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If you haven't heard the news, New York Mets wunderkind Matt Harvey has been diagnosed as having a partially torn ulnar collateral ligament. Harvey has said that he wants to avoid surgery if possible, but this sort of thing usually ends up with a visit to Dr. Tommy John for James Andrews surgery. As per usual, everyone on Twitter remembered their extensive medical training and pitching mechanics expertise and did the most productive thing that they could: lay blame for Harvey's unfortunate circumstances at the feet of his pitching coach, his manager, his conditioning, his conditioner (the hair kind), his genetic makeup and, of course, dumb luck.

Any time a team loses a young pitcher like Harvey for an extended period of time, there's an inevitable period of mourning and second-guessing as to what could have been different. Even for fans of other teams than the Mets, it's sad to see a bright star like Matt Harvey go down. Is there something that could have been done?

Warning! Gory Mathematical Details Ahead!
A few months ago, I did a study on what really predicted whether pitchers would sustain an injury, based on markers from the previous year (or two). Using a database of injuries that we maintain here at BP, I was able to locate all pitchers who had Tommy John surgery from 2002-2012 and check what risk factors would be obvious at the beginning of the year. In the original study, I found that elbow injuries (of any sort) were most closely associated with a previous elbow injury, as well as with a low home run rate and the raw number of pitches thrown the year before.

When I ran a similar regression (for the initiated, a stepwise binary logit) predicting who would end up having Tommy John in the next year, I got something similar. The best predictor was the presence of a previous elbow injury. The second was a high groundball rate in the previous year. The raw number of pitches did not enter in as a predictor. There was also no effect for walk rate, strikeout rate, or any of the other performance-based metrics. Harvey does have an above-average grounder rate, but according to our database, he had no previous significant elbow injury to speak of.

I also looked at whether there were certain "abusive" pitch counts that predicted a greater chance of undergoing Tommy John surgery (using the same Cox Regression methodology as in this article). In general, I found that there weren't really any effects of note until a pitcher crossed the 115-pitch mark in his start. When I looked at elbow injuries more generally, there was a red line at 120 pitches in an outing before effects started to appear. There were also effects for previous elbow injuries and age, with younger pitchers slightly (but significantly) more likely to get hurt. Matt Harvey did have games this year in which he threw 121 pitches (April 29th), 116 pitches (May 22nd), 116 pitches (June 18th), and 121 pitches (July 8th). There's a 114 in there from May 28th as well.

In the original article, I also pointed out that the results from the regressions that I've run are based on pitchers whom managers and pitching coaches believed could handle that level of workload. Again, we assume that managers and pitching coaches are smart enough to introduce bias into the sample (i.e., they have an idea who can and who can't do that). But even knowing that these guys are considered durable enough to handle it, we still see some pretty awful effects for injury once you get up to 115-120 pitches in an outing. The marginal risk added by extending Harvey past 110 pitches in the four highest pitch count games above (that is, the extra risk incurred from going from 110 to 116 pitches) was worth about half of the risk of a previous history of an elbow injury. For those 34 extra pitches, they pushed Matt Harvey's risk halfway to the worst risk factor there is.

These analyses are blind to issues like pitching mechanics, and the injury dataset we use does not include unreported injuries, so there could be biases in the study that we can't fully account for. I am very happy to hear other arguments that those factors may significantly moderate my findings, but as of right now, I think we need to have a small conversation. Those 34 extra pitches that Matt Harvey threw probably bought the Mets two or three extra innings on those days that he pitched, but purchased it with an increased risk of injury to Harvey.

We need to talk about whether the increased risk of losing Harvey for a year (or even for two weeks) was worth it. It's piling on to pin the fact that Harvey will miss a year on the Mets, but it's also not right to excuse them completely. They took a risk and got burned.

You could try to make the case that those were three absolutely vital innings, or that the buzz that surrounded Harvey was worth more to the team than his 2014 season (because the Mets won't win the World Series this year, and it's not likely next year either). You could make the case that even if they hadn't pushed Harvey, there's always the underlying risk that a pitcher will get hurt. You could make the case that the risk of injury and the lost productivity that might follow is actually worth it. What I think isn't fully understood is that while pushing a starter to high pitch counts is not an automatic injury sentence, it is an increased risk. Like teenagers saying "It'll never happen to me!" or investors screaming "But this market is different!", it's easy to pooh-pooh that risk, but it seems that the risk added is generally believed to be much lower than it really is.

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ethanwitte
8/27
Kind of off the subject, but this makes me think that what the Marlins have done this year with Fernandez has been genius. He's a talent that has proven the minors wouldn't not have been beneficial, yet they have managed his workload wonderfully. I researched his Pitcher Abuse Points, and with a 100 IP minimum, Fernandez ranks 109 out of 124 pitchers in PAP. Mike Redmond should finish top 5 in manager of the year for that stat alone
dethwurm
8/27
Great! It kind of squares with the old PAP stuff, which put the point of increasing risk at 120 pitches if I recall correctly. Though I know that approach was largely abandoned... Based on the previous article, if the extra pitches increased risk by half that of a previous elbow injury, that's about 14%? Also, do you have a number for his previous risk %, so you could say if his risk went from like 0% to 14%, or 50% to 64%, or something?
Behemoth
8/27
It seems counter-intuitive that the 34 pitches that you mention have a substantial impact on Harvey's likelihood of injury. In the past, many pitchers regularly threw those sort of numbers of pitchers, and, if your suggestion is correct, we'd surely anticipate an epidemic of TJ surgeries. The other thing that is surely important is the number and velocity of warmup pitches that are thrown both before a start and between innings. If we don't have that info, it seems hard to say much that's meaningful here - say Harvey throws fewer warmup pitches than average - could he then not go a little deeper than normal?
LlarryA
8/27
Past findings (Will Carroll and others) have been that warmup pitches generally don't matter. The statements were that almost all warmup pitches are at less than 75% effort, and that was the level below which it didn't have any effect. I can't speak for how valid or rigorous those conclusions are. If Harvey warms up 'extra hard', though, then we maybe have something to say about his coaching...
LlarryA
8/27
Oh, and as to The Past, pitchers used to get more of a breather at the bottom of the lineup. A bad hitter (Yu-ni-es-ky...) today is still a lot more dangerous than 4+ decades ago. I think there was also a much greater effect of billions of youth pitches building up the strength of those who would survive to make the majors, while anyone whose arm wasn't up to it got weeded out quietly (if painfully) along the way.
Behemoth
8/28
I think that throwing more than 120 pitches on a reasonably regular basis continued much later than 4 decades ago. I'm also not sure that facing inferior hitters makes much of a difference. It's not like NL pitchers only throw at 85 when the opposing pitcher is up. I think there is a legitimate point that pitchers now throw harder than at any point in the past, and that this potentially has an impact, but I suspect that the truth is more complex than just throwing the 116th pitch once vastly increases the risk of needing TJ.
aaronbailey52
8/28
At some point you have to figure the body fatigues and you start using muscles differently. Bumming around in the weight room I've learned that one false move when tired can leave my back angry for days. Logical to contend that at some point the will to continue passes the body's ability to continue IN SAFE FORM. Results may not be measurably different, but the process ends up wrecking the arm.
Behemoth
8/28
I'm not really disputing that. I'm just unconvinced that the point that this occurs for all pitchers is 116 pitches (ignoring the length of innings, weather conditions, quality of opposition and other relevant factors).
dethwurm
8/28
I don't think anyone claims that it's a magic number for all pitchers, but on average there it is. Absent other info, it's the point where you start to raise an eyebrow. But if you know it's Pedro Martinez or CC Sabathia or something, adjust expectations accordingly.
aaronbailey52
8/29
Like the 4 minute mile or 10 second 100-yard dash, perhaps 115 pitches is just plain pushing the limits of human endurance. I doubt it's been tried, but what if we took 100 guys and had them throw 125 pitches in a simulated game setting. Every 15 pitches, the subject would receive an MRI or FMRI or whatever on his arm. This assumes the medical testing wouldn't take much longer than an average half-inning. Now I know what valuable knowledge I can leave as my legacy after I win the lottery.
kenraty
8/28
MLB had a report yesterday that revealed several really high pitch counts for Harvey while he was in college. Surely this could have contributed to putting him at higher risk, yes?
smitty99
8/28
Yes. I think pitcher do the damage when they are young. Little league pitchers are pitching multiple games a week. High school heroes are throwing 150 pitch games to win the big game. College pitchers throw high pitch games. I believe this has much more of an effect than five extra pitches in a big league game. Another more important factor may be a long inning. Throwing a 35 pitch inning, for example, may be worse than a 120 pitch total game. I have read a bunch of studies that concluded that Pitcher Abuse Points pretty much just gives you who has the most pitcher abuse points. It's not very reliable at all.
koopbri
8/29
Why do you run that ridiculous, condescending "Gory Mathematical Details" comment in every column, even when there are none beyond the reach of the average high school student?
koopbri
8/29
Let me apologize for that last comment. I was having a bad day.