Every Day

January - April 2006 Issue

Sports Medicine Center Studying Major League Injuries

William Raasch, MD

Medical College of Wisconsin Orthopaedic Surgeon;
Director, Sports Medicine Center

The Sports Medicine Center is working with Major League Baseball to study ways to help prevent injuries among professional baseball players. William Raasch, MD, who is also the team physician for the Milwaukee Brewers, talks about the current study and the center's other innovative programs.

Q. How did the center start working with Major League Baseball?

In September 2003, Major League Baseball decided to award grants to any research study that would lead to changes that might reduce the risk of injury. The effect pitching mound height might have on injury risk is an idea we were pursuing in a pilot project on our own. In 2003,when baseball first offered the grant, we submitted our study to more thoroughly look at mound height effects and were the first grant selected.

Q. What’s the goal of the study?

The theory is that as you raise the mound, the motions that the arm goes through are changed, and can result in additional stress to both the shoulder and elbow. I’m not sure when the regulation mound height changed to 10 inches, but the height has been raised. So the question was, “Have we created an environment that now puts greater stress on the arm resulting in a higher incidence of injury?” We proposed looking at three different mounds — a 10-inch mound, which is regulation; an 8-inch mound; and a 6-inch mound — as well as having the athletes throw from flat ground.

Q. How will it work?

We use a motion analysis system, which consists of eight digital cameras with 42 different markers. We will be able to analyze motion at each of the different mound heights. By collecting that data on approximately 20 different players, we’ll be able to determine if there is increased stress on the shoulder or the elbow based on the height from which the pitcher has thrown.

We have run 7 collegiate throwers and will be evaluating 13 more after spring training. The initial seven were from the University of Wisconsin-Milwaukee team and were a great group of kids to work with.

But we won’t be able to collect the final Major League throwers until early 2006 when the players get back as we want to test them during their usual throwing season.

We had one of the League’s experts come in to see the system and he was very impressed with our motion analysis lab. Now we just need to get the final players in to finish the study.

Q. What do you think the study will find?

We can’t really say that we can decrease the risk of injury at this point. What we are hoping to find is that we can decrease the stress on the shoulder and elbow. We can run mathematical models — calculate the different stresses and forces on the shoulder at the different mound heights and determine if more stress occurs as the mound is raised.

We’ve known for a long time that during rehabilitation for a shoulder injury, there’s a difference between flat-ground and mound throwing. You start them off throwing on flat ground and they do fine, but when they first get to the mound, the pitcher will often struggle with a recurrence of symptoms. We know something is going on — we’re just trying to quantify exactly what is going on when they switch from flat ground to mound height.

We may not find much difference between 10 inches, 8 inches and 6 inches. We may not find a difference between 10 inches and 6 inches. We may only find a difference between 10 inches and flat ground.

Q. What might be the impact of the study?

Mr. Selig is very proactive. I think if we discover that we are creating more stress and subsequent injuries by having elevated the mound to 10 inches, the League will consider change.

All mound heights are 10 inches in college and high school, so this could also affect the non-professional game. If Major League Baseball were to change its mound height, the others would probably change their mound heights as well.

Q. What is the Performance Enhancement Program (PEP)?

It’s a program that focuses on improving performance. We break it down to improving power, speed, quickness and agility. It can focus on whether the athlete wants more power or strength — like a power lifter or a shot putter. Or, are they looking for more quickness and agility — like a basketball player or a soccer player. So we can tailor it to meet their needs.

Q. What programs are available through PEP?

We have a throwing program called “The Perfect Game.” It’s a six-week program, twice a week where athletes work on their throwing mechanics. They have their motion analyzed at the start and end of the program, so we can see if we’ve helped them improve, and they can see what they’ve done correctly and what they still need to work on.

There are also programs that focus on injury prevention. There’s a specific PEP program for ACL (anterior cruciate ligament) injury prevention. ACL injuries are very common in female athletes, more common than in male athletes. They move differently, and this program helps them move in a better way to reduce the less stress on the knee and the likelihood of an ACL tear.

Also, with the motion analysis system, we can provide very specific analysis for individual athletes. We can analyze their slapshot, their golf swing, their soccer kick and more.

Dr. Craig Young, also an orthopaedic surgeon, is a company physician for the Milwaukee Ballet. We have a dance medicine program focusing on the dancers and prevention of the types of injuries they experience.

Q. Who can benefit most from the Sports Medicine Center?

We see everything, from the professional to the grade school athlete to the weekend warrior to the 70-year-old who plays senior tennis. We focus on all sports.

Q. What makes the Sports Medicine Center different from other sports programs?

The Sports Medicine Center is first and foremost a physicians group with the Medical College. Because so much of treating a sports injury is physical therapy, we have integrated the physicians group with Froedtert Physical Therapy. Our athletic trainers our also an integral part of our center and are our front line workers in dealing with the athletes at their high school, college, club or professional team.

We have this group of dedicated therapists and trainers who specialize in sport medicine so when the patients come in to see the doctors, we can provide them with a complete service. Often, after they’re better, then the next step is, “How do I keep from getting hurt?” or, “How do I enhance my performance?” And that’s where the performance enhancement center comes in.

Our recent expansion has focused on motion analysis and performance enhancement. That’s been a natural evolution of our initial concept of providing everything under one roof in a truly physician-run, coordinated program. The standard model would have the physicians in one building and a hospital-based therapy group somewhere else. The physician writes a prescription for therapy and the patient walks off to find the therapy group. Sometimes the notes get back from the therapist and the physician wanted something a little bit different. Here, if there’s a concern or a misunderstanding, they just walk down the hallway about 30 steps and here we are. It’s continuity of care and quality of care that I think makes us different than most programs.

Q. Do you have other baseball studies in mind?

We have what I call the wiffle ball study. Mike Maddux, the pitching coach for the Brewers, was telling me one day how he and his brother, Greg Maddux, who pitches for the Cubs, used to play wiffle ball all the time. They loved it and they think it contributed to their arm speed. They thought it was a great training program. I mentioned to him that I had been planning a project to compare throwing a regular baseball to throwing an unweighted ball or a wiffle ball to see if you can train the arm to generate more arm speed. He thought it was a great idea.

The first step is to determine what distance should the pitcher throw the wiffle ball to re-create normal throwing mechanics. So, we brought in some college athletes and we have found that at about 35 to 40 feet, the 60 feet regulation mechanics are reproduced. From there we can start to analyze their arm speed and how fast their shoulder will internally rotate when they accelerate the ball. We’ll see if you can train the muscle to work faster, and then transfer that to throwing a regular baseball, and maybe create a faster fastball.

Q. What else is going on at the Sports Medicine Center?

Marcus Hanel, bullpen catcher for the Milwaukee Brewers, will be joining our throwing program and we’re adding a more general program for ball players that will focus on hitting as well as throwing. With any skills training, you really need someone with expertise in the field. We’re great at preventing and treating injuries and acquiring data through motion analysis, but Marcus Hanel has the experience in the field. He’s worked for the Brewers for years, and he’s an outstanding individual. He’s done this before, and he’s agreed to work with us. Now, we’re just setting up the details and we’re hoping to have this up and running in January when the kids will start swinging the bats again.

It’s similar to what we’re trying to do in golf. We can do an analysis of a golf swing, and like anyone else, we can read Jack Nicklaus’ book on the perfect swing. But ultimately you need to have that professional who can say, “This information is great, and with it I can now correct your swing.”

We need that expertise and that’s why we’re bringing in individuals from outside, experts in their respective fields, as consultants who can really take our program to the next level.

Author: William Raasch, MD

Source: Every Day

Date: January - April 2006 Issue