CBS Sports Radio: Dr. Tehrany talking baseball injuries on CBS Sports Radio: The Score 1260 with Mike Lindsley

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Last week CBS sports radio affiliate, The Score 1260 with Mike Lindsley featured Dr. Armin Tehrany in a segment, where he spoke about Steven Matz ‘s elbow injury and soreness, along with other pitching related injuries.

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Mike Lindsley: 

Our next guest super-accomplished Dr. Armin Tehrany, the Clinical Assistant Professor of Orthopedic Surgery at Mount Sinai School of Medicine. Talking a lot about the recent Steven Matz’s injury and a lot about injuries in general – Tommy John in big league pitchers.

Armin, it’s Mike Lindsley and Michael Tricarico here on The Score 1260 in Syracuse, welcome aboard.

Dr. Armin Tehrany:

Thanks so much guys, I appreciate it.

Mike Lindsley:

Let’s get into, first, Steven Matz’s recent injury. I know he is coming back, but how about the recovery process, the seriousness of this injury? A lot of people thought in the beginning that this was going to be potentially disastrous for Matz, and now he is back. Take us through the sequence.

Dr. Armin Tehrany:

Here is the thing. With a player like Matz, who has already had the Tommy John surgery back in 2010, the Mets are going to be real sensitive to whether or not he is going to get that injury again, because if you are going to get that injury for the second time, the chances of doing well in the league are going way, way down. So, they are going to be hypersensitive. When he got an injury last week, what happened was everyone was worried about him re-injuring and needing Tommy John surgery again. And there is a host of different things that you can get from a just overload of being a pitcher. What he ended having wasn’t an ulnar collateral ligament injury at all, he had a little bit of elbow soreness, and as a result of that, all he needed was a little bit of rest. As an opposed to waiting for another week, they seem like they are ready to let him play on Friday. He should do just well. He may get a little injury here and there, that’s also going to create more sensitivity. Plus, if you are far away from where your team doctors are like he was, he was on the West Coast when he first got the injury, so it took some time for him to get checked down on the East Coast, he might have to be out a little bit longer. That’s what happened with him as opposed to just have been close to his doctors. The ost important thing there is to get checked out, and, if necessary, get an MRI scan to ensure that the ulnar collateral ligament that he had reconstructed is intact, and it seems like it is. It’s just an issue of rest and this might happen again.

Mike Lindsley:

Armin,obviously  you are around this stuff all the time. Have you read Jeff Passan’s new book “The Arm”?

Dr. Armin Tehrany:

I have not.

Mike Lindsley:

Okay. Have you heard about it at least?

Dr. Armin Tehrany:

I’ve heard about it, but I haven’t read it yet.

Mike Lindsley:

It’s really good, it’s revolutionary. He is a national Yahoo lead baseball writer for and he came with this book on Tommy John surgery and a couple of the past careers of certain guys . Debunks a lot of myths, he traveled to Japan and saw some workloads on what’s right and what’s not. What I took out of that book, first and foremost was, a lot of people thinks  that it is just an easy solution: Oh, he has Tommy John, no problem! One year later he will have a better arm, his arm will get fixed as it is easy as one, two, three. And I kinda sit back, and go: hang on a second! Tommy John surgery isn’t exactly like the magic wand and everybody is better and they are just gonna shoot right into the hall of fame. Isn’t there a myth going on right now in baseball: Oh, he is going to have Tommy John, a piece of cake, no problem he’s going to come back better. It’s the easiest thing we are doing right now, it’s no problem, it’s just like walking every day. I don’t think so, I think Tommy John is a lot more serious than people think, and I think we are getting a misconception nationally. Your thoughts.

Dr. Armin Tehrany:

You couldn’t be more correct about that. I read an article in The New York Times a few years ago that battled me. There are now kids at around 14-15 years old who pitch, who try to convince their parents to go with a normal elbow, to go see an elbow surgeon and have a Tommy John surgery because they think their elbow is going to be even better than the way God made it. Can you believe that? That’s one of the most serious myths I’ve ever heard, which was devastating. I can’t imagine a player who has got an elbow injury thinking that they can get better than natural for their elbow with the surgery.

Tommy John surgery is fantastic, it can work very, very well, but just like any other major surgery, especially open surgery which is what these elbow players get, there are risks. There is a risk of nerve injury, there is a risk of tendon damage, there is a risk of infection. I’ve heard of rare cases where instead of the ligament actually being taken, by accident, a nerve in the arm gets taken, and that can destroy the player’s career. It’s rare mind you, but it’s very important for people to understand that no surgery can guarantee a 100% return. In fact, the higher level the athlete, the harder it is to get that athlete to 100%. Why? Because, these kids who get the ulnar collateral ligament injury in the first place, get it because they overuse the elbow. If you get them back to a level where they can play, what are they going to do? Start over using the elbow again, so it’s dense to reason that they run the risk that number 1, they can’t back to 100%, just because that’s how things are; and number 2, they can injury it again and put stress on it, so they don’t get to the same high level. It’s not so much the surgery as it is the fact that our elbows are really not meant to be used in the fashion they are used, where we have so many pitches. That’s why the kids now have to have a pitch count, they’ve got to be careful about the throwing curve balls when they are young. They have to be watched because that overuse can be devastating.

Mike Lindsley:

What preventative measures, you just mentioned a couple of them, should younger kids take? When do you think it’s the appropriate age for somebody’s curve balls and those more junk pitches to be thrown?

Dr. Armin Tehrany:

There are schools of thought that say at age 8 you can throw this number of pitches, at age 11 you throw more pitches, at age 13 you can start throwing curves, at age 16 or 17 you can start to throw sliders. The best thing to do for that, and I feel real strongly about this, is to visit the American Orthopaedic Society of Sports medicine. They’ve got the protocol and they’ve got lots of information about the details about the age and the size of the patients and the kids, and when they should start throwing a certain type of pitches. What I will tell you is that, more importantly than that, we have to understand that the coaches and the trainers that work on these teams, they do the best they can. But if the kids are throwing all year round, Mike, it’s really hard on them.

Mike Lindsley:

Right

Dr. Armin Tehrany:

They have to be careful. We gotta teach the kids, the coaches and the parents, that while we’d love for the kids to play baseball and pitch all year around, so he can be a superstar and get real good, he or she is doing him/herself a disservice by throwing that much. They are better off, actually, playing different sports, so they can use all their muscles properly. When you are just pitching all the time, you run the risk that a lot of  other muscles are out of whack and they are not going to be balanced properly, the shoulder has to be checked at the same time. There is a lot of literature that proves that if your shoulder is not it the right condition, it puts too much stress on your elbow. Stretching, for example, the sleeper stretches, that we constantly push the pitchers to do. It’s a combination of things. Age is one thing, the number of pitches is the other thing, but it’s also the mentality of the kid, and more importantly, the parents, to make sure the kid is trying to grow up balanced in terms of multiple sports. They can still try to emphasize one sport like pitching, but they have to do it in a very cautionary way, so the kid doesn’t burn out, not only within his elbow but psychologically.

Mike Lindsley:

Dr. Armin Tehrany with us, Clinical Assistant Professor of Orthopedic Surgery at Mount Sinai School of Medicine. In along those lines, Armin, I look at it from talking with Tommy John myself, former big leaguers like Steve Curley, being in major league clubhouses, talking to folks like you, talking to Jeff Passan when he came in to talk about his book. I feel like we are in a role reversal here. I mean, these kids from age 10, 11, 12 throwing, throwing, throwing, and just so specific to baseball, and some are on pitch count, some aren’t. Parents and coaches are careless, and as they get older and their body is developed, they pitch less. It should be reversed. You should be pitching based on your age, as you get older in middle school, little league, and then high school and college, and then as you get to be a grown man or woman, all bets are off. You are out of those diapers, you got the big boy pants on. Half the reason why these guys can’t throw 110-120 pitches at a game is cause they were throwing a 130 when they were 12.

Dr. Armin Tehrany:

That’s exactly right. We have to understand that while the kids are growing up, they are young and they are healthy, and they can heal fast. But they can still degenerate the tissues that they have even as a child. And so, you are right, we have to take advantage of the fact that we know that when you put your minds on your body, that includes your elbow ligaments, even if you are a kid. While on a positive note practice is great, it makes perfect and you can get better at your sport, and you can learn more, we have to accept the fact that too much, even at young age is very, very detrimental, and can potentially ruin the career of a kid who is on his way up to high school level and college level. I can’t tell you how many kids I’m seeing who are under the age of 15, who are starting to these injuries that we used to see when they were 25. And it’s all because there is so much pressure on the athlete to do more, and perform more, and start at a younger age. I applaud the fact that parents and the kids want to do better, and they want to be better, and they want to push themselves more. But the body can’t handle so much of that, we have to understand our minds are much stronger in getting something done, especially in a sport, than our bodies are. The mind can handle it and push the body, but the body sometimes can’t. That’s why we’ve put together these rules and regulations, and guidelines for young athletes, so they don’t get injured at a young age. That’s worse when you get injured at a young age, not only for the kid but for the parents. For me to have to talk to the parents and tell them that their kid has a devastating injury that requires surgery, it’s true that the success rates of ulnar collateral injury are very, very good, trust me, the parents would still love it if the kid never had it in the first place. Prevention is the best way the get a great result for the elbow.

Mike Lindsley:

All right. Final thing from us. A guy we saw come through Syracuse, he has tree trunks for legs, big body, again, today’s day and age nutrition, trainer, the whole deal, he just had an absolutely enormous contract extension from the Washington Nationals. We saw him come through here with the Syracuse Chiefs, and that’s Stephen Strasburg. He already has had one Tommy John surgery. My buddy Jacob from high school who pitched and went through Padre’s  training camp before it was all over for him, and he had Tommy John, he was a lefty. He told me one night over a couple of cold ones, he said: Mike, listen, Stephen Strasburg is going down again, I’m telling you! He said: the torque and the violent delivery really worries me! How about Strasburg’s future, and I’ve been told that, from multiple people, he is a really talented guy. Again, nutrition, personal trainer – everything set up, but: delivery, torque and he is already a Tommy John victim here. What do we have with Strasburg?

Dr. Armin Tehrany:

We have to accept the fact that it’s great to be big and strong. But as a pitcher, that kind of power that you have, especially in the legs, it causes more damage, ultimately to the elbow. The elbow is a small joint, it only has so much muscles, the ligament is only a certain size, it can handle only so much power. He can have the greatest form there is, but you are absolutely right, there is no question that a big, muscular guy like him, does run the risk of being able to re-injure. If you said to me: what should he do about it? There is not much really he can do because this is his life, this is his dream, he wants to be able to succeed. So, he is doing all the right things, which are to try to stay fit, try to have a good trainer and have a good nutrition, and I would tell a person like him: You know what? Enjoy yourself. Be extra careful, try not to gain too much more weight, because the bigger you are, the potentially harder you can fall, or your ligament can fall, and you don’t want to tear that ulnar collateral ligament a second time.

Mike Lindsley:

Dr. Armin Tehrany, Clinical Assistant Professor of Orthopedic Surgery at Mount Sinai School of Medicine talking baseball injuries, pitching injuries, recent injury of Steven Matz, and breaking it all down for us. I really appreciate the time here, Armin, and I know you are on Twitter as well, why don’t you throw your handle out there. It’s @MOCNYC, right?

Dr. Armin Tehrany:

Yes, sir.

Mike Lindsley:

Follow him there as well. Armin, really enjoyed it, thanks for the time.

Dr. Armin Tehrany:

Thank you. Take care.