I’m not a doctor and I haven’t spent years studying the fragility of the human elbow when it is asked to fire baseballs at 95 mph. This isn’t an idea grounded in any new research, but it’s an idea I’ve been thinking about over the last week as UCL tears claimed more big name victims. Everyone has an idea about what’s behind the rise in UCL injuries, but no one seems to have the right or complete answer to the problem because they keep happening to our favorite hurlers. As teams and the league move forward and try to determine a set of best practices for keeping pitchers healthy, I’d like to offer a theory about what’s behind the rise in Tommy John Surgeries over the last few years.
In the last calendar year alone, Jon Roegele has confirmed 64 such surgeries for pitchers and players such as Jonny Venters, Joel Hanrahan, Dylan Bundy, Matt Harvey, Kris Medlen, Luke Hochevar, Brandon Beachy, Jarrod Parker, Patrick Corbin, Jameson Taillon,Matt Moore, Ivan Nova, Jose Fernandez, and soon, Martin Perez. That’s just a sample of the players who went under the knife for the same surgery this year. It’s starting to feel like a crisis. Maybe it’s a blip. A cluser. A random flux. But as the best medical minds in the field start to show signs of concern, it’s worth rethinking the problem.
It’s entirely possible that high workloads in youth baseball, higher velocity, more sliders, and more intense workout regiments are behind the rise in UCL injuries. I don’t have evidence to dispute that per se, but it also appears as if all of the things we’re doing to keep pitchers healthy doesn’t seem to be working. Maybe these pitchers are doomed by the time they enter professional baseball and the problem needs to be attacked sooner, but it’s also possible that we’ve misunderstood the rise in injuries.
Again, I’d like to stress that this is an idea we should investigate and not one which I can support at this point in time. I threw it out on Twitter a few days ago and it got some positive feedback, so I thought it was worth articulating.
What if we aren’t actually observing an increase in UCL tears? I know that doesn’t make sense given everything I just told you, but hear me out. What if everything we’re doing to protect young pitchers is actually working exactly like it’s supposed to. Let’s use Matt Harvey as an example. Pretend Harvey was born 20 years earlier and was entering the majors in 1992 instead of 2012.
Harvey wouldn’t have been exposed to youth pitch counts. He wouldn’t have spent nearly as much time playing competitive baseball as a kid. He wouldn’t have spend as much time in the weight room. Imagine that, instead of having all of this training and all of this access to surgical procedures as a kid, Harvey was basically just a kid who played for a few months every year.
In this world, Harvey probably wouldn’t have Tommy John Surgery in 1994 as a member of the Mets. But I wonder if that’s because he never would have made it to the major leagues in the first place? Maybe his UCL was always going to blow out and in the 2010s, he was protected enough that he was able to keep it intact until he made it to the big leagues. In the 1990s, that ligament would have blown out when he was 16 and he would have lost zip on his fastball and never made it to the show.
Maybe we aren’t observing a spike in tears, maybe we’re observing an increase in the number of pitchers who blow out their elbow later in life. Instead of those with “fragile” UCLs going down in high school, they’re going down when they’re 24 or 25.
Let’s say you have 100 14 year old kids. Let’s say of those 100 talented pitchers, 20 of them have the stuff to make it to the MLB level in some capacity. In 1990, I would argue that of those 20, only 9 or 10 of them would make it to the show because the other 10 or 11 would hurt their arms during their high school or college careers such that MLB teams wouldn’t have interest. The problem is that we don’t have data on UCL injuries going back far enough. We have data on the UCLs that got repaired, but not the ones that weren’t.
In 2010, perhaps our training techniques are allowing all 20 of those pitchers to reach the majors, but our training techniques couldn’t protect them forever. We delayed the surgery, but we couldn’t avoid it. The elbow was always going to crumble, but we’ve done enough to make sure a chunk of amateur pitchers survived into their pro careers.
Maybe guys simply pitched through the injury two and three decades ago. If that’s the case, we aren’t seeing a spike in injuries, we’re just seeing a spike in this particular response to the injury. This is a data problem. We simply don’t know if this theory has legs because we don’t know how many pitchers ruined their UCL without having TJS in the 1980s. And we can’t really know.
I’m fully aware that I’ve presented a theory that can’t really be tested. In a technical sense, we’d want to expose one group of pitchers to the modern practice of protecting them and one to the older model and track them throughout life. But the primary problem is that such a strategy is horribly unethical. Maybe MLB could fund an opt-in MRI tracking study, but beyond that, you can’t play God with the futures of minors.
I know that James Andrews and his colleagues are reporting lots of damage to the UCLs of young pitchers, but we simply don’t know what they would have seen if they were studying them twenty and thirty years ago. The rise of the surgery might be because there are more UCL tears or because the surgery is better and more available, so people with hurting elbows go in for an exam.
As I said earlier, this theory might not hold. But right now, it seems like we’re doing a terrible job protecting pitchers so it’s worth exploring. Instead of assuming we’ve failed, what if we’re actually succeeding in a really impressive way? Maybe instead of looking at Jose Fernandez‘s injury as a failure, maybe he’s having the surgery specifically because we were able to protect him long enough to develop into an MLB caliber starter. It’s worth considering. Maybe instead of a crisis, this is actually a success story about the pitchers we never would have had a chance to see rather than the pitchers who we’re losing for a year.