Revolutionary New Bat Prevents Common Injury Could Save Millions $$

Written by admin on August 13, 2013 – 9:14 am -

A bit wordy and obviously written as an “Advertorial” but a very excellent description of the anatomy and mechanics of an endemic baseball injury. Hook of the Hamate Fracture costs millions each year in medical costs and lost work product. The injury is almost exclusively the result of a “checked swing.” The bat design and theory is sound. Excellent and interesting read. Enjoy!

It’s April 9, 2013. Gordon Beckham of the White Sox stands at the plate facing down the Nationals pitcher Gio Gonzalez. The promising young hitter has weathered a tough few years of disappointing averages, but his 2013 season is off to a solid start. He’s batting over .300, meaning it could be the season of the turnaround, the year that redirects his career to come.
A 2-2 fastball fires from the mound. Beckham swings big, spinning almost 360 degrees before hunching over in pain. No one knows why. Moments later, Beckham would be in the dugout with trainers staring at his hand with a strange, clinical detachment, curious how his body had betrayed him.
In reality, the pain had little to do with his mega swing. Beckham actually sustained an injury on the pitch before–a typical high outside fastball that he appeared to innocuously foul.
“When I swung through the ball, I definitely felt it,” he tells me later. “It did not feel good.”
Beckham, who’d never broken a bone in his life, fractured his hamate–a bone in the wrist all too familiar to major league players for its propensity to crack unexpectedly. He’d require surgery and couldn’t be back to play for seven weeks. His turnaround was stopped in its tracks.

It Could Have Been Prevented
At the same time, a graphic designer named Grady Phelan was formatting a Kickstarter campaign for an invention that had consumed the last decade of his life, along with $125,000 in personal savings. Called the ProXR, his patented creation tilted the knob of a bat by 23 degrees specifically to prevent the fairly common hamate fracture that Beckham had incurred.

The especially bitter irony? Not only did Phelan already have a small pile of supporting research along with the MLB’s approval to use his bat in play; the ProXR had been admitted into the Hall of Fame three years earlier! Despite such an endorsement, Phelan couldn’t convince a major bat manufacturer to produce the ProXR. And without the major bat manufacturers on board, it was impossible to convince players to adopt the technology.
Phelan’s Kickstarter campaign failed to reach its $40,000 goal while Beckham sat on the disabled list for seven weeks. Almost $800,000 in salary effectively disappeared to a benched Beckham, and the White Sox slipped to second-to-last place.
But as I would learn in researching this very article, that wasn’t the end of the story for Grady Phelan, the ProXR, or even Gordon Beckham (who’d return from his injury batting over .300). Just when things seemed the most hopeless for the homegrown ergonomic bat, the largest, most historical brand in baseball took serious notice.

A Game Of Traditions
Even though Ray Chapmen died after being struck in the head by a pitch in 1920, it took almost 40 years and a grandfathered MLB mandate for many reluctant players to adopt batting helmets. Today, it would be ridiculous to consider the helmet as contrary to the sport’s purity, but even the most insignificant tropes of baseball have a long half life. Bats haven’t changed in 135 years, but bat grip has changed.
No doubt, the same sense of tradition that fought the helmet for so many years has kept the baseball bat relatively stagnant throughout history. The construction has become absurdly precise, the wood has gotten harder, and bat manufacturers have amassed a very scientific understanding of moisture content and grain, but the bat design itself has gone nowhere. Before the ProXR, the MLB hadn’t approved a single new bat design since the 1970s. And maybe that wouldn’t matter, if not for one important catch:
“Bats haven’t changed in 135 years, but bat grip has changed,” Phelan explains. You see, baseball used to be a game of finesse. Look up photos from 1900 and earlier, and you’ll spot players choking up to bunt and slap at the ball. It was a calculated approach to batting, built to find the holes in a team’s defense.
When a baseball player hits the ball, their wrist is ostensibly struck by a hammer.
Around 1910, players adopted a new grip, dropping their hands to the bottom of the bat in a quest for most swing speed, beginning a trend that would only accelerate as strategy gave way to brute-force homerun hitting. So the bat’s knob–once a safety catch–began grinding its way into the bones of every major league player as they rode the bottom of the stick for maximum speed.
Today, when a baseball player rolls their wrists through the point of impact with the ball, pressure skyrockets, and their hamate endures forces as great as 80 PSI–meaning that bone is ostensibly hit by a hammer. In response, the ProXR isn’t just lathed symmetrically like most bats. Instead, it tilts that knob by 23 degrees (which happens to be the precise range of motion of the human wrist) to work with human anatomy to mitigate hamate impacts by roughly 25%. In theory, that’s enough to prevent many breaks.

Needing Advocates
The logic behind the ProXR isn’t really all that difficult to grasp. In fact, while it was convincing enough to be tested (successfully) at the Washington University School of Medicine’s Biometrics Lab, getting a professional MLB player to try it out is a whole other challenge. It’s hard to imagine why that may be. After all, Tiger Woods adopts the newest club technology Nike has to offer year after year. What makes baseball players different? It comes back to that idea of tradition.
“I think ball players are superstitious,” Mike Hessman tells me. “If they have something they like, it’s hard to break them of that.”

Hessman is a journeyman ball player currently at the Louisville Bats. He holds the all-time homerun record for minor league play (with over 400 homers as of this season). Hessman’s other claim to fame is that he has a bat in the Hall of Fame–specifically, a ProXR he borrowed from a buddy during batting practice and eventually tried out in a major league start just because “it felt good.” Hessman ended up hitting a double at Wrigley Field, which was the bat’s first hit in the majors. A few days later, the Hall of Fame claimed the prototype for itself (recognizing the ProXR’s inauguration as either history or novelty), and Hessman’s interest faded a bit as he made his way to play ball in Japan. (The Milwaukee Brewers’ Prince Fielder used it later in a few games as well.)
I ask Hessman if it would be hard for a professional to adjust their swing to the ProXR’s unconventional design. He estimates that a day of batting practice should be adequate. The tougher challenge is, again, one of changing a player’s mentality.

“I think minor leaguers will try anything. They see something new and want to check it out,” Hessman explains. “[But] I think the guys that are established don’t like to change a lot of things that have worked for them in the past.”
The guys that are established don’t like to change.
It’s a sentiment that seems mostly true. Though in fact, Louisville Slugger makes somewhere around 400 different permutations of their iconic bats to appease particular player tastes, and one recent bat startup has claimed roughly 20% of the MLB bat market specifically by selling the idea of extremely subtle, artisan customization.
Phelan explains the shortage of early adopters in the majors through a slightly more nuanced lens. Players are surely bat-loyal, he learned attending the Cardinals spring training camp in 2006, but they’re brand loyal, too. “Very few guys will change their bat brand. If you’re a Louisville Slugger guy, you’re going to die a Louisville Slugger guy,” he says. “At camp, it became apparent to me that these guys like my tech, but they love their brand of bat.”
“So I asked them, ‘If you can get this on your brand of bat, would you use it?’ Their answer was ‘I’d give it a try.”

Wooing The Big Boys
Grady Phelan is a true basement inventor. He hasn’t played organized baseball since high school. He was inspired to create the ProXR, not while having beers with some deep network of major league buddies, but while swinging at hickory nuts in his backyard alongside his kids. The bat slipped from his hands, almost struck his son, and left a strange bruise on Phelan’s hand. After months of research, Phelan would learn that his grip’s compression had short circuited his own nerves–another nasty side effect of choking down on the traditional knobbed baseball bat–and he’d eventually create his patented design by dumping six figures into ideas dreamed up in his home woodshop.

Hickory nuts make for a great design anecdote but a very humble industry pitch. When Phelan received a patent confirmation for his ProXR design in 2006, he immediately brought the idea to a big company in his own hometown of St Louis: Rawlings.
“I don’t want to put Rawlings on the spot,” he insists, “but I basically got this response:”
a. Nobody is going to use that.
b. You can’t ever manufacture that.
c. You’ll never get MLB to approve that.
d. You’ll never get that in a game.
e. You’ll never get a player to play it.
It was a damning rejection (and Rawlings was not available for comment), but Phelan interpreted the negativity as a “to-do list” instead of a dead end. As of 2010, a, b, c, d, and e had all been checked off the list–a huge accomplishment by any metric–but Rawlings still hasn’t expressed interest in licensing the design.

The ProXR–before finishing the tilted knob.
From Phelan’s perspective, he not only needs a company like Rawlings to sell players on trying the bat for safety reasons; he needs Rawlings to sell players on trying to bat for performance reasons. Because the ProXR has a tilted knob, it could theoretically offer players a bit more finesse during the final milliseconds before striking the ball. Maybe that’s true. Maybe it isn’t. But the only way for anyone to know is for the bat to get into the hands of more players. And the best way for that to happen is for a major bat maker to push the tech.
“This will sound cheesy, but this is a David and Goliath thing, and a ‘it’s not invented here’ thing. I’m a graphic designer and an inventor who’s trying to convince bat companies that this is the real deal, that there are serious problems with the bat. And it’s not in their best interest to admit there are problems with the bat.”
As For Beckham…
The pro companies won’t touch it, so the baseball players won’t touch it. But what about those who’ve sustained hamate injuries? What about Gordon Beckham himself? Does he wish he’d been using a ProXR to avoid the hamate injury?

“If you’d asked me two months ago, I might have said, ‘Yeah, I wish I’d been using it,” Beckham admits. “Now that I’m back swinging the bat okay, I’d say no.”
If you’d asked me two months ago, I might have said, ‘Yeah, I wish I’d been using it.’
Like most major leaguers, Beckham is brand-biased, having used the same bat (an Old Hickory) since coming up to the majors in 2008. But when I asked if he’d heard of this safer bat, he divulged that he had actually swung a ProXR before. Beckham, ever the southern gent, called it a “great concept” that “definitely felt better” in regards to its tilted knob. He even went on to tell me that “it felt like you could really pull that bat through the zone really nice”–meaning there really may be something to Phelan’s arguments about more wrist flexibility being a good thing for striking the ball.
His qualm, however, was a big one: Because the bat is asymmetrical, its margin of grip error is in some ways more like a golf club than a baseball bat. “If you grip the bat, you’ve gotta make sure you grip it exactly the right way,” he explained. “If you’re not swinging and hitting the right perfect spot on the barrel, you’re going to have trouble.”

That might not sound like a big deal–after all, golfers make it work–but players like Beckham will almost compulsively grip and regrip the bat, searching for that perfect feel of grain in their hands. It’s a habit that could be hard to break, which is why Beckham even suggests that the ProXR might work better for players when introduced to them young. Indeed, there’s little impetus for Beckham to switch now since the hamate is actually removed when broken, meaning it won’t be a recurring injury for him or any other baseball player.
“I feel like, for guys who have broken their hamate, they’re not going to use it,” Beckham says. “For guys who’ve used a different bat for their whole life, it’s going to be difficult to change the feel of what they’re doing.”

So Now What?
Despite Beckham’s grounding skepticism, I was left at a loss when parting with Phelan after a surprisingly fast hour on the phone. Sure, he was a humble basement inventor, but he seemed neither a shyster nor a quack. In fact, our discussion had proven that he had all the pragmatism of any good designer, and he had an incredible tome of knowledge on the topic to boot. If anything, the cruel joke was on him: His product was failing to catch specifically because of its watershed design.
Before hanging up, I’d asked if he’d pitched Hillerich & Bradsby, manufacturers of the Louisville Slugger (the official bat of the MLB). He had in September of last year.
Our R&D team said that Grady’s presentation was one of the best they’d ever seen.
Phelan assured me that the pitch had actually gone quite well, but how could that possibly be? He was still stuck honing his bats out of his basement. I wanted to know what could have gone wrong with Phelan’s sell–maybe baseball was having its own NFL crisis moment, and product manufacturers were afraid to touch injury. Maybe the bat companies were developing their own patented tech to mitigate hamate injuries without paying licensing. Or maybe Phelan had just completely misread the polite repartee of a disinterested company, and baseball at large was okay with the Gordon Beckhams of the world occasionally missing 6 to 8 weeks of play to injury.
“[We] were intrigued,” Rick Redman, a Hillerich & Bradsby spokesperson tells me over email. “Our R&D team gets a lot of product pitches and they said that Grady’s presentation was one of the best they’d ever seen. But our focus has been on our MLB Prime which we introduced to MLB fields this season, a reinvention of our wood bat line with innovations that created the hardest wood bats we’ve ever made…”
It was a heck of a rejection–a total affirmation of Phelan’s work and a complete slap in the face of innovation at the same time. But the industry’s hesitance still made no sense. Why make harder bats in lieu of making them safer? Why say an idea was stellar but then ignore it?
Then, just a few minutes later, I received a surprising follow-up from Redman:
“A little addition, in a hallway conversation just a few minutes ago I learned from Bobby Hillerich, our Director of Wood Bat Operations, that he continues to work with Grady on this project and that we would like to have it in our repertoire for any players who want it. “
And with that, it sounds like after a decade of striking out, Grady Phelan may have finally landed a hit.
[Images: Leland Payne, 1909 via Library of Congress, Denard Span via Wikipedia]


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Thumb Ligament (Ulnar Collateral Ligament) Injury

Written by admin on October 29, 2012 – 10:08 am -

Chris Paul of the Los Angeles Clippers, Henry Blanco of the Arizona Diamondbacks, and Jeremy Bridges of the St. Louis Cardinals are three of many professional athletes who have recently sustained injures to the ulnar collateral ligament of the thumb. Paul is on schedule to return to regular season play on October 31st versus the Memphis Grizzlies–10 weeks after surgical repair and rehabilitation of his Ulnar Collateral Ligament. It may be difficult to contemplate that such a small ligament can cause such a detrimental effect on an athlete’s season, but as the key stabilizer of the main joint of the thumb, the UCL is the sine qua non of thumb stability and grip strength. It is usually torn by forceful hyper-abducting of the thumb. Hyper-abduction is bending backwards toward the radius bone of the forearm (or away from the hand). This is typical of a fall onto one’s hand with fingers outstretched or when a football player’s right thumb is caught in the jersey of an opponent moving to the player’s left.

Partial tears are more common and can be managed with bracing or casting for several weeks. Complete tears require operative intervention. The surgical procedure is simple and is a direct repair of the ligament to its normal attachment site using bone anchors (screws with suture attached). The screws are countersunk into the bone the sutures are passed into the end of the ligament and tied. This pulls the ligament back to its normal attachment site. The thumb is immobilized for 4-6 weeks, followed by an additional 2 weeks of protected range of motion, so that 8 weeks following the surgical repair the athlete is ready to return to play. Non-operative of treatment UCL injuries requires functional bracing for 4-12 weeks (depending upon severity) and daily active range of motion exercises. Athlete’s often choose the surgical option for its shorter rehabilitation time, and lower likelihood of chronic instability of the metacarpal-phalangeal joint.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com.

Caitlin Davis, ATC/LAT is a post graduate fellow at GOSM… For more information, visit us at www.atcfellowship.com

References

Godges, DPT, MA, OCS, J. (n.d.). Thumb ulnar collateral ligament repair and reabilitation. Retrieved from http://xnet.kp.org/socal_rehabspecialists/ptr_library/04WristandHand Region/26Hand-ThumbUlnarCollateralLigamentRepair.pdf

Katolik, L., Friedrich, J., & Trumble, T. (2008, November). Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint: a retrospective comparison of pull-out sutures and bone anchor techniques.. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18971729.

Rotoworld. (2012, August 7). Player page – henry blanco. Retrieved from http://www.rotoworld.com/player/mlb/2449/henry-blanco

Rotoworld. (2012, September 2). Player page – jeremy bridges. Retrieved from http://www.rotoworld.com/player/nfl/742/jeremy-bridges

SportingNews NBA. (2012, October 20). Chris paul trying to break hesitation after recovering from hand injury . Retrieved from http://aol.sportingnews.com/nba/story/2012-10-20/chris-paul-hand-injury-update-los-angeles-clippers-team-usa-stats-roster-schedul


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Orthokine Therapy: Modern Day Fountain of Youth?

Written by admin on October 1, 2012 – 9:52 am -

Orthokine therapy is a new sports medicine treatment recently receiving widespread interest and acclaim. It was developed primarily for the treatment of osteoarthritis (OA) by German doctors, Dr. Peter Wheling and Julio Reinecke, PhD., of Dusseldorf, Germany. Little is known about this experimental technique, and there is scant data to support its efficacy, but anecdotal reports have been, high-profile and promising. Much like the mythical fountain of youth, the technique, its clinical mechanism, and its results are shrouded in mystery. Similar to Platelet Rich Plasma Therapy (PRP therapy), whose mechanism and effect has been discussed at great length, and is now widely-recognized in the public consciousness as the standard musculoskeletal rejuvenation therapy, Orthokine therapy is also an autologous treatment provided as an injection of the patient’s own blood. There are no foreign materials or substances used, so risk of adverse side effects is minimal, and the injections are well-tolerated.

In theory, proteins commonly found in patient’s blood –such as Interleukin – 1- Receptor – Antagonist (IL -1Ra) – possess inherent anti-inflammatory and analgesic properties that serve to protect and to preserve the cartilage in an arthritic joint against degradation by osteoarthritis.

During the Orthokine procedure, blood is obtained from the patient using a syringe containing beads that will enhance and/or release the production of these cartilage-protective proteins. The blood is stored at body temperature for up to 9hours, during which time, the concentration of the joint preserving proteins, have increased up to 100 times greater than normal. After the incubation period, the sample is centrifuged to isolate the enriched serum of proteins from the other elements of blood. It is then divided into numerous vials that may be used immediately or frozen for future treatments. The serum is then injected into the affected joint to decrease pain, increase range of motion, and decelerate the progression of degenerative joint disease, and (hopefully) improve the joints longevity. The practitioners report almost immediate improvement and symptom resolution for 2-4 years.

Orthokine therapy is being used throughout Europe but is not yet FDA approved for use in the United States. Professional athletes such as Kobe Bryant and Alex Rodriguez are among those who have traveled to Europe to receive the Orthokine therapy with the hopes of alleviating pain, enhancing their performance and extending their athletic careers.

It is unclear whether Othokine is the long-sought OA treatment (minimally invasive, long-lasting, relatively inexpensive to provide), the next innovation, or just the latest “snake oil” cure-all. It is certain, however, that despite the lack of clinical data, many more modern day Conquistadors will travel to Europe to imbibe this latter day fountain of youth, following the examples of the superstar “Ponce de Leon” that preceded them.–at least until it is “discovered” again somewhere else.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com.

Caitlin Davis, ATC/LAT is a post graduate fellow at GOSM… For more information, visit us at www.atcfellowship.com

References
Wehling, P. D. P. (2012). Molecular orthopaedics. Retrieved from http://www.wehling-hartmann.de/en/wir-ueber-uns/
Wheling, P. D. P. (2007). Osteoarthritis: The individual osteoarthritis therapy. Retrieved from http://alfa-arthro.com/dokumenti/BookletOA_Pat_05062007.pdf


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Red Sox Crawford Elects Rehab for Elbow injury

Written by admin on April 27, 2012 – 11:34 am -

Boston Red Sox CF Carl Crawford recently sought a second opinion on his aching elbow.  The diagnosis of a partial tear of the UCL (“tommy john ligament”) was confirmed by Dr James Andrews.  Details surrounding the the onset of the injury are unclear, but reports confirm that an MRI and 2 medical opinions concur on the diagnosis.  Although traditionally, treatment of UCLs has favored surgery over rehab, recently many baseball subspecialists have elected a more conservative approach for partial tears.  Apparently Crawford has been treated with a PRP injection and a course of rehab.  Generally this requires 3 months of activity restriction and rehabilitation.  Long-term results for non-operative treatment are mixed, and PRP is an emerging technology, so Bosox fans will cross their fingers and hope for a speedy return of their Left Fielder.  For more info on PRP injections http://www.orthonc.com/news-updates/what-prp-therapy.


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Posted in Elbow, Sports Medicine | No Comments »