In May, with more than four months of professional baseball left to be played, there are plenty of fans of hapless teams hanging on to hope that this year is finally their year.

Those thin threads of hope have an analog on the field: The fortunes of teams valued at hundreds of millions of dollars hang on the soft tissue holding together the elbows and shoulders of a couple dozen twenty-somethings who can heave a baseball nearly 100 miles per hour.

What better way then to protect those fortunes — not to mention the lucrative salaries paid directly to players — than to set pitchers to a training program that applies the best scientific research on the wear and tear of repeated throwing and teaches the sort of proper form that can prevent injury?

Because information to guide those decisions is available.

“Using biomechanics, we can identify a pitcher whose, say, arm is too high or too low and in a dangerous position,” said Glenn Fleisig, research director at the American Sports Medicine Institute in Birmingham, Ala. “And we can tell them how to change to reduce the likelihood of injury.”

Of course, you can lead a coaching staff to science, but you can’t make them change.

If these young players grow up to coach, they’ll likely be passing down to their players the wisdom they’re learning now, from their coach. Photo: The Suss-Man (Mike)

“If you think about how the decisions get made on when and how guys work out, for the most part, it’s folklore,” said Will Carroll, a sportswriter who specializes in injuries from mundane to traumatic. “It’s hand-me-down wisdom that coaches learned from their coaches. It’s not what they’re reading in sports medicine journals.”

Not that there is any shortage of research in sports medicine journals.

Since the Major League Baseball season started in early April, Fleisig and collaborators have published studies on elbow tendon replacement surgery, six-week throwing programs for high school-aged baseball players and shoulder nerve injuries particularly prevalent in volleyball players.

When elbow ligaments and tendons are repeatedly moved in a unnatural way, injury is common. Surgery is often required for players to continue playing without pain and further injury. Photo: Magnus Manske

“He’s a busy guy,” Carroll said. “I know him well, and it’s my business to know what he’s up to. But I don’t even know all the stuff that Glenn’s done.”

For his part, Fleisig continues to churn out scientific studies, expecting a new breed of coach will make use of it.

“When we set up ASMI, it was as a research center,” said Fleisig, a biomedical engineer. “We’re not coaches. We’re scientists. We try to supply the coaches with useful information.”

A complex motion

For all the hitting, running, catching and sliding that electrifies fans, nothing can happen in a baseball game until a pitch is thrown. And describing the thrown ball in terms of biomechanics slows the pace of the game to a crawl. In fact, it took Duquesne University athletic training professor Peggy Houglum more than 1,200 words to describe the process for a book on musculoskeletal injuries.

Standing 60 feet, 6 inches from the plate and the batter, the pitcher begins the action — which generally takes place in one smooth and unbroken motion — with a windup that lines up the body parts for the synchronized movements that propel the ball toward the catcher. This often involves starting with the throwing hand and ball in the glove, joined in front of the pitcher, and progresses with a slight step backwards against the “pitching rubber,” a slab of white rubber that marks the point atop the mound from which pitchers must work.

“The body winds up so that all segments of the body from the legs to the arms are able to contribute to the ball’s propulsion,” Houglum wrote.

It’s an action Carroll sees reaching back into our distant past.

“There’s a physiologist, William Calvin, who wrote a book about it, suggesting our brains grew and our speech centers evolved alongside the center that coordinates throwing,” Carroll said. “Throwing a spear straight and hard once, and then going to pick it up, is a completely natural thing.

“What isn’t natural is throwing a baseball 100 times over a couple hours.”

The high speed of a player delivering a pitch requires high-speed, sensor-aided imaging to sort out all the moving parts. Photo: ASMI

Set atop the rubber, a right-handed pitcher ends up facing to their right, toward third base. The pitcher’s hands separate as a stride forward begins. The throwing hand and the ball reach back, while the glove hand moves toward the target.

The striding foot strikes the ground, and “that’s when the pelvis rotates toward the batter,” Fleisig said. “And the pitcher’s trunk follows it, rotating, but there’s some lag in the shoulders.”

It takes a brief moment for the shoulders to turn to match the pitcher’s waist and trunk, for the flexed arm to straighten and whipsaw toward the plate, and it makes all the difference in the world.

“This is a fraction of a second. It’s not even clear on much video,” Fleisig said.

To much lag focused a great deal of the acceleration on the ligaments in the elbow. Too little lag means asking too much of the shoulder in creating the acceleration require to throw with impressive speed.

“It’s the difference between a good pitcher and a great pitcher, or a pitcher with or without too much stress on the arm,” Fleisig said.

And it’s measurable. Or, at least, it is now.

Coaching by feel

“The old-timers — the men who coached pitchers decades ago — just watched,” he said. “They put in their time as players, watched a lot of baseball and tried to describe their experiences to the players they coached.”

But there’s only so much that can be gleaned from observing at real speed.

“They could see whether a pitcher was taking a long or short stride as they threw, and where the arm slot was — whether a pitcher was throwing with their hand high up above their shoulder or lower and to the side,” Fleisig said. “They could talk about how to grip the ball, but the rest was just guessing.”

The first major stress on coaching came with the introduction of video as a coaching tool.

“It was eye-opening,” Fleisig said. “They saw things they couldn’t understand.”

To throw a curveball — which drops faster toward the plate than the arc of a normally thrown ball thanks to a great deal of spin imparted by the pitcher — coaches believed the pitcher’s hand needed to be situated on the side of the ball. Their fingers, led by their little finger, pulled down on the front of the ball. Or so it was thought.

“The first coaches to watch a curveball thrown on video were probably cursing their players out for doing it wrong, because they’re seeing each curve thrown with the hand on the back of the ball and the thumb coming down first,” Fleisig said.

Video revealed that the pitcher’s hand was behind the ball on pretty much every pitch, whether it was a garden-variety fastball or a pitch with funky spin that made it fall or slide sideways. But the pitcher — and the coach who had no other way to describe the proper way to throw — understood only how it felt to throw a curveball.

Click here to view the embedded video.

“And it feels like you’ve got your hand on the side, and you’re pulling with your pinky first,” Fleisig said. “So once they figure out that it looks different than it feels, they’ve got a dilemma: How do you teach ideal technique? Do you teach it like it feels, or like it looks on this new video tool?”

ASMI’s work is presenting coaches with a new dilemma. The Institute has a library of more than 2,000 athletes from little league-aged kids to elite professional pitchers.

“We put two dozen reflective markers on them, and they throw from the pitcher’s mound in our laboratory while our cameras and computers record all the movements from windup to the follow-through after the release the ball,” Fleisig said.

The result is a complicated stick figure, which is compared by ASMI “biomechanists” with advanced degrees in ergonomics and biomechanical engineering against the range of other recorded pitchers.

“We’re watching the angle of their forearm to upper arm as they stride, where their front foot lands, the way their trunk swivels around to help generate speed as the arm moves through the throwing motion,” Fleisig said.

The American Sports Medicine Institute (ASMI) biomechanically evaluates this pitcher by placing white censors on his joints and ligaments, and monitoring his pitch. Photo: American Sports Medicine Institute

Timing and angles are crucial to a pair of the most important factors of a pitcher’s success: throwing hard and keeping the throwing arm in good working order.

“We know the biomechanics of proper pitching, the combination of good ball velocity without excessive stress on the elbow and shoulder,” Fleisig said. “We also know the difference in adults and children throwing fastballs and curveballs. The current challenge is to spread the science to the field.”

That’s the new dilemma.

“The questions have been out there. The need has been out there. This science hasn’t always been out there,” Fleisig said. “When major league teams come to us, they bring the best pitching coaches. And those coaches are in the same position the last generation was in. How do I translate these new scientific findings into things I can teach to pitchers?”

If this young pitcher is guided by a well-informed coach, he can take steps to avoid injury very early in his career. Photo: Paul-W

An ounce of prevention

And how does that knowledge get applied to prevent injury?

“In most cases, I don’t think it does,” said Carroll, whose baseball season workday is spent writing about pitchers who have torn a ligament or loosen the capsule of tissue around the shoulder that keeps the arm bone from pulling slightly free of its socket during the powerful whip of the pitching motion.

On Monday Kansas City Royals pitcher Danny Duffy was diagnosed with a torn ulnar collateral ligament in the elbow on his throwing arm.

It’s no small thing that many baseball fans are well-acquainted with the UCL, and no small thing that the tear was not a career disaster for Duffy. He’ll just have a surgical repair known as “Tommy John surgery,” named for a Los Angeles Dodgers pitcher who was the first patient to have his UCL replaced with a piece of tendon from elsewhere in his body.

“The thing about these Tommy John surgeries nowadays, they’re so efficient at doing them. Danny is going to come back even better, even stronger,” Royals manager Ned Yost told the Associated Press. “It’s just missing out on Danny’s development for a year and Danny’s production for a year which is what hurts.”

Rehabilitation following Tommy John surgery is so refined that almost all patients recover completely, according to Carroll, and often within nine or 10 months (compared to 18 months before John began pitching again).

Click here to view the embedded video.

“What’s bothering most people a bit is that there are surgeons doing 500 of these surgeries, and we’re seeing the number of high school kids in the operating room growing,” Carrol said.

While the odds say Duffy will return without losing his skills, the Royals have lost the services of a young pitcher working for the (relatively) low price of just under $500,000.

The Washington Nationals spent much of last season without young phenom Steven Strasburg, who still made several million dollars. The Boston Red Sox are paying pitcher John Lackey, who is rehabbing from a Tommy John procedure in November and out of commission for most or all of this season, more than $15 million in 2012.

Major League Baseball pitchers Danny Duffy of the Kansas City Royals, John Lackey of the Boston Red Sox, and Stephen Strasburg of the Washington Nationals all underwent Tommy John surgery to correct a problem caused by the unnatural repetition of the pitching motion. Photos: Duffy: Keith Allison from Owings Mills, USA, Lackey: Keith Allison, Strasburg: dbking

“How much is a year worth?” Carroll asked. “For teams without so much money, who are relying on one guy, they could be screwed.”

And with so much money at stake, Carroll wonders why a trip to a place like Birmingham for a morning-long session with a researcher like Glenn Fleisig isn’t a must for every pitcher on every major league roster.

“There are clues that teams can look for to decide whether a pitcher’s throwing motion is bad, but why look for clues?” Carroll said. “We can do the examination, look at the science and say here’s how much force there is on your shoulder. Here’s how much force there is on your elbow. And we know these are the norms.

“For what you have at stake, why not just spend a couple thousand dollars to send them to Glenn?”

We guess you could call that a failure, but Diana Nyad’s 29-hour quest to swim from Cuba to Florida was called on account of shoulder pain, waves and asthma. But no matter how disappointed Nyad may have been, we’re impressed.

Jolted by the thought that a 61-year old would jump into the ocean to embark on a 103-mile swim, we looked around and saw a mushrooming number of insanely hard runs, swims, triathlons and bike rides — and spotted a trend.

In running, ultra-endurance events are defined as longer than the 26-mile marathon. In cycling, longer than the 100-mile century. There’s no set definition in swimming, so far as we can tell, but Australia’s 19.7 kilometer, open-ocean Rottnest Channel Swim, has to qualify. The race had 173 solo entrants in 2011, up from 100 in 2001.

While the rest of us may wonder what it takes to run 26 miles or ride 100, ultra-athletes don’t stop with such paltry challenges. The Ironman triathlon, which features a 2.4 mile swim, 112 mile bike ride, and 26 mile run, once seemed intense, the far end of endurance.

No longer. The ultra-bikathons include Wisconsin’s Dairyland Dare, which maxes out at 180 miles of hills.

And from there, things get worse. Much worse. The Tour de France bike race is one of three “grand tours” that normally exceed 2,000 miles in length. There’s the Furnace Creek 508, which bikes non-stop across 508 miles of Death Valley and the Mojave Desert.

And there’s the Race Across America, an annual, coast-to-coast sufferfest where sleep is optional and minimized, and where the bikers sometimes use duct tape or bungee cords to hold their heads up.

France has a triple-Ironman, and Africa has the Marathon des Sables, a gritty, six-day, 155-mile jog ‘n slog through the Sahara Desert.

Once a year, you can swim around Manhattan. It’s only 28 miles, and we hear raw sewage has stopped spewing into the Hudson River…

So we got to wondering. How (and why?) do these athletes attempt the near-impossible? Are the barriers physical — or mental? What are the rewards – and what are the risks of attempting such outlandish performance?

Why – the motivation question

Let’s start with the hardest question. Why in the world would anyone attempt these distances without being paid for it? “There are extremists in all activities,” says Ronnie Carda, a marathoner who heads the physical education activity program at the University of Wisconsin-Madison. “These are very committed individuals. Everyone looks at it as challenge, but most have a real love for it. I had a good friend who used to do ultra-endurance runs, absolutely loved it. But I assume there are people who get obsessed, and I have talked to some who have tried double Ironmans [swim 4.8. miles, bike 224 and run 52] and said one was enough.”

“Certain people, personalities, have to keep proving things to themselves,” says Bob Mazzeo, an associate professor of kinesiology and applied physiology at the University of Colorado, who studies high-altitude athletes.

“People ask, why am I doing this, and I say why do people climb Mt. Everest or do any other tough athletic endeavor?” says Charles Olson, who rode the Furnace Creek 508 last year under the nickname Brooklyn Beast. “It’s to see if you can. I was doing the Ironman, but it wasn’t enough. I’ve always been interested to see how far I could push things, including myself. As a child, I had slot cars and model trains, would see how fast they would go until they fell off the tracks or the engines would burn out.”

Finally, there’s the age factor. Ultra sports are made for older folks, says David Tanner, 61, who has completed Ironmans, the Race Across America (RAAM) and other ultra rides, swims and runs. “I have been around ultras in a lot of different sports, and most competitors weren’t superfast when they were 20. This is an opportunity for people who have perseverance and a good mental attitude to do well in a sport where they weren’t maybe fast enough when they were younger. In an ultra-marathon, sometimes the older you are, the wiser you are, and wisdom is more important than a high VO₂ max or muscle mass.”

VO₂ max measures the amount of oxygen a person can take in; higher levels allow greater athletic performance.

Tanner, a research associate at the Indiana University Human Performance Lab, added one more reason to push the limits. “Everything in your life can be going down the tubes, but you can enter an ultra, forget your problems for a day or two, finish dead last, and still feel good about yourself. It all comes down to self-satisfaction and personal achievement.”

Evolution ‘r us

This outburst of ultra-athleticism may amount to a return to our evolutionary roots, says Joel Stager, in the department of kinesiology at Indiana University. “There is a lot of evidence that humans may be some of the best endurance athletes on the planet, that we evolved to out-endure most animals.”

This excellence shows up in the most basic measurement of metabolic capacity, the volume of oxygen that can be delivered to the muscles per unit time. “Humans have a high value for VO₂ max per kilogram of body weight,” Stager says. “We have the ability to out-metabolize, and the ability to run long distances at a relatively modest pace, so if you put those together, we can out-endure most other species.”

What must training accomplish?

Training for an endurance sport has both emotional and physical goals, and while each event has its particular needs, the focus is on high-endurance, slow-contracting muscles.

Physically, training for an ultra-endurance event should:

Tanner says one of the biggest improvements in endurance athletics concerns nutrition. “Most of us used to make do with homemade brews, whatever you could get in real food. Today, so many companies engineer food that is specifically designed for endurance. You do need protein during a long event, people did not think that before. We have products that are more easily digestible, so you can get close to matching your caloric intake to your output.”

Not just a body game

Sources differed on whether ultra-endurance sports are tougher on the mind or the body, but there is no question that a multi-day race can tax the willpower. Having swum 10 miles or run 50 – do you have what it takes to swim another 10 or run another 50 to reach the finish line?

Training eases the inevitable confrontation with the pain and suffering of a long event, says Olson. “There are tough times in training. Last summer, I would be training 18 hours a day, would leave at 4:45 a.m., and on such a long day, it’s a struggle to find places to eat and drink.”

Olson, who trains in all weather, says “Through the training, you are learning how to deal with adversity.”

Mind control also helps during a race, Olson adds. “When you start getting negative, you have to be cognizant of that, typically you are getting hungry or thirsty, or your mind is playing tricks on you to get you to stop. I eat, change my cadence, or take a five-minute break; do what I need to do to get my mind back in synch. I tell myself I don’t want to let my children down, try to set an example, show that you can do anything you put your mind to.”

How to train

If the goals of training are clear, there’s no clear agreement on what it takes to reach them. Just as carbo loading in preparation for a long race faded 30 years ago, training hours are also on the wane, says Tanner. “Some people thrive on a massive amount of training, but most ultras are not doing the mileage we were 20 years ago. For [the 1989] RAAM, I was training 600 miles a week. I think most people now do not do that much, they substitute quality, hills, intervals, time trials, indoor efforts. There is whole lot more science to training.”

The nature of the training depends on the goal. “There is a huge difference between the people who are competing for the trophy versus the people who are out there for the challenge of going the distance,” says Carda of Wisconsin. “I can’t tell you the number of people that do an Ironman and don’t have a whole lot of intention of running much in the marathon.” Instead, many people many walk a large section of the marathon, which concludes the event. “It’s more about going the distance.”

And those differences affect the training, Carda adds. “If I’m going to compete, there has to be an intensity element. If your goal is strictly a finish, to meet the challenge of the distance, [you will use a different training routine]. It really depends on what your goals are.”

But even a moderate training schedule for, say, an Ironman or a 100-mile foot race will be intense – and time-consuming. Many ultras “are very good time managers,” says Carda. “One gentleman I know who does the Ironman annually found a way to train on an hour a night during the week, and went for long ride on the weekend.” Another would start a 100-mile bike ride at 5 a.m. Saturday, then met his wife and kids at a park. “They would have lunch and he’d be finished for the day. He found a way to put his family into it.”

Running risks

Even in sports that require an extraordinary physical effort, it’s possible to overdo it, says Mazzeo, who focuses on high-altitude athletic performance. “At Pikes Peak, in August, they have a half-marathon, starting at 8,000 feet, up to the summit at 14,000 feet. The next day, there’s a full marathon, up and down, and there are people who run both of them. That is crazy.”

The result of too much exertion, day after day, is called staleness or over-training syndrome, and the symptoms include lowered performance, sleep disturbances, unusual muscle soreness and a feeling of heaviness, even depression. These symptoms are “pretty common here in Colorado, with many triathletes training twice a day for six or seven days a week,” says Mazzeo. “Full-blown over-training syndrome can take a year for recovery, it’s quite significant.”

Ultra-endurance sports can hurt. Bikers can suffer neck seizures and genital numbness, or crash. Runners injure feet, joints and soft tissue.

And there is some evidence linking regular, long-term exertion with atrial fibrillation, a sometimes permanent heart-rhythm abnormality. “Endurance sport practice increases between 2 and 10 times the probability of suffering atrial fibrillation, after adjusting for other risk factors,” according to a 2008 study.¹ This surprising rate of atrial fibrillation may be due to genetics, changes in heart structure or inflammation.

And benefits

And what are the pay-offs of such exertion? We’ve all seen research showing manifold benefits of regular physical activity, and we have to suspect that many apply to ultra-athletes. “When we look at people who have maintained a highly active lifestyle for decades, we don’t find a lot of downsides,” says Indiana’s Stager. “They have lower blood pressure, lower heart rate, less body fat, and muscle mass, better cardiopulmonary performance, more heart capacity, and more elasticity of the arteries.”

High-level exercise helps the brain’s ability to think and make decisions. According to a 2010 ³ review of exercise in older adults, “A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia; however, there were mixed results of the effects of exercise interventions on cognitive function indices.”

Stager says that in an ongoing study, the cerebellum, a part of the brain that is involved in voluntary motion, “appears to have a greater mass, more cells and more connectivity. As we age, we start having balance and gait problems that lead to falls and injury. What if we found that one hour of exercise a day would offset as many as 20 years of aging, which is what we appear to be finding?”

“There are some pretty surprising” results, Stager says. “The message for years was that the brain wasn’t involved in exercise, but that does not seem to be the case.”

Stager recognizes that these benefits are not affecting the majority of the population, which is growing more sedentary and obese. “What’s happening is that in term of fitness is that the haves have more, the have-nots have less.”

And while these benefits are not exclusive to ultra-endurance athletes, the rise of these long-distance events does seem to represent the extreme of a significant shift toward higher intensity. Marathon runs, to take one gauge of popularity, are surging: In 2011, more than 100,000 people applied for the New York marathon, and almost 27,000 ran the Boston marathon. And the 160-mile Race Across Indiana had about a dozen participants when it started 25 years ago; 1,250 finished the 2011.

Is it about togetherness?

Another factor that explains the explosion of ultra-endurance sports is marketing, Carda says. Ultras, Carda adds, are “just the next phase. In the ’60s, people started running, there was a fitness craze. There were marathons — not everybody got involved – but suddenly every city had a marathon.” In a beneficial spiral, cities have realized that ultra events – from the marathon up, can attract dollars. “There have always been bikers and runners, and the triathlon has been around for a long time, but the marketing end of things has caught up. “The Ironman is one of those events that has cachet, it’s the in thing to do.”

One more thought. Most people cannot relate to the idea of completing a marathon, let alone an ultra event, but the utterly ridiculous nature of these challenges brings the participants closer. “There is an ultra family, it doesn’t seem to matter what sport,” says Tanner. “There is competition between individuals, but the real competition is you against the distance, against the course. If you finish, then you win, in your own mind. You enjoy the people you are with, make a lot of friends, and when you go back to work on Monday, you have the satisfaction that you were able to push your limit, do something you thought maybe you could not do.”

That’s pretty much what we heard from Olson, who’s heading back to the Furnace Creek this fall. “Anybody who is going an ultra distance, even the real racers, will look to help you along in your journey. They will offer advice because they want you to finish.”

– David J. Tenenbaum