A new study confirms an old one on kids and curves

Back in 2009, I wrote an article for the New York Times citing a study that concluded there isn't much evidence to link curveballs and arm problems among kid pitchers. According to the study, the far more serious problem was overuse - too many pitches thrown over seasons dragging on too many months. It turned conventional thinking about kid pitchers and throbbing elbows on its head. Yet the study's primary author, Glenn Fleisig, was quite sure about which way his data pointed.

From the article:

Why for so many decades have most doctors and youth coaches believed otherwise? Fleisig said the evidence had been based largely on anecdotes, and that over the years those stories simply began to sound like fact.

“Why did people believe the world was flat? Because one guy told another it was flat and it looked flat. Until someone discovered that it wasn’t,” he said.

Fleisig took a lot of heat for the study and for refusing to back away from its conclusions. This week, vindication of sorts. A five-year study conducted at the University of North Carolina and commissioned by Little League Baseball reached the same conclusion.

As Glenn said in the Times article, no one is urging ten-year-olds to snap off a curve every other pitch. But data are data, and the curveball apparently isn't as harmful as many of us thought. And I have both hands raised on this one. In 2005, I wrote a piece for the Times lamenting the all-curve all-the-time approach of many youth pitchers at the Little League World Series. I should have been writing about pitch counts.

On kids and curves, big leaguers aren't experts

The debate over when youth pitchers safely can begin experimenting with curve balls is about as old as the most elderly reader of this blog. I've found references going back 60 years.

As a rule, I pay attention to the advice coming from pediatricians, orthopedic surgeons, biomechanics researchers. These are people who understand the human body, how it works and when it's stressed in risky ways. They don't always agree, and this article about youth pitchers and curves shows that. But the debates are over real issues.

On the other hand, I'm wary of the advice of pro baseball players and that includes those who rent themselves out as youth pitching coaches. They've tutored hundreds of kids, but does that qualify them as experts?

What brings this to mind is a comment last week by Dave Johnson, former big-league pitcher with the Orioles and Tigers, now a broadcaster with the Orioles. Johnson gives pitching lessons, his son is a prospect in the Orioles organization. He's a nice guy.

Johnson was quoted by blogger Roch Kubatko:

"For me, it's like, go back to when you teach a kid to throw a curve ball. Is 10 too soon? Is 12 too soon? The fact is, we don't know. We really don't know. Some guys have great curve balls and have arm trouble their whole careers. Others don't ever have arm trouble. Some start at 12 and never have a problem. Some start at 11 or 15 and say, 'I blew my arm out. I threw too many curve balls in Little League.' There's no way to say definitely."

Next time, Johnson should say:

"I've been giving lessons for years. But you know what? I'm really not the best person to ask. I do know this: While there is no conclusive medical evidence that curves are bad, the top surgeons say don't throw them until 15. That's good enough for me. In fact, if I catch any Little Leaguer goofing around with curve balls the sentence will be a season playing lacrosse!"

Thanks Ben

Another viewpoint on kids and curveballs

Found this at Checkswing.net, which is hosting a lively forum on kids, curves and the Times article. This post was written by a gentleman named Tom LaPrade:

"It amazes me that so many youth coaches who I've shared this article with refuse to acknowledge the validity of the studies. It's as though the notion that a curveball is more dangerous than a fastball is a religious crede of some sort, Not one of the youth coaches I've talked to is a scientist of the biomechanics of throwing, so what other reason could they have for their resistance to these studies than the fact that, for them, the "danger" of throwing a curveball is merely continued worship at the altar of baseball myth?

"But one thing that is obvious is that the act of throwing in any fashion is violent on the arm. Thus it is a legitimate question to ask which methods of throwing are MORE violent. There are probably a handful of experts without an agenda who are qualified to answer this question. And Nissen and Fleiseg are those people.

"So I accept this study as a scientific breakthrough. It’s the role of science to challenge received wisdom and preconceived pieties. I have no personal reason to doubt the study. I never felt any different as a kid throwing one kind of pitch over another, and as a coach I've never heard a kid complain about throwing curveballs v. fastballs. If a valid, peer-reviewed, blinded, controlled study by leaders in the field of biomechanics of throwing conclude that a curve is no less safe than a fastball, wouldn't it be awfully presumptuous of us to dispute it just because most people I know think curveballs arent as safe as fastballs? Who's to say the act of throwing the changeup with the unnatural grip and awkward pronation of the wrist (does anyone throw anything with that motion except a baseball pitcher tossing a changeup?) is not the most dangerous of pitches?

"People used to say the world was flat because that's what the smart people used to say, it looked flat, and everybody repeated the "fact" that the world was flat. Thankfully there were people who had the temerity to challenge these convictions that were based more on certitude than certainty. Think about it, if in fact these studies are correct, then we may be hurting kids by telling them to throw fastballs. Shouldnt the truth be more important than our cherished shibboleths?"

More on youth league pitchers and curveballs

In yesterday's New York Times, I wrote about kids and curveballs. Physicians and coaches have been warning about the dangers to young arms from curveballs for decades. Are they too cautious?

Maybe, according to two recent studies that found no connection between curves and elbow injuries in kids.

The article includes reaction from orthopedic surgeons who don't see the research as the last word.

Here's an interview that didn't make the article. I spoke with Joseph Chandler, Director of Medical Services Emeritus for the Atlanta Braves and an expert on kids and baseball injuries. He's not convinced that curves are harmless.


Question- Your reaction to the curveball research? (performed at the American Sports Medicine Institute)

Answer- This is a study that needed to be done. The problem is how it is interpreted, how the results are used. People need to remember it is a laboratory study done under laboratory conditions using a small number of pitchers, a small number of pitches.


Q-Are the results a setback for surgeons hoping to discourage curves for kids?
A-I think a lot of people wish the study had shown the curveball is a terrible pitch. It didn't really show that. So perhaps the curveball is not the devil. But there are certainly troubling things associated with kids throwing lots of curveballs.

Q-For instance.
A-Overuse. Kids throwing too many pitches. Kids pitching year round.

Q-How should parents and coaches interpret the curveball research?
A-One of the interesting things in the study is this: People see what they want to see. They focus on what they want the study to show. Some will take from this: Oh, you see the curveball is not a bad pitch. When they could be saying: what a great pitch the changeup is. (The study showed changeups generating less force on young elbows than fastballs or curves) So maybe the curveball is not the devil. But when you start throwing it so young, it makes it harder for a kid to truly learn how to pitch and build arm strength.

Q-In light of the new research, have your thoughts changed about when kids can safely begin throwing curves?
A-My philosophy has always been and to this day is not before fourteen-and-a-half. Why do I come up with that? It's an age where general body maturation is to a point that it can withstand more stress on the arm. Waiting until 14 protects the arm and gives a kid a chance to learn how to pitch.

Q- Little League Baseball has no rules regarding curves. The kids are 11, 12 and 13. Should there be a policy?
A-I think there should be a statement or policy discouraging breaking balls. I think it would be very difficult to prohibit curves. Who is going to monitor that? Who is going to decide what is a curveball?

Q-You polled 100 major- and minor-league pitchers in the Braves organization about when as youth players they began throwing curves. What did you learn?
A-For the most part, they didn’t throw them when they were 10-11-12 years old. The average age was 14. For major leaguers, it was 15. That's not firm scientific data (that kids who defer on throwing curves remain healthier and ultimately have more success). But it's pretty darn good.

Another warning about kids and curveballs

Little League Baseball continues to allow kids to throw curveballs. Before deciding the issue, it's waiting for results of a five-year study due to be completed in 2011.

Meanwhile, the medical evidence against kids throwing curves continues to pile up.

Researchers at Rush University Medical Center in Chicago recently released a study on children and pitching injuries. Their conclusions include this one: Youth pitchers should not learn curves until age 14, two years after Little League. “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.

This is hardly a surprising conclusion. Or a new one. Many surgeons have been saying the same thing for years. Robert Kerlan, the surgeon who cared for Sandy Koufax, had this to say about kids and curves in 1976.

"The unnatural contortions of the arm and elbow are harmful enough to the pros, to say nothing of young athletes whose bones and joints are still growing. We shouldn't put pressure on them that will ruin the development of their skeletal structures and lead to deformities."

Local Little Leagues don't need to wait for Williamsport. They can ban curves on their own, and a few progressive ones have done so. Why haven't more? Enforcement of a no-curve policy is a legitimate issue. Umpires would have to be trained to recognize a curve right away and be prepared to warn - after multiple infractions, even eject - pitchers. That seems surmountable and, if it saves a kid's arm, worth the trouble. The bigger issue, it seems, is the attitude of the adults. Would we support, promote, defend this? Sign me up. I'm locking arms with the late Dr. Kerlan.

Thank you, Doug Abrams.

Curveballs and Little Leaguers

I recently came across this quote about youth pitchers and curveballs.

"The unnatural contortions of the arm and elbow are harmful enough to the pros, to say nothing of young athletes whose bones and joints are still growing. We shouldn't put pressure on them that will ruin the development of their skeletal structures and lead to deformities."

Speaker: Robert Kerlan, Sandy Koufax's orthopedic surgeon.

Spoken: 1976.

Admittedly, I am fixated on this issue. But it is incredible to me that Little League Baseball - and other youth leagues - continue to resist rules banning curves. The notion that the clinical evidence isn't there is laughable. How much evidence did Little League need before requiring batting helmets?