Showcases and UCL Injuries in Elite Professional Pitchers
Recent research by Peter K. Kriz, MD and colleagues in the Division of Sports Medicine at the Warren Alpert Medical School in Providence, RI has revealed interesting information concerning the relationship between the number of High School Showcases attended, ulnar collateral ligament injuries requiring reconstruction (UCL-R) and level of performance among professional baseball pitchers.1, 2
Subjects. 845 pitchers selected in the first 5 rounds of the MLB draft (2011-2020).
Methods. Showcase performance and injury data were gathered from publicly available data bases. Pitchers were divided into two groups. The “early group” (19.09 years) consisted of pitchers who experienced UCL-R one standard deviation less than the average age of the population of pitchers, The “late group” (24.79 years) consisted of pitchers who experienced UCL-R one standard deviation more than the average age of the population of pitchers.
Results.
229 pitchers (27.1%) underwent UCL-R
Peak fastball velocity recorded at showcases was the strongest predictor of UCL-R
Peak fastball velocity among those who underwent UCL-R was significantly higher than that for those who did not undergo UCL-R (91.67 vs. 90.71 mph)
Pitchers with “early” UCL-R participated in nearly twice as many showcases as those with “late” UCL-R (5.38 vs. 2.89)
The average number of HS showcases attended by all pitchers more than doubled over the duration of the study (2.88 to 6.00 total showcases)
Pitchers attended their first HS showcase at a younger age (15.63 vs. 16.52) over the duration of the study
Pitchers who experienced UCL-R later in life had a better chance of reaching the MLB level than those who experienced UCL-R earlier in life
48.1% of the “early group” reached the MLB level
86.2% of the “late group” reached the MLB level
The chances of those who pitched in 10 or more HS showcases reaching the MLB level were one-half of those who pitched in less than 10 HS showcases
For every year that a pitcher did not tear his UCL after throwing 90 mph at a HS showcase, the likelihood of reaching the MLB level increased 24%
Conclusions:
Higher HS showcase volume (more showcase appearances) was associated with a lower likelihood of reaching MLB level.
The longer the time between achieving 90-mph and experiencing a UCL tear, the greater the chance of achieving MLB level.
Recommendations:
Avoid HS showcases before age 16; there is still enough time after age 16 to attract attention and no one cares how you perform at ages 14, 15 or younger.
Observe Pitch Smart Guidelines (https://www.mlb.com/pitch-smart/pitching-guidelines).
Avoid early season showcases; allow yourself time to ramp up pitching volume and velocity.
Avoid late season showcases; fatigue increases UCL risk.
If shoulder and/or elbow pain is present leading up to a showcase, avoid the showcase; pain increases UCL risk.
Put less emphasis on achieving velocity at ages 15 and 16; most pitchers in this age bracket do not have the skeletal maturity, core strength, leg strength, arm strength or proper throwing mechanics to handle the forces that high-velocity throwing generates.
Avoid programs that promise quick gains with high risk: low rewards
Work with an experienced instructor qualified in throwing mechanics.
Stop comparing yourself to the metrics of others.
Get stronger; players at all ages from youth to HS can benefit from being stronger.
More is not better; gains occur during rest and recovery – give yourself time to recover and improve.
Takeaways:
Train and pitch smart.
Early matures are bigger and stronger and tend be at greater risk because they hrow harder and pitch more often than late matures.
The velocity threshold for UCL tears in HS pitchers is 90-92 mph.
The rehab time for a UCL-R is 12 to 18 months.
Original UCL tissue is stronger than replacement tissue.
Lifespan of UCL-R is 3-5 years.
The earlier a UCL tear, the greater the risk of a second tear and the shorter the career length.
Chances of needing a second UCL-R is approximately 50%.
References:
Kriz, PK, et. al. Ulnar Collateral Ligament Tear in Elite Baseball Pitchers: Are High School Showcase Exposures Associated with Injury? AM J Sports Med. 50(11):3073-3082, 2022.
Kriz, PK, et. al. Effect of HS Showcase Exposures and Timing of UCL Tear on Pro Baseball Careers in Elite Pitchers. AM J Sports Med. 2023 Feb 13:3635465221150509. doi: 10.1177/03635465221150509. Epub ahead of print. PMID: 36779588.