Is throwing a slider safe for a HS Freshman?

[mudvnine]

Not to argue, but keep in mind that these studies most certainly DID NOT prove what they set out to prove. These weren't organizations looking to prove that curves are as safe as fastball. These were organizations (mostly ortho surgeons) who have been preaching for three decades that young pitchers should stay away from curve balls because they are dangerous. They started with that hypothesis. The conclusion was that they COULDN'T support their positions. That's important, because this wasn't a study that is skewed toward proving that curves are safe. Just the opposite. Andrews was actually not very happy with the conclusions. His position is that previous observations that curve ball pitchers are more often injured (which actually also wasn't substantiated) was wrongly blamed on the pitch itself. Instead, he now opines, its true but because pitchers who throw more curves attain more success and are subsequently overused. I just wanted to make it clear that Nissen, Andrews, and Fleisig are ortho people who have been preaching the dangers of curves for many, many years. They certainly weren't out to promote the curve. To their credit, they admitted to what the research showed.

"Not to argue" also....but you're just not getting it, my point that is. Their "studies", were to ask the 481 kids a bunch of questions....

METHODS
This study was approved by the Institutional Review Board of HealthSouth Medical Center (Birmingham, Alabama). In this study, the 481 participants from a previous study were followed over the course of 10 years (1999- 2008). All were healthy, active youth baseball pitchers (aged 9 to 14 years) at the time that the study was initiated. Although we know of no rule prohibiting girls from playing in the participating leagues, all participants were boys, who were contacted by telephone each fall and invited to participate in an annual survey.

The participant was asked whether he played baseball during the past 12 months and what positions he played. If he had pitched, he was asked how many innings he had pitched and for what teams during the past fall, winter, spring, and summer. Whereas the number of pitches thrown would have been preferred instead of the number of innings pitched, most young pitchers and their families did not typically keep track of their annual pitch counts. Players were also asked what types of pitches they threw in competition (fastball, curveball, etc) and whether they participated in any showcases.

The annual survey included medical questions. The participant was asked whether he experienced any pain from pitching or other throwing, where the pain was located, and whether he received any medical treatment. Furthermore, he was asked whether the pain or injury had led to any missed practice, missed games, or surgery. He was also asked whether he planned on playing organized baseball in the future or he was retired. When a player declared that he was retired, he was asked if the reason was injury, failure to make the team, lost interest, or another reason. If a player did not play baseball for 2 consecutive years and indicated that he was retired, he was removed from the follow-up list and called no more.

The number of injuries was determined by identifying all players who had elbow surgery, had shoulder surgery, or had retired owing to throwing injury during the 10-year study. Retirement or surgery resulting from other activities (eg, collisions, weightlifting, batting, fielding, and nonthrowing sports) were not considered an injury in the current study.

The players were then divided into 3 groups: injured, successful, and short-term pitchers. Injured pitchers were those who had elbow surgery, shoulder surgery, or retired owing to injury. The other participants were divided into the remaining 2 groups based on how many years they
pitched in the study; successful pitchers were those who pitched at least 4 years during the study, whereas shortterm pitchers were those who pitched 3 or fewer years. Data for the 3 groups were compared with analyses of variance. Differences were considered significant when P\.05.

Fisher exact test was used to compare the risk of injury between players who pitched 4 or more years during the study and those who pitched less than 4 years. Fisher exact test was then used to investigate the risk of injury for each of the 3 proposed risk factors—high volume of pitching,
throwing curveballs at a young age, and concomitantly playing catcher. To test the risk of injury from high volume, injury rates were compared between pitchers who pitched more than a particular number of innings in at least 1 calendar year and those who did not. Specifically, Fisher exact tests were run using cutoff points of 70, 80, 90, 100, 110, 120, and 130 innings. The cutoff point was used from the Fisher exact test that produced the lowest P value. Similarly, the Fisher exact test with the lowest P value was identified for throwing curveballs before age 10, 11, 12, 13, 14, and 15 years. Participants who played catcher for at least 3 years during the study were considered to be catchers.
Because of the potential that pitchers who simply pitched more years were more likely to experience the proposed risk factors, the data were stratified and reanalyzed to examine this potential exposure bias. Specifically, Fisher exact tests were performed separately for those who pitched
at least 4 years in the study and for those who pitched less than 4 years in the study. Results for each Fisher exact testwere considered significant if P \ .05.

.....they NEVER physically examined anyone of these kids.

No wonder they could only use "surgery" as the determining factor as to what an "injury" was, they had no farking idea of where or what the kid hurt. They don't know, or apparently care whether it was a muscle/tendon strain, ligament sprain, cartilage wear or impingement....tendonitis, bursitis, medial apophysitis, or osteochondritis dissecans (had to look the last two up ).

They simply came to conclusions from anecdotal information that they received from a bunch of 10 through 15 year olds. You deal with young 10-15 years, ever know any of them to embellish a story, not understand the questions or instructions you directed at them, or have them not give you "the truth, the whole truth, and nothing but the truth"?

You now ask this....

Anyone else on here, regardless of your opinion on this issue, want to agree with Dirt that Andrews and Fleisig don't know what their doing? Anyone?

Hell yes, I'll step up and say that "Andrews and Fleisig don't know what their doing".....when it comes to conducting "research" on how youth baseball players/pitchers are injuring their arms or not. They might be great surgeons, but clinicians and researchers they are not....IMNSHO.

Based on that "research", now I'm even more pleased that I'm overly cautious with what, how, and how much I allow my "adolescent" pitchers to throw.

[Roothog66]

[QUOTE=mudvnine;2119062]

"Not to argue" also....but you're just not getting it, (my point that is. Their "studies", were to ask the 481 kids a bunch of questions....

.....they NEVER physically examined anyone of these kids. No wonder they could only use "surgery" as the determining factor as to what an "injury" was, they had no farking idea of where or what the kid hurt. They don't know, or apparently care whether it was a muscle/tendon strain, ligament sprain, cartilage wear or impingement....tendonitis, bursitis, medial apophysitis, or osteochondritis dissecans (had to look the last two up ).

They simply came to conclusions from anecdotal information that they received from a bunch of 10 through 15 year olds. You deal with young 10-15 years, ever know any of them to embellish a story, not understand the questions or instructions you directed at them, or have them not give you the "truth, the whole truth, and nothing but the truth"?

You now ask this....

Hell yes, I'll step up and say that "Andrews and Fleisig don't know what their doing".....when it comes to conducting "research" on how youth baseball players/pitchers are injuring their arms or not. They might be great surgeons, but clinicians and researchers they are not....IMNSHO.

Based on that "research", now I'm even more pleased that I'm overly cautious with what, how, and how much I allow my "adolescent" pitchers throw.

Fair enough, but my reply was to the fact that you seemed to indicate that you thought they "set out" to prove that curve balls were as safe as fastballs. Do you now understand that this was not what they were trying to prove?

Asking questions is how most clinical studies are done, including the vast majority of clinical drug tests. In those tests, they ask about side effects. Such studies are dependent upon the subjects reports, that doesn't render them invalid. Their method of clinical study is perfectly accepted in the scientific world.

Further, Nissen's studies DID take measurements on actual subjects. What would be your explanation for that study's results?

[mudvnine]

OK. If you believe evolution can, in anyway, be called "myth" I have a better understanding of where you're coming from. It's what your parents told you and what their parents told them, etc., so, scientific evidence be damned.

Root, not you're grasping at straws. Where did I ever say which "myth" that I believe or subscribe to? You have no idea of where I'm "coming from", you simply want to read into things with the hopes that trying to discredit a poster, will somehow make you look more correct.

Unfortunately for you, I believe people here are capable of seeing right through that, and know when I was simply making a joke with SK, in a reply to him when he joked with me about "reasons" and "myths" versus "facts"....which apparently we have very little of, when it comes to how youth baseball players are injuring their arms.

It's what your coach told you and what their coach told them, so....

Again, if the position is that the relevant evidence isn't complete enough to convince you to take a chance, I completely respect that. As (was it you?) mentioned earlier, we have the ability to do more thourough studies and it's a crime that they haven't been done.

I appreciate that, and yes, it was I who stated, and believes that with our modern technology, we shouldn't be using anecdotal information from a bunch of kids, as our basis for concluding what really is or isn't damaging to young arms.

[Roothog66]

Look up the word empirical in the dictionary.

Perhaps I should have written personal observations are not NECESSARILY empirical evidence. Many, as you have done read it as "personal observations" and go no further. For it to be empirical evidence it must be sense observation that is objective. Saying "I've seen several kids who throw curves get hurt" is not empirical evidence. It is anecdotal evidence. That doesn't make it useless, just much less valid scientifically. It provides a correlation, but makes the error of linking cause and effect without necessarily defining merit.

An example: "The thermometer reads 72 degrees." That is empirical evidence because we can all see that. "It is cold in here" is not empirical evidence although it is based on personal observation. "Water freezes at 32 degrees F." If this is based on clinical testing, it is valid because it happens all the time and I can test it at home and will, with no exceptions, come up with the same result. "Cold water makes a penis shrivel" based on subjective observation of your own experience is not empirical evidence, it is anecdotal. Again, anecdotal evidence is useful becuase it is the basis for forming hypotheses, but is not as scientifically valid as true empirical evidence. True empirical evidence doesn't involve a conclusion.

[Roothog66]

Root, not you're grasping at straws. Where did I ever say which "myth" that I believe or subscribe to? You have no idea of where I'm "coming from", you simply want to read into things with the hopes that trying to discredit a poster, will somehow make you look more correct.

Unfortunately for you, I believe people here are capable of seeing right through that, and know when I was simply making a joke with SK, in a reply to him when he joked with me about "reasons" and "myths" versus "facts"....which apparently we have very little of, when it comes to how youth baseball players are injuring their arms.


I appreciate that, and yes, it was I who stated, and believes that with our modern technology, we shouldn't be using anecdotal information from a bunch of kids, as our basis for concluding what really is or isn't damaging to young arms.

It's not anecdotal. The kids aren't drawing conclusions. The question is simply "have you had surgery on your arm or did you retire from pitching because of arm pain. This was to limit the analysis to "serious injury" because that is the concern of the study. The FDA approves studies all the time based on nothing more than interviews with test subjects asking questions about side effects on drugs. These are valid methods. If you won't we can limit the study to saying that the curveball results in no more surgeries than the fastball. Would that be more valid in your opinion? Actually, that is probably closer to the actual results. Maybe I put too broad a brush on the study. The purpose of the study was to answer the question of whether curveballs were a factor in what has been reported as a greater number of the incedence of surgery on young arms.

I also will apologize for the "myth" remark. I think "dogma" would have been a more appropriate term.

[mudvnine]

Fair enough, but my reply was to the fact that you seemed to indicate that you thought they "set out" to prove that curve balls were as safe as fastballs. Do you now understand that this was not what they were trying to prove?

OK, I'll admit that I misspoke on what they "set out to prove"....really is irrelevant in the overall scheme of things, but that's fine....you win that one.

Asking questions is how most clinical studies are done, including the vast majority of clinical drug tests. In those tests, they ask about side effects. Such studies are dependent upon the subjects reports, that doesn't render them invalid. Their method of clinical study is perfectly accepted in the scientific world.

Oh contraire, those are simply "symptom", or as you point out side effect, or adverse reaction studies, and not the studies to the "signs" of how the medication is actually treating the disease process. Do you really believe that a doc would send a patient home with a bunch of meds to treat his cancer, and then simply call him to see it they're working?

Let me just add this for consideration....

In my 18+ years as a paramedic, I have no idea how many thousands of trauma patients I delivered to area hospitals, but I can tell you that with every one of them, the doc wanted to know their "mechanism of injury" in as much detail as possible, so he could accurately put his physical findings together with that, and what the patient told him his symptoms were at the moment, to make his diagnosis and eventual treatment protocol(s).

Many times he would order X-rays, CAT scan, or MRIs to get a more in depth "look" at what was being presented before treating, or discharging.

So when I hear of "research" that is in essence, diagnosing a problem when several of the very basic, accepted, and expected diagnostic methodologies are missing, I have to strongly question the validity of that research.

Further, Nissen's studies DID take measurements on actual subjects. What would be your explanation for that study's results?

First tell me what you think he "measured" on those actual subjects.

[Roothog66]

OK, I'll admit that I misspoke on what they "set out to prove"....really is irrelevant in the overall scheme of things, but that's fine....you win that one.


Oh contraire, those are simply "symptom", or as you point out side effect, or adverse reaction studies, and not the studies to the "signs" of how the medication is actually treating the disease process. Do you really believe that a doc would send a patient home with a bunch of meds to treat his cancer, and then simply call him to see it they're working?

Let me just add this for consideration....

In my 18+ years as a paramedic, I have no idea how many thousands of trauma patients I delivered to area hospitals, but I can tell you that with every one of them, the doc wanted to know their "mechanism of injury" in as much detail as possible, so he could accurately put his physical findings together with that, and what the patient told him his symptoms were at the moment, to make his diagnosis and eventual treatment protocol(s).

Many times he would order X-rays, CAT scan, or MRIs to get a more in depth "look" at what was being presented before treating, or discharging.

So when I hear of "research" that is in essence, diagnosing a problem when several of the very basic, accepted, and expected diagnostic methodologies are missing, I have to strongly question the validity of that research.


First tell me what you think he "measured" on those actual subjects.

I have been a subject of clinical drug trials (explain a few things?). We're not talking about the practice of using drugs, we're talking about clinical trials. I was given a drug and answered questionnares about the effects. This is how they are done. Of course this isn't how a doctor actually treats a patient.

Would you have the testers open up the arms of these kids and document the damages? Actually, that would be great, but impractical.

Nissen measured the actual degrees of force and amount of supination and pronation on actual participants. Understand, I only posted the abstracts of these studies. The actual studies are quite lengthy and not available for free to the public. I will admit that I have the complete ASMI studies, but have not read the entire text of the Nissen study done by a Connecticut Children't hospital.

[mudvnine]

It's not anecdotal. The kids aren't drawing conclusions.

It certainly is anecdotal....

anecdotal [ˌænɛkˈdəʊtəl]
adj
containing or consisting exclusively of anecdotes rather than connected discourse or research conducted under controlled conditions.

The person(s) drawing the conclusions are irrelevant, it's a method of research that is described. They simply gathered a bunch of kids "symptoms" and left out any of the "signs" associated with them....not to mention any further, or arguably better diagnostic tools available.

The question is simply "have you had surgery on your arm or did you retire from pitching because of arm pain. This was to limit the analysis to "serious injury" because that is the concern of the study.

The only limit to the analysis was their own, and not to what is or was available to do something more complete, or dare I say "scientific"?

The FDA approves studies all the time based on nothing more than interviews with test subjects asking questions about side effects on drugs.

The FDA approves a lot of things that I don't agree with or adhere to; read the events leading up to the FDA's approval of Asparatine, and the dangers associated with it if you want to start talking about the FDA's involvement in studies and/or recommendations.

These are valid methods.

To do what.....study drug interactions, disease processes, cause of injuries?

If that's the case, why spend all the money on actual physical testing facilities and equipment....why not just ask folks how they feel after a traumatic event, and draw our conclusions from that?

I hope you recognize the absurdity of applying an "apples to oranges" testing methodology when it comes to the various things that are out there being "tested".

If you won't we can limit the study to saying that the curveball results in no more surgeries than the fastball. Would that be more valid in your opinion? Actually, that is probably closer to the actual results. Maybe I put too broad a brush on the study. The purpose of the study was to answer the question of whether curveballs were a factor in what has been reported as a greater number of the incedence of surgery on young arms.

I don't want to say anything about the results of the study. How could I, when I believe it was an invalid study to assess the actual physical processes happening within the arm/shoulder/elbow, and potential/possible degradation of given body parts of the various pitches thrown?

I also will apologize for the "myth" remark. I think "dogma" would have been a more appropriate term.

Thanks Root, no hard feelings. I actually believe you're one of the better, more conscientious coaches posting here, and enjoy reading your posts and learning from your pitching insight.

I respect your points of view, even if I don't agree on some of them 100%. IMO, there's nothing wrong with that, just a healthy form of discussion that forces us both to reexamine our beliefs and understanding of what we're doing out there on the field.


It's all good,
mud -

[azmatsfan]

I knew I had read about this study a while back and I finally found it. It's a study from 2002 involving the ASMI folks among others. The results were that pitchers ages 9-14 experienced more elbow and shoulder pain if they threw curve balls or sliders. Here's the abstract:

http://ajs.sagepub.com/content/30/4/463.abstract

Maybe curve balls aren't more dangerous, but there are still too many questions for me to allow my youth pitchers to throw them. I don't see the hurry to teach the curve ball to kids with open growth plates when they can be just as effective with a FB and CU at that age. If they are going to pitch HS ball they have plenty of time to learn those pitches when they are older.

[songtitle]

I knew I had read about this study a while back and I finally found it. It's a study from 2002 involving the ASMI folks among others. The results were that pitchers ages 9-14 experienced more elbow and shoulder pain if they threw curve balls or sliders.

I hope anyone can see the lack of logic in the conclusion they reached. Of course the good pitchers were throwing curves. Of course, they were the ones overused.

This is like saying they studied car accidents for the year, and determined that anyone wearing blue jeans is more likely to be in an accident. So, you are safer wearing khakis, or totally safe if you go pantless.

[Roothog66]

I knew I had read about this study a while back and I finally found it. It's a study from 2002 involving the ASMI folks among others. The results were that pitchers ages 9-14 experienced more elbow and shoulder pain if they threw curve balls or sliders. Here's the abstract:

http://ajs.sagepub.com/content/30/4/463.abstract

Maybe curve balls aren't more dangerous, but there are still too many questions for me to allow my youth pitchers to throw them. I don't see the hurry to teach the curve ball to kids with open growth plates when they can be just as effective with a FB and CU at that age. If they are going to pitch HS ball they have plenty of time to learn those pitches when they are older.

This was the first year of the same study I brought up from 2009. Note the last line in the conclusion. This was 2002. they followed up on this study for a ten year period and found that their conclusions from the one-year study weren't valid. In effect, the findings of the one year evaluation is what lead them to continue it for ten years.

After the ten year evaluation, Andrews explained the 52% association by noting that kids who threw curves were the same ones throwing more innings. He found a correlation between excessive innings and injury and a common overlap of kids throwing curves and overuse. So, his advise is still not to throw curves, but for the reason that curveball pitchers get more outs and are, therefore, relied upon to pitch more innings which is bad. that was my bizarre logic argument earlier.

[Roothog66]

I knew I had read about this study a while back and I finally found it. It's a study from 2002 involving the ASMI folks among others. The results were that pitchers ages 9-14 experienced more elbow and shoulder pain if they threw curve balls or sliders. Here's the abstract:

http://ajs.sagepub.com/content/30/4/463.abstract

Maybe curve balls aren't more dangerous, but there are still too many questions for me to allow my youth pitchers to throw them. I don't see the hurry to teach the curve ball to kids with open growth plates when they can be just as effective with a FB and CU at that age. If they are going to pitch HS ball they have plenty of time to learn those pitches when they are older.

I will also say that kids are not as effective at young ages with just a fastball and change up (not that I think that alone is enough of a reason to learn one). In fact, the curve is probably much more effective among younger pitchers who are pitching to batters who haven't learned how to hit it yet. In these age groups, even a not-so-good curve will get outs. A few years later, the mediocre curve gets ripped.

[Roothog66]

I knew I had read about this study a while back and I finally found it. It's a study from 2002 involving the ASMI folks among others. The results were that pitchers ages 9-14 experienced more elbow and shoulder pain if they threw curve balls or sliders. Here's the abstract:

http://ajs.sagepub.com/content/30/4/463.abstract

Maybe curve balls aren't more dangerous, but there are still too many questions for me to allow my youth pitchers to throw them. I don't see the hurry to teach the curve ball to kids with open growth plates when they can be just as effective with a FB and CU at that age. If they are going to pitch HS ball they have plenty of time to learn those pitches when they are older.

I'll also say it is worth the time to get the full reports. It doesn't cost too much and you get a much better idea of the methodology involved than can be provided by the abstract. I've read the ASMI studies, but not yet Nissen's.

[JJA]

I'll also say it is worth the time to get the full reports. It doesn't cost too much and you get a much better idea of the methodology involved than can be provided by the abstract. I've read the ASMI studies, but not yet Nissen's.

The 2009 study is actually free if you know where to look. I have a copy on my computer but am too lazy to put it on my server. It's a nice paper, pretty well done.

[scorekeeper]

…No wonder they could only use "surgery" as the determining factor as to what an "injury" was, they had no farking idea of where or what the kid hurt….

Obviously you’ve never paid attention to the movie “Johnny Dangerously”. Its FARGIN! Jeez, I thot you wuz edumacted. Wat a maroon!

[azmatsfan]

Obviously you’ve never paid attention to the movie “Johnny Dangerously”. Its FARGIN! Jeez, I thot you wuz edumacted. Wat a maroon!

"You fargin' bastages!"

[tradosaurus]

farging iceholes!!!

[daque]

Another study with no clear definition of a curve ball but this study helps clarify it for me. Since the greatest majority of these kids were playing on the small diamond, their curves must have supinated the forearm in order to be effective. The pitching distance is just too short to get an effective MLB to break. That being the case, both of the pitches studied were a slider and a slurve both of which necessitate forced supination. Neither pitch would have been a true MLB curve.

[scorekeeper]

… The pitching distance is just too short to get an effective MLB to break. …

I have to admit that I once saw a for real MLB type 12/6 curve thrown from a 46’ mound. Of course the guy throwing it was a 6’6”/275 pounder who was 36YO and before blowing out his hip, was a super starter at Az State and had signed a contract. He did it, but it only “broke” about a foot from rotation. The rest was gravity because it was thrown so slowly.

Point being, there ain’t a lot of 12Us I’ve seen who have the coordination, skill, and pure strength to get enough rotations on a baseball to make it curve much on a 46/60 field.

[daque]

Point being, there ain’t a lot of 12Us I’ve seen who have the coordination, skill, and pure strength to get enough rotations on a baseball to make it curve much on a 46/60 field. [/QUOTE]

Nor, for that matter, on the 60/90 field either. But they can if they add lateral rotation to the vertical viaa supination.

[tradosaurus]

Point being, there ain’t a lot of 12Us I’ve seen who have the coordination, skill, and pure strength to get enough rotations on a baseball to make it curve much on a 46/60 field.

Nor, for that matter, on the 60/90 field either. But they can if they add lateral rotation to the vertical viaa supination.[/QUOTE]

I saw a few pitchers in travel ball on a 54/80 field that had some great curve balls. My son, for whatever reason I can't explain, could throw a curve ball for strikes when he was 12 on a 50/70 field.

Now at 60/90 in 14U he is struggling so far to get his curve ball to break. Go figure.