Perils of pitching: Is it time for helmets?

Tampa Bay Rays starting pitcher Alex Cobb lies on a stretcher as he is taken off the field by medical personnel after being hit by a line drive by Kansas City Royals’ Eric Hosmer during the fifth inning of a baseball game on June 15, 2013, in St. Petersburg, Fla. (AP Photo/Brian Blanco)

Brian Blanco

Even diehard baseball fans may not know the significance of Aug. 17, 1920. A tragic event on that day, however, led to a dramatic equipment change aimed at protecting the safety of baseball players.

Ray “Chappie” Chapman, a shortstop for the Cleveland Indians, was struck on the left side of his head by a pitch while batting. According to a New York Times article, the pitch caused “a depressed fracture in Chapman’s head three and a half inches long ... and lacerated the brain not only on the left side of the head where the ball struck but also on the right side where the shock of the blow had forced the brain against the skull.”

Chapman was killed by a pitch while wearing only a wool baseball cap. For the following spring training, the Indians tried a new leather head covering. Modifications of head protection continued until the Brooklyn Dodgers first used the plastic batting helmets similar to ones used today. The National League mandated batting helmets in 1956, and the American League did so in 1958.

Chapman’s death is generally regarded as the impetus for mandatory helmets in Major League Baseball.

Fast forward to 2013. Will the frightening head injury suffered by Tampa Bay Rays pitcher Alex Cobb on June 15 eventually lead to mandatory head protection for pitchers?

In the fifth inning of Saturday’s game, a line drive hit by Kansas City’s Eric Hosmer hit Cobb in the right ear. The ball was estimated to be traveling at approximately 102 miles per hour when it slammed into his head. Cobb was taken off the field on a stretcher and rushed to Bayfront Medical Center in St. Petersburg.

As scary as the injury was to watch, it turned out reasonably well. Cobb was discharged from the hospital the following day, suffering only a mild concussion.

His injury marks the fifth such event in the last five months in Major League Baseball, according to ESPN’s Willie Weinbaum.

Doug Fister was hit on the top of the head, and Mickey Storey was hit in the face. Both suffered only minor injuries. J.A. Happ suffered a skull fracture when he was hit on the ear.

Pitcher Brandon McCarthy wasn’t as lucky as the others.

While pitching last season for the Oakland Athletics, McCarthy was hit in the left ear. He suffered a skull fracture and epidural hemorrhage requiring brain surgery. He returned to pitch this season for the Arizona Diamondbacks, but McCarthy suffered a seizure last week believed to be caused by the initial brain trauma.

One could argue that forcing pitchers to wear protective headgear after these five injuries would be an overreaction. While certainly horrific to witness, even five injuries seems to be a small number considering the number of baseball players and games each season.

Unfortunately these injuries might be more common when one considers baseball at every level. A 2004 study in the American Journal of Sports Medicine analyzed catastrophic injuries in high school and college baseball over a 20-year period. The authors found that pitchers hit with a batted ball comprised the second most common mechanism of injury, accounting for 34 percent of all catastrophic injuries.

The solution to this problem could prove to be much more complicated than simply mandating padded baseball caps. MLB recently had tests performed on two prototypes from EvoShield and two from Unequal Technologies. Apparently none of these four padded caps were effective against baseballs traveling over 100 mph.

A review of those five recent injuries suggests that padded caps, even if they did adequately protect the skull, might not be enough.

Four of the five pitchers — Cobb, Happ, Storey and McCarthy — were injured when the balls hit their faces or ears below the caps, according to Weinbaum.

A baseball rocketing off the bat of an MLB slugger can shatter the jaw or eye socket of any pitcher and cause brain damage in the process. Bryce Florie of Hanahan was pitching for the Boston Red Sox on Sept. 8, 2000, when a line drive struck him in the face, causing multiple bone fractures in his cheek and around his eye. Even a batting helmet would not prevent those injuries.

Does baseball then need to explore helmets with some sort of protective visor or cage over the face?

Pitchers would likely resist any effort to mandate that type of equipment. Their peripheral vision could be impaired, making it difficult to hold runners on base. The helmets also might subtly affect their pitch deliveries. I suspect that if given the option, most pitchers would refuse to wear helmets and accept the small risk of injury, even if that risk is potentially fatal.

This inherent risk presents an opportunity for baseball equipment manufacturers. Maybe they can design headgear that not only protects the skull, but also the face while being unobtrusive at the same time. We probably haven’t seen any headgear like what would be needed, but I suspect it’s coming. Hopefully someone creates it — and MLB adopts it — before a pitcher suffers the same fate as “Chappie” did on Aug. 17, 1920.

Dr. Geier is an orthopaedic surgeon and Director of MUSC Sports Medicine. For more information about baseball injuries and other sports medicine topics, go to Dr. Geier’s blog at