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April 14, 2003

Under The Knife

Redbook Redux

by Will Carroll

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Last year, I was given the privilege of writing a story that hadn't been written. It's a story about a hidden treasure and one that opened my eyes to yet another hidden game in baseball. While "original" UTK subscribers will remember this story, I think it's important enough to bring to a BP audience. I'm also going to be speaking with American Specialty in the near future, bringing you more insight from the true masters of injury analysis. I hope you enjoy. --Will

Outside of baseball, the Redbook is unknown. Even inside baseball, many front office personnel I spoke to were unaware of its existence. Even I had no knowledge of the Redbook until a recent conversation with a former baseball athletic trainer. He mentioned the book in passing and I had to bring him back to it. 'There's a book with all the info?' I asked. After telling me about it, I went on a quest to find the book. A bit of searching later, I found that the publisher was in fact MLB's insurance consultant, a company called American Specialty Companies Inc.

Three phone calls later, I was speaking to the writers of the book, Mike Pfefferkorn and Tim Eshelman. Eshelman is one of the firm's three founders, along with his brother, Pete, a former Yankees farmhand and employee. Eshelman realized that I was only a short drive away and invited me to the small town of Roanoke, Ind., American Specialty's headquarters. We'd love to talk to you, answer some questions, they said--we even have a little diner here in town. Stunned at the opportunity, I gassed up the Volvo and planned out my questions.

On a stormy Tuesday afternoon, I drove the two hours to meet with both of them and to see the Redbook. American Specialty was founded in order to assist sports and entertainment businesses to obtain insurance coverage and manage risk. While Major League Baseball is a major client, American Specialty also handles other well-known clients such as the NCAA and the Special Olympics, to name a few, and has become the clear industry leader in this category. Very few companies are willing to underwrite such coverage and it takes a specialized firm like American Specialty to find companies willing to take on risks such as a multi-million dollar athlete signed to a long-term contract.

The first fact that surprised me was that few contracts are insured. The big ones are, but that's getting to be a problem as well. One loss like an Albert Belle can ruin the experience for the insurance marketplace, said Pfefferkorn. All players are covered under standard worker's compensation coverage, much like most people are at their place of employment. The difference is startling. "In the workplace, only one percent of workers suffer injuries that last three days or more," said Eshelman. "In Major League Baseball, nearly 50 percent are on the disabled list for 15 days or more." It is obvious that even a small decrease in injuries would add up to significant cost savings for each baseball club.

I asked how American Specialty collected the information. "We utilize the official Major League Baseball disabled list," Pfefferkorn said, tapping a small binder, "and team athletic trainers provide tremendous insight into the nature, diagnosis, and prevention of injuries." I asked if they had any figures for which trainers were the 'best' in the game. "We don't keep specific things like that," Eshelman said. "There are preventable injuries, like shoulder injuries, and there are unpreventable injuries, like someone breaking an ankle." Clearly, the Geoff Jenkins injury was fresh in his mind.

The term 'preventable' made my ears prick up. I asked what differentiated a preventable injury from an unpreventable injury. What it amounts to is overuse. An unpreventable injury is pretty clear: "Someone breaks something, or an injury occurs as the result of a collision, no amount of prevention will stop some of those from happening and there's no predicting them," Pfefferkorn said. Rotator cuff injuries are the easiest ones to say are preventable. Almost every rotator cuff tear is the result of either poor mechanics or overuse. When Pfefferkorn was asked whether there is a pattern to injuries among younger and older players, he said: "Younger players are almost by definition more healthy, but the difference is not as much as you'd probably think."

The data back up his statement. While a player under 24 has a 1 in 3 chance to injure his shoulder, a player between 37-44, the oldest group, is almost 1 in 4. A similar principle applies to strains and tears. A younger player is much more likely to experience a tear than an older player, when looked at in a linear manner. However, the older player is more likely to experience strains. The difference in each comparison is about 20 percent. For the other top injuries (fractures, inflammations, sprains and the ubiquitous other), the difference from the youngest to oldest groups is less than two percent in each category. While the data does move linearly, Eshelman has a theory about why the differences are not greater: "The players who play that long tend to be the healthier players anyway. They stay in better shape in order to continue playing at that age."

We continued to talk as we headed to lunch. The 'little diner' turned out to be an excellent restaurant. I'll admit I was shocked to find a four-star restaurant in small-town Indiana, but it should not have surprised me to find that American Specialty also owned the restaurant. "I was born in New Orleans," Eshelman told me, "and this was our club for a while, but about two years ago, we opened it to the public." There were signs all across town for a 'Patriotic Pops' concert on the Fourth of July. No surprise, American Specialty was the sponsor of this as well. During our fabulous lunch, I was asked as many questions as I was asking. It was clear that not only were the two writers very interested in hearing how baseball fans looked at injuries, they were interested in how their data could be better used by baseball. One of the problems of the Redbook, to me, is in fact not a problem at all, but a matter of priority. While the data is broken down clearly, grouping injury by team, lost salary, lost days, and several other categories, there are questions that interest me as a fan and writer that serve no purpose to a risk manager. The other problem is that often, they are working with the same vague and incomplete data that I work with. They have the advantage of a small maroon folder--the actual disabled list. It was only the second time I had seen it and it was a bit different than the other time, though I won't detail how here.

I pointed out that trainers are often a bit defensive about the Redbook, since it can be both a good thing and a bad thing--good if their team is healthy, but used as a lightning rod if a team has a long list of players on the DL. "It is tough," said Pfefferkorn, "but I think they know we just publish the facts. It's pretty easy to tell which trainers like us by looking at which teams have the lowest incidence of injury. If they look good in the book, they like us. The opposite is true as well."

I can hear many of you shuffling in your chairs, wondering which teams came out well and which came out not so well. The fact is that most teams are within range of the average and that the fluctuation, even averaged out over five years, is probably the result of randomness or 'luck.' Only three teams are significantly worse than average to warrant mention--Boston, Anaheim, and Milwaukee. Four teams make it on the opposite sides as the 'healthiest' teams--San Francisco, Minnesota, and both Chicago franchises. Looking at the lists by dollars lost rather than days, it is clear that teams that are younger and cheaper do better. Though Tampa Bay has only been around since 1998, the team has lost nearly a quarter of all salary to the disabled list. While there are many factors that make the Devil Rays a troubled franchise, no team can afford such losses. An upside is that the team recognizes this and has brought in noted physician Dr. James Andrews as medical director. The Devil Rays didn't make significant strides in 2002, but the team will likely turn things around, both by improved medical care and policies and by getting younger as they move from aging veterans to homegrown talent like Carl Crawford and Rocco Baldelli.

Moving back to the offices, Pfefferkorn gave me a quick walkthrough on how the book is organized. There is the executive summary, interviews with Billy Beane, Giants trainer Stan Conte, and White Sox conditioning coach Steve Odgers, and then over 150 pages of data in graphs and tables. There was clearly no way for me to digest all the information available, but there were many things that caught my eye. The clear uptrends in number of disabled players, dollars lost, and days lost were stunning. While some of the increase in days lost could be attributed to increased acceptance for surgical remedies and the increased age of players due to conditioning, the trend goes beyond simple analysis and will be a defining issue for baseball. In an industry that can return pitchers from devastating shoulder injuries, return an All-Star shortstop from elbow surgery in two weeks, and allow a player to break records in his late 30s, the next frontier is injury prediction and prevention.

I was surprised to find that there was no analysis of pitch counts or other factors that are good measures of pitcher abuse. While the writers were familiar with more progressive analysis such as Keith Woolner's Pitcher Abuse Points, the fact is that the data is not made available to American Specialty. Pitchers, according to the data, are likely to be disabled at some point during the season, to undergo surgery, and are likely to cost a team more than players at other positions. After seeing the data, I believe that while teams may try to prevent injury to pitchers and should continue using metrics to try and maintain their staff's effectiveness, the unnatural act that we call pitching will by necessity need an approach outside the orthodoxy of today's baseball. Whether this is a return to the four-man rotation of the past or to Grady Fuson's two-starter paired rotation, the team that comes upon even a slight improvement over current injury patterns will essentially gain the services of an extra pitcher. Since depth is a concern for smaller market teams, these clubs have an even higher incentive to find a better formula and to think outside the box for solutions.

On the position side of the data, even the healthiest teams can expect to lose no fewer than 10 players to the DL at some point during the season. Of this, we can expect half to be pitchers, leaving a likelihood that no more than two or three players will be disabled at any one time. Adding to this expands the need for either depth, positional flexibility on the roster, or both. It also requires an opportunity cost analysis in the move from a starting player to a player who may be only a replacement-level performer, reducing the effectiveness of the entire roster by a factor of several runs.

Other facts that intrigued me included the marked increase in injuries of all types that happened at age group 33-34. A team that kept its players below this age or did not contract players into this age group would hold a distinct advantage over teams that allowed themselves to overmature. It was also quite interesting that players in 'walk years' of their contracts actually tended to be injured more, which controverts orthodox thinking. The trend actually increases when the length of the contract increases, though there are such a small number of contracts over four years that sample size becomes a problem. One particularly outstanding analysis contained in the book states that relief pitchers might be harmed by increased specialization. Specifically, the act of warming up may be causing wear and tear that is often unnoticed. While a pitcher's pitch count may be reasonable, is one also including warm-up pitches or 'high stress' pitches such as those made in pressure situations? A final piece of information that caught my eye was a quick question offered about the effects of nutrition, supplements, and performance-enhancing drugs. Unfortunately, without testing, there is no way to correlate injuries with drug usage, but the idea that a substance as 'harmless' and accepted as creatine may be affecting the health of a team negatively gives great gravity to the subject, from a risk management standpoint.

As I have often said, injury is the hidden frontier of baseball knowledge. Is the key to unlocking the mysteries inside the Redbook? Perhaps. The limitation is not the book's relative inaccessibility but rather the accuracy of reported data and increased analysis of the data it contains. Much of the research that I would do with the data, such as correlating performance to injuries, following the patterns of susceptibility to injuries in players as they move from one organization to another, and in following causation are simply either impossible due to the limitations of the data or of no value to a risk manager.

I ended my trip to American Specialty with hearty handshakes and a knowledge that I had seen the Holy Grail. Perhaps I only got a small sip of the knowledge the Redbook contained, but I knew that by exposing it to a greater base of baseball fans, it increases the likelihood that at some point, baseball injuries will become a transparent statistical class that is as acknowledged as on-base percentage or park factors.

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