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This is why we can’t have nice things

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MILLER PARK – I didn’t get much of a chance to comment on Jose Fernandez earlier as I was traveling and had to immediately get to work at the ballpark Tuesday, but what an absolute shame for not only the Marlins but the entire sport as this was perhaps the best young arm in the game.  While Tommy John surgery doesn’t end his career, it puts a career on hold, and the procedure is not always the automatic cure many believe it to be. Just ask Edinson Volquez and Francisco Liriano. Even Stephen Strasburg isn’t quite as electric as he was before surgery. I hope we get to see Fernandez return as what he was: a remarkable talent.

What’s troubling, including and beyond Fernandez, is this: of the 22 major league pitchers who have had Tommy John since Feb. 18 – an astonishingly high number –  the overwhelming majority have been young. The surgery patients have averaged 23.4 years of age. Think about how young that it is? Think about what that tells us? Think about what that might mean, for, say, Gerrit Cole. (Including minor league arms, the TJ toll is at 34 this spring, including Jameson Taillon.)

I think that average age is telling in what is behind this unprecedented rash of pitching injuries.

EXHIBIT A BEHIND THE TJ POX OF ’14:

We are seeing a generation of bigger, stronger, harder-throwing pitchers than we’ve ever seen.  According to PITCHf/x velocity has been on the rise every year since 2007, and that is in part because Strasburg, Matt Harvey and Fernandez have entered the game.

Here were the fastball velocity leaders among MLB starters last season:

 

1. Matt Harvey 95.4

2. Stephen Strasburg 95.2

3. Jose Fernandez 94.8

 

What do they all have in common?

One has come back from Tommy John surgery (Strasburg), one is rehabbing from Tommy John surgery (Harvey), and one is likely about to have it (Fernandez).

One theory shared by myself and others is this: pitchers are getting bigger, stronger, throwing faster … but those ulnar collateral ligaments are not growing and becoming stronger. It’s simple physics, the harder you throw the more force you exert on your elbow and shoulder. This has been proven scientifically by the good folks at ASMI. In short, pitchers are out-growing their ligaments.

EXHIBIT B:

We are seeing young pitchers – amateur pitchers – throwing more often than they ever have before.

It’s not just the absurd 157-pitch count I witnessed Harvey accumulate one afternoon while pitching at North Carolina in regular season game against Clemson. It’s not just the ridiculous 400 pitches Dylan Bundy threw in a three-day period in high school. It’s the sport specialization and the growth of year-round play, the growth of showcases, tournaments and travel ball.

A great read from Tom Verducci over at Sports Illustrated: ”A study out just this month in the Journal of the American Academy of Orthopedic Surgeons found that year-round play in the amateur market has contributed to a 10-fold increase in Tommy John surgeries for youth pitchers.”

Stunning.

(Good news for the Pirates: Cole was not a year-round thrower as an amateur player).

What we know is pitchers are often throwing too much at younger ages. We know they are bigger, faster and throwing harder than ever before. The stresses are coming from extra force AND extra reps at younger ages. So despite all of the medical advances, preventative care practices and data entering the game, it explains why we are seeing injuries increase.

It explains why baseball can’t have – or at least manage – nice things.

- TS

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Comments

  1. NMR says:

    Well done, Travis.

    At this point, I’m about 98% convinced that the increase in elbow injuries comes down to simple physics, as you’ve written. The UCL is the weakest link in the chain. Simple as that.

    And at least to me, the correlation between youth injuries and year-round play only makes the argument against overuse that much more valid. Kids are not bigger, faster, stronger like their Jose Fernandez conterparts, but their bodies are still growing. Putting extra stress on a growing ligament logically seems like a pretty poor thing to do.

    I will take a moment to point out a silver lining. The knee-jerk reaction from the dinosaur segment of the game has inevitably been to point the finger at “babying” pitchers and claim this rash of TJ injuries proves it does nothing to help.

    One small fly in the ointment: pitchers arms are made up of more than an elbow ligament.

    This has completely gone under the radar, but the injury you almost never see anymore was the one that ended careers: rotator cuff. Shoulders injuries have been proven to be far more likely to end or hamper careers than elboy injuries, and SOMETHING we’re doing has greatly decreased them.

    Maybe the takeaway from all this is that it’s not the end of the world to undergo Tommy John surgery, but a bump in the road.

  2. Jim S. says:

    Great topic, and great article, Travis!

    I listened to James Andrews a couple of weeks ago on MLB Radio, and he clearly pointed a finger at all of the throwing young kids are doing (playing for several travel teams, throwing multiple times per week, showcase tournaments all over the country, pitching and preparing to pitch all year long, etc.). I don’t think that was any revelation.

    He said that any time he sees a HS kid throwing 90 MPH or greater, he cringes because he says he knows to a very high confidence level what will happen at some point. He said his research shows that it is almost a certainty a HS kid who throws 90+ will end up a patient of his or a doctor performing similar surgery. He said it is very rare to find an 18 year old has the skeletal structure to withstand that sort of violent trauma over and over again.

    He was asked why they throw 90 at younger ages now, and he pointed to all of the pitching they do. Kids just develop their top end velocity at much younger ages now because they throw so much more than ever before. He said it takes a really special kid to throw that hard that young w/o being overworked. Maybe Cole fits in that category? There is incentive to do it because the kids who throw harder stand a better chance of getting scholarships and being drafted higher, as we know. He said the smarter teams are looking for kids who project to throw 95 at age 22-24, rather than age 18. I guess that means kids like Kingham and Glasnow. The Bucs have talked about finding kids who have room to grow and increase their velocity year by year into their 20′s, but I’m sure that is a tough strategy to perfect. I would also say that most college coaches are probably just fine with 18 year olds who throw 93-94 already. They just need them for the next few years, and what happens after that is not as big of a concern to some college coaches.

    This is a tough one to solve. As I said, you get rewarded for early velocity. In that situation, kids will look to display early velocity.

  3. NMR says:

    Very interesting, Jim. Thanks for sharing.

  4. bpn8pitt says:

    Not a whole lot MLB can do. A lot of that damage is being done before the kid is even drafted. I’m sure they could advise NCAA and high schools on what to do, but beyond that I don’t know.

    FWIW, the leagues I umpire in do limit how many innings and games a kid can pitch in, in a given week. What it can’t regulate is how many leagues a kid plays in. Traveling teams, playing Colt/Legion while on a HS team. Fall Ball.

    I definitely agree year round is an issue. But I think genetics is an issue too. Some guys have rubber arms. Some guys don’t.

  5. jdk47 says:

    I think your assessment is dead-on in both respects. Ligaments aren’t getting any stronger, but the rest of the body is (and bigger as well). I think the modern crop of pitchers have about reached the limit of the torque that can be applied to the human body’s tendons and ligaments. Combine that with the year-round pitching these guys are doing from the time they are 12 years old and the inevitable result is the rash of arm injuries we are seeing.

  6. Chuck H says:

    I can’t imagine how a batter could possibly hit a 95-99 mph fastball, being as I never played professional baseball. It doesn’t give the hitter much time to see where the pitch is, let alone to hit it. I would think a lot of it is guess work on the part of the hitter, and if he is correct, the ball will go a long way, but hey, what do I know.

  7. cmat0829 says:

    Great post Travis and everyone… seems to me the entire food chain will need to evolve, notably the high school, amateur and college levels…. and just because the path to eventual TJ surgery has been paved before major league teams get to develop their pitchers it doesn’t mean that teams should throw caution to the wind and quit ‘babying’ pitchers… anyone who keeps that narrative alive is ignoring facts and science….

  8. Jim S. says:

    Thanks.

  9. Jim S. says:

    I think you are right about the inability to limit exposure to diferent teams, different leagues, etc., bpn. Each tournament can try to do its best to limit things for its event, but they don’t know how many kids pitch on the Tuesday and Thursday before a Fri-Sun tournament. They can’t control that some of these kids might actually pitch in 2 tournaments the same weekend. You read stories all the time about how some kids are hired guns for elite travel teams. They live in one place, but play for teams in 2 other places and just fly in for the games they are going to pitch. I’m sure that is pretty uncommon, but it does happen with the elite pitchers.

  10. Jim S. says:

    As for the shoulder injuries decreasing, do you think it is a case of better mechanics being taught?

  11. Jim S. says:

    It may take awhile for things to filter down to the 12 and 13 year old levels, cmat. But, I think you are right that change has to start at the lowest levels. Maybe there is hope for that. I don’t know if anyone would agree with this from personal experience, but I’ve been told by a friend who has had 3 sons go through youth football, up to high school football that coaching has changed so much in just the last several years regarding proper tackling to avoid head contact. He said everyone is quickly getting on board. I don’t know if that actually is the case, but if it is, it means there is hope that youth coaches will start doing the right thing more and more.

    Before my son’s 12U practice last night, a few of the coaches and dads were talking about this very issue with pitchers. I don’t recall them discussing it last year.

  12. toochca says:

    Jim, I think mechanics may have to do with it. I also think training off the field has more to do with it. Not only are players training the large muscles groups but people have become more mindful of training the smaller muscle groups, especially in the shoulder area.

    Unfortunately, as far as I know, unlike the shoulder there aren’t any muscles which cover the elbow. The muscles all begin and end at the elbow.

  13. Ron says:

    What ever happened to playing multiple sports when young? Today kids too often get locked into one sport and play it until hurt or burned out.

  14. Steelkings says:

    First off let me say hello to all the new people. Did the pens get beat or something?

    Travel summer baseball is not going to go away. Its the best way to get noticed by a college scout. With that said, it is what it is.

  15. Ghost says:

    Gonna play devil’s advocate (and with the disclaimer that I’m no orthopedic surgeion).
    Did Jose Fernandez’ pop because of damage that began when he was 14 years old? Or because he kept pitching the other day through discomfort and tried hiding it from the team? I’m not saying Tom Verducci has to be wrong. But he’s just too certain for my comfort with his declarations of having identified the boogey man.

  16. One issue you all are NOT bringing up . . . . the big influx of weight training that has been pushed into baseball in the last 30 years. Those excess muscles added in a skeletal structure not prepared for that bulk leads to a crash of the weakest link.

    Steve Blass mentions this frequently. He believes its not the number of pitches thrown, but not throwing enough. Bob Gibson, Juan Marichal, Sandy Koufax, Don Drysdale, Nolan Ryan———all pitched every 4th day, in 4 man rotations, and rarely went less than 9 innings. They threw pitch after pitch after pitch.

    However, there wasn’t much in the way of weight training then. Altering the muscles in those who throw naturally and freely changes the dynamic of the arm.

  17. Buck Showalter also mentioned that one of the counter-actions that could be taken is lowering the mound. It was done once in the 60′s. He said in addition to the harder throwing and the follow through, that even that little bit of gravity coming off the higher mound could be adding to the problem. He also commented that it would likely have another positive impact – less strikeouts and more balls in play – which is why it was done previously. I thought this was all interesting.

  18. Ghost says:

    Groat, I’m strongly inclined to agree with your second paragraph. I’m in my fifth decade of following the Pirates and MLB baseball and I can never remember pitchers being felled by injury as frequently as they are these days. And I don’t think the year-round thing is necessarily the culprit. Back when I was a kid in the early and mid-seventies, the guys I knew with the best arms pitched in the spring and through the summer, then played quarterback in the fall! Basketball season was the only time “off.”

    That said, I don’t know what the actual injury rates were for pitchers when guys like Walter Johnson or Bob Gibson threw. We probably never will know for sure because for the longest time, guys pitching with damaged arms probably just faded away from the scene.

  19. Steelkings says:

    @ Groat

    Absolutely spot on buddy. Especially in high school where weight training coaches are having athletes train with linear reps designed for football type motions. Baseball is a rotational sport. In high school, rotational strength and conditioning is rare away from the baseball field. On the field you will see cord work ect. But not in the weight room.

  20. Naterosboro says:

    You’re correct in thinking most of hitting is guess work. Even at lower levels. It’s about knowing the count, situation & pitcher on the mound, and guessing (or “looking for”) what he’s going to throw. That’s why guys can look so bad on some swings. They’re either looking for a fastball and they get something offspeed, or they’re looking offspeed, but get a different offspeed pitch (or a fastball). That’s also a reason why they crush mistakes. They’re looking for a pitch, and the pitcher throws it in the wheelhouse.

  21. Nate83 says:

    I personally think the rise in fastball speed thing get blown out of proportion. I think it’s the other pitches (slider, curveball) being thown at too young of an age and at a much higher quantity before these guys even get drafted that is the bigger issue. I’ve heard a fair amount of concern over the last few days about MLB seeing this as a big issue in terms of popularity of the game. It will be interested to see what they discover and how they handle this.

  22. NMR says:

    Great point about weight training, Groat, but I have to disagree with the next part.

    The fault I see in that argument is selecting generatinal arms as your sample. Huge bias there. I think it is impossible to compare injury rates over that amount of time. Back in those days, you hurt your elbow and you were done. No twitter or internet or surgery. That was it.

    With all due respect to Mr. Blass, I don’t ask his opinion instead of going to an actual doctor and I see no logic in doing the same with pitcher injuries.

  23. NMR says:

    Would love to see this.

  24. NMR says:

    Jim, I’m not sure I believe that mechanics are being taught with a focus on safety these days, at least systematically. I see a lot of focus on maximizing velocity, especially at young ages, and I think that may actually be adding additional torque to these joints.

    I’m certainly no doctor, but from what I understand, shoulder injuries are more muscle related than ligament. Overuse of any muscle cause damage, whether it is throwing a baseball, running, swimming, etc. If that is actually the case, then I think it’s logical to conclude that pitch counts have at least played a partial role in the reduction of shoulder injuries.

  25. Jim S. says:

    Thanks, toochca and NMR. Interesting stuff.

  26. Jim S. says:

    I have heard the same thing about pitching mound height, 3and10. It does seem to be part of the problem.

  27. Andrew says:

    I have seen what Toochca is writing cited frequently, never bothered to explore it more, as reducing shoulder injuries. The early sports medicine doctors introduced mostly similar regimens, Blackburn Six Pack, Jobe Exercises, that focused on strengthening the rotator cuff muscles and scapular muscles.

    This supposedly reduced a lot of the muscle and tendon issues along with some the concomitant labral problems. It is a story I hear frequently and I’m inclined to believed it.

  28. Andrew says:

    Steel I agree, it is not the influx of weight training but improper application and programming. Sagital plane work is fine when done correctly, there is carry over to the other planes but for baseball you need specific rotational work. Also for overhead athletes especially pitchers I personally think that any lifting overhead should be kept to a minimum if done at all, a lot of these athletes are lax in their shoulders, no need to put them in that position and then load it.

  29. Jeff King says:

    I’m printing this column Travis and showing it to all of those kids (and parents mostly) who have become obsessed with all-star teams and travel teams.
    We’re talking only 9-year-olds here , but we’ve run into a situation with our local little league in which several players from our undefeated team from last year did not meet the age requirement to move up from the coach-pitch league to the player-pitch league. Granted, some only missed the deadline by a few days, but still rules are rules.
    As a result, several other players from our town and teams, and nearby towns and teams formed a travel team(s) in order to be able to pitch.
    In one of the leagues, they play 45 games. In another, they play 60-65. And they’ll play another 25 or so in fall travel leagues.
    Now you might think this is not a big problem but I contend it’s already the starting point for arm fatigue and problems because every one of those wants to pitch and every one of them wants to throw it threw a wall.
    I have a 25-year-old son and a 9-year-old. I coached my older one all the way until he was 17 and I’ve seen players who were stud pitchers burn themselves out by pitching on travel teams then coming back and pitching in our own local league. As a coach, I hated it because I would never want them to pitch too much even if they were willing to. As a result, our team took a lot of poundings. But I’d rather do that than risk a kid getting hurt.
    And things 7-8 years ago were no where near the emphasis placed on it now.

  30. Interesting article (you number freaks will love it!) by Matthew Kory in Sports on Earth, entitled “Pocket Ace.”

    In the article he acknowledges Jon Lester as the Red Sox’ “top-of-the-rotation” hurler. He asks the question: does Jon Lester qualify as an “Ace”?

    I have always been of the opinion that not all #1 Pitchers in rotations are Aces. AJ Burnett was an Ace; Francisco Liriano and/or Gerrit Cole are not!

    Interesting reading for those who choose to follow it up.

  31. Yep. The way most kids are weight training is a problem. I have seen some college coaches and trainers that have put together good kettlebell workouts. Rotation swings and other stuff that are really awesome for firing the muscles most often used in baseball.

  32. I think to some degree the elbow injuries are preventing the shoulder injuries. Rehabbing an elbow and shoulder are almost exactly the same. So when these guys blow out their elbows and do a year of rehab it has a preventative effect on shoulder injuries.

  33. Steelkings says:

    Not to pat myself on the back ….But
    ______________________________________________________________________________
    From Monday:

    “Uncle Steelkings prediction:
    Wandy’s upcoming box score 6IP 2ER 5K’s 2BB – Shutting up all the doubters”
    ______________________________________________________________________________

    Wandy’s line score today:
    5IP 2ER 4k’s 1BB

    Go ahead….Say it…………………….I am a ?????

  34. NMR says:

    sonofab…ah, just kidding! ;) I was thinking about you on Dejan’s Game Thread!

  35. Andrew says:

    Can we get some optimistic full game predictions then?

  36. Steelkings says:

    Yes…I Predict that Hurdle will not do whats right and make Watson or Wilson the closer.

  37. Well, lowering the mound would certainly lead to less strikeouts and balls in play, and also more hits and runs, which in turn lead to more pitches being thrown, particularly in stressful situations. There is no easy answer to this problem.

  38. Steelkings says:

    Here’s a 9 from Uncle SK:

    9. The Farns – Kyle Farnsworth, who saved a game for the Mets on Monday was optioned to AAA Vegas on Wednesday. Farns said, not just no, but, Yuck no! The Mets, who at this time are flexing their internal Nutting released the Farns two days before they would have had to pay him a large bonus to his contract.

    8. Tuesday GP was 4 for 4 with 2XBH 2 runs scored and with 3 RBI’s. He is just simply not ready for prime time.

    7. ……….Of the 40 games the Pirates have played, they have scored 3 runs or less in 20 of them. 18 games with 2 runs or less. 9 games with 1 or less. Shut out 3 times.

    6. The run through June 8th will decide our season. They have to play this stretch at .500
    series with the Yanks, Orioles, Nats, Mets , Dodgers, Padres and Brewers is one of the toughest stretches they will face this year.

    5. Reese McGuire, catching prospect , went 2-for-5 for Low-A West Virginia on Wednesday, and is hitting .414/.452/.414 over his past seven games.

    4. Rosenthal clarifies some details of the offer made by the Pirates to fellow top outfield prospect Gregory Polanco, reporting that the team’s offer would have guaranteed six or seven years in the range of $20MM to $25MM. The length and total guarantee would have shifted based upon whether or not Polanco qualified for an additional year of salary arbitration as a Super Two player. (In that respect, then, the offer looks to be quite similar to the terms agreed upon by the Rays with Chris Archer. As MLBTR reported, Archer’s $25.5MM guarantee hinges upon whether he reaches Super Two status, as expected; if he does not qualify, he would be promised just $20MM.)

    3.

  39. Jim S. says:

    I predicted 6/2 myself for Wandy yesterday, Steel.

    But, I am patting myself on the back.

  40. Jim S. says:

    Good post, Jeff K. Those kids were lucky to have you as a coach if you refused to over-pitch them.

  41. Jim S. says:

    Thanks, Groat!

 
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