MLB pitchers don't regain performance level after Tommy John surgery

     Major League Baseball players who undergo Tommy John surgery are less likely to regain the performance level they had before surgery, according to a Henry Ford Hospital study.

The study is the first to show a link between the surgery and declining pitching performance at the professional level. It also involved the largest cohort of professional pitchers to date to examine the issue.

Researchers analyzed pitching statistics of 168 MLB pitchers before and after surgery between 1982 and 2010 and found diminishing returns in three major pitching categories: Earned runs average (ERA), walks and hits per inning pitched (WHIP) and innings pitched (IP). The findings:

ERA increased 4.15 to 4.74.
WHIP increased 1.40 to 1.48.
IP declined 59 to 50.

"Tommy John surgery is an effective surgery and most pitchers get back to pitching after surgery. But it's not going to improve their level of performance," says Vasilios (Bill) Moutzouros, M.D., a Henry Ford orthopedic surgeon and the study's senior author.

"There's been a perception that the surgery will make you better. Our findings debunk that perception. Eighty to 90 percent of major league pitchers will get back to pitching at the major league level but they just won't be as effective as they were before injury."

The study is being presented at the annual meeting of the American Academy of Orthopedic Surgeons March 11-15 in New Orleans.

Tommy John surgery, named after the former Los Angeles Dodgers pitcher who underwent the pioneering surgery 40 years ago, has been since performed on legions of pitchers at the professional and collegiate levels. In medicine it is known as ulnar collateral ligament (UCL) reconstruction. During the two-hour outpatient procedure, the ulnar collateral ligament in the medial elbow is replaced with a tendon from the same arm or from the hamstring area.


               
       

 IMAGE: This is Vasilios (Bill) Moutzouros, M.D., a Henry Ford Hospital orthopedic surgeon and study's senior author.
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Until Henry Ford's observational study, other research had shown that a high percentage of players returned to the same level of performance after UCL reconstruction, and the perception among players, coaches and parents was that UCL reconstruction would even lead to a higher level of performance. In the only other study involving just MLB pitchers (68 pitchers), 82 percent of them returned to the mound after surgery and had no significant decline in performance.

Henry Ford researchers sought to examine the effects of UCL reconstruction on pitching performance involving the largest cohort of MLB pitchers and identify risk factors associated with the pitching injury, says Robert Keller, M.D., a third-year Henry Ford orthopedic resident and study co-author whose father Phil was a teammate of Tommy John in the 1970s.

The cohort of 168 pitchers pitched in at least major league game after undergoing UCL reconstruction between 1982 and 2010. Data collected included the year of surgery, pitchers' age, years of MLB experience, height/weight, body mass index, pitching arm injured, pitching role, pitching statistics, and whether the pitcher returned to MLB pitching after surgery. This was then averaged for the three years of pitching before UCL reconstruction and for the three years after returning to play.

For comparison, researchers collected similar data of 178 MLB pitchers in a control group with no prior UCL reconstruction and age-matched them with a corresponding UCL reconstruction pitcher. Performance was determined using three years of statistics before their "index year" (their roster year of either 2004 or 2005) and three years after their "index year."

Drs. Moutzouros and Keller used paired analysis, generalized estimating equation model and other commonly used research tests to evaluate the data. Other highlights:

- UCL pitchers were "statistically better" than the control group in ERA, WHIP, IP and win percentage in the three years and two years before surgery.
- In the year before surgery, UCL pitchers' performance declined significantly.
- After surgery, the control group was either superior in nearly every performance measure or no difference observed.
- A predictor of surgery is MLB experience. Sixty percent of pitchers required UCL reconstruction within their first five years in the MLB.
- While the cause of UCL injury is not fully known, orthopedic specialists theorize it's due to overuse and stress on the elbow, pitching velocity and joint motion, Dr. Keller says, adding that surgery isn't a panacea.

"We even have parents who come into our clinic asking if their children can have the surgery even before they injure anything because they think potentially it can make them better. What this study shows is it doesn't. Matter of fact, players get statistically worse after having this surgery."

Study finds no greater soccer injury risk on artificial playing surfaces

New research presented today at the 2014 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) found no greater injury risk for athletes playing on artificial playing surfaces.

The use of artificial playing surfaces at sport venues has increased significantly in recent years, primarily due to the advantages of artificial turf over natural grass: longer playing hours, lower maintenance costs and greater resilience to harsh weather conditions. Despite these advantages, many elite professional soccer teams are reluctant to install artificial turf because of a perception that injuries occur more often on these types of surfaces.

In the study, "Safety of Third Generation Artificial Turf in Male Elite Professional Soccer Players," Italian researchers reviewed injuries involving players in the top Italian football (soccer) league during the 2011-2012 season.

A total of 2,580 hours of play were recorded (1,270 hours on artificial turf and 1,310 on grass). For every 1,000 hours of play there were 23 injuries recorded on artificial surfaces and 20 on grass, with muscle strains being the most common injury (13 on artificial turf, 14 on grass). The authors of the study do not consider the injury rates between the two surfaces to be statistically significant, as only three injuries per 1,000 hours of play were attributable to artificial surfaces.

The study authors concluded that there are no major differences between the nature and causes of injuries sustained on artificial turf and those that occur on natural grass surfaces.

Major League Baseball players win more games following Tommy John surgery

Since 1986, 83 percent of patients returned to professional play

Ulnar collateral ligament (UCLR) reconstruction, otherwise known as "Tommy John Surgery," is a procedure frequently performed on Major League Baseball (MLB) pitchers with a damaged or torn ulnar collateral ligament, a common elbow injury, typically from overuse.

In the new study, "Rate of Return to Pitching and Performance after Tommy John Surgery in Major League Baseball Pitchers," * presented today at the 2014 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), researchers looked at the rate of return to MLB pitching following UCLR, the level of performance in pitchers returning to MLB, and the difference in overall performance between pitchers who underwent UCLR and demographic-matched controls who did not. Researchers evaluated UCLR pitchers between 1986 and 2012 using a number of performance-based statistics and compared them with matched controls: age, body mass index (BMI), position, handedness and MLB experience.

In the year prior to surgery, the UCLR pitchers were outperformed by controls in terms of the number of innings pitched, games played and winning percentage. However, after undergoing UCLR, pitchers allowed significantly fewer walks and hits per inning pitched (WHIP), won a higher percentage of games, and recorded lower earned run averages (ERA) than prior to their surgeries. The UCLR pitchers also recorded higher winning percentages and lower WHIP and ERA in their post-surgical career than the control group. Overall, 83 percent of UCLR patients were able to return to MLB, and their careers on average lasted an additional 3.9 years.

The authors of the study concluded that there is a high rate of pitchers returning to MLB following UCLR, with a significant improvement in pitching performance.

Disney Research soccer analysis suggests home advantage is result of strategy

An automated analysis by Disney Research Pittsburgh of team formations used during an entire season of professional soccer provides further evidence that visiting teams are less successful than home teams because they play conservatively, not because of a mythical home advantage.

The researchers, employing the first automated method for detecting formations, analyzed a whole season of player and ball tracking data compiled by Prozone for a top-tier professional soccer league. They found that teams usually played the same formations for both home and away games, but that the way they executed those formations was significantly different.

The players consistently played more forward up the field at home than they do on the road, both when attacking and defending. The home team thus is more likely to win the ball when it is in an advanced position, which can lead to more shots on goal.

"It also means that home teams actually run less, so they don't get as tired during the match," said Patrick Lucey, a Disney researcher specializing in automatic measurement of human behavior.

The researchers will present their findings at the MIT Sloan Sports Analytics Conference, Feb. 28-March 1 in Boston, MA.

The automated formation detection method developed by Disney Research also summarizes game information in a visual form.

According to Lucey, "You can think of it as a weather map that shows which team is dominating and the tactics that each team is using."

An earlier study by Lucey and his colleagues, which used ball action data compiled by Opta for a professional soccer league's season, showed that performance measures such as shooting and passing percentages were similar for home and visiting teams. But home teams more often had the ball in the forward third of the field, where players were in position to get more shots on goal. Lucey said it appeared visiting teams were playing "not to lose," rather than playing "to win," reflecting the common wisdom to "win at home and draw away."

The new study takes that analysis deeper, showing that the home/away differences are the result of how formations are executed, not different formations.

Recognizing player formations is relatively easy for human observers, but until now has been difficult for computerized methods, Lucey said. The Disney researchers, however, have found a way to account for players as they swap roles during the course of play.

While a team scout might be able to summarize the formations used in a game by an upcoming opponent, the computerized method enables detailed analysis of multiple games or an entire season of play – far more data than any human could make sense of. This formation analysis also can occur during a game, providing a tool that might help both coaches and broadcast commentators visualize team performance in real time.

Elite Soccer Players Run Less

Millions of pounds may be splashed on elite footballers in the English Premier League, but it is those who play in the second and third tier of football who run further on the pitch, new research reveals.

For years, players in the top tier of English football have been paid much higher wages compared to those in the Championship and League One. However, research at the University of Sunderland has found it is those in the lower leagues who are covering a greater distance at a higher intensity.

Research published in the journal Human Movement Science analysed 300 players in the English Premier League, Championship and League One. It is the first time research has looked at the match performance across all three divisions.

The research found that those in League One ran a lot further at a higher intensity than those in the Championship. The same was true when Championship players were compared to those in the Premier League. The researchers believe this could be due to more teams adopting a long ball style of play the further you go down the football pyramid.

However, academics did find that those playing in the Premier League performed a greater number of passes and successful passes. They also received the ball more often and had more touches of the ball than those in the Championship and League One.

The research, 'Match performance and physical capacity of players in the top three competitive standards of English professional soccer', could also back up the belief that players at a higher standard have a far higher level of technical skill, and do not use the long ball tactic of 'kick and rush'.

Additionally, the research found that when players were relegated from the Premier League to the Championship, they began to run more distance at a higher intensity. However, when players moved in the opposite direction they didn't change the levels of running and intensity.

Dr Paul Bradley, led the research and is a senior lecturer in Sport and Exercise Science at the University of Sunderland, said: "This research highlights that the long ball game does make you work harder, and that the context of the game dictates how each individual or team works. Some of the results were quite surprising as we expected there would be differences in the technical areas between the leagues, but not the physical nature."

The report stated: "The data provides new insight into the possible impact technical characteristics have on match running performances and highlights that players at lower standards could tax their physical capacity to a greater extent….These findings could be associated with technical characteristics inherent to lower standards that require players to tax their physical capacity to a greater extent."

What's the Sound of a Hundred Thousand Soccer Fans?

Mention vuvuzela to soccer fans, and they may cringe. The plastic horn rose to prominence during the 2010 World Cup in South Africa, where tens of thousands of those instruments blared in packed stadiums. The loud, buzzing noise soon became a major annoyance, disrupting players and even fans watching on TV.

Now, for the 2014 World Cup in Brazil, organizers have introduced the maraca-like caxirola as the official instrument of the event. The caxirola, based on the African caxixi, was invented by Brazilian musician Carlinhos Brown to be more subdued than the vuvuzela. To see if this was really the case, Talita Pozzer and Stephan Paul of the Federal University of Santa Maria in Brazil studied the acoustics of the instrument, finding that a single caxirola, at least, poses no threat to the user's ear.

Their work will be presented at the 166th meeting of the Acoustic Society of America, held Dec. 2-6, 2013, in San Francisco, Calif.

In their analysis, the researchers asked 22 volunteers who had never seen the instrument to play it as they thought it should be played, finding that people tend to either shake it along its longer axis or its shorter axis. A recording device placed at the ear of each subject measured the sound of the caxirola.

The researchers found that if shaken along the longer axis, the instrument produces twice the sound energy as when shaken along the shorter axis. But because volume depends logarithmically on the sound energy, the difference is only just noticeable to the ear. In both playing styles, the sound pressure levels were comparable to that of a normal conversation – and roughly 45 decibels lower than that of the vuvuzela, corresponding to 1/30,000th times the sound energy. In other words, you would need 30,000 caxirolas to produce the same sound pressure level as a single vuvuzela.

The researchers also captured the acoustic signature of the caxirola played in both styles, measuring how the frequency and intensity of the sound varies over time. The signature was similar in both cases.

The next step, Paul said, is to measure the caxirola's sound power levels, which, unlike sound pressure levels, are independent of distance and the instrument's surroundings. The researchers can then input those measurements into a computer model of soccer stadiums, simulating exactly what kind of noise thousands of caxirolas would make, showing whether or not it would be harmful.

Since its introduction last year, the caxirola has already been mired in controversy. After disgruntled fans hurled the instrument on the field during a match in April, officials banned the instrument for the Confederations Cup last summer. Whether the caxirola will be distributed during the 2014 World Cup has yet to be determined, Paul said.

Perhaps it's not the caxirola's acoustics that's a cause for concern – but its aerodynamics.

Soccer (football) players suffer more injuries when their team is ahead

Male football players are at a greater risk of injury five minutes after a card has been given or after a goal has been scored. The frequency of player injuries also increases when their own team is in the lead. These are the findings of researchers at the Sahlgrenska Academy, who, in collaboration with Fifa, have analysed injuries over the last three World Cup tournaments.

Football players do not just injure themselves whenever and however. On the contrary, injury frequency follows a clear pattern that is dependent on how various events in the course of a match affect players’ emotional and physical states.

This is borne out by three new studies conducted at University of Gothenburg’s Sahlgrenska Academy with the support of the international football association, FIFA.

Greater risk for players in the lead

The studies, which are based on injury statistics from the 2002, 2006 and 2010 World Cup tournaments for men, and which were published in the British Journal of Sports Medicine, show that:

• Injury frequency varies depending on whether a team is winning, losing or if the outcome is not yet decided. Players in winning teams are at the greatest risk of injury.

“This may be due in part to the fact that a losing team starts to play more aggressively,” says Jaakko Ryynänen, a PhD student at the Sahlgrenska Academy who contributed to the study.

Exposed position for strikers

• The risk of injury varies between the various positions, the frequency of injury being greatest amongst strikers:

“One possible cause is that the results of any one match are very important in international tournaments. This may accentuate the role of the strikers, leading to increased pressure on them,” says Jaakko Ryynänen.

• There is a direct link between the number of free kicks and the number of injuries per match. A match with more free kicks has a higher injury frequency.

• Injury frequency increases within a five minute period after a yellow or red card is issued, and following injuries and goals.

“One theory is that players lose their concentration following disruptive breaks in play, which then increases the risk of injury,” says Jaakko Ryynänen.

Surprising finding

A surprising finding is that the number of injuries per World Cup match increases if there is a longer break between matches.

“It sounds contradictory that the risk of injury increases with longer recovery times, but our theory is that this may be due to players losing their focus on match games after a break of several days. Perhaps teams also play at a higher level of intensity after they have rested for a number of days and have more energy.”

Prevent injuries

According to Jaakko Ryynänen these studies are important in terms of being able to prevent injuries.

“Our primary goal is to contribute with knowledge that can prevent injuries. The ability to recognise periods of matches when the injury incidence is high may be important in terms of preventive measures, for example replacing players at risk of suffering a repeat of a previous injury. Since there are more than 260 million football players in the world, preventive measures could help a lot of people. “

Temporary red card

Continued research could also result in new rules. Jaakko Ryynänen mentions as one example the introduction of temporarily sending off players for aggressive behaviour, as is the case with ice hockey.

“This is something for the governing bodies of football to consider. For our part, we will continue our research in order to identify more opportunities for injury prevention, and to see whether the conclusions we draw are also applicable to football at lower levels. “

The article “Foul play is associated with injury incidence: An epidemiological study of three FIFA World Cups (2002-2010)” will be published in the British Journal of Sports Medicine on 15 October.

Link to the article

The article “Increased risk of injury following red and yellow cards, injuries and goals in FIFA World Cups” will be published in the British Journal of Sports Medicine on 15 October.

Link to the article

The article “The effect of changes in the score on injury incidence during three FIFA World Cups” will be published in the British Journal of Sports Medicine on 15 October.

Link to the article