When you think about injuries related to professional baseball, arm injuries are typically what come to mind. However, due to the exposure to unique sets of high-frequency repetitive motions, spinal injuries are more common than you would think. In fact, with the number of players increasing on the injured list annually, back injuries are the sixth most prevalent form of injury, with rates estimated at 12%.
At NewYork-Presbyterian, injured athletes have access to high quality medical, surgical, and rehabilitation services to help them rebound from their injury and return to their sport. Below, Christopher Ahmad, MD, Team Physician for the New York Yankees and Chief of Sports Medicine at NewYork-Presbyterian/Columbia, and Ronald Lehman, Jr., MD, Chief of Spine Surgery and Director of the Athlete Spine Center at Och-Spine at NewYork-Presbyterian/Columbia, discuss their retrospective case series analyzing the frequency and impact of spine injuries experienced by Major League Baseball (MLB) and Minor League Baseball (MiLB) players, which can include cervical and lumbar disc herniations, neck radiculopathy, lumbar nerve root impingement, and sciatica. This is the first study to date to use the MLB-commissioned Health and Injury Tracking System (HITS) database to study the epidemiology of these types of diagnoses.
The Challenge
We really didn’t know the prevalence or burden of spine issues among professional baseball players. We wanted to see if these injuries really have an impact, and what that impact is. We went down this pathway of looking at and defining the scope of the problem – which players have degenerative disease, which have disc herniations, cervical or lumbar – and then identified which type of player has the most disability if they do experience one of the spine injuries.
Research Goals
Given the lack of data concerning these types of injuries, we wanted to ascertain the incidence and prevalence of them and the burden they have on players. We wanted to answer: What does it require to treat these players? Which players need surgery? How quickly can we get them back on the field based after treatment or surgery?
We published three papers about spine injuries among MLB and MiLB players. In the first paper, we analyzed the instance and prevalence of cervical and lumbar spine-related neurologic conditions. In the second, we focused on the burden of lumbar spine conditions among players. In the third paper, we focused on the burden of back and neck strains and sprains. The compilation of all three articles gave us a 360-degree view of spine injuries that professional baseball players can sustain.
Research Methods
For this retrospective case series study, we utilized data from the HITS database to really define the scope of the problem. The data we analyzed included neurological diagnoses that resulted in at least one day out of play and were not sustained during the off-season. We also looked at player age, position, and calendar month during which the injury occurred; whether the injury required surgery; whether it was a new injury or a reinjury; and did it have season-ending or career-ending status. We also obtained the days missed from play for each injury.
Key Findings
In our first paper published in Spine in 2022, we found 172 cervical or lumbar spine-related injuries accumulated in the HITS database. Of those:
- 29 (16.9%) required surgery
- 33 (19.2%) were season-ending
- 6 (3.5%) were career ending
- 11 (6.4%) were re-injuries
The injuries occurred most during the regular season, April to September. We then broke that down between cervical and lumbar spine conditions and found that 73% of all injuries were in the lumbar spine and 13% in the neck. The average number of days missed for low back issues was 34, and for neck it was almost 22 days. Basically, that means for all players, if you had a lumbar spine issue, you were going to be out for a month.
Our second paper, which was published in Clinical Spine Surgery in 2023, focused solely on the impact of lumbar spine-related injuries. We found:
- 206 instances of lumbar spine-related injuries, with lumbar disc herniations being the most common injury
- 27 (13.1%) required surgery
- 60 (29.1%) suffered season-ending injuries – 45 of which were lumbar spine injuries
This identified a need to better understand how we can get players back in a reasonable amount of time after these surgeries.
In our final paper, which was published in Clinical Spine Surgery this year, we found:
- 3,447 cases of neck/back strains and sprains among players.
- Approximately one-quarter (721) occurred in the MLB, versus 2,726 in the MiLB
- Of the overall cases, 136 (3.9%) were season-ending and 22 were career-ending.
- The high incidence of neck and back strains and sprains accounted for nearly 40,000 aggregate days missed.
The most common finding among all three papers is that pitchers have a two-times higher rate of having a sprain, strain, or spine-related neurologic issue than all other position players. We expect rotator cuff and shoulder injuries to be much higher in pitchers; however, the high prevalence of spine injuries likely has to do with the repetitive high torsional forces that pitchers endure. Pitchers generate high velocity because they basically extend their lumbar spines and then significantly flex in a relatively short span with their follow through, which puts a huge amount of torque on there. As a result, there’s a lot of strain that’s placed on the spine, especially the lumbar spine.
Future Implications
This case series really helped us understand the burden of spine injuries and provides us with more objective timelines and averages for when you can expect the player to get back after injury. Once we had that information, we were able to share it with the MLB and MiLB teams and medical staff so that they understand the extent of the problem and how long it typically takes to come back. But a big thing that we need to focus on is creating training programs that helps prevent injury or treats injury in a way that gets the players back to playing the game more quickly.
What we’ve done at NewYork-Presbyterian/Columbia as an immediate next step is taken this information and collaborated with our physical therapists to develop high-performance athlete protocols for athletes of any level who experience a spine injury. We’ve developed protocols for before and after surgery so that everyone is on the same page on how the patient progresses and when they get moved to the next level of rehabilitation. For example, if a professional baseball pitcher ends up having a discectomy, we know that in a certain number of weeks, they can start once again doing basic throwing and jogging. Then after a certain number of weeks, they can start pitching in the bullpen. Then a few weeks after that, they can do a simulated game and then finally get back on the mound. So we’re trying to develop these protocols and make them as objective as possible.
The other key component of our future work is working with the training staff and therapists – not just with the teams – so that everyone is on the same page to ensure that these players and other patients are getting back to their daily life in a reasonable timeframe. Our goal is to create a national standard of care and rehabilitation for professional baseball players with spine injuries that can be reproduced with all teams so that everyone can get a much better assessment and prognosis.
