CSS Button No Image Css3Menu.com

Baseball Prospectus home
  
  
Click here to log in Click here for forgotten password Click here to subscribe

<< Previous Article
Premium Article What Scouts Are Saying... (05/30)
<< Previous Column
Premium Article Baseball Therapy: The ... (05/27)
Next Column >>
Premium Article Baseball Therapy: Intr... (06/03)
Next Article >>
Premium Article Scouting the Draft: 20... (05/30)

May 30, 2014

Baseball Therapy

The Hard Part About Preventing Tommy John Surgeries

by Russell A. Carleton


On Wednesday, we had a news story involving Drs. James Andrews and Glenn Fleisig and Tommy John surgery. Normally when that’s the case, it means that someone’s season is over (and sadly, that’s been happening a lot lately). But this time, it was the good doctors responding to what they termed an “epidemic” of ulnar collateral ligament transplants (the actual name for Tommy John surgery) and offering some helpful tips to prevent the elbow injuries that require the procedure.

I have absolutely no expertise in orthopedics, but I’ll trust that these guys know what they’re talking about. Their recommendations ranged from the obvious (exercise, rest, and nutrition are vital to a pitcher’s health) to the more earth-shaking (think twice about winter league baseball—can you do a winter league without pitchers?). To my untrained eye, the recommendations all make sense if the goal is to prevent UCL tears. Now, if all teams and pitchers would simply follow their recommendations…

Oh, if only making people healthier were that easy! We’d have a country filled people who had healthy weights, were non-smoking, were moderate drinkers, and about 50 other things.

So here comes the tough part. How on earth will we get pitchers to follow these rules? When reading through the steps that Drs. Andrews and Fleisig recommend, my first thought was about how many of these rules are broken on a regular basis. Not only that, but how many of them would be a hard sell to the actual players involved. Some of them would be easy enough—optimizing pitching mechanics is something that all pitchers want to do anyway. But I about spat out my drink when I read this:

“2. Do not always pitch with 100% effort.”

Well now, aren’t we contradicting just about every cultural message that a given pitcher has ever heard. Yes, he might have heard this advice from his pitching coach in the past, but we still live in a “Rah rah, give 110 percent all the time” culture. Consider the following: There’s a small fascination that people have with the idea that closers do not seem to pitch well in non-save situations. For example, sometimes a closer hasn’t pitched in five days and just needs an inning of work. Despite the fact that his team is actually down 7-1, he comes into the ninth. And he gives up two extra runs, not that it matters. I’m going to out on a limb and suggest that sometimes, that’s a pitcher not going 100 percent. He doesn’t need to, so why should he? Yet, when he’s asked about it after the game, it would be borderline heresy for him to say, “Yeah, I was just out there to get my work in. I wasn’t throwing everything 100 percent. Just trying not to get hurt.”

The rest of this article is restricted to Baseball Prospectus Subscribers.

Not a subscriber?

Click here for more information on Baseball Prospectus subscriptions or use the buttons to the right to subscribe and get access to the best baseball content on the web.


Cancel anytime.


That's a 33% savings over the monthly price!


That's a 33% savings over the monthly price!

Already a subscriber? Click here and use the blue login bar to log in.

16 comments have been left for this article. (Click to hide comments)

BP Comment Quick Links

mdlockhart

I heard a panel discussion on MLB network recently about pitching. The baseball guys said there are good examples (Maddux) of people who learned that throwing as hard as you can is not necessarily the most effective way to pitch. Slowing down may produce more movement and therefore be more effective. We saw it in golf when Tiger Woods took something off his drive to stay in the fairway. Harder is not always more effective.

May 30, 2014 09:14 AM
rating: 3
 
50cubs

This culture used to exist. It existed for most of baseball history. When I was growing up in the fifties, pitchers were supposed to "learn how to pitch", which meant, among other things, "pacing yourself". You weren't supposed to throw hard all the time, but save your best pitches for high-stress situations, which were then called "jams". If you threw hard all the time, you wouldn't be able to finish the game, and pitchers were trained to finish the game.

Justin Verlander is a modern hard thrower who pitches this way. He saves his best stuff for late in the game.

May 30, 2014 12:39 PM
rating: 3
 
Plucky

How much would it cost an ML team to simply implement a policy that every pitcher on the roster (perhaps extending down to AAA or AA) gets an MRI every other month, no matter what? That obviously could never be a solution at college or amateur levels, but for an ML team it could catch problems where a player is trying to hide an injury. Knowing the MRI is coming anyway might get players to be more frank with health staff

May 30, 2014 12:40 PM
rating: 1
 
BP staff member Ben Lindbergh
BP staff

We talked about something like that on this episode of Effectively Wild.

May 30, 2014 12:50 PM
 
David Jackson

It'd be cost effective (hell, MLB teams should OWN their own MRI machines) but the union would take serious offense at anything that took players who "feel great" off the field and reduced paydays.

May 30, 2014 12:53 PM
rating: 0
 
Plucky

I seriously doubt union opposition would be a serious hurdle. We're talking about teams trying to fork over a decent chunk of money in the interests of player health. If the union is concerned teams will manipulate the results to stiff players, I doubt the owners would object to giving players the right to take the MRI results and get 2nd/3rd opinions, and then give them a grievance procedure if they object to being placed on the DL

May 30, 2014 13:30 PM
rating: 1
 
therealn0d

Yep, you can pick one up at Home Depot for cheap...o wait

May 30, 2014 14:11 PM
rating: -1
 
David Jackson

$250-$500K.

May 30, 2014 16:12 PM
rating: 0
 
BP staff member Russell A. Carleton
BP staff

I just googled "cost of MRI" and it turns out that no one really knows. Just grabbing a number, $2000 per MRI, which seems to be at least realistic, times 6 months times say 50 pitchers in the system is $600k. Teams could probably get a punch card where they get a free one with every 5 they buy deal and knock some of that cost off, so let's say that it's somewhere in the low-to-mid 6 digit range. That's the right order of magnitude.

Now, for that to make sense, you'd have to make the case that the MRIs would give additional information that would save the team more than 600k (or whatever) in lost production. Would constant MRIs mean that they could intervene to actually prevent an injury or would it just document the inevitable decline into a shoulder or elbow injury? I don't have the expertise to comment on that one.

Also, there's the side effect that no one enjoys an MRI... and if signing with this team means I have to do 6 of them a year... I'm going over to that other team.

May 30, 2014 13:45 PM
 
therealn0d

You're overlooking the fact that MRI machines get scheduled use. There are very likely people that really very much need an MRI while a baseball player, you know, could wait. "This guy might be dying" vs "This guy might need to rest his arm."

May 30, 2014 14:09 PM
rating: 0
 
David Jackson

Buying the mobile MRI trailer they stick onto the back of hospitals is only $250-$500K. Forever (not counting an MRI tech).

I just can't see a "routine" MRI dinging someone who swears up and down their healthy being an acceptable outcome for the union. Though honestly I don't know what a "physical" entails for "signed pending a physical"

Wasn't there a pitcher who just outright didn't have an UCL? Born without it?

May 30, 2014 16:16 PM
rating: 2
 
David Jackson

(can't believe I typed "their" just... just ignore me.)

May 30, 2014 16:46 PM
rating: 2
 
NoHRTyner

I believe you are referring to R.A.Dickey.

May 30, 2014 21:00 PM
rating: 1
 
thegeneral13

It's an interesting idea, but I see a few issues. First, MRIs are going to give a lot of false positives. MLB pitchers are all going to have abnormalities in their arms, even when they are healthy. It's probably going to be difficult to separate normal wear and tear from the early signs of something more serious, and by the time something more serious is visible the injury has already occurred. Second, if you do see something abnormal that won't heal on its own (bone spurs, etc.), do you surgically repair them even if the pitcher says he feels fine? That's sort of in violation of the Hippocratic Oath. Third, MRIs can also miss a lot of things, particularly in shoulders. In many cases arthrograms are used for shoulders to help see better, but you can't do these regularly because they involve injecting fluid into the joint and you can't resume throwing until that fluid has dissipated. And even arthrograms miss enough things in shoulders that surgeons sometimes just skip them and do exploratory arthroscopy if they think there is a problem.

In short, I think the false positives and false negatives are so prevalent with currently available technology that the most useful indicator is ultimately how the pitcher feels. Hopefully technology will improve or the research into variance in velocity, release points, etc. will bear fruit so injuries can be prevented without telling pitchers not to throw 100%!

May 30, 2014 15:23 PM
rating: 2
 
SlackerGeorge

The other value of MRI in healthy individuals is developing baselines, such that abnormal results can be more easily diagnosed. These baselines in NFL players should help them learn more about brain injuries. Baseball should use whatever tools it can that make financial sense in order to better manage injuries. Not only to improve performance and extend careers, but to also help players avoid chronic pain and disability post-career.

May 30, 2014 18:03 PM
rating: 1
 
Pat Folz

Aren't there injury risks associated with NOT giving 100%? Changing mechanics and whatnot.

May 31, 2014 15:41 PM
rating: 0
 
You must be a Premium subscriber to post a comment.
Not a subscriber? Sign up today!
<< Previous Article
Premium Article What Scouts Are Saying... (05/30)
<< Previous Column
Premium Article Baseball Therapy: The ... (05/27)
Next Column >>
Premium Article Baseball Therapy: Intr... (06/03)
Next Article >>
Premium Article Scouting the Draft: 20... (05/30)

RECENTLY AT BASEBALL PROSPECTUS
Fantasy Rounders: The Young and the Splitles...
Premium Article Minor League Update: Games of Thursday, May ...
Premium Article What You Need to Know: Bummed!
Premium Article The Prospectus Hit List: Friday, May 22
West Coast By Us: Day 1: In The Land Where E...
Premium Article Rubbing Mud: The Quarter-Season Odds Report
Going Yard: The Near Perfection of Pederson

MORE FROM MAY 30, 2014
Premium Article Perfect Game Presents: 2014 MLB Draft Rankin...
This is Not Your Father's Baseball Road Trip...
Premium Article What You Need to Know: Reversals of Fortune
Premium Article Minor League Update: Games of Thursday, May ...
Fantasy Article Fantasy Starting Pitcher Planner: Week 10
Fantasy Article Free Agent Watch: Week Nine
Daily League Strategy: Kluber Club

MORE BY RUSSELL A. CARLETON
2014-06-13 - Baseball Therapy: What You Can Do With Your ...
2014-06-10 - Premium Article Baseball Therapy: Can Draft Lightning Be Bot...
2014-06-03 - Premium Article Baseball Therapy: Introducing My Daughter to...
2014-05-30 - Premium Article Baseball Therapy: The Hard Part About Preven...
2014-05-27 - Premium Article Baseball Therapy: The Annual Amateur Draft G...
2014-05-20 - Premium Article Baseball Therapy: Beware the Genius Tag for ...
2014-05-13 - Baseball Therapy: Analytical Master or Leade...
More...

MORE BASEBALL THERAPY
2014-06-13 - Baseball Therapy: What You Can Do With Your ...
2014-06-10 - Premium Article Baseball Therapy: Can Draft Lightning Be Bot...
2014-06-03 - Premium Article Baseball Therapy: Introducing My Daughter to...
2014-05-30 - Premium Article Baseball Therapy: The Hard Part About Preven...
2014-05-27 - Premium Article Baseball Therapy: The Annual Amateur Draft G...
2014-05-20 - Premium Article Baseball Therapy: Beware the Genius Tag for ...
2014-05-13 - Baseball Therapy: Analytical Master or Leade...
More...

INCOMING ARTICLE LINKS
2014-07-01 - Premium Article Baseball Therapy: Do Some Pitches Do More Da...
2014-06-17 - Baseball Therapy: What High School Has to Do...