This is why we don’t have nice elbows

Some things dumbfound me. Okay, many things do, but in particular this did when I read it:

“Despite the recognized risk of pitch type and amount of pitches, nearly a third of those we surveyed did not believe pitch counts were a risk factor for injury. Even more disturbing was that fact that a quarter of players and coaches thought that a pitcher’s performance could be enhanced by having a Tommy John surgery,” said lead author of the study, Christopher S. Ahmad, MD of Columbia University’s, Center for Shoulder, Elbow and Sports Medicine.

This must be the direct result of a decreased emphasis on health and science education. Has to be! How can anybody, seriously, think that Tommy John surgery would improve a pitcher’s performance, unless the pitcher is injured! Was a two-by-four used to in educating these people about the human body? I cannot see how they can think, “If you take a tendon from another part of a person’s body, tie his elbow back together with it, and let the tendon start to work as the ligament it replaced during months of rehab, this will make you better!

Football has a major problem with concussions, not just in the NFL but from the peewee leagues up. Baseball has a problem with pitching injuries, once again from the little leagues on up. Both sports need to step up their efforts to help, literally, the little people. MLB is not doing a good job, based on the above report.

First MLB needs to explain, very loudly:

“The reason a pitcher feels stronger after Tommy John surgery is because he was injured! The surgery gets him back close to normal, but does not get him all the way back!”

Second, MLB needs to explain that it very specifically limits innings and pitch counts for young pitchers. Young players shouldn’t put up large pitch counts and innings in the minors or majors. (Carl Pavano is an example of what can happen. He was abused in the minors, which helped cause his injury times in the bigs).

Major league teams, to varying degrees, have learned that improperly throwing pitches can cause injuries. This is why they slowly introduce new pitches to younger arms. MLB needs to make sure that coaches of younger players understand this.

Major League Baseball needs to explain that pitch counts, even if you don’t like them, are implemented to manage the fatigue factor in pitchers. MLB needs to stand up and say, “Geesh, people, you are trying to hold your 12-year-old to the same pitching workload as CC Sabathia?!? Are you insane?! Do not do it! You need to listen to these young arms and encourage them to tell you when they’re is tired.”

Cliff Lee, knowing how his body heals, didn’t feel comfortable working on short rest in the playoffs*. But the example is always the huge workloads. MLB needs to make sure that coaches don’t hold major league pitchers as examples. It is the minor league pitchers who should be examples to younger players. Minor league pitchers are not pitching the numbers established major league pitchers are.

* I assume this, but it holds true with many things I have heard about him.

As I write this, Cardinals pitcher Adam Wainwright appears to be heading to Tommy John surgery and a year away from the mound. Whenever I hear about something like this I wonder: Could biometric studies of his pitching motion have corrected the flaw that led to this? Did the Cardinals do biometric studies on their pitchers? Would the cost of doing a biometric study on Wainwright be more or less than the cost of paying him not to pitch? In fact, biometric studies on pitching motions would cost clubs less the cost of a single start of the pitcher. A. Single. Start.

Then I realize the problem: Major league teams do not seem to want to invest in keeping their pitchers healthy. This limits their credentials in spreading the word to younger generations, which in return gets them less than effective players. It is beneficial to make sure your draft picks are healthy. But major league teams choose not to do that.

This, sadly, is why people think surgery will improve a pitcher’s performance. Pitch ‘em till they break, then make them better.

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  1. Brad Johnson said...

    Before anyone cites increased velocities for TJ survivors, the vast majority of those cases can be explained away by the rigorous rehab process. Often rehabbing from TJ produces a “best shape of my life” effect. Additionally, the time off can help other parts of the body to heal up via extended rest(not just in the arm either). There are several other explanations to increased velocity too.

    There is no theoretical reason to suppose that Tommy John surgery in itself helps to increase velocity.

  2. ecp said...

    To my knowledge, MLB does not limit innings and pitch counts for young pitchers, but many individual teams do (some more so than others), so I don’t see how MLB has the responsibility of making this clear to the public.  Unless you are suggesting that MLB SHOULD impose such limits.  But your article does not make that clear if that is your point.

    Regarding biometric studies, I seem to recall that a baseline study need to be done, followed by additional studies later for comparison purposes, isn’t that correct?  If the study is done, say, when a young pitcher signs his first contract, the damage may already be done if the kid was overworked as an amateur.  Additionally, there’s plenty of room for interpretation in the results – ie, one expert may conclude that a pitcher is at serious risk while another completely disagrees.  Which makes it not much better than the eyeballing.  Witness Mark Prior:  For every so-called expert who said he had perfect mechanics you could find another who saw huge red flags.  I’m not trying to disparage such studies – they are certainly a first step in the right direction – just pointing out that they are not a panacea for all.

  3. Mat Kovach said...

    ecp, you bring up some very good points. But, in regards to the Cardinals, they seemingly did nothing with Wainwright even though he already had a partial tear in is UCL. So there was at least some baseline on his elbow condition there.

    Biometric studies will also give you information regarding the forces in play (i.e.: what is the strain on the elbow, core, etc.) .. At least this is what ASMI gives when they study a pitcher. Using this information, teams can correct flaws or work to reduce problem areas.

    In addition, biometric studies and then show if there are changes (good or bad) after the baseline is established.

    It appears with Wainwright, even a pitcher with a tear in his UCL misses starts with a “forearm strain” they did little more than hope.

    And his elbow finally snapped.

  4. CJ said...

    I have seen many articles by sport writers which perpetuate the idea that Tommy John surgery can improve a pitcher’s fastball velocity.  No wonder young players believe that it’s true.  Maybe newspapers should require their writers to research claims about medical topics before they print it as fact.

    Before Wainwright’s injury came to the fore, I had read blogs about the “inverted W” pitching motion which used Wainwright as an example.  I’m not a pitching mechanics expert, but it seems like there were some warning signs.  But once a pitcher is successful, teams probably think that reconstructing a pitcher’s delivery is risky, since they don’t know if he will continue to be successful afterward.

  5. Brad Johnson said...

    More importantly, mechanical changes greatly increase injury risk, even if the change is an “improvement.” This is partly because the body naturally discovers the path of least resistance. Changing mechanics could overexpose joints that were partially protected by “flawed” mechanics.

    Nothing is truly understood about the relationship between mechanics and injury. When you have a very successful veteran, a hands off approach is probably best.

  6. Mat Kovach said...

    Brad, good points. But, it seems that the Cardinals didn’t even check those points. You can look for flaws, find them, and then develop a plan (with risk) to correct it OR ….. develop a plan for when the breakdown occurs.

    The Cardinals are now looking to give the sixth and seventh starters, a non-signed free agent, or trade prospects for a pitcher to take up 30+ starts.

    But that gets into a “if you don’t invest to keep pitchers healthy at least invest in a backup plan” discussion.

  7. pft said...

    Not a single piece of evidence in this article that proves pitchers after TJ surgery do not increase velocity 1-2 mph, for at least least some pitchers.  The reason for the increase may be argued, but guys like Pavano and Westbrook for example did have a velocity increase.

    This does not mean people should want to have TJ surgery, just that it may not be the end of the world if it is needed. Prognosis is much better than shoulder surgery.

    “Major league teams do not seem to want to invest in keeping their pitchers healthy”

    Nothing to support this quasi-religous belief either.  That teams who give million dollar bonuses to pitchers, spend money on development for several years, and then get a profit windfall for 6 years of MLB service underpaying the pitcher well below his market value do not want them to stay healthy is an interesting theory though.

    Fact is, nobody knows for sure why pitchers get injured.  Thirty years ago you had guys throwing 250+ IP in the majors at age 21-22 without pitch counts, and some were healthy for most of their long careers. Pitchers today are babied as they rise up through the ranks with pitch counts and IP limits get injured.  It’s not an exact science.

    Perfect example is J.Tazawa.  When signed by the Red Sox he used to pitch out of the stretch. Red Sox felt that put more stress on his arm, and got him to pitch from a wind up with no runners on.  A year later he needed TJ surgery.

    And sometimes you can sacrifice effectiveness for health.  Crag Hansen was a 1st round pick said to be MLB ready but had poor mechanics which may have made him prone to injury.  Red Sox tinkered with his mechanics to keep him healthy.  He may be healthy as a result, but he lost his FB command and effectiveness, and is toiling somewhere in the minors stuggling to get outs.

    So it is not an exact science.  It may be that some people are predisposed to these injuries as throwing baseball 90+ MPH a 100 or more pitches per game is an unnatural act.

    All the more reason to abandon the current system where young pitchers are wage slaves for 6 years. Some of them only can last 6 years before injury strikes.  Everyone should be a FA after their first contract expires, or at least be a FA by the time they turn 28 regardless of service time.

  8. TCQ said...

    I’m not a doctor and I’m not even particularly well read on the literature, so I won’t speak with any certainty, but wouldn’t the obvious answer to the TJ thing be that the replacement ligament hasn’t been worn down by the strain of throwing baseballs really hard in basically the same way for almost your whole life? Maybe that’s not true, and it’s pretty definitely going to be difficult to parse due to the biases pointed out by Brad/1, but it doesn’t seem but so far-fetched given the sophistication of the surgery.

    This article didn’t exactly sway me, either, since it’s mostly just intermittently bolded incredulity. It’s not like the author cited real evidence any more than the people he’s criticizing have.

  9. Mat Kovach said...


    It most certainly is not true and the people that developed the surgery and rehab, as well as the people that continue to improve on it have been saying it for years.

    From Dr. Andrews in the article:

    “There’s no way we can make it better then the good Lord made it”

    So, if you think it isn’t far-fetched, they you have to ignore the expertise of the people involved in the surgery and rehab.

  10. TCQ said...

    That’s fair enough (and I’ll submit that you added a lot more to my knowledge with that one link than you did in the entire article), although the emphasis on not getting the surgery if you aren’t hurt seems irrelevant since that reasoning is more predicated on fat tail chances of the surgery going really badly versus how well TJS works usually.

    I’d also mention that my intent was to point out an at least reasonable-sounding reason to think TJS might add some velocity (on top of training biases) to counter the article’s thrust of mostly just calling people idiots.

    But seriously, good link, I do appreciate it.

  11. Mat Kovach said...

    Once again, you have things very wrong. The surgery is successful about 85% of the time. The MAJOR LEAGUE rate is higher. The lower percentage of success is in younger arms. So the fat tail chance of the surgery going wrong is *exactly* in the group of mis-informed dolts that think it will help them (or the young arms they are responsible for).

    The only people that think UCL reconstruction will increase velocity are, with all due respect, are mis-informed idiots. It is *not* reasonable thinking. That is *exactly* the point.

    Sorry to offend, but when about 25% of TJS is now happening to high schoolers ( attempting to justify the wrong answer is hurting kids and not “reasonable-sounding reason to think TJS might add some velocity”.

  12. TCQ said...

    Okay, ripping off MGL here, but it’d be a heck of a neat trick if you quit trying to be a politician here just for a second, because whatever message you’re attempting to get through here basically amounts to noise in your rhetorical signal.

    I’m not necessarily trying to be a jerk here, but what does this sentence mean, exactly?


    I think that should be in the dictionary by the word “nonsense”. Sorry to offend.

    Moving on from my issues with tone and writing to what parts of your meaning I can parse out, here’s what I think the main issue is: the definition of the word “injured”. Which sounds like semantics, but the thing is, you could (theoretically, but I don’t think this’ll raise that much controversy) have elbow injury/fatigue without meeting the normal parameters for invasive surgery. It doesn’t seem unreasonable to think that a person like that might be injured in this more minor way for maybe years before actually tearing their UCL. Thus creating the appearance (and arguably reality!) of TJS improving velocity.

    I don’t really think I deserve to be getting rhetoric just because I’m raising the possibility that a pitchers’ elbow can wear down in subtle, cumulative ways along with catastrophic tears. And please, don’t act as if I’m “hurting kids” by making these comments. Leave save the children campaigns to the pros: this is frickin’ THT, and not to be diminutive, but I’m not causing hundreds of unnecessary surgeries or whatever by trying to have a conversation.

  13. TCQ said...

    I’m with you here, Brad. My argument (in that one little regard)would be that, in the flawed, stupid world of athletic medicine, there basically isn’t any other way to spend a year focusing on rest and conditioning. This isn’t an endorsement: forcing your pitchers (I’d note here that pitchers aren’t children and they aren’t dogs, so they aren’t really “forced” to do anything. If you’re a pitcher, you want to pitch. This is well documented, so I should be more careful assigning all the blame to the system here)  to go until they suffer an injury before giving them a chance to really rest is really, really bad. But that’s basically how it works, and in that sense TJS does cause any rise in velocity that occurs, because it caused the rest and conditioning, too.

    I do want to re-emphasize that that sucks, but I’m not making a morality play here.

  14. Brad Johnson said...

    One caveat, the word “cause” has a very specific definition in this instance and it’s what I’m getting hung up on. TJS may ‘correlate’ with improved velocity in some cases but it’s most certainly not the cause.

  15. Brad Johnson said...

    “Thus creating the appearance (and arguably reality!) of TJS improving velocity.”

    I can appreciate the general direction of your argument, but the parenthetical above is verifiably wrong. In such an argument, you would be assigning one variable (out of several) the entire descriptive significance when it stands to reason that rest and conditioning almost certainly play a much larger role in recovering from fatigue driven declines in velocity.

    The fallacy here is that this is a moving system but only one part is being examined while everything else is changing. The way to evaluate this properly is to freeze that system by holding all things constant. Doing so, you will find (as the top specialists in the field have) that TJS, in and of itself, contributes to a slight expected DECLINE in velocity. That is what experts in the field have found via intensive research and data crunching.

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