Earlier this week, rising star Matt Moore was diagnosed with a partially torn ulnar collateral ligament in his left pitching elbow. This is simultaneously shocking and all too familiar.
It’s shocking because Moore pitches for the Tampa Bay Rays, who until recently had enjoyed the best pitching health in baseball. From late 2005 to mid-2009, only one pitcher at any level of the organization, left-hander Jake McGee, went under the knife for Tommy John surgery, the lowest rate of reconstructive UCL surgery for any team. From May 2008 to August 2010, only one Rays starter at the big league level, Scott Kazmir, spent a single day on the disabled list, making Tampa Bay’s pitching staff the healthiest in baseball by a mile. (Both nuggets via The Extra 2%).
It’s familiar because Moore’s injury means he might need Tommy John surgery. Moore and the Rays are still debating whether rehab or surgery is the best option, but if the 24-year-old goes under the knife, he’ll become the latest in a running tally that’s on pace to shatter the record for the most Tommy John surgeries in a season.
According to research conducted by The Hardball Times and Beyond the Box Score writer Jon Roegele, eight pitchers at either the major league or minor level had undergone Tommy John by this date last year. The highest annual total in Roegele’s dataset came in 2012, when 58 pitchers had the operation; that year, 12 pitchers had undergone the surgery by this date.
When top Pirates pitching prospect Jameson Taillon had Tommy John surgery on Wednesday, he became the 20th pitcher to suffer that fate in 2014. And that number is growing. Surgery is likely for Moore, but even if he opts against it, the ranks will swell when Braves reliever Cory Gearrin and Angels prospect Brian Moran have the procedure in the coming days. The 2014 season is on pace to annihilate the previous record for Tommy John surgeries in a calendar year.
What the hell is going on? How did so many (mostly young) pitchers get so badly hurt that they had to agree to a surgery that will prevent them from pitching for a year or more? And what can teams and players do to prevent this from continuing, or from worsening?
When trying to pinpoint the cause of a medical epidemic in sports, asking Dr. James Andrews is the best place to start. The renowned orthopedic surgeon/ligament whisperer has performed countless operations on injured pitchers, football players, basketball players, and even pro wrestlers and is considered the foremost expert on elbow repair. In an interview with SiriusXM Radio’s Mike Ferrin and Jim Duquette, the good doctor offered his read on the disturbing trend.
“The big risk factor is year-round baseball,” Andrews said. “These kids are not just throwing year-round, they’re competing year-round, and they don’t have any time for recovery. And of course the showcases where they’re pitching for scouts, they try to overpitch, and they get hurt.”
That sentiment popped up again and again when I polled an array of talent evaluators, including general managers, assistant general managers, analytical front-office types, and others. Many pointed an accusatory finger at teenage pitchers getting the chance to perform in front of scouts in a way that wasn’t as prevalent in the pre-showcase era, and pitching in a way that might lead to injuries as a result.
“The rise of Perfect Game baseball and other summer travel baseball has dramatically decreased the off time for younger players,” one American League executive said. “Kids are traveling all over the country from 8 years old on, and playing year-round. Colleges are recruiting younger and younger, and kids feel like if they don’t compete in every summer or fall event, they will lose their chance for exposure. That kind of exposure also leads to kids absolutely airing it out at max effort. When the section behind the plate is loaded with recruiters and scouts, kids absolutely take it up a notch and try to throw it through the backstop. The damage that is being done early can’t be undone by managing workloads once pitchers get into pro baseball.”
Kiley McDaniel, the scouting-oriented national baseball analyst for Scout.com, agreed. “This originated in the Dominican. In the DR, once you’re 17, you’re ‘old’ and don’t have as many opportunities to get rich or even sign at all, so the system is geared for both hitters and pitchers to peak as quickly as possible in terms of tools, with velocity being the biggest one for pitchers. Now that high school pitchers can get $5 million to $7 million and are scouted year-round from underclassmen ages, a first-world country has the right pressures in place to foster the same environment.”
Some observers have grown skeptical of the strength training methods pitchers use, particularly teenage pitchers.
“It used to be that we didn’t see these injuries until they got into high-level professional baseball,” Dr. Andrews said. “But now, the majority of the injuries are either freshmen in college, or even some young kid in ninth, 10th, 11th, 12th grade in high school. These young kids are developing their bodies so quickly, and their ligament … isn’t strong enough to keep up with their body, and they’re tearing it.”
Dan Jennings got his first job in Major League Baseball as a scout with the Cincinnati Reds in 1986, then went on to become one of the game’s top talent evaluators over the next 28 years. He yearns for a time when young, developing athletes used methods other than maximum-weight bench presses and dead lifts to build strength.
“Back in the day, you’d be pitching melons in a field, doing things with your hands — that’s how you built strength, from your elbows to your fingertips,” Jennings said. “Because of the new strength and conditioning programs, that’s been taken out. By the 10th grade, you’re told to focus only on football, or only on baseball; kids no longer play multiple sports. You get these specialized regimens where you build large muscle groups, but not the small muscles around the rotator and UCL. The large muscles get developed so large that when you try to decelerate, you can get badly hurt.”
Starting two years ago, Roegele wrote a series of articles seeking to solve the mystery of the rising Tommy John trend. Jeff Zimmerman and Brian Cartwright teamed up to produce another insightful Tommy John study in the 2013 Hardball Times Baseball Annual. You should read them all, since there’s a ton of excellent research in there, but if you want a CliffsNotes version, it’s this: Roegele found that “after controlling for pitching role and age, pitchers headed for Tommy John surgery threw all pitch types harder, and more fastballs and sliders than average.”
One National League executive echoed those findings. “Kids are throwing harder every year,” he said. “The 2014 draft class is almost historic in terms of power arms, and that speaks more to a change in culture away from pitchability and finesse and toward the biggest power stuff possible to light up radar guns and blow guys away. The harder you throw, the more torque you put on your elbow, the more likely you are to break down and get injured — and it’s happening at historic rates and happening to some of the best power pitchers in the game.”
The problem here is obvious: Teams aren’t going to stop coveting big, strong guys who throw hard. And even if they ignore the weight-training fiends who turn themselves into muscle-bound lunkheads, they’ll still want flamethrowers, which means they’ll still get burned.
“There are several factors that lead to increased velocity,” one AL baseball operations official said. “I think what has happened is that, due to improved training and instruction, pitchers throw harder. Joints and related connective tissue are put under greater stress from the increased velocity. Many claim that they can reduce injury with ‘their program.’ There is no evidence to support those claims. I am afraid, in fact, that many of these programs — several of which are well designed — actually increase injuries. The conundrum is that they also improve performance.”
Though these common themes dominated most of the conversations I had regarding injuries and the surging rate of Tommy John surgeries, several respondents weighed in with their own theories. One AL executive said he and others in his front office have kicked around various ideas lately without coming across an aha moment.
“Are pitchers rushing back from injuries?” he said. “Either rushing back from Tommy John or other injuries, as opposed to waiting it out longer? TJ used to be a set time period that you were down for. Now is there too much of a rush to get back earlier, to help for half a season or to start a season, instead of sitting it out long enough?”
Even when pitchers do take the requisite time to heal and rehab, a recent rash of second Tommy John surgeries (most notably for Oakland’s Jarrod Parker) has exacerbated industry concern.
“We are coming into an era where a lot more pitchers have had TJ in high school, college, or their early professional career over the past decade,” another respondent said. “TJs are not good forever, and we are getting to the point where many pitchers had their first surgery somewhere between five and 10 years ago. We have also gotten a lot better at rehabbing surgeries the first time, to the point where guys are able to return to the mound as something very similar to what they were before. The more successful first surgeries we have, the more second surgeries we are going to have.”
One quantitatively leaning NL front-office member noted that advances in medical imaging have likely contributed to increased Tommy John rates.
“Assessing UCL integrity is very difficult, but it’s easier than ever to identify partial tears that might lead a player to elect surgery rather than go the rehab route,” he said. “So as more young pitchers identify UCL issues and elect for surgery, we’ll probably see more and more second- or third-time TJs in the future.”
Like many other teams, that executive’s club conducts copious studies on everything from body type to biomechanics in order to spot trends that might prevent injuries. But he’s not saying what his team has found. And for all its efforts, that club has still dealt with plenty of pitcher surgeries over the past few years.
Unfortunately, limiting pitch counts and/or adhering to the so-called Verducci Effect — which Baseball Prospectus writer Russell Carleton debunked last year — doesn’t guarantee a healthy outcome. Kris Medlen and Brandon Beachy, the two talented Braves starters who underwent their second Tommy John surgeries this spring and thrust Atlanta’s season into doubt, had relatively few miles on their arms before cracking the majors. They were both converted infielders, as was their teammate Gearrin.
The Pirates, who’ve become known lately as one of the most analytically inclined, detail-oriented organizations in the game, obsess over the tiniest details of a young pitcher’s routine in an effort to keep their prospects healthy. They put the best ones through biomechanical testing to promote ideal pitching mechanics, and they’ve gone much further than that.
“Every two weeks we get a weight check,” said 22-year-old right-hander and 2010 fourth-round pick Nick Kingham in an interview with Pittsburgh Tribune-Review writer Travis Sawchik. Weight checks are just the beginning, Kingham said. “We track our sleep, our water intake, our hydration and everything. Every day you have to do it. We have a point system, and you try to get as many points as you can. We are pretty heavy on health in this organization.”
Sawchik’s story was a well-researched, broad piece that touted the Pirates’ armada of top pitching prospects. A month and a day later, Taillon had his surgery. Maybe we shouldn’t have been surprised, given the omen MLB GM turned MLB Network analyst John Hart dropped in the last paragraph: “Remember the Mets with the Big Three? With (Paul) Wilson and (Bill) Pulsipher and (Jason) Isringhausen, that whole group? Some years, some development systems, it works out better. For some others, it doesn’t work out at all.” Cite the infamous, massively touted, and ultimately failed “Generation K” and the baseball gods might not react kindly.
And really, despite all of this theorizing, the baseball gods might be the ones to blame. Maybe luck, or random variance, or whatever you want to call “shit happens” is the reason for all of this. Though we’re seeing more Tommy John surgeries than ever before, it’s usually a bad idea to make sweeping judgments at the moment when conditions are the most chaotic; we simply don’t know what the numbers will look like a year from now, five years from now, or 10 years from now.
“I think, as human beings, we look for causal relationships, but that doesn’t mean one exists,” one stumped scout said. “It really could be heads coming up 12 times in a row. Completely meaningless.”