2016.12.23
Updated 2017.7.18

While the increasing numbers of pitchers who require Tommy John surgery is troubling, at the end of the day it isn't that big of a deal. In the worst case, the Tommy John Twist can mean retired pitchers have trouble combing their hair or brushing their teeth with their pitching arm, or their shoulder aches when it's going to rain, when their playing days are over.

Matt Harvey 2014

The far more troubling part of the epidemic is the hockey-sticking increase in the incidence of Thoracic Outlet Syndrome and other causes of blood clots in baseball pitchers.

Blood clots which can lead to disability or even death.

I call the meta-syndrome Pitching-Induced Coagulation Syndrome (PICS).

Pitching-Induced Coagulation Syndrome (PICS)

Pitching-Induced Coagulation Syndrome (PICS)

I have identified a number of tricks, shortcuts, and general movement patterns that pitching coaches employ because they often yield quick velocity boosts. The problem is that these tricks and shortcuts work by overloading and pushing pitchers' arms to the limit.

And, as I discuss in The Epidemic, increasingly beyond it.

What's worse, it seems that these problematic tricks, shortcuts, and movement patterns may be causing problems beyond just elbow and shoulder problems. By that I mean problems like Thoracic Outlet Syndrome (TOS) and other (IMO related) causes of blood clots in baseball pitchers.

Why do I say the incidence of Thoracic Outlet Syndrome in baseball pitchers is hockey-sticking? According to one source, there were...

  • 7 cases of TOS in M/MiLB pitchers from 2001-2015.
  • 6 cases of TOS in M/MiLB pitchers during 2016 alone.

Another source says 13 MLB pitchers underwent surgery for TOS from July 2001 through July 2014, which is far less than the current trend of at least 7 cases of TOS in 2016.

While Dr. Glenn Fleisig of ASMI has been receptive to some of my observations and suggestions, the Mayo Clinic continues to advocate what in my opinion is an at least ahistorical, and in my opinion problematic, movement pattern called the Power Position.

Mayo Clinic Pitching Power Position

Mayo Clinic Pitching Power Position

In my opinion, the Mayo Clinic is selling as "safer" a movement pattern that, in truth, is extremely dangerous. And perhaps life-threatening. I assume that is because they are blindly following and advocating, rather than questioning, the Stinkin Thinkin that characterizes the conventional wisdom abut pitching mechanics.

That's something that you'd hope a prestigious institution like the Mayo Clinic wouldn't be vulnerable to, but nobody seems to be thinking particularly well about pitching mechanics and injuries at the moment.

What's the big deal, beyond career-ending injuries?

Why PICS?

Why is a new term necessary? Why call it PICS and not use an existing term like Thoracic Outlet Syndrome (TOS)?

Because of an age-old problem.

Pitching-Induced Coagulation Syndrome (PICS)

Different people are looking at what I believe is the same core problem from different perspectives and using different terms to describe what they are seeing. That's a problem because it disguises the problem's...

  • Root cause
  • Incidence
  • Magnitude

High school, college, minor, and major league baseball pitchers who have been diagnosed with...

  • Axillary Artery problems
  • Aneurysms (especially Axillary Artery)
  • Arterial Clot
  • Axillary Artery Thrombosis
  • Effort Thrombosis
  • Ischemia of the Throwing Hand
  • Thoracic Outlet Syndrome
  • Paget-Schroetter’s Syndrome
  • Pulmonary Embolisms

...and other causes of baseball injuries that lead to or involve blood clots include...

1964 Whitey Ford
...
...
...
...
...
...
...
...
...
1974 Pete Richert
...
...
...
...
...
1980 J.R. Richard
...
...
...
...
...
...
...
1988 Dennis "Oil Can" Boyd
...
...
1991 Lance McCullers
...
...
1994 Kevin Rogers

...

1996 David Cone

1997 Rich DeLucia
1997 Derek Wallace

1998

1999

2000 Woody Williams

2001 Kenny Rogers

2002

2003 Hideki Irabu

2004 Aaron Cook (PULMONARY EMBOLISM)

2005 Felix Heredia

2006 Tom Glavine
2006 Roberto Hernandez
2006 Glendon Rusch (PULMONARY EMBOLISM)
2006 Kip Wells

2007 Kenny Rogers

2008 Jeremy Bonderman
2008 Davis Romero
2008 Kip Wells

2009 Matt Harrison
2009 Ian Kennedy
2009 Noah Lowry
2009 Joshua Poytress

2010

2011 Taylor Hammack
2011 Bobby Jenks (PULMONARY EMBOLISM)
2011 Tom Lemke
2011 Bobby Parnell

2012 Chris Carpenter
2012 Dillon Gee
2012 Rio Ruiz
2012 Carlos Villanueva

2013 Josh Beckett
2013 Deolis Guerra (PULMONARY EMBOLISM)
2013 Shaun Marcum
2013 Clayton Richard
2013 Chris Young

2014 Jaime Garcia
2014 Drake Curry
2014 David Thompson (POSITION PLAYER)

2015 Mike Foltynewicz
2015 Shane Greene
2015 Dominic Taccolini

2016 Cam Bedrosian
2016 Richard Castillo

2016 Dillon Gee (PULMONARY EMBOLISM)
2016 Matt Harvey
2016 Luke Hochevar
2016 Phil Hughes
2016 Scott Oberg
2016 Tyson Ross
2016 Jason Vargas
2016 Kyle Zimmer

2017 Jeurys Familia
2017 Phil Hughes (AGAIN)
2017 Tyler Thornburg

Some of these cases likely have a genetic/lifestyle basis. However, I am concerned that the incidence of blood clots in baseball pitchers is likely rising due to how baseball players are being taught to pitch (and throw).

Mike Foltnewicz Pitching Mechanics

Mike Foltynewicz

Mike Foltynewicz's problem is particularly troubling because it doesn't involve (pronounced) Hyperabduction. Rather, his flaw is Premature Pronation and the Tommy John Twist as a result of following the common cue to Point the Ball at Second Base.

The Problem

I believe Pitching-Induced Coagulation (PICS) is the result of problematic cues like...

  • Get your elbow up.

...and a general movement pattern that I call the...

Telling pitchers to get their (Pitching Arm Side) elbow up can lead to a problem that I call...

I lay out the terrifying implications of PICS in...

How Dominant & Durable Pitchers (Actually) Throw

Pitching-Induced Thoracic Outlet Syndrome often results from a misunderstanding of how great pitchers (actually) throw the ball.

Justin Verlander

Notice how, into foot plant, rather than getting his pitching arm side elbow up ABOVE the level of his shoulders, Justin Verlander's Pitching Arm Side elbow is just BELOW the level of his shoulders.

Justin Verlander

Root Causes

Pitching-induced Thoracic Outlet Syndrome can result from a number of things...

References