Until It Hurts, the Video

Beacon Press just put out this short clip about Until it Hurts. Thanks to Jessie Bennett, Digital Content Developer and Blog Editor at Beacon.

What a new study ignores re: Tommy John surgery

A new study finds that 95 percent of skeletally mature high school pitchers were satisfied with their Tommy John elbow reconstruction surgery. Almost as many (94.7 percent) returned to competitive baseball.

This is great news for young players who've been over pitched to the point that their elbows just quit. If they have the surgery, they're likely to be happy with the results. All but a few will get back to playing baseball.

My son had Tommy John surgery in 2006. He returned to baseball and, four years later, I think would say he's satisfied with the results. Still, it was an experience well worth avoiding. A few reasons why:

It's a serious operation performed under general anaesthesia. I can remember well my son's surgeon meeting with us before surgery and seeking his signature on a consent form. It detailed the things that could go wrong during this or any major operation: chance of damage to arteries or nerves, blood clots, stroke and death.

The rehab is grueling. It took months of work - two or three as I remember - before my son could straighten his arm. It was another month or two before he began gently tossing a baseball and his first game back as a pitcher was more than a year after the operation. For much of that time, he was seeing a physical therapist each week, sometimes several times a week.

There were doubts and setbacks. After some workouts - this was many months into his recovery - he'd report strange feelings in his arm. Phantom pains. Numbness. It was difficult to know whether these signaled that the operation had failed or simply were part of the healing process. In any case, they caused concern.

It wasn't cheap. I don't know the full amount that we and our insurance carrier spent getting my son's fastball back. Conservatively, I'd say $15,000.

So while I'm glad that Tommy John surgery has recorded a 95 percent patient satisfaction rate, my question to parents of young pitchers: How much more satisfying would it be to avoid the surgery?

What pro athletes can teach us about youth sports

In the 1980s, I was a reporter for a newspaper in Baltimore assigned to cover the Baltimore Orioles. For eight months each year, I traveled with the team around the country, writing about what I witnessed at the ballpark and occasionally outside the ballpark. This is one of those outside-the-ballpark stories that has stuck with me.

Each season, the Orioles visited New York twice for series against the Yankees at Yankee Stadium. The players, manager, coaches - and us writers - stayed at the Grand Hyatt in Midtown. Some of the traveling party commuted to Yankee Stadium by chartered bus. Occasionally, I hopped on.

As we got close to Yankee Stadium, we got a view of a bunch of athletic fields. Always - in my memory, at least - they were crowded with kids, playing pick-up sports, running, jumping, batting, kicking. Mostly, having fun.

I remember something unexpected. As we approached the fields, heads turned. Conversations ended. Players suddenly (and shockingly, for me) were very interested spectators. I'm not sure what they were thinking. To me it felt like longing. Maybe even envy. (Ironic because the kids on those fields would have been feeling exactly the same things about the big-leaguers.)

What I took from this scene is pretty simple. Pro athletes, more than most of us, understand that sports can provide some of the most carefree moments in a child's life. They also understand that there's no rush about turning sports into a job. I haven't met too many professional athletes who thought travel teams for eight-year-olds was a brilliant idea.

For the past year, I've been keeping a tally of those who have been quoted about keeping sports fun for kids (and managing the ambitions of the coaches and parents). Here’s my list (including one mom): Billy Andrade and Brad Faxon (golf,), Mike Richter, Mark Messier and Wayne Gretzky (hockey), Joe Dumars and Phil Jackson (basketball), Debbie Phelps, mother of Michael (swimming), Tommy John and Jim Poole (baseball).

If you know of others, fill me in.

Tommy John surgery comes to high school

For parents - and there will be plenty - spending July 4 weekend in
the bleachers at youth baseball tournaments, consider this.

The table below is a window into the operating room of James
Andrews, the prominent orthopedic surgeon and sports doc to many
pro athletes. Note the spike in kid athletes undergoing Tommy John surgery. Fifteen years ago, patients coming to Dr. Andrews for the ligament replacement operation were exclusively college and professional pitchers. Not a single high school pitcher. Certainly no patients younger than that.

Now, a different story. In 2008, kid players accounted for nearly one in three of Dr. Andrews' TJ patients. Frightening.

Click on the chart - much easier reading.

Mouthguards, helmets and Tommy John surgery

As followers of this blog know (due to my railing on the subject) all youth sports injuries are not created equally. There are two major types: acute injuries that are incidental to the sport being played, i.e., turning an ankle on second base or catching an elbow in the face during a fight for a rebound; and overuse injuries caused pretty much by one thing: playing sports so intensely that a kid's body breaks.

Some recent info on both types:

According to a new study, the number of acute baseball injuries is falling, at least those that are showing up in hospital emergency rooms. The annual number of those injuries fell 24.9 per cent from 1994 to 2006, according to the research, just published in Pediatrics.

From the report: "The most commonly injured body parts were the face (33.5%) and the upper extremity (32.4%). The most common injury diagnoses were soft tissue injury (34.3%) and fracture (18.4%). The most common mechanism of injury was being hit by the baseball (46.0%). Children in the 9- to 12-year age group had the highest injury rate (2.4 per 1000 population). When injury rates were calculated by using baseball-participation data (2003), children in the 12- to 17-year age group had a higher injury rate (19.8 per 1000 participants) than those in the 6- to 11-year age group (12.1 per 1000 participants)."

More from the study: "Youth baseball is a relatively safe sport for children. Although injury rates and the total number of injuries declined during the study period, our findings indicate that there are opportunities for making baseball an even safer sport for children. We recommend that all youth baseball players wear properly fitted mouth guards, that all leagues, schools, and parks install safety bases, that all batters use helmets with face shields, and that all players use safety baseballs."

Meanwhile, there's less (i.e., nothing) to indicate a dip in overuse injuries among youth baseball players. In fact, the anecdotal reports point to just the opposite. Here's the latest alarm bell, a good piece on youth pitchers undergoing Tommy John surgery in last week's Oregonian. If you question whether we're really putting kids at risk, consider this paragraph from the article:

"Dr. James Andrews of Birmingham, Ala., has become a household name in the baseball world. He has seen a steadily rising percentage of young pitchers coming in for his elbow ligament replacement surgery. More than one-quarter of his 853 patients in the past six years were at the high school level or younger. One was 7."

A child's sports injury and the blame game

One question I'm getting a lot as I do the book-talk thing around the country in support of Until It Hurts is: Why do you blame yourself? It's a reference to Ben's elbow injury, a classic case of overuse, and our family decision for him to undergo Tommy John surgery so that he could return to baseball.

I do flog myself a bit in Until It Hurts, mostly for falling in like with his pitching arm when he was a rec league phenom (I was his coach). I also point a finger at myself in a piece about a father's pride and a kid's injury that I wrote last month for the New York Times.

The last thing I want is to turn this into a pity party for the author. The hope is for our family story to be seen as a cautionary tale, one that might alert parents to the real and present danger of overuse injuries. Many of us are pretty clueless when it comes to connecting the dots between a child who's overdoing it and the serious injuries - stress fractures, growth-plate injuries, in my son's case, ruptured tendons - that occur three to five years down the road.

I remember chatting about this with Lyle Micheli, a prominent sports doc who started the first clinic for kids with sports injuries at Children's Hospital in Boston. I asked Dr. Micheli if parents generally understood the role they played in a child's overuse injury.

"In the majority of the cases, the parents do not feel responsible. In retrospect, some will say, 'Maybe he was doing too much.' But it is very rare for parents to say, "It was our fault. We pushed too hard."

So, once a kid is injured, do parents accept Micheli's advice to dial down the intensity?

"To the extent they think it will make the kid better and get him back to his sport, yes," he told me. "And by the way, they want the right answer from me. Which is [one that returns a child] to playing as soon as possible."

Sure. Yet most of us wouldn't think of letting our kids ride a bike without a helmet. Go figure.

The legacy of Tommy John

Youth baseball injuries are a favorite (better said, frequent) topic in this space. I wanted to call attention to a new study that underscores the seriousness of the problem.

Tommy John surgery, invented in 1974 as a last resort for saving the career of the great major-leaguer, has become a common operation among amateur pitchers. And this population seemingly gets younger each year. Dr. James Andrews, the orthopedic surgeon to the stars, whose patients include pro athletes in virtually every sport, has witnessed a remarkable spike in the number of his high school patients.

Before 1997, 12 of Dr. Andrews's 97 Tommy John patients were 18 or younger - 12 per cent. In 2005, 62 of 188 were high school students - nearly a third.

The operation is highly successful. Most kids get back to pitching eventually. But before that day comes there are surgical risks, tens of thousands of dollars in medical expenses, casts, slings, physical therapy and the like. Where are we (parents and coaches) when these promising young arms are being worn out?