Until four years ago, medical professionals across Major League Baseball were not speaking the same language. The league finally installed an injury surveillance system, and in 2011 Michael Ciccotti was appointed to lead an elbow study group under baseball's medical advisory committee.
Ciccotti, the Phillies' head team physician and director of sports medicine at the Rothman Institute, initiated research on the ulnar collateral ligament, now the most-discussed tissue in baseball. "Let's see if we can find out some answers," commissioner Bud Selig said last week. "Nobody has them, I'll tell you that." The onus falls to Ciccotti and his colleagues.
They met Monday in New York. The five-person elbow research group is analyzing data from five separate studies using MLB's streamlined data from 2010 to the present.
"It's so complex that we're not going to answer the question," Ciccotti said. "It's not like in September we're going to have the answer. But we're moving in the right direction so we can go to the next phase."
The first phase has five components. Ciccotti's group interpreted the data for trends in how, when and where the injuries occur; conducted subjective interview evaluations with pitchers after surgery; objectively measured postoperative performances; compared healthy pitchers' mechanics with those after surgery through a biomechanical analysis; and surveyed media members.
Some of those studies will soon be statistically relevant with five years of data. The biomechanical analysis - through electronic body sensors - was conducted on selected pitchers during spring training. The goal was to see how efficient the surgery was in restoring correct mechanics.
Last week, Houston reliever Jose Cisnero became the 20th major-league pitcher to undergo Tommy John surgery since the start of spring training. Miami ace Jose Fernandez had the same surgery on Friday. The attention to the issue has never been greater.
"In many ways, it's makes us more focused," Ciccotti said. "We're not ready to say this is absolutely an epidemic, but it definitely makes us more focused on trying to solve it and hopefully decrease the incidence and ultimately prevent it."
Ciccotti said older data indicated no more than 20 surgeries per season from 2000 to 2011. There were 36 ulnar collateral ligament replacements in 2012 but just 19 in 2013.
"We thought, 'Maybe that was a blip,' " Ciccotti said. "Then this year, we're at a pace that's much higher."
There is a rise, too, in the amount of pitchers who need a second Tommy John surgery. That is why Ciccotti's group has focused on pitchers after their operation. The procedure is billed as a low-risk, slam-dunk decision for younger pitchers.
That may not be for certain.
"There are a lot of urban myths out there," Ciccotti said. "We want to see how professional baseball players feel after they've had an ulnar collateral ligament surgery."
The initial trends suggest a strong correlation to the rise of year-round youth baseball. Part of the solution, Ciccotti said, will be educating parents and coaches on how to monitor young pitchers.
"There may be something to cumulative injuries," Ciccotti said. "When you start throwing as a youth, you're throwing a lot more because you're not playing any other sports. You're throwing year-round. You get these minor injuries, but they don't stop you. Little tweak here, little strain here, it may be cumulatively causing microscopic injuries to that ligament.
"You have raised the risk of, at some point in your career, having that dramatic injury that tears the ulnar collateral ligament."
More pitchers, of course, are throwing harder than ever. Advancements in science and health have pushed the human body to the point where the ulnar collateral ligament cannot keep pace. That ligament is the "prime stabilizer" in the elbow, and much of the body's force goes through it. If there is a weakness anywhere else in the body, it increases the force on the elbow.
"If you do it long enough, then, unfortunately, the odds are not on your side," Ciccotti said. "At some point you might get fatigued. Maybe your mechanics aren't precise, or you get a little tired, or your muscles aren't strong. You might not be stretched out enough, or it's cold outside.
"That perfect, brilliant balance is lost."
And it is Ciccotti, along with his partners, who must reassemble it.
The Phillies Phestival at Citizens Bank Park raised $904,732 Monday to benefit ALS research. More than 7,000 fans attended the annual autograph and auction party.
Since the Phillies adopted ALS as their primary charity in 1984, more than $15.2 million has been raised for the fight against the neuromuscular disease.