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Concussions are traumatic brain injuries that are caused by a direct blow to the head or a sudden jolt that causes the head to jerk violently. Concussions, although far less common than the typical overuse injuries that we see occurring in baseball to the shoulder and elbow, they can be far more catastrophic. A recent survey of teams in professional baseball at the Major League level reported only 66 concussions between 2007-2013. Only 66 concussions over 7 years is certainly not a big number, which raises several questions: Are concussions being missed as a diagnosis? Or maybe players under report their symptoms? Perhaps concussions in baseball are just truly that rare.

The baseball medical community is seeking answers to these questions as well as others as relates to traumatic head injury. With or without those answers, experts and the MLB are taking action. The MLB has updated concussion-screening protocols and experts are developing safety equipment to ensure player safety. The updated “on the field” concussion protocol, although present, will be hard for fans to see. But what fans might see is new headgear worn by pitchers to protect them from line drives by hitters directly at them, or “come-backers”.

The velocity of these “come-backers” can reach speeds of 120 mph making pitchers absolutely defenseless. Comfortable, wearable headgear that does not inhibit performance is the ultimate goal. As there is always an aesthetic hurdle to clear, the goal is to gain league wide acceptance by pitchers so that it is part of the standard game day uniform. There are currently three most favored design types either in trial or that have been utilized. The first is a custom fit hard shell that surrounds the high-risk

areas of the head, shielding it from a batter’s line drive. It is made from hard, lightweight, material and the top is left open to reduce weight and allow airflow. The second is the SST Pro X Guard, which is a cap insert that can be inserted to one side or both depending on the pitchers preference. This is a more minimalistic design that is lightweight and low profile while offering a hard shell protector for sensitive areas of the side of the head. The third product is the isoBlox® padded cap. It is essentially a baseball cap with extra padding to the entire under-surface. Although there are others these are three viable options to increase safety for pitchers.

So why doesn’t anyone wear them? Some say it’s because only 1 in 300,000 pitches result in a line drive in the direction of the pitchers head making it so rare it doesn’t require mandatory headgear. Others say that “come-backers” most often hit pitchers in the face, thus a facemask would be the most important component so headgear alone does no good. However, there are recent notable examples where injury sustained by a batted ball directly striking the pitchers head would have been mitigated by any of these types of additional protection.

As usual, baseball will decide what is best for baseball. As practical designs improve that do not affect performance more than likely some type of protection will ultimately be embraced by baseball for all pitchers. For the time being, there are options and it is a choice for pitchers, fashion or future.

 

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Keith Meister, MD is Director of Texas Metroplex Institute for Sports Medicine and Orthopedics (TMI), Arlington, TX and Head Team Physician, Texas Rangers. For more information and TMI programs, go to http://www.tmisportsmed.com

 

 

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