Journal of Sports Medicine, 2015. • 250 starters during 2010 season included in study • Video for each pitcher was reviewed for Inverted W and early trunk rotation • Identified shoulder or elbow surgery from beginning of career to end of 2010
  39. 39. • Inverted W – defined as elevated of 1 or both elbows above the shoulder in early cocking phase of throwing motion
  40. 40. Early Trunk Rotation – trunk rotation before stride foot hits the ground and occurrence of non vertical trunk rotation at initiation of trunk rotation
  41. 41. Results • 2 investigators achieved consensus on inverted-W in 88% of players and early trunk rotation in 86% of players Rate of Surgery, n/Total (%) Position With Position Without Position Inverted-W 28/93 (30%) 42/155 (27%) Early trunk rotation 37/111 (33%) 30/132 (23%)
  42. 42. Future Directions Return from injury studies using pitch tracking, batted ball tracking, and defensive player tracking
  43. 43. Questions or Comments? Email: grayad@missouri.edu Twitter: @MizzouSportsDoc

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