CUMMING, Ga. (AP) — Tim Griffith sits in his scrubs in a lightly adorned examination room at Peachtree Orthopedics' Cumming office, the same space where earlier in the day he saw a patient who had pitched in four baseball games in four days.
In Griffith's view, that's not right. A pitcher, especially one who's young and still growing, should not be throwing that much and putting his arm at serious risk for future injury. A bigger problem is that Griffith, an orthopedic surgeon who's been with Peachtree since 2014, is seeing cases like that more and more, with the resulting injuries stacking up.
"Oh, there's no question that it's an epidemic," Griffith said.
Arm injuries, particularly in the elbow, are far from an undercover issue in baseball. Every young MLB pitcher forced to go under the knife — Yu Darvish, Matt Harvey, Stephen Strasburg are just a few in recent years — raises the alarm to the fragility of the pitching arm.
The reasons for the increase are varied and controversial. Major league pitchers are throwing less than they did in the past, but they're throwing much harder, and more velocity puts more strain on ligaments like the ulnar collateral ligament, which is what's replaced in the increasingly common Tommy John Surgery.
And while pitch counts are watched more closely in pro ball, the increased workloads of younger pitchers might be offsetting that benefit. That's mainly where Griffith is working, meeting the crisis head-on at its source and trying to change the future of baseball for the better.
Griffith is an Atlanta native, and his home city is perhaps the one most in need of his guidance. Georgia's travel ball scene has a reputation for being particularly rigorous and taxing on prospects' arms. A recent column by Baseball America editor John Manuel addressed the topic.
"A lot of kids have left their arms at the East Cobb complex," a scout told Manuel. "A lot of clubs are wary of Georgia high school pitchers."
Not everyone is to blame, in Griffith's eyes. He works as the team physician for Forsyth Central, Lambert and West Forsyth high schools and spoke positively of those schools' management of pitchers. The implementation of a more regimented pitch count rule in 2017 was another step towards greater protection of pitchers on the high school ranks.
"Most of the problems I'm seeing, they're not through the schools," Griffith said. "They're through travel ball and teams like that."
West's head baseball coach Mike Pruitt would be in agreement. In the almost 30 years that he's been coaching baseball, Pruitt has seen more players throw more during the year and not get what he sees as the proper rest. He can only advise his players on what to do during the season, because once they hit travel ball, it's almost always out of Pruitt's hands.
Griffith didn't play baseball himself, but he quickly discounts the notion that pitchers should try to get seen as much as possible. He has worked with the New York Mets and the Atlanta Braves in draft preparation and in diagnosing injuries, and doing so hasn't made him sympathetic to the idea of upping a young pitcher's workload.
"I think people really strongly feel that if their kid's not involved in baseball every possible second, there's not a chance of making it to the majors," Griffith said. "Which is funny to me because I've met professional pitchers who didn't start pitching until they were in college."
The travel organizations aren't ignoring the uptick in arm injuries, and they have their own precautions to manage pitchers' workloads. Perfect Game, a leading organizer of showcases and tournaments, has its massive LakePoint complex out in Cartersville, and the facility is in constant motion for much of the year.
Perfect Game's tournaments follow MLB's PitchSmart guidelines, which resemble those that the Georgia High School Association implemented this year. Team Elite, a local travel program that counts Forsyth Central's Ethan Hankins and South Forsyth's Landon Sims among its members, tries to be even more conservative than that in how it handles pitchers, said Brad Bouras, Team Elite's founder and general manager.
"We don't necessarily send out literature and education pieces, because we're not an orthopedic group . but we obviously do everything we can to explain to parents," Bouras said. "Sometimes, kids want to play and pitch more than we let him because we know it's been a long time (and) they haven't built up."
Griffith said the general agreement among orthopedic surgeons is that players need to take three months a year off from throwing. That idea hasn't become a staple, though, to Griffith's dismay.
"Despite our recommendations, despite us trying to make that a presence in the community, we're not necessarily seeing people respond," Griffith said.
Forsyth Central alum Nik Verbeke remembers abiding by those guidelines, more or less. But he still played travel baseball for most of the year, hopping between different teams, playing tournaments most weekends and seeing plenty of teammates getting hurt and burnt out.
"When you're like 10, 11, they think you've got a rubber arm," Verbeke said. "So I'm sure they threw me multiple times during a weekend. I'm sure that I overdid it sometimes, for sure."
Verbeke, who now pitches for Furman University in South Carolina, has been lucky enough to escape significant injury so far. That's why the specifics of the arm injury epidemic have been so hard to nail down: Some pitchers can well-exceed guidelines and be unscathed, and others can be overly cautious and still get hurt.
Arm injuries can be particularly challenging to deal with, as they're typically a more subtle injury, less apparent than an ankle twisted around or a bone sticking out of someone's leg. The intrigue of diagnosing injuries is part of what attracted Griffith to the field, and the uptick in arm injuries over the years has drawn his attention independent of any media coverage.
He's looking into ways to improve treatment of injuries, working on a study with MLB that involves statistical analysis of surgical techniques and their outcomes. But Griffith's main focus with young pitchers is prevention, with the hope that they can play longer before they get injured or that they avoid injury altogether.
Griffith's patients and their parents have almost always been receptive to his suggestions and guidance. There's the occasional instance of noncompliance, but nobody outright says that they don't believe him.
Griffith thinks of the issue as being somewhat like getting people to stop smoking cigarettes — enough education and awareness, and knowledge will become more pervasive. The worst thing that he can do is not say anything.
"I think the danger is seeing these kids and saying, 'Oh, this is a strain . and we'll be okay,' because they probably will be, and not taking this opportunity to educate them and ask them about their numbers or ask them about what they're doing, what their volume is," Griffith said. "So it just takes the extra time as a doctor to do that."
http://accesswdun.com/article/2017/11/609310/doctor-in-cumming-trying-to-change-the-future-of-baseball