UTK Special 3/11/24

Modernizing The Return

I’ve returned from an epic SABR Analytics conference, where the Baseball Prospectus founders had a great panel, where Gary Huckabay picked up the Lifetime Award, and where the organization he built 29 years ago swept the research awards. I highly recommend any SABR event and I’ll get back to the injuries on Tuesday, but this simply can’t wait:

For the last few months, somethings been happening behind the scenes that I knew was coming. It started with a call from Alan Jaeger, the pitching guru, and then a ton of discussions from influential people at the American Baseball Biomechanics Society meeting. It continued to snowball, with Jaeger and Randy Sullivan (Florida Baseball Armory) leading what they kept referring to as a “coalition.”

What they were doing is attempting to modernize the return-to-play and return-to-throwing protocols, the same ones that have been around largely since the 1980’s. Most in use today, from top to bottom, are based on the work of Dr. Kevin Wilk. Wilk is a giant of the industry and his work is a big part of the success of the Tommy John surgery, which is anywhere from 83 percent to over 90 percent successful, depending on how that “success” is defined. (This was a constant point of concern to Jaeger, as the common definition is “one pitch made at the previous level.”)

What this group, led by Jaeger and Sullivan, has done is create a new throwing program designed to be individualized, using all the data and knowledge of the last few years to improve the program beyond that of the standard. That’s a tough thing to do, given how high the bar of success is, but it also makes sense, given how much we’ve learned and how many more tools are at our disposal.

Jaeger told me that this program has been in the works for years, not months. “The writing of this program was the culmination of a number of factors: first and foremost, knowing that the current protocols were not positioning the athlete to return to their peak performance, and that the current protocols were based on a one-size-fits-all program. [Sullivan] and I shared this frustration, and we have both witnessed this similar frustration with countless other coaches in the baseball community over many years. And we wanted to address it.”

Indeed, the program is an evolution. Sullivan told me via email that “our manual aims to provide clarity, individualization, a more holistic, multi-dimensional approach, and it smooths out the rough edges during transitions, adding any novel stimulus more gradually.” By creating “smoother change”, the program should focus on progress rather than arbitrary distances and time.

With the recent changes in elbow surgery, it’s time that the rehab changes as well. With this new program, I’m interested to see how many pick this up quickly and how we’ll see results. It’s not going to be a traditional academic model, but there’s very little in the way of real studies to underpin the current one-size-fits-all program used almost universally.

I asked Sullivan what he felt was the most important takeaway from his program. His answer sums up what he and the 50+ expert coalition are trying to do: “When returning from injury, clear, comprehensive guidance from experienced experts can be crucial. Alan and I collectively have over 50 years experience treating and training players working to recover from injury and ultimately, to improve their performance. This manual, endorsed by over 50 industry experts, will provide the foundation you need to optimize your outcome and bring you back better than ever.”

Most of the improvements in the system come from allowing the player himself to individualize the program, based on the way the arm feels. While data would be nice on this, it largely doesn’t exist and in most situations, it’s impossible. While technologies exist to get biomechanics and workload, they remain outside the mainstream. Jaeger’s emphasis on feel does create issues where a player overdoes things or has a coach/supervisor that lacks the medical awareness, but this is no worse than the vast majority of rehabs that are done without a baseball expert involved on any side.

The key to this is a new “mound preparation phases” which includes much more extensive throwing, including long toss. In most current rehab protocols, the pitcher clears 120 feet - a distance Dr. Frank Jobe used due to the distance he had available at the Dodgers’ facility - and immediately goes to mound work. In this program, there’s a section that allows an athlete to get more flat ground work at distances closer to what many work at on the side prior to injury. Most outside the baseball orthodoxy are stunned this isn’t already done, so it’s an immediate win.

Jaeger says he uses a line from me in this phase - “allowing the rehabbing athlete to become an athlete again.” This is a key piece than has long been lost for too many rehabbing pitchers. There’s a vast difference between the medical portion of the rehab (often called “return to throwing”) and the sport-specific part (“return to sport.”) Vague definitions and overlap happen here, with the athlete at the mercy of people that have very little in the way of data or even expertise in the field at most times. While this can add to time lost, an increase in success rate and in mound success upon return would be a win, and this is an area ripe for research and follow-up.

I’ll spare you all the technical details, but suffice it to say that reading through the manuals, watching the videos, and following the program gives you all the information you need and more. While Jaeger and Sullivan are headlining this affair and did much of the work, there are a number of people that have offered suggestions and some that have been more involved, offering up information from people like Nunzio Signore, Nolan Rappe, and Ben Brewster. It’s a lot of information and for anyone interested in pitching, rehab, or the state of the art in pitching, reading through this is well worth your time.

Not only is this manual now available, it’s free. You can find it here at this link. I’m proud to not only be a part of this coalition, but to be introducing it to the public here at Under The Knife.

The hardest part now begins. With Tommy John surgery and the newer augmented repair procedures having such high success rates, being “better” is difficult. Add in that this isn’t scientifically vetted yet. Jaeger told me he’d rather get it out there, being peer reviewed and endorsed than wait years for academic studies, and that makes sense.

My other concerns is that this doesn’t address the timing concerns many have with the current rehab programs. While the Jaeger/Sullivan program brings in more of the knowledge we have today, I feel we’re still leaving months on the table in terms of rehab times. With augmentation, the idea of getting players back faster while maintaining success and safety, has been largely abandoned, leaving only the hope of a percent or two increase in success rate.

The biggest strength this has is the sheer number and influence of the people signing on, of which I am proud to be one. Many are already integrating this into programs and there’s been a great deal of sharing of best-practices, allowing the individual expertise of members to be integrated into the system/protocol.

Many are surprised that Jaeger and Sullivan are simply giving this away. That’s a clear tip-off that those people don’t know Jaeger and Sullivan well. Both have long, distinguished careers, well known businesses, and stellar reputations. Doing something for the good of the game is right on brand for both. I’m excited to see how quickly this program gets picked up and following along as the results and other data gets collected. I’m also hoping that the sheer influence of both the coalition members and the size of their following pushes some teams to get involved, if not at the pro level, then at the lower levels where we’re seeing more and more of these cases and rehabs happening.

Of course, my hope is that this program becomes less and less necessary, rather than more. The prevention/reduction of the sheer number of arm injuries, especially at the lower levels, is a bigger and more complex goal. Jaeger acknowledged this, saying “there are a number of concerns that I have, and I'm sure, would be very much so consistent with what [Sullivan] believes. But until that gets resolved, it's good to know that athletes have an option now to Rehab in a manner that [we] feel are significantly better for the athletes ability to return to peak shape, and peak performance.”

That’s a worthy goal and one I couldn’t agree with more.