What if there was a machine that prevented a Little League pitcher from future harm?
Or a way to detect and repair fraying soft-tissue muscle before it required surgery and months of rehabilitation, or worse, ended participation for good?
When the University of Pennsylvania designed its new musculoskeletal wing to include a Human Motion Lab in 2014, it had every young athlete in the region, and beyond, in mind. Some of the technology, invented and advanced by noted elbow guru James Andrews in his Birmingham-based American Sports Medicine Institute, was already available, as was the institute's four-year study of youth elbow injuries so shocking that it triggered protective rule changes in Little League and more than 40 state high school baseball organizations.
ASMI's study, published three years ago, found that athletes ages 15-19 accounted for 56.8 percent of all so-called Tommy John surgeries from the start of 2011 through 2015. It has led to improvements in mandated pitch counts and rest days for Pennsylvania, Delaware and New Jersey high school athletes and to healthy debate over the value and hazards of choosing to play one sport exclusively.
It also led to Penn's broadening from an early focus on lower-extremity injuries to include the use of video and computer graphics to analyze and correct inefficient and injury-inviting pitching form.
Said Neil Ravitz, chief operating officer of the Penn Musculoskeletal Center: "There's nothing like this in this area. There are performance labs. But nothing like what Josh does here or what they do down here."
Josh Baxter is the 25-year-old coordinator and manager of the Human Motion Lab, strategically placed amid Penn's musculoskeletal services. In it you will find wires intended to connect from a computer to various stress points on an athlete's body, measuring efficiency that, they hope, will lead to preventive correction.
There is also the use of ultrasound to detect microscopic fraying before it becomes a full-fledged blowout, and the ever-evolving use of video.
There are even a pitching mound and a taut net with a camera behind it, to better analyze the faulty mechanics that have led to injury and/or unnecessary stress.
"Orthopedics is all about load," Baxter said. "Every problem in orthopedics is a mechanical problem. So we can quantify those mechanics with these type of measurements. Patients who have movement disorders and pathologies. Children with cerebral palsy use three times more energy to walk. So surgeons can use this to go in and move tendons around so they're attached to new parts of the bone.
"What this allows them to do is use a computer model to test what would happen if I do the surgery a certain way. Or you can pre-measure the likelihood of developing arthritis and do preventative rehab and retraining to combat it. These are the tools. Some are the same as they use for fun things like video games. Surgeons are already very skilled at determining this. This just gives them an extra tool to confirm their intuition."
"Mechanics is key to most musculoskeletal injuries," said Samir Mehta, chief of Penn's Orthopaedic Trauma and Fracture Service. "If you get injured just minding your own business, not by colliding into someone else, there's probably something weird about how you move that's driving that injury. Now, can we quantify that enough to prevent injury? Maybe."
The obvious hope is that limiting elbow and shoulder trauma from throwing too hard, too often, and for too long without rest will reverse the escalating need for ulnar collateral ligament reconstruction — the elbow procedure commonly referred to as Tommy John surgery. But what if young pitchers could also, through the use of medical technology, correct flaws in their delivery before such flaws lead to those injuries? It might save the kid from the dreaded, yearlong ordeal of recovering from surgical repair while his peers continue to play.
"That's the beauty of an area like this that is so baseball rich and baseball heavy," Mehta said. "You can do a natural history study, which we've talked about. You have kids pitching at 9 or 10 years old. We can argue whether that's even a good idea. But you can follow them and have them in here every year — age 9, age 10, age 11, age 12, age 13 — and you could follow what happens to their elbow over time."
Mehta's own son is a Little League all-star whose Haddonfield team won its district championship this year before bowing to Millville — hometown to major-league all-star Mike Trout — in the sectional tournament.
A pitcher, Mehta's son also plays for an AAU team in the fall and spring and trains over the winter. Mehta is a Little League coach, too, but one with a unique perspective.
"I'm a little nutso about it," he said with a laugh. "So all three of my son's coaches I have communicating to each other. So he doesn't pitch 20 pitches today and another 20 pitches tomorrow."
Mehta's "nutso" is actually prescient, said Ravitz, whose initial efforts to bring young ballplayers into the lab met with some stiff resistance.
"The thing we've found culturally in baseball is that the people who are coaching them and training them and have built legitimate businesses around their performance don't love the idea of an academic center saying, 'Come in here and we'll decide,' " Ravitz said. "Because we're not pitching experts. We're scientists and caregivers.
"So as we rethought it, we began working with programs. We can say to the coach, 'You're still the coach. But look where we can take this with the science.' And since we restarted with that approach four months ago, we've had great reception from the coaches, from some of the larger [AAU] programs in South Jersey."
In the four months since "rethinking," Ravitz said, the center has seen a steady flow of clients — not just of pitchers, but also of those seeking to recover from Achilles and patella tendon injuries, or avoid their recurrence. Right now, the center sees more patients with that description, but Ravitz has been in contact with baseball coaches from several local universities about integrating the center into their year-round programs.
"One of the universities locally wants to bring their pitchers in — preseason, midseason, end of the season," Mehta said. "What will be interesting to see is what happens once they are done their season. And the next season approaches. Do they recover? Or is there still some micro-trauma in their elbow from the entire previous season of pitching?
"There are all these great questions."
The answers to which those involved with Penn's Human Motion Lab expect to find over the next few years, as they expand their client base, and therefore database.
"Not everyone can throw a baseball 90 miles an hour," Mehta said. "But for those who can, how do you get them from 91 to 95 miles an hour? That's form. That's performance improvement. Versus injury prevention.