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One year ago, Cory Luebke was two weeks post-op, the first and only major-league hurler who had undergone Tommy John surgery in 2014, and the only one, in fact, since Matt Harvey hit the surgeon’s slab in October 2013. Within a month, though—in the space between March 18th and Opening Day—there would be six more big-league arms sliced open: Luke Hochevar, Kris Medlen, Brandon Beachy, Patrick Corbin, Jarrod Parker and Bruce Rondon. After the season began, the bloodbath continued more or less unabated. The spring would claim the ulnar collateral ligaments of, among others, Matt Moore, Jose Fernandez and Martin Perez. The threat had become ubiquitous.

The anniversary of that dam break has coincided with a series of tangentially related, not-quite-converging conversations about pitcher injuries. First, an Orange County Register feature by Pedro Moura explored the Dodgers’ new habit of stockpiling pitchers with serious or lengthy injury histories. The piece delved into the team’s balancing of the risk and reward those pitchers offer, and (in greater depth) into the club’s growing, large-scale commitment to both biomechanical analysis and long-term, data-driven research into injury prevention. Dodgers President Andrew Friedman said, “I would contend that any kind of advantage in injury prevention is significant,” which qualifies as candor for him.

Then, over the weekend, a long discussion of Tommy John surgery took place at the Sloan Sports Analytics Conference. Glenn Fleisig, the second-most famous name in this arena, led that discourse, so it naturally centered on Fleisig’s two most constant talking points: the pressing need for education and protection of youth pitchers, and the value of biomechanics to the future of injury prevention.

It wasn’t in direct response to that panel discussion, but Nate Silver also weighed in on injury prevention as a common good during the Conference, remarking that he would like to see greater open sourcing of injury data, allowing the public punditry (guys like Silver) to address problematic trends and help reverse them.

There are, I think, three fundamental facts that need to be highlighted whenever we talk seriously about preventing pitching injuries. There are also three deeper conversations, each including its own set of facts, but also demanding careful consideration on a more subjective level.

Let’s start with the facts.

Fact No. 1: Teams are never going to release detailed injury data to the public.
Even Nate Silver knows this. He might hope the NHL will stop classifying injuries only by which half of the body is afflicted, but he’s sane and rational, so he knows better than to think we’ll ever get baseline medical data collected preemptively, or specific and granular information about individual injuries. Even if a team took an MRI of every starter’s elbow after every start, they wouldn’t tell us they were doing it, let alone give us any of the results before they had to do so. There are not only competitive disincentives to that sort of disclosure, but legal hurdles to it: technically, each player has the right to refuse to allow his health information to be made public, and even if they give their permission, certain information—anything more than the “minimum necessary” standard spelled out in HIPAA—would still be considered private and protected.

Fact No. 2: Teams would rather win games than spare injuries, and those goals conflict more often than you might think.
Ever since Kerry Wood shredded his UCL 15 years ago, teams have held their pitchers to stricter and stricter pitch limits, and lifted them earlier and earlier in games. Yet pitchers keep getting hurt, and specifically, good, young pitchers keep getting hurt. (Consider that group from last spring.) It would be fair to ask why more teams haven’t experimented more. Surely, some other form of workload modification could effect a greater change in the injury risk each pitcher bears than the simplistic pitch-count approach has done.

There’s a simple reason, though, and it’s a reason that isn’t going anywhere: They backed into a more effective way to use pitchers. As it turns out, having a starter avoid seeing the opposing lineup the third or fourth time prevents runs. Mixing and matching relievers prevents runs. Higher-intensity, shorter outings prevent runs. If the model of pitcher protection the league shaped at the turn of the century had stopped everyone’s arms from hurting, but made everyone worse, that model never would have survived. Instead, the opposite has happened, and it did.

We’re on an evolutionary path toward more pitchers throwing fewer innings apiece. That isn’t going to change, at least until it stops working so damn well. And even beyond the pure performance improvement this new model of pitcher usage has wrought, there’s an economic upside to this way of doing things. Teams are spreading their injury risk among more pitchers. That makes any single injury less costly than it might be otherwise. It also means each individual pitcher, when healthy, has less value to the team. That might sound like a bad thing, but when it gives teams a bat and ball during arbitration, extension and free-agent negotiations, they don’t mind so much.

Fact No. 3: If a solution to the problem of pitcher injuries is ever found, it will be technological, not logistical.
The Internet is so papered with the marketing efforts (both explicit and guerrilla) of 3-D printing companies that it’s hard to find trustworthy literature, but it’s inevitable that some form of synthesized ligament or support structure (like this, for instance) will be available by, say, conservatively, 2035. Technology, not exercise regimens, biomechanics or rest patterns, will revolutionize injury prevention for pitchers.

This is so, in particular, because retraining the body or changing rest schedules has a direct impact on a pitcher’s ability to get batters out. Forget the team side of that equation for a moment. Getting pitchers to buy into those things is hard enough. Not every mechanical adjustment that improves a pitcher’s health outlook also improves his performance. In fact, one of the major recommendations any orthopedist would make to a pitcher is to stop throwing so hard. Modulate effort. Take a little pressure off the muscles and connective tissues that have to stabilize the arm throughout the throwing motion, a motion more violent with each added mile per hour.

Now, teams need innings-eaters, too, and surely some pitchers would understand and pursue the benefits of increased durability, even at the cost of a tick on their fastball or 10 percent of the slider’s sweep. The guys who can both afford to do so and successfully maintain those changes, though, are few and far between. A lot of mechanical problems stem from a lack of foundational strength or understanding, but a lot of others are simply how a pitcher’s body works. Rebuilding a delivery a guy has used since he was 15 is easier said than done.

Of course, every pitcher would stay healthier if he could throw more and pitch less. Six- or seven-man rotations, seven- or eight- or 10-man bullpens, these things could perhaps lower injury rates—there seems to be consensus that fatigue is a primary culprit and every inch of extra rest might help. Both teams and pitchers would fight that kind of innovation, though, because (from the team perspective) there’s a limit on both the depth of the pitching talent pool and the size of the roster, and because (from the player’s perspective), more rest means fewer innings, and fewer innings mean fewer dollars. The mental makeup required to reach MLB doesn’t involve a whole lot of risk-reward analysis. Most pitchers would rather bet on themselves and aim high than accept a limited role in the name of lowering the likelihood of getting hurt.

In short, all medical recommendations get their value from the patient buying into them and following them carefully. When the patients are pitchers, there are a lot of obstacles to that.

This last fact leads me right into one of the cornerstone conversations that need to happen, so let’s walk through those now.

Conversation No. 1: Aesthetics, fair play and the nature of sports
Most of the most likely solutions to the problem of pitcher injuries involve biotechnology, even if only in a fairly liberal use of the word. Before we embrace those new innovations, we should take a moment to consider what implementing them would mean. This goes somewhat beyond pitchers, by the way. Many emerging tech advancements could knock on the door of sports across the country and world in very short order. Players might be able to overcome what have been systematic, unavoidable, painful disadvantages. In so doing, though, they’re likely to end up as something our parents and grandparents would have called cyborgs. Half man, half machine.

The decade-long PED scandal that enveloped the game gave sports fans in the United States an identity crisis. We came out of it with the firm feeling that we want our competitors to be humans, straining the limits of physical achievement, but not artificially surpassing them. If that was true in regard to steroids and amphetamines, it seems to me that it would also hold when the issue is a cloned, synthetic elbow tissue, or a shoulder brace that automates the deceleration of the arm after release.

For what it’s worth, too, solving pitcher injuries—or even decreasing them by 10 or 15 percent—would tilt the already-endangered balance between pitchers and hitters even farther toward the former. It’s not easy to make an analogous change that makes hitters a whole lot more effective, so if pitchers ever do start staying healthy while pitching at their current levels, a new set of problems is going to arise. No one is ever going to score.

Conversation No. 2: Ethics
In the Moura piece on the Dodgers, Conte alludes to a longitudinal study that will get underway this year. Eighty 2014 draftees (volunteers for the study) will have their range of motion checked, their velocity tracked and their upper body subjected to a baseline MRI for each of the next five years. Several MLB teams are involved. Heaven help us if one of them is the Astros.

That’s a glib comment, but the issue is serious. If a pitcher is capable of taking the mound and pitching effectively, from where does his team—or the conductors of this study, or the public—draw a legitimate right to such detailed medical information? Brady Aiken paid a heavy price for agreeing to an MRI before signing with the Astros. The Astros appear to have acted speculatively on information with little or no proven link to increased injury risk. They declared the top pick (and consensus top talent) in the 2014 Draft to be damaged goods, even as he toed a bullpen mound and fired the ball in at a clean 97 mph.

Major League Baseball is an industry unto itself, one that will soon do $10 billion in annual revenue. Its teams are each billion-dollar corporations. It pays its employees a lower percentage of total revenue than either of the other major American pro sports leagues, and it gives especially little to the hundreds of players populating each team’s minor leagues. That those last players, especially ones without the protection of union membership, might be asked (or even given a forum in which to volunteer) to submit to medical imaging without established need seems wrong.

If anything comes of this study, if teams learn what to look for in an MRI right before an arm explodes, they’re going to start wanting as many players as they can get to submit to pre-screenings, of sorts. That’s an ethical nightmare, not least because it seems perfectly realistic. As fast as technology seems to be bringing the promise of improved pitcher health to us, it remains very possible that injury risk will be predictively diagnosable before it becomes fixable. I don’t have to walk you through the problems that would pose for pitchers who pop up red flags. To harken back to the question of what we want from sports: surely, part of the answer is that everyone get a fair shake—that they be allowed to succeed or fail more or less according to their ability. Aiken was but a glimpse into a phenomenon that could be ugly, where teams might refuse that opportunity to players whose futures look grim, no matter how dazzling their present.

Conversation No. 3: How to do this right.
For the time being, despite the counterarguments above, let’s treat injury prevention as a universal good. If we do that—if stopping pitchers from getting hurt is a goal to which we’re ready to commit—there’s a right way to go about it, one that best answers the ethical questions at issue, maintains competitive balance throughout the league and has the highest chance of producing real results. I don’t know exactly what that will look like. (If I did, you wouldn’t be reading any of this. Theo Epstein would be, and I’d be rich as hell.) Here’s an encouraging framework that could lead us in the right direction.

You’re probably familiar with DARPA, although you might know their caricature better than their true nature. They are the Defense Advanced Research Project Agency, and they more or less gave the United States the Internet, GPS and drones. (Two out of three ain’t bad.) In an article in the Harvard Business Review in October 2013, two former directors of the agency detailed its model for fostering innovation. The major tenets, bullet-point style:

· Projects with closed-ended time horizons. There are no blue-ribbon commissions at DARPA. Problems are either solved in the time allotted, or dropped until the next time some problem solver comes up with an idea around which to build a new project.

· Teams of competitively hired, temporary colleagues under a truly exceptional project manager.

· Devotion to ‘Pasteur’s Quadrant,’ wherein research takes an active interest both in understanding the true nature of the subject and in applying new knowledge to a real-world problem.

· Independence.

It would be easy to find the engineering and scientific talent necessary to make the innovations needed to radically change pitcher injury rates for the better. The task at hand is sufficiently complex as to attract brilliant minds, but not so daunting or obscure as to bore them. It’s almost certain, given the ground left to cover, that a deeper understanding of the throwing motion and its various dangers would grow out of the research done in search of the solution. The only difficult element to maintain, in baseball, would be independence, but a well-led team reporting directly to Rob Manfred should be able to work as freely as necessary. If teams can accept that the future is in a collective solution engineered by science, and not in individual experimentation or manipulation, then the problem of pitchers getting hurt so tragically often might not be long for this world.

Thank you for reading

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This was awesome, Trueblood. I hope we see many more of your articles here, along with cyborg pitchers.
I'm having Super Baseball 2020 flashbacks
Brilliant work. Thank you.
Outstanding job tying together the biggest issues in this area. There are a lot of moving parts here, and I really hope that teams respect the medical privacy of minor leaguers. Great, thought provoking read, and I hope we see more on these topics.
How about 3-d printing me some new knees in vitro?
"No one is ever going to score" 1) Lower the mound and/or 2) Shrink the strike zone and/or 3) Bring in the fences Not a hard problem to solve.
I keep thinking back to Mike Marshall (the relief pitcher one with the degree in kinesiology, not the other one)and what he was uniquely able to do. Yet no teams wanted to hire him to teach his methods. Maybe he was onto something low-tech that worked.
The internet: brought to you by DARPA and Professor Kleinrock from UCLA. Go Bruins!
Nice work. Regarding this: "Mixing and matching relievers prevents runs. Higher-intensity, shorter outings prevent runs"... Why hasn't a team tried maxing out every pitcher to three innings? Hire 10 long relievers, 1 setup man, 1 closer, and treat every inning like a relief inning? Arms aren't made any better for 100 pitches every five or six days than they are for 40-50 pitches every two to three days, so why not try it? Greater matchup flexibility. Teams try it all the time in my replay league. Sometimes it works.
Didn't the rockies try this a while back and we're laughed at for it?
3/06 Because Tony La Russa's starting pitchers have been unable to get past the middle innings consistently this season, he has refused to let them try anymore. The Oakland Athletics manager last night unveiled a platoon system for his starting rotation that he and pitching coach Dave Duncan have been sitting on since they first discussed it 11 years ago while with the Chicago White Sox. La Russa, who has 13 pitchers on his active roster, scrapped the traditional five-man rotation for a nine-man rotation divided into three-man platoons. Todd Van Poppel, Ron Darling and Kelly Downs are in the first group; Mike Mohler, Bobby Witt and John Briscoe in the second; and Bob Welch, Shawn Hillegas and Rich Gossage in the third. Dennis Eckersley remains the closer in a four-man bullpen. Limiting each pitcher in the platoon to between 40 and 60 pitches, the system allows La Russa to send out each group on two days rest.
I would add that starting pitchers are going to have a harder time buying into this kind of platoon because no one wants to be in a situation where they can get all of the blame (a loss) but none of the credit (a win) if they can only go a max of three innings.
Why are we so sure that there is a solution to this problem?
Fantastic article. The ethical concerns are fascinating.
I'm glad you bring up the ethical (and I might even say moral) considerations, particularly as they relate to bargaining power. One question, though, as to one tiny aspect: would eliminating (or, more realistically, discounting) players due to medical imaging really be an attack on the meritocracy of baseball? Might it be more properly viewed as a path toward a full accounting of present + likely future merit, where teams gain more and more ability gauge the future? And in particular, for every player who's discounted, someone else is bumped up to take his place -- sucks for Brady Aiken and the 2050 version of Brady Aiken, but if someone else is paid the money and given the opportunity, does this actually raise any ethical problems?
This was a great read.
In response to Conversation #3 - Texas Baseball Ranch! This group of pioneers are rolling up their collective sleeves and doing wonderful things. Do they have all the answers? No. Are they headed down the right path? Yes, I believe so. Invest in a session at the camp and see for yourself. Wolforth and his very impressive cadre of coaches approach pitching from a holistic tact that will blow your doors off. More importantly, I believe their methods will create healthy arms at all levels in baseball.