Pitching injuries

Baseball season is underway. With the pros, college and high school teams taking to the baseball diamonds and Little Leaguers soon to follow, orthopedic specialists at Rush University Medical Center are cautioning players to be aware of and take precautions against throwing injuries. An analysis of pitching injuries by researchers at Rush is published in the March/April issue of Sports Health.

“Throwing a baseball is one of the fastest and most violent maneuvers that any joint in the body is subjected to. The violent and rapid motion places numerous structures in the shoulder at risk for injury,” said Dr. Shane Seroyer, lead author of the report and sports medicine fellow at Rush.

Prevention of injury is the key to a long career. Pitchers, especially youth pitchers, should limit the number and types of pitches thrown to minimize the risk of injury.

“For pitchers under 14 years old, we encourage fast ball and change-up pitches and discourage the use of a curveball to prevent injury,” said Dr. Charles Bush-Joseph, sports medicine specialist at Rush and co-author of the report.

Bush-Joseph breaks down the number and type of pitches appropriate for various age groups.
• 9-10 years old: no more than 50 pitches/game and 75 pitches/week
• 11-12 years old: no more than 75 pitches/game and 100 pitches/week
• 13-14 years old: 75 pitches/game and 125 pitches/week
• 14 years old: begin throwing curveball pitch
• 17 years old: begin throwing slider pitch

According to Seroyer, if injury does occur, the early discovery of symptoms, followed by conservative management with rest and rehabilitation can help to decrease the need for surgery in the future.

Shoulder pain may occur during any of the six phases of throwing, which are wind-up, early cocking/stride, late cocking, acceleration, deceleration and follow-through. According to the sports medicine specialists at Rush, diagnosing pain from overhead throwing is one of their more difficult challenges, but shoulder pain most often emanates from one of the following five sources: damaged cartilage, rotator cuff injury, abnormal scapula movement, impingement, and neurovascular disorders.

Injury to cartilage (the labrum), which surrounds the shoulder joint, occurs with trauma to the shoulder joint. Labral tears are among the most common injuries for overhead throwers and generally result from the cocking and acceleration phases of overhead throwing. Cartilage also wears down with age and use.

Damage to the rotator cuff, a term given to the group of muscles and their tendons that act to stabilize the shoulder, can lead to tendonitis and muscle tears. Although one specific movement could cause injury to the rotator cuff, this type of injury is often the result of the “wear and tear” from the overhead throwing motion.

The thrower will often complain of diffuse shoulder pain aggravated by overhead activity and will notice weakness and decreased velocity. Night pain down the arm to the elbow is also common. Conditioning and proper throwing techniques is critical in preventing rotator cuff injury as the results of rotator cuff repair surgery have been disappointing in elite throwers.

Scapular (shoulder blade) pain is the result of abnormal scapular movement, malposition and snapping of bursal tissue around the scapula. The scapula provides a stable base for muscles in the shoulder, thus abnormal positioning and movement can force the arm into strenuous positions and lead to decreased motion and rotation or “dead arm” syndrome. Muscle strengthening and conditioning are necessary to keep the scapula in place for an effective overhead throw. Initial treatment for scapular pain is rest, analgesia (pain relievers), and nonsterodial anti-inflammatory drugs.

Impingement results from pressure on the rotator cuff from part of the shoulder blade as the arm is lifted. Pain during the late cocking and early acceleration phases of throwing is most common. Impingement can cause local swelling and tenderness in the front of the shoulder, and pain and stiffness may be felt when the arm is lifted or lowered from an elevated position.

Conservative treatment for impingement includes oral, nonsteroidal anti-inflammatory medication, stretching to improve range of motion, injections of local anesthetic and a cortisone preparation to the affected area and rest. Rotator cuff and shoulder blade strengthening and conditioning will help shorten recovery time. Difficult cases may require surgery to remove the impingement in order to create more space for the rotator cuff, allowing for freer movement to lift the arm without pain.

Neurovascular disorders occur when nerves or blood vessels are being compressed, blocked or pinched causing fatigue, loss of velocity, vague shoulder pain, a sense of heaviness, achiness or cramping in the arm. Numbness, tingling, weakness of grip and loss of manual dexterity may also be symptoms experienced after the onset of throwing. Although rare, neurovascular disorders cause significant damage and recovery may be difficult. Successful non-operative treatment methods include rest and thrombolytic and anticoagulation injections used to diffuse blood clots. However, thirty percent of throwers will not respond to conservative measures and will require surgical intervention.

Mathematician: Yankees Win!

NJIT mathematician foresees tight races in Major League Baseball's Eastern divisions

Larger differentials in Central and West in 2009

The New York Yankees, Boston Red Sox, Cleveland Indians and Los Angeles Angels should make the playoffs in the American League (AL) in 2009 with most other teams lagging well behind. The National League (NL) should see another very tight race in the Eastern Division as has occurred in recent years.

However, this year it looks like there may be a three-way tie among the defending World Series Champion Philadelphia Phillies, the Atlanta Braves, and the New York Mets,. Two of these teams should make the playoffs (one as Eastern Division champion and the other as NL wild card team) while the Chicago Cubs and Los Angeles Dodgers should handily win their divisions, said Bruce Bukiet.

Bukiet, an associate professor of mathematical sciences and associate dean of the College of Science and Liberal Arts at NJIT, once again provides the number of games each Major League Baseball team should win in 2009 based on the mathematical model he developed in 2000.

The contest for primacy in the AL East should go down to the wire with the Yankees winning 99 games to the Red Sox 97. With the two best records expected in the Major Leagues this season, both teams should make it to the post-season, one as AL East winner and the other as the AL wild card team. The defending AL champion Tampa Bay Rays should take third place with 91 wins. In the AL Central Division, the Indians should win 88 games to the Minnesota Twins 83, while the Angels should win AL West by a whopping 21 games with 92 wins while the Texas Rangers and Oakland Athletics win 71 each.

In the National League East, Bukiet is concerned that for the third year in a row his favorite team, the Mets, will miss the playoffs on the last day of the season. "The model has been quite accurate with the Mets over past few years with the Mets slightly underperforming and the Phillies slightly over performing. If that repeats itself, it would spell another season of final game heartbreak to Mets fans."

In the NL Central Division, Bukiet's model calls for the Chicago Cubs to win 97 games, 12 more than the second-place St. Louis Cardinals. The Pittsburgh Pirates should win just 60 games, the least in the Major Leagues.

"In the NL West, the Los Angeles Dodgers should win 91 games, while the Colorado Rockies and the Arizona Diamondbacks tie for second place, 8 games back," said Bukiet.

His expected wins for the AL are the following.

AL East: Yankees – 99; Red Sox – 97; Rays – 91; Blue Jays – 83; Orioles – 68.
AL Central: Indians – 88; Twins – 83; White Sox – 79; Tigers – 78; Royals - 71.
AL West: Angels – 92; Rangers – 71; Athletics – 71; Mariners – 65.
For the NL, he projects the following.

NL East: Braves – 88; Phillies – 88; Mets – 88; Marlins – 73; Nationals – 67;
NL Central: Cubs – 97; Cards – 85; Brewers – 82; Astros – 80; Reds – 75; Pirates – 60;
NL West: Dodgers – 91; Diamondbacks – 83; Rockies – 83; Giants – 78; Padres – 76.
"These results are merely a guide as to how teams ought to perform. There are many unknowns, especially trades, injuries and how rookies will perform," said Bukiet. "Over the years, the predictions have been about as good as those of the so-called experts. It demonstrates how useful math can be in understanding so many aspects of the world around us."

Operations Research published Bukiet's mathematical model on which his predictions are based. His model computes the probability of a team winning a game against another team with given hitters, bench, starting pitcher, relievers and home field advantage. Bukiet has appeared on CNN Headline News, the Jerusalem Post and Fox Radio's Roger Hedgecock Show, KOGO, San Diego and others. Interview Bukiet in person at 501 Cullimore Hall, by telephone (973-596-8392) or email bukiet@m.njit.edu.

Bukiet, an avid Mets fan, has used this mathematical model to determine whether it is worthwhile to wager on games during the baseball season. His picks are posted (for academic purposes only) on his website (www.egrandslam.com). These picks have produced positive results for six of the eight years he has posted them.

Bukiet's main areas of research have involved mathematical modeling of physical phenomena, including detonation waves, healing of wounds, and dynamics of human balance. He has also applied mathematical modeling to sports and gambling, in particular for understanding baseball and cricket. He is currently working on National Science Foundation projects to train math and science teachers for high-need schools and to bring computational research projects into Newark High Schools. Bukiet won the 2008 Mathematical Association of American-NJ Section Distinguished Teaching Award and received the NJIT Excellence in Teaching Award in 2006 for Outstanding Work. Bukiet received his PhD in mathematics from the Courant Institute of Mathematical Sciences, New York University.