{"id":104912,"date":"2023-11-06T03:00:00","date_gmt":"2023-11-06T09:00:00","guid":{"rendered":"https:\/\/www.unmc.edu\/newsroom\/?p=104912"},"modified":"2023-11-03T11:49:52","modified_gmt":"2023-11-03T16:49:52","slug":"a-new-angle-on-baseball-pitchers-and-arm-pain","status":"publish","type":"post","link":"https:\/\/www.unmc.edu\/newsroom\/2023\/11\/06\/a-new-angle-on-baseball-pitchers-and-arm-pain\/","title":{"rendered":"A new angle on baseball pitchers and arm pain"},"content":{"rendered":"
\n

Ed Fehringer, MD, has thought about the problem of baseball pitchers with arm pain ever since he was a baseball pitcher thinking about his arm pain. \u201cEddie\u201d used to lie awake at 15, hoping if he gritted his teeth hard enough, maybe he could be a baseball player just a little bit longer.<\/p>\n\n\n\n

He wasn\u2019t in denial. Not about the pain, and especially not about what it meant in the bigger picture.<\/p>\n\n\n\n

If he wanted to keep going, he had to keep going.<\/p>\n\n\n\n

That meant he couldn\u2019t tell anyone. He applied the Icy Hot in secret and kept his thoughts about arm pain to himself.<\/p>\n\n\n\n

\u201cWhen you talk about arm pain with baseball pitchers,\u201d he said recently, \u201cyou enter a strange realm of fear and folklore that conditions you to keep your mouth shut.\u201d<\/p>\n\n\n\n

He\u2019s Dr. Fehringer now and 40-something years later still thinking about pitchers and arm pain. He\u2019s probably thought more about it from more angles than just about anyone. He\u2019s looked at the problem as a player, as a father with a son who has pitched from youth ball into high school, as a youth coach in charge of a dozen kids at a time and, yes, as a physician. Dr. Fehringer is a professor of shoulder and elbow surgery at UNMC.<\/p>\n\n\n\n

He’s made the study of baseball arm pain part of his clinical research.<\/p>\n\n\n\n

\"\"
Ed Fehringer, MD<\/figcaption><\/figure>\n\n\n\n

Every year, he sees more and more young baseball players in the operating room. If you know someone who plays or follows baseball seriously, they likely know a young player who has undergone ulnar collateral ligament (UCL) reconstruction, or, as it is commonly known, Tommy John surgery.<\/p>\n\n\n\n

Dr. Fehringer said there\u2019s been \u201can astonishing rise\u201d in Tommy John surgeries among young people in recent years. It gnaws at him.<\/p>\n\n\n\n

Dr. Fehringer\u2019s goal is to have fewer of these surgeries performed. He wants young baseball players on the mound and out of the operating room.<\/p>\n\n\n\n

\u201cIt doesn\u2019t have to be this way,\u201d he said.<\/p>\n\n\n\n

(\u201cTommy John\u201d UCL repair is the only elbow surgery Dr. Fehringer doesn\u2019t perform. With his research on throwing arm pain, \u201cOver the last eight years, I’ve felt it better to keep myself not conflicted,\u201d he said.)<\/p>\n\n\n\n

What if we kept young players playing through personalized treatment plans, making an adjustment here or there? What if the signal of arm pain meant not a prescription of shutting down or a prescription for surgery, but for one of a slight change in body motion? What if you could do the rehab before the serious injury?<\/p>\n\n\n\n

He thinks he can help make these surgeries less commonplace.<\/p>\n\n\n\n

He believes this goal is in sight because<\/em> he\u2019s looked at the problem from so many perspectives.<\/p>\n\n\n\n

He doesn\u2019t have one single \u201caha\u201d answer. In fact, one of the things he has discovered through his research is that there is no one-size-fits-all answer.<\/p>\n\n\n\n

But he has collected an incredible amount of information.<\/p>\n\n\n\n

Something the medical community often understands that the baseball world sometimes less often does is that pain itself is information.<\/p>\n\n\n\n

\"\"
Dr. Fehringer says he believes he can help make pitching arm repair surgery (ulnar collateral ligament reconstruction, or, as it is commonly known, Tommy John surgery) less common through a different approach.<\/figcaption><\/figure>\n\n\n\n

As a former young pitcher himself, Dr. Fehringer knows why players rarely share this information, because one result of admitting your arm hurts is being scratched from the lineup.<\/p>\n\n\n\n

And players already on the bubble, like young Eddie Fehringer, are very aware that not playing can lead to not playing.<\/p>\n\n\n\n

So much of our relationship with sports is emotional and complicated. (Think of all the ups and downs you go through every football Saturday.) Our relationship with sports when our own kids are involved can be even more complicated and a lot more emotional.<\/p>\n\n\n\n

Even parents, like him, who want to keep their kids safe, also worry about their kids losing their shot.<\/p>\n\n\n\n

And so, young players often take calculated risks about what information to share and when. Until it\u2019s too late. And then there\u2019s another Tommy John surgery, another damaged UCL.<\/p>\n\n\n\n

That\u2019s how we often deal with baseball arm pain, Dr. Fehringer said. With two extremes. With rest on one side or with surgery on the other.<\/p>\n\n\n\n

But his decades of thinking about the problem, from every perspective, have taught him that there are possibilities in the middle.<\/p>\n\n\n\n

If you study anatomy. If you understand baseball-specific movement. If you are a surgeon who also can converse comfortably with players and coaches on using a wind-up vs. a slide step.<\/p>\n\n\n\n

If you cultivate an environment in which players feel safe enough to be honest about their information, their pain.<\/p>\n\n\n\n

If you could explore what that pain meant for one pitcher, as opposed to another.<\/p>\n\n\n\n

When Dr. Fehringer sees his arm-pain patients in clinic, the clinic often includes a pitcher\u2019s mound.<\/p>\n\n\n\n

Dr. Fehringer consults with pitchers and their parents in a motion lab on the UNMC-Nebraska Medicine Omaha campus.<\/p>\n\n\n\n

\"\"
When Dr. Fehringer sees his arm-pain patients in clinic, the clinic often includes a pitcher\u2019s mound, as with Creighton Prep pitcher Davis Everett as his parents, Tom and Cody Everett, looked on.<\/figcaption><\/figure>\n\n\n\n

It is both clinical care and clinical research. Dr. Fehringer has published in the Orthopaedic Journal of Sports Medicine and published a self-published book on his journey of discovery<\/a>.<\/p>\n\n\n\n

He\u2019s working on a hypothesis.<\/p>\n\n\n\n

\u201cA treatment program can be devised that is unique to you,\u201d Dr. Fehringer said. \u201cWhich it should be, if it is going to be effective.\u201d<\/p>\n\n\n\n

A pitching workout as personalized medicine.<\/p>\n\n\n\n

Very personalized medicine.<\/p>\n\n\n\n

\u201cThere is no one-size-fits-all solution to pain,\u201d he said. \u201cJust as there is no one-size-fits-all way to pitch.\u201d<\/p>\n\n\n\n

Throwing a baseball, he said, is not an arm movement or a shoulder movement. It is an all-body process, \u201ca chain reaction from back foot to fingertips, every link important and interacting with others.\u201d An adjustment to any link in the chain could potentially add velocity or lead to injury. And each player\u2019s chain is his own.<\/p>\n\n\n\n

One wrong link, and \u201cYou\u2019re asking those joints to do something they are not designed to do,\u201d Dr. Fehringer said.<\/p>\n\n\n\n

Young pitchers, and even Major League Baseball pitchers, are often kept on \u201cpitch counts.\u201d But perhaps the problem is less about how many times you do something than how many times you do something wrong<\/em>.<\/p>\n\n\n\n

Dr. Fehringer works with these pitchers on minimizing this risk.<\/p>\n\n\n\n

\u201cMy years as a surgeon have taught me that well-intentioned advice may end up being counterproductive,\u201d he said.<\/p>\n\n\n\n

For example, \u201cKeep your elbow up.\u201d<\/p>\n\n\n\n

Not always.<\/p>\n\n\n\n

Every pitcher is unique, he said, and must find movement that fits his particular body type and temperament.<\/p>\n\n\n\n

Every pitcher\u2019s pain might have a different meaning or a totally different cause.<\/p>\n\n\n\n

Dr. Fehringer has thought a lot about this over the decades. He knows there are 15-year-olds today, lying awake at night with aching arms thinking about it too.<\/p>\n\n\n\n

He hopes to help them find a way to keep going that doesn\u2019t involve gritting until something gives.<\/p>\n\n\n\n

He continues his clinical research, working with his pitcher\/patients, still thinking about the problem from all angles. Former pitcher, concerned dad, youth coach, surgeon-scientist.<\/p>\n\n\n\n

But these days he\u2019s not just thinking about pitchers with arm pain; now he\u2019s talking about it. In hopes that he can share some of what he has learned. In hope that a player admitting his arm hurts might become the beginning of a conversation, instead of the end.<\/p>\n<\/div><\/div>","protected":false},"excerpt":{"rendered":"

UNMC’s Ed Fehringer, MD, brings deep personal experience and a physician’s expertise to addressing the growing problem of pitching injuries.<\/p>\n","protected":false},"author":75,"featured_media":104913,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"58082,43274,102517,69773,60826,35084","_relevanssi_noindex_reason":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-104912","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","topic-patient-care","topic-research","department-college-of-medicine","department-orthopaedic-surgery-and-rehabilitation","department-unmc-today-todays-headlines","author_override-kalani-simpson-unmc-strategic-communications"],"yoast_head":"\nA 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