Jose Fernandez: Preventable or Inevitable?

Jose Fernandez is broken. After allowing him to throw ridiculous pitches that opposing hitters simply couldn’t touch, his elbow threw in the towel in the fifth inning of his start on Friday night. You can basically see the injury occur in his in-game velocity chart.

Brooksbaseball-Chart (3)

In the fourth inning, his four-seam fastball averaged 97.7 mph; in the fifth inning, 90.0. An eight mile-per-hour velocity loss from one inning to the next is worrisome, to say the least, and MRIs have apparently suggested the worst. It hasn’t been officially announced, but the expectation is that Fernandez will need Tommy John surgery, which will take him out for the rest of 2014 and most of the 2015 season, most likely.

In the wake of nearly any serious injury to a pitcher, the discussion moves to whether or not the pitcher was handled correctly, Was he asked to throw too many pitches, or too many innings, or was he allowed to throw too many of a certain type of pitch? In Fernandez’s case, you could present both sides.

On the one hand, the Marlins handled Fernandez with some care last year. He was limited to no more than 86 pitches in his first seven starts as a big leaguer, and he didn’t break 100 pitches in a game until his 13th start. Even since breaking that threshold, he has most often been held to fewer than 100 pitches, and he’s only broken 110 pitches once; a week ago, against the Dodgers, he threw 114.

If you believe that injuries are caused by pitchers throwing while tired, and you think that pitch counts can serve as a proxy for when a pitcher begins to wear down within a given start, then you’d likely conclude that the Marlins handled Fernandez with care. A pitcher who has averaged 95 pitches per start — most of them coming with the bases empty because no one was good enough to get a hit off of him — would not generally be classified as an abused arm.

But then there’s the other side of the argument. Fernandez was brought to the majors as a 20 year old, and was asked to throw 173 innings against big league hitters before he was shut down in mid-September. He’d thrown 134 innings in A-ball the year before, so so not only did his workload increase by 30% year over year, but the quality of opponent increased dramatically, and I think it’s fair to say that innings against big league hitters probably require more of an effort from a pitcher than innings against minor league hitters. Maybe even 170 innings against big leaguers is just too many for a developing arm. Or maybe 300 combined innings in your age 19/20 seasons is just too many.

Or maybe we just have no idea. After all, Rick Porcello made almost the exact same jump as Fernandez, throwing 125 innings in A-ball at 19 and then 170 in the majors a year later, and he’s yet to have any major elbow issues. CC Sabathia threw 145 innings between A-ball and AA at age-19, then threw 180 in the majors as a 20 year old, and he’s been one of the most durable pitchers in baseball over the last decade. Felix Hernandez threw 172 innings between Triple-A and the Majors as a 19 year old, and then 191 additional big league innings at age-20, and he’s shown no ill effects from his early career workload.

There simply isn’t enough evidence to blame Fernandez’s workload for his injury, and it’s not like the list of guys who have been developed more conservatively are avoiding surgery at a higher rate. Elbows are blowing out at the same or higher rates than they ever have been, even in the age of limiting pitch counts and innings totals. While Fernandez did have a larger workload than most 20 year olds, against better competition than most 20 year olds, it’s difficult to suggest that any other type of handling would have produced better results. There are a lot of teams trying a lot of different solutions to try to keep their young pitchers healthy, and everyone is failing. Everyone.

In some ways, figuring out pitcher health with our current tools and metrics feels like trying to go to the moon in a hot air balloon. Maybe we can see the goal, and maybe we have a vehicle that moves us in the direction of that goal, but we’re not getting to space in a basket, and we’re not going to keep pitchers healthy with pitch counts and innings totals. That doesn’t mean we abandon all caution and stop counting pitches and innings entirely — you absolutely can run a pitcher in the the ground due to overwork, but MLB teams just aren’t doing that anymore — but perhaps we just accept that it’s going to take a technological leap forward before we actually know enough to measure when a pitcher is actually in danger of blowing his elbow out.

Hopefully, in 10 or 20 years, in-game live biomechanics have proven useful, and teams will be able to measure things that have proven to actually matter. There are companies already pitching products like this, though the industry is in its infancy. I could see these kinds of tools actually providing some real benefit down the line, and perhaps that kind of technology will help turn the tide of pitcher injuries.

For now, though, we’re grasping at straws. We don’t know how to keep pitchers healthy, and we don’t know if the Marlins could have kept Fernandez healthy. It sucks that another great young arm has gone down, but this is just the reality of where we’re at with keeping elbows in tact. We don’t know how to do it, and we don’t know why Fernandez blew out when Porcello and others have not. Hopefully, some day, we’ll know. For now, we just accept our ignorance, and keep the finger pointing to a minimum.




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Dave is a co-founder of USSMariner.com and contributes to the Wall Street Journal.


189 Responses to “Jose Fernandez: Preventable or Inevitable?”

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  1. FeslenR says:

    Maybe it’s all the work outs these guys do?

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    • Austin says:

      My dad loves this argument, but I find it very flawed and with no real supporting evidence. Volume, intensity and %weight of maximum are all variables in weight lifting. Fernandez is not a big guy for his height either, so I fail to see any correlation.

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      • Bip says:

        On the one hand, sometimes having stronger muscles can take the stress off other parts of your body. On the other, maybe there is no effective way to strengthen elbow ligaments, and having stronger muscles just means that it’s possible to put more stress on the ligament than before.

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      • Belloc says:

        Fernandez is 6’2″ and weighs 245. Would would be a big guy for his height in your world?

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        • Austin says:

          Well, I’m 5’4 205, so forgive me if I don’t think he’s big. Tall, yes. And no I’m not obese. Maybe he’s “big” for a pitcher.

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        • LG says:

          5’4″ 205? unless you’re a serious powerlifter, you’re probably severely overweight

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        • Austin says:

          I am a serious powerlifter, and I’m also in the military. Overweight /=/ obese. They don’t allow you to be fat in the military lol

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        • John Rocker says:

          Do you guys even lift?

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        • TKDC says:

          I swear I didn’t rig this, but honestly it doesn’t matter if I did. I went to the Seahawks roster (picked them because they won the Super Bowl), and I went down to the first player that was listed at 6-2, which turned out to be linebacker Brock Coyle, who weighs 245. I’m super proud of you for being jacked at 5’4″, but 245 pounds is definitely big for 6’2″

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      • Johnny Danger says:

        We are really struggling to prevent rude elbows. I don’t know what it will take to keep them “in tact” ;}
        Just messin’, Great Article Dave, you are the King of the Universe.

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    • Costanza says:

      ITT: people proposing their pet theories without evidence. Precisely what Dave cautions against.

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  2. Chris Traina says:

    The thing I wonder is if these injuries that require tommy john are wear and tear, or a single traumatic event.

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    • Anon21 says:

      If the “single traumatic event” were something other than “throwing a pitch,” I think we’d know it by now.

      I guess maybe you’re getting at “throwing a pitch in a particular situation, with a particular motion, at a particular level of fatigue,” such that on this theory, with perfect knowledge of biomechanics, managers could literally sprint out of the dugout yelling, “Jose, don’t throw that pitch!”, wait ten seconds, and say “Okay, go get ‘em, champ” and thus successfully avoid a season-ending injury. Seems kind of wacky and implausible, but like Dave said… we just don’t know!

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    • TangoAlphaLima says:

      I suspect it’s essentially a combination of those two things. A single pitch probably gets the job done as far as tearing the UCL, but the UCL has probably been weakened due to years of wear and tear.

      In other words, it’s highly unlikely that a player who is pitching for the very first time would tear his UCL on his first pitch. But after he’s been throwing for a few years, maybe it’s the 20,000th pitch that actually causes the tear.

      Dave’s graph above supports this theory to some extent. Fernandez was going fine until the 5th inning. It’s likely that late in the 4th inning or early in the 5th inning he tore his UCL. Maybe on a single pitch, or maybe on a handful of pitches, but it’s clear he showed no signs of any elbow problems prior to that.

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  3. Mike says:

    At what point does someone start investing what role PEDs might play in some of these injuries; is it possible some elbows are breaking down due to an unnatural level of stress placed on them due to coveted increases in velocity?
    Seems many like to report on velocity declines, which are common among arms just one, two or three years removed from college or being drafted.
    Just sayin’.

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    • Andrew says:

      At what point does someone start investing what role PEDs might play in preventing some of these injuries; is it possible some elbows could be prevented from breaking down with thoughtful, scientific, sanctioned use of modern medical science rather than treating it like some kind of evil black magic?

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  4. tz says:

    Does it just seem like more guys are blowing out their elbows than “the good old days” because now we have so much info on ballplayers and their injury histories even before they hit the big leagues?

    In the pre-Tommy John surgery era, I’d have to bet that lots of guys got to say AA-level ball before suffering elbow injuries that ended their career before we ever heard anything about them.

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    • mr33 says:

      Recently I heard an ex-pitcher/broadcaster say pitchers in the past were reluctant to get their elbows checked out because a surgery was viewed as the end of the line. Rather, they just sucked it up and kept going until they fizzled out. Combined with perhaps less vigilant front offices in the past, it seems plausible an increase in diagnoses is covering up advances when it comes to reported injuries.

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      • jorgesca says:

        yeah that makes sense, since Fernandez was still throwing 90 MPH, perhaps with a week or two of rest he could go back to 92-94 and just avoid the surgery this year and keep sucking it up and of course decreased results.

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      • senor_mike says:

        This theory seems to have some legs. I would wager that the percentage of hard-throwers (95mph+) back in the 50s>70s is much smaller than it is today.

        Hard-throwers most definitely existed back then (Ryan, Richards, Dalkowski, etc.), so what would account for that % difference? I am sure some of it can be attributed to standard workout regiment that pitchers go through for their careers, but unaccounted elbow injuries would help explain many of the mysterious differences in the eras. And more importantly, it would help outright eliminate many misleading data correlations.

        Anyway, say what you want about theories/hypotheses/whatever you want to call them, but considering that solving baseball’s 64 billion dollar question is going nowhere fast, theories are all anyone has. At some point one of them is going to stick well enough for someone much smarter than I am to be able to mine something actually useful.

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  5. Anon says:

    Nice graph. I particularly like that the error bars are shown.

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    • Bip says:

      I think it’s the variation. An error bar in this context might be when the measurement system is only precise enough to give the velocity range that where the true velocity of the pitch most likely occurred. I think here they actually represent the max and min velocity of pitches in the inning, where the dot is the average.

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  6. buddyglass says:

    It seems likely that throwing a baseball really hard and adding movement is just inherently stressful to the human body. Some pitchers are blessed with bodies that can handle repeated abuse; others aren’t.

    Ergo there may be no “safe” level of pitches-per-game or innings-per-year or possibly even days-between-starts for a pitcher like Fernandez who is capable of throwing the ball in a way that exceeds his body’s parameters for safe usage. It may be that capping his per-game pitch count or innings per year you’re would only have delayed the inevitable.

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  7. It's Simple says:

    I’m not a physician, but it seems uncomplicated to me: if one throws hard ALL THE TIME, then injuries will occur, whether as a result of “wear and tear, or a single traumatic event.” Walter Johnson could maybe throw mid 90s heat, but I am of the believe he lived in the 80s. Max effort throwing leads to durability issues. Personally, I think it is pitcher injuries that will ultimately help reduce the decline in offense; if you cannot field high strike out guys year round, runs scored will rise.

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    • It's Simple says:

      *belief

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    • Anon21 says:

      On this theory, then, Randy Johnson was actually capable of cutting loose and buzzing them in there at 115 MPH, and his forbearance is what caused him to enjoy a long, healthy career with an intact UCL?

      Sorry, not buying it. You need to account for the guys who did live in the mid-to-upper-90s and never blew out their elbows.

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      • Anon says:

        Exceptions can exist.

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      • It's Simple says:

        I’m not saying that, I’m saying that pitchers didn’t approach their limits in the same way pitchers regularly do today, so the fragile weren’t weeded out. Of course, there are also individual idiosyncrasies, such as Randy Johnson’s durability. But we also can’t really know how close he might or mightn’t have come to destroying his arm in those ridiculous years.

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        • Spit Ball says:

          Smokey Joe Wood was certainly weeded out.

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        • It's Simple says:

          The evidence that Smokey Joe Wood threw even as hard as Johnson seems mostly apocryphal.

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        • joser says:

          But the fragile were being weeded out. Some guys like Koufax made it to the majors before their arm wouldn’t let them pitch anymore; others walked off a minor-league ballfield cradling their elbow or clutching their shoulder, never to pitch again. The minor league scorebooks of the past century and more are full of guys who looked amazing until they suddenly didn’t, and vanished from the game without ever making a mark at the major league level.

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      • Bip says:

        There is no absolute “max effort” velocity. If Mark Buehrle threw max effort, maybe he would sit in the low-90’s, and maybe he would blow out his elbow from too much exertion. I don’t find it at all hard to believe that Johnson could have gained 2-3 MPH on average if he exerted more effort, and that he may have been risking his health if he had.

        If the theory of max effort is wrong, then why do many player’s gain velocity when moving to the bullpen?

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      • Bearman says:

        The problem is not everyone is 6’5 or whatever Randy was. Teams want to develop the next Nolan Ryan or johnson rather than the next Maddux or Glavine. Hard throwers are rare, but teams make everyone throw hard now because velocity is quantifiable.

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        • tz says:

          Randy Johnson is 6’10”, and built wiry, kind of like an Olympic-level swimmer. Even with that working for him, he’s obviously been blessed with an A+ set of ligaments, tendons, cuffs, etc. to last as long as he did (just like Ryan, Blyleven, etc.)

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    • cass says:

      What evidence informs your belief?

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      • It's Simple says:

        None at all.It’s conjecture. Not a lot of evidence to be had with respect to pitchers from the dead ball era, in any case.

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  8. Gregory says:

    stats for improving pitcher health seems a little too empirical

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  9. j6takish says:

    Justin Verlander has thrown 1800 major league innings. He was an extreme hard thrower in his youth and age has slowed him down but he still throws 93-95. He was ridden pretty hard by Leyland, routinely threw 120 pitches in a game. He only made 20 minor league starts before coming to the majors and has never been on the disabled list.

    However, he was an accomplished college pitcher and threw 450 innings across 3 years of college. I’m sure he had a heavy workload in high school as well.

    The point I’m making I guess, are american pitchers less likely to be injured? They throw innings with a gradual build to where foreign signed players usually make the majors sooner and with less mileage on their arms. What about pitchers who pitched in college VS those drafted out of high school? Maybe this is all just noise and arm injuries are all just bad luck and life is indeed a wasteland of cruelty

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    • tjk says:

      Jose Fernandez was drafted out of a Florida high school

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    • Michelle says:

      Just thinking about the list of names this year, the eye test doesn’t seem to agree with it, but who knows? Maybe there is some difference between pitchers who only went to the high school level or the college level or American vs. international pitchers. I would be curious to see if the data would find any differences.

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    • Dave K says:

      Has anyone looked into this theory?

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    • BrickSkuad says:

      Actually I read an article recently, or perhaps just a comment– my memory is failing me– postulating that American/Candian born pitchers were more likely to become injured due to the nature of our competitive youth and high school aged leagues. In short the article claims that kids are pressured by the competitive culture and desire to make it to college and then the Major Leagues to throw their hardest stating when they are 10-12 years old. The wear and tear put on the arms due to these kid’s desires to impress scouts and coaches so that they may get scholarships and potentially drafted ends up hurting them in the major leagues when their work load greatly increases. And you see it, 17, 18,19 20-year-olds all throwing 95mph+.

      BNon-American baseball players, especially those from Latin America do not have the same type of coaching and competitive leagues as what exists in the US, Canada and perhaps Australia. Often times these prospects don’t actually start throwing their hardest until they reach a certain age or sometimes even drafted by a professional team.

      This is by no means scientific fact, nor am I saying that this is the only right answer. This correlation is not causation. But it is interesting when you look at all the non-latin american born pitchers who have succumbed to elbow injuries and subsequent TJ surgeries in the past several years: Wainright, Nathan, Billingsley, Strasburg, Carpenter, Beachy, Luebke, Medlen, Harvey, Hanrahan, Hudson, Burnett, Tomlin, Westbrook, Madson, Griffin, Johnson, Corbin to name a few.

      I understand that Nova, Fernandez (although he went to HS in Florida but was born in Cuba) Betancourt and many others do not fit this mold. But there do seem to be more American, Candian, (Australian?) born pitchers who play in these structured competetive leagues that fit the trend.

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    • Bip says:

      Actually there has been some press lately about how American colleges can be really irresponsible with their pitchers. Look at UNC. They’re currently running Carlos Rodon into the ground.

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    • Stats All Folks says:

      Of the 37 pitchers listed as “Notable baseball players who underwent the surgery” on Wikipedia, 15 were drafted out of high school, 5 were drafted out of junior college, 14 were drafted out of a four year college, and 3 were international signees. Far from exhaustive of course, but there doesn’t seem to be anything to suggest high school draftees are more/less likely to need TJS.

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    • Cheesewhiz says:

      And Nolan Ryan threw into his 40’s. Randy Johnson threw forever. Kent Tekulve was famous for having an indestructible arm.

      All that proves is that Verlander and those others hit the genetic lottery.

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    • Johnston says:

      “Maybe this is all just noise and arm injuries are all just bad luck and life is indeed a wasteland of cruelty.”

      Nailed it.

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    • Emo kids everywhere says:

      “life is indeed a wasteland of cruelty”

      Totally bro. Totally.

      *Heads off to Hot Topic for some new tongue studs after putting 43 black rubber bands on my wrist*

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  10. Spit Ball says:

    This article is not even worth writing given what we already know about young pitchers and their Minor/Major league track record. Follow these kids close from age 9 up then we can talk. Absolutely not inevitable.

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    • bdhudson says:

      Enlighten me – what is it that we already know that leads you to believe this was not inevitable?

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    • TheGrandslamwich says:

      Pretty please present your evidence following them from age 9 up.

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      • hurtin' says:

        There was a special on MLB Network on Sunday regarding this topic. Jim Kaat and Tom House mentioned that kids now a days basically pitch year round: AAU, multiple travel teams, showcases etc. They said something to the extent of , “back in my day, we didn’t pitch all year, we played other sports.” I guess what they mean is, these kid pitchers are basically spending their “bullets” at a very young age, so that by the time they are in HS, college, MLB, their elbows are wasted. Obviously, little leagues probably don’t keep records so it would be hard to quantify. Something to think about.

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        • joser says:

          And “back in the day” lots of pitchers wrecked their arms before ever making a mark at the major league level. We don’t remember them because they vanished from the minors, or maybe never even made it that far.

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  11. jdbolick says:

    It may be worth noting that Fernandez increased his slider usage from 12.7% last year to 21.3% this season.

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    • Steven says:

      This could be worth looking into. Is it this? Or is it the fact that he started throwing his sinker in the 3rd (or is that a miscatagorized slider?), then proceeds to injure himself sometime in the 4th.

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      • jorgesca says:

        If anything from that particular start should be looked at is the fact that he was throwing up before gametime.

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        • Ruki Motomiya says:

          It definitely seems like being sick would increase risk of other injuries due to your body being weak at the time.

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    • Tom B says:

      This is the most obvious red flag, as breaking pitches are what put the most strain on your elbow. You can throw fastballs until your shoulder falls off and you’ll never hurt your elbow.

      Is this not common knowledge? I wonder why this seems to be overlooked.

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      • Tom B says:

        Breaking ball use at a young age was severely frowned upon in the leagues I played in. This is what needs to be tracked on all of these TJ cases.

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      • Costanza says:

        Tom House, who is an expert in pitching biomechanics, has frequently stressed that no pitch, when thrown properly, puts any more stress on the arm than another pitch.

        It is possible that curves are more likely to be thrown improperly, but that is a different argument than “curves are bad for developing arms”.

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        • KCDaveInLA says:

          I used to wonder how in the hell Kevin Appier didn’t destroy multiple parts of his arm just during his wind-up.

          I used to hear that many high school coaches would not allow their pitchers to throw sliders or curves until their junior year, due to the potential wear on the wrist and the elbow. Anyone else ever hear that?

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        • Steven says:

          Tom House is absolutely not an expert in biomechanics. I doubt he actually claims to be; it’s probably something most people just assume since he teaches mechanics to players. Regardless, House does not have the requisite kinesiological knwoledge to actually be a biomechanical expert.

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        • yuh says:

          > Expert
          > Mark Prior

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      • Belloc says:

        The biomechanical studies conducted by ASMI (Dr. James Andrews is one of the co-founders) have shown that a fastball is the most stressful pitch on the shoulder and elbow joints. And Newton’s Laws of Motion would certainly predict such a finding.

        I don’t know about common knowledge. But I would trust the laws of physics and James Andrews in this field.

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    • Phantom Stranger says:

      He had unnatural break on his slider/curveball for a starter. You occasionally see relievers with his type of extreme break, but I always worried about the amount of stress he was generating every time he snapped one off.

      It was a devastating pitch against hitters but I suspect it played a role in this injury.

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  12. Dave D says:

    I think heavy workloads at 20-23 are pretty negative. Look at Nolan Ryan, most durable pitcher ever. He should be the role model. He pitched 6 years from age 19-25 before ever going over 152 innings. Surely it’s a combination of things and the culture changed with free agency and bug money contracts, but if long term health were the priority I’d think long or middle relief/ 5th starter who often is skipped would be ideal for young pitchers. Sure there are exceptions but for every Felix there are probably three Priors, Kerry Wood, Jose Fernandez who were aces at 22 but…

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    • Anon says:

      Ryan is a bad example. Yes he didn’t go over 152 IP until age 25 but then he was ridden hard over the next 3 years throwing an average of over 310 IP the next 3 years, developed arm problems, missed a large chunk of 1975 and spent 4 of the next 5 years as basically a league average pitcher. Ryan never pitched over 250.1 IP after age 30.

      Ryan is not a testament to how pitchers should be handled, he is a testament to the fact that he was one tough SOB pitching through pain in the middle of his career.

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      • Dave D says:

        IMO you’re sort of right, sort of wrong. Ryan was over used when he came to the Angels in 1973-74. He didn’t blown out his arm though. Ryan was pretty darn good when I started following the Angels as a kid in 1977. He threw 7 shutouts that year and would have had a better record with a good offense. My point was that the fact that (while probably unintentional) he benefitted long term from not being over used when he can up at age 19 and the next 5 years. He clearly is a symbol if longevity later in his 30s and 40s. I bet if he pitched 600+ innings at 20-21-22 like Fernandez was probably on pace for this year he may have never had length of career.

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    • Wobatus says:

      Doc Gooden, man was he ridden hard. 191 innings at 18 in minors. 218 as a 19 year old rookie. 276 as a 20 year old. 250 as a 21 year old. He didn’t break down for a bit, but I think it was that early work load more than the coke that derailed him. He was never the same after 1985 really.

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    • Wobatus says:

      He pitched 205 innings majors and minors combined at age 19 in 1966.

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    • cass says:

      Discussing individual pitchers is truly pointless. You can use any given pitcher who got injured or didn’t get injured as an example of anything. These are anecdotes, not data.

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  13. Metz says:

    How many times has a pitchers funny bone been hit?

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  14. dang says:

    This is a shame. Phillies fan here, but first and foremost a fan of good baseball. Jose Fernandez was a constant source of entertainment, hopefully it’s a quick recovery and he’s back to being his old self.

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  15. john jay says:

    The constitution says if hard throwing is responsible for injuries, then the Cardinals are doomed.

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  16. Magick Sam says:

    I think that overuse can be a contributor to these pitcher injury problems, but I also firmly believe that Kerry Wood and Mark Prior would have still injured themselves on delicate pitch counts (though perhaps later or less frequently). Maybe James Andrews has a point, saying that year-round baseball puts stress on young throwers limbs, but I see this as another possible contributing factor and not really the crux of the problem. It looks, to me, like a mechanics crisis. What’s being taught to young pitchers around the world, to tack a few miles per hour on to their fastballs, is destroying these guys’ elbows and shoulders. Chris O’Leary gets some flack for being a pseudo-scientist, and not supporting his claims with real scientific data, but I think the science is starting to come around on a lot of what he’s been preaching for the past bunch of years…and he called Fernandez’s TJ just a few weeks ago- where Verlander and Dan Haren are two guys he’s been lauding as pictures of healthy mechanics and neither guy has had a single arm injury that I can recall.

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    • Bill says:

      Yes, but if I’m a young pitcher and I’m given the choice between throwing 95 and making the Majors, but having an increased risk of TJ surgery or not making the Majors, I’m choosing the injury risk every time.

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      • Magick Sam says:

        I get your point, but I don’t really think that young pitchers are making those decisions- I think that coaches and baseball organizations are teaching these mechanics and trying to act like they’re healthy because they ‘work’ (add velocity)

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  17. Dr. Thomas Verducci, M.D. says:

    My research, utilizing my extensive medical knowledge and statistical expertise, predicted that this may or may not have happened.

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    • Belloc says:

      He is such a tool. Now his solution is to get rid of the pitcher’s mound.

      Of course he conveniently ignores the number of non-pitchers who have torn their UCLs, including Albert Pujols. And they aren’t throwing hundreds of fastballs at 95 mph or more, along with the assortment of other pitches, over and over again every week.

      You want to minimize torn UCLs in baseball? Eliminate the overhand throw. I think we call that softball.

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  18. Walker says:

    Wanna talk about throwing tired? Jose Fernandez just threw a game where he was throwing up beforehand. And waddayaknow, he tore a ligament during that game.

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    • Chaz says:

      Exactly. I didn’t see your comment until after I posted mine, below. So few writers covering this seem to have noticed Fern was sick as a dog before the game! It seems so obvious to me that it might well have been the reason he blew out his arm.

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    • bdhudson says:

      Yeah, I have also heard that nausea immediately weakens all of your soft tissue. I know that every time I get sick my knees just start exploding!

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    • Bill says:

      It would be interesting to see a doctor’s opinion on this. Isn’t this type of thing exactly what the main stream sports media is supposed to be doing?

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  19. Emcee Peepants says:

    I agree with Magick Sam – mechanics are the culprit, but coupled with genetics. It already takes a freak of nature to throw 90 mph or 80 mph sliders and a super freak to throw 95 mph plus with 85 mph sliders. Some guys get from freak to super freak on natural ability with solid mechanics (Verlander, Big Unit, Clemens, Felix). Some get from freak to super freak by compromising mechanics (Strasburg, Harvey, Fernandez). Maybe this recent run of literally all the most exciting pitching prospects of the past 4 years ending up under the knife will get teams to really look closer at the poor pitching mechanics that some guys are using to achieve their level of dominance. A 95 mph fastball isn’t very useful to anyone if you can’t throw it for 12-18 months.

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    • David says:

      Wasn’t Harvey held up as one with great mechanics? Using more lower body (“drop & drive”) than normal?

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      • Magick Sam says:

        Not by O’Leary. I actually haven’t seen much praise for Harvey’s mechanics anywhere…

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        • Emcee Peepants says:

          O’Leary liked them when he was younger but apparently the mechanics fell apart as he got closer to and broke into the majors. There is an extended post on his site about Harvey specifically.

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        • Wobatus says:

          So as he became really good his mechanics were making him more an injury risk?

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        • Emcee Peepants says:

          Short answer, yes, at least according to O’Leary, he of the inverted W theory. Harvey used to have his hand above his should as he planted his foot, but started dropping his hand down to make more of a T (not quite an inverted W) as he planted his foot. O’Leary cites this as poor mechanics and increases injury risk. I first heard of him when Strasburg had TJ and he was saying he predicted it based on his inverted W mechanics. He cites Clemens as a good example of keeping the ball high, and he was a power pitcher forever with no elbow issues. His site looks like it was made in Geocities, but has some interesting info: http://www.chrisoleary.com/

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        • This is what Chris O’Leary predicted (he also correctly predicted Strasburg’s Tommy John surgery before it happened):

          “Jose Fernandez
          In terms of other pitchers who I think could fall victim to the elbow injury epidemic, the picture below of Jose Fernandez was recently brought to my attention by a reader.

          [Pic]

          Unfortunately for Jose Fernandez and Marlins fans, this picture shows both premature pronation and a resulting timing problem. While this arm action may improve both Jose Fernandez’s velocity and his stuff, it will most likely also lead to elbow and shoulder problems.”

          http://www.chrisoleary.com/projects/PitchingMechanics101/Essays/PitcherElbowInjuryEpidemic.html

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        • Steven says:

          Oh god, do not bring up O’Leary. He and Dick Mills are likely the worst people out there for biomechanical “analysis.” O’Leary has no correct kinesiological backing of his claims. Some of what he says is correct, but he also says a lot of things that aren’t. Before you believe ANY biomechanical evaluator, find out what their qualifications are. O’Leary may not be useless in the area of mechanics, but he is useless in the biomechanical area of mechanics.

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    • Emcee Peepants says:

      In thinking about it more, and doing some looking, I found this:

      http://mlbreports.com/tj-surgery/

      A lot of hard throwers on there, but also Jamie Moyer and Randy Wolf, among other softer tossers. I guess what I should have said is that the injury likely occurs from developing poor mechanics trying to improve whatever kind of edge the pitcher has (not just velocity). Anyway, to blame it solely on high velocity seems foolish after looking at this list.

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  20. Let me add to this discussion one aspect that is overlooked.

    Pitchers throw off a mound. Meaning their throwing is done with an overload.

    Which in turn means that pitchers are putting more stress on their joints than they capable on their own.

    Sprint athletes like Usain Bolt train very limited on running on a slight decline. Because it’s very stressful for the joints.

    Now, pitchers there’s off mounds in the past too. What has changed?

    The overall strength has improved, and thus the velocity.

    Guess what HASNT changed?

    That’s right. Tendon strength.

    My quick fix for this pitching epidemic is to lower the mounds slightly.

    That way I think we could cut down on these injuries by quite a bit.

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    • Swfcdan says:

      They’ve been raised in the past decade too have they not?

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    • Belloc says:

      Even pitching on flat ground isn’t going to solve the problem that leads to UCL tears: valgus extension overload.

      ASMI did a study in the 90s when MLB considered raising the mound to 13 inches in order to curtail offenses. ASMI found that there was no difference in stess on the shoulder and elbow joints between a mound of 10″ and a mound of 13″. Nevertheless, MLB decided not to raise the mound.

      The problem with lowering the mound is twofold: Pitchers would have to adjust their mechanics, which in turn could lead to more injuries. And lowering the mound is perceived (and I think the perception is real) to give the hitter an advantage. Giving the hitter an advantage would mean more base-runners, longer innings, higher pitch counts per inning – all of which leads to a greater risk of injury to pitchers.

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  21. Chaz says:

    All these comments and no one has mentioned that Fernandez was vomiting pre-game? One would have to think that the potential for dehydration in such a situation would be high, and studies have shown that muscles and tendons are more likely to be injured when the body is dehydrated. Also, it’s not too hard to see how a pitcher might have to ramp up his effort to pitch through feeling lousy. There’s no way to know for sure, but having Fern pitch through his stomach illness seems like an awfully stupid management decision that may have contributed to his injury.

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  22. Grimace says:

    And of course Fernandez is on my fantasy team.

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  23. thekcubrats says:

    Chaz nailed it. Astonishing none of the commenters thought of it. But absolute malpractice that the writer of the article didn’t discuss that aspect. Not as bad as the Fish’s manager’s and staff’s malpractice in letting the sick kid go out and predictably ruin his arm, but still…

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  24. Mike says:

    Thank you ,BigBubbaNoTrubba: overall strength has improved, as has velocity. Thirty-five years or so ago, Nolan Ryan and J.R. Richard were regarded as the hardest throwers of the day, then came Dwight Gooden. Now almost every team in the league has a handful of guys in their bullpens who touch 98 mph, not to mention a starter or two. We have guys coming out of college throwing 99 who weren’t drafted out of high school. How is that possible? Given what we’ve seen in the past 15 years, from Mark McGwire to Roger Clemens, Bonds, Braun and Bastardo, how can we not look at PEDs as a possibility of these torn ligaments. As Biggbubba mentioned, tendon strength hasn’t changed. And it’s not like Mark Buerhle is having arm trouble, that I know of.

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    • bdhudson says:

      Strength training and conditioning techniques have also improved greatly since Gooden’s day. You’re free to point at PEDs if you like, but you can’t ignore other potential possibilities.

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      • Spit Ball says:

        They have improved but “the beach body epidemic” may be hurting some of these guys. Any human who has ever lifted weights consistently for a time knows it will decrease flexibility unless you are careful and work on range of motion, balance, flexibility etc. Some of these pitchers look like Bench, Curl, Shoulder press guys.

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        • Plucky says:

          I’m 99.9% sure that major league franchises who employ full-time professional strength and conditioning staffs, and whose players work out at team facilities are not making that mistake. All these people, the athletes included, are professionals here, not jersey shore bros

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  25. Not a Doctor says:

    Personally, I wonder about some of these pitchers’ changeups. Harvey, Strasburg, and Fernandez all had great armside run on their changeups. If you watch them throw in slow motion, there’s a slight pronation and extension (bending back) of the wrist. Sometimes a slight radial deviation. I would imagine that puts a lot of strain on the elbow because it’s not really a changeup, it’s a screwball.

    Of course, after a cursory glance at the x-mov data from 2013, it appears that that’s not the whole story. Not only that, Hector Santiago who actually purports to throw a screwball, and was hitting over 95 on a radar gun at one point with his fastball (another characteristic shared between Fernandez, Harvey, and Strasburg), has not torn his UCL yet, to my knowledge. It’s possible other pitchers are generating arm-side run without pronating or extending their wrist, but I’m not sure how that would work exactly. I still think it could be a factor.

    Those suggesting this might be increased recognition of injury may be right, but it certainly seems like an epidemic. If I were MLB I would be putting out a bunch of huge grants to get people to figure this out. You can’t have the game’s youngest and most exciting players all going down one after another like this.

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    • Bip says:

      A regular fastball involves some pronation as well. To my knowledge, injury has really been linked to changeup usage. Fernandez rarely uses the changeup anyway. It would have to be a really stressful pitch to cause the injury when he throws it <5% of the time.

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    • Spit Ball says:

      No biggie, Hubbell threw one for years “back in the day” and the only drawback was he had to shake your hand backhanded in his older years.

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  26. Shane young says:

    I think I remember reading the in game report saying Fernandez had food poisoning and had thrown up before the game. I wonder if he tried to overcompensate from fatigue…idk something to think about

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  27. thekcubrats says:

    Can’t believe some commenter in here blamed PEDs for causing TJs… Really?

    Wow that’s just monumentally thick. Not as stupid as the Fish manager and staff allowing Fern to go, sick and dehydrated… and then leaving him in endlessly while velocity and results plummeted…

    Doesn’t it seem far more likely that the recent spate of TJ surgeries (not this one in particular, which was a crime committed by stupid management, forcing the probability of an injury) might be related to the sudden absence of PEDs?

    People want, like Bud wants them to want, to think of PEDs in terms of bodybuilding sluggers cheating the game, but the posterboy ought to be Jason Grimsley, a fringe arm trying to hang onto million dollar possibilities by juicing himself into continued relevance. You remember Jason, don’t you? Guy who crawled through drop ceiling to retrieve Albert Belle’s corked bat from ump’s room? Read something:

    http://en.wikipedia.org/wiki/Jason_Grimsley#Illicit_drug_use

    His drug use began in 1998 while in Buffalo, New York. After a nine-year MLB career, he was in the minors trying to get back to the majors after a shoulder injury. Among the drugs he has used are Deca-Durabolin, amphetamines, human growth hormone and Clenbuterol. Prior to the use of performance enhancing drugs he had earned a total of $1 million; subsequently he earned $9 million. His ERA dropped by a run.

    9 > 1

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  28. Mike says:

    Ancient Greeks lifted weight and performed resistance exercises. Fernando threw a screwball, the motion for which apparently protects the UCL. All I am asking is, could PED use play a role in what is being described as an epidemic?
    As much as PEDs can aid training and recovery, could they also harm?
    It’s not like pitchers getting a little help is new or unfounded: http://sportsillustrated.cnn.com/2011/writers/the_bonus/08/02/nitkowski/

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  29. Mike says:

    “The ulnar collateral ligament (UCL) can become stretched, frayed or torn through the stress of repetitive throwing motions.” – eorthorpod.
    Would increased strength – whether increased muscle mass or increased velocity – not contribute to more stress on the ligament?
    No clue why a young pitcher would want to increase his velocity.

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    • Steven says:

      Velocity = better = might actually reach the majors = might become a multi-millionaire instead of living with 3 other guys in a shitty apartment on the monthly $1,200 salary.

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  30. Couth says:

    What do you expect the ratio of starters to relievers should be for TJS? What ratio are we currently observing?

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  31. Max G says:

    Strasburg, Harvey, and now Fernandez. Heck, just this year alone, by the the time the first month of the season was barely done in April, we saw the likes of Matt Moore, Kris Medlen, Jarrod Parker, Patrick Corbin, and Brandon Beachy all fall victim to Tommy John’s dreaded knife. Obviously Beachy is a repeat offender, and no surprise, but clearly something is very different about the fragility of starting pitcher elbows compared to the workhorses of the 1980s, 70s, and 60s. Or even the 1990s. I don’t remember this many Tommy John surgeries then, and there were plenty of hard throwers, juiced or not.

    There is no magic innings pitched max number that will prevent these types of injuries, because there are a lot of factors that determine the intensity of each of those innings, not the least of which is simply the number of pitches thrown per inning, combined with pitch-type percentages.

    I think David Cone summed it up best during a Mets game last year, when he was interviewed in the booth and explained how stupid the concept of an innings pitched max is on injury prevention. I recall him explaining that every inning is different, and that you don’t have 150 or 170 or even 10 innings that were exactly the same in terms of intensity, duration, physical exertion, etc., so how is that max number even calculated? There is no basis for it. The Felix Hernandez 19-20 yr comp is a great point to that end; as stated in this article, his elbow has held up beautifully.

    So the question comes down to not how many innings should be the max during early player development, but what exactly is weakening the elbow so severely that every dominant young hurler seems to suffer the same result? I’d look at the workouts. If all starting pitcher workouts can be tabulated, is there a component of the typical SP workout regimen that is commonly shared among the pitchers that have suffered elbow injuries? That would be a good place to start.

    Something must explain how Nolan Ryan could throw 98 mph every 4th day for 3 decades, on very high pitch counts, whereas healthy, young, athletic pitchers with the benefit of modern protein shakes and specifically tailored workout routines cannot maintain Ryan’s velocity for even two years consecutively, on 5+ days rest, without suffering some major elbow injury.

    There is an answer to this somewhere, and I’m guessing it will be in the workout data if that can be collected and tabulated for analysis somehow.

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    • Dave D says:

      Yeah, Max, I agree Nolan Ryan should be studied. I know he worked out his legs like crazy. Hydration is one point already brought up jut I also wonder about diet. I bet Ryan ate a lot of red meat. Nutrition, right kind of rest allowing body to recover are better studied in other athletes. Maybe pitchers should study body builders regimens on avoiding muscle fatigue.

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    • Cheesewhiz says:

      I’d say it has a lot to do with high stress pitching without proper recovery time before the muscles and ligaments are fully developed, like as a child or teen.

      One of the biggest developments over the past 20 years or so is the crazy sports parent. Parents that treat the child’s sports development like a professional coach.

      This doesn’t just apply to pitching elbows. You can pretty much apply it to all positions and sports.

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  32. Swfcdan says:

    Sliders, sliders, sliders. Jo-Fer is a heavy sliderball pitcher, and that’s what increases his injury risk. I bet it was a slider that was the pitch that caused the injury, we all know sliders are what cause injuries by far the most.

    Horrible news for baseball, but a welcome relief for us fantasy owners who have to go against rivals with that kid in their rotation. Im torn!

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      • Swfcdan says:

        And Jo-Fer throws both sliders and curves…there’s likely your answer.

        The question then is, are pitchers throwing more sliders/curves nowadays? Whether that’s choosing them over cutters/splitters/change’s due to better effectiveness or just throwing a greater percentage of sliders/curves in a game?

        There does seem an awful lot of slider/curveball pitchers these days, and a lot less who throw cutters and change’s (and particularly splitters) more as secondary offerings. Something to think about for MLB teams maybe.

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  33. Phantom Stranger says:

    Anyone want to comment on Jose’s game management? By that I mean his average intensity per start? I realize as a young pitcher you have to prove you belong in the Majors, so it’s hard to let up on the throttle. But most of the starts I saw had him throwing at or near his peak velocity, inning after inning.

    Pitching coaches are going to have to emphasize on managing a starter’s intensity and pacing over 30+ starts. Most pitchers will break down if they pitch at their physical limits for 180 innings. I see a lot of young pitchers basically throwing at playoff-intensity levels, start after start. This is definitely a trend that has become increasingly common in recent years.

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    • Swfcdan says:

      Very good point, hadn’t thought of that. Could be a cause for sure. Guys shouldn’t be able to consitently throw 97mph inning after inning if you think about it, not unless you’re built like a horse.

      Reducing intensity and settling in at 94mph should be the way forward. Maybe Jo-Fer was told this and just wanted to throw gas every inning and strike the world out, who knows.

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      • Bip says:

        Another thing is young people don’t know their limits as well. It’s not just because of inexperience; they are actually neurologically not as developed in that area. I think some arm pain/soreness is normal. Being able to tell the difference between a routine level of pain and a level that indicate overexertion may be very difficult.

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  34. jose fernandez jr says:

    yeah trying to strike people out is bad.

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  35. Hurtlockertwo says:

    Why do some players get hurt often and some never?? The fact that two guys can both throw 95mph doesn’t make them the same. Diet differences, muscle mass, simple heredity are all going to factor in. There is also likely a maximum stress point that the human elbow can withstand without injury. With the velocity of current pitchers I would think we are geeting closer and closer to that point.

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  36. Josh says:

    What about the old time guys who threw more innings in one season at 20 or 22 than Stephen Strasburg has in his 5 year career and some of these guys did it for 10-15 years.

    To me, its counterintuitive to say a guy needs to be limited when he is young and agile as opposed to when he is older and broken down. Tom Seaver threw 250+ innings as a rookie and the only reason Greg Maddux didnt is because nobody realized he was capable of dominating major league hitters for 250+ innings yet.

    It seems to me the rise in TJs correlates with the athletes having more or less on demand access to MRIs, where as just a few years ago a player may have to wait a couple weeks to have a MRI taken. Maybe pitchers are more capable of performing with a damaged UCL than we think they are

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    • LHPSU says:

      So, how many pitchers have Tom Seaver’s career back in the day?

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    • Swfcdan says:

      In that case though the pitchers still wouldnt continue after finding out they had a torn tendon in the past. So it would take a few weeks longer before they had TJ. Doesn’t explain the jump in surgeries now.

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      • jorgesca says:

        TJ surgery is not black and white, radiology have certainly advanced and I think it might have to do with finding ANY structural damage = TJ now, whereas in the past you might have not even seen the damage.

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  37. TrisSpeakerFanboy says:

    Dave, You mentioned some companies are already looking into biomechanics. Can you name any of them off the top of your head? This is an interesting topic, and I’d love to read about their research.

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  38. TKDC says:

    Another possibility is that in 20 years this is a 15-day DL stint and the replacement ligament is artificial, meaning you can tear it as many times as you like. I’d honestly bet on the effects becoming less severe over prevention becoming better.

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  39. Mike says:

    I new if my elbow was sore or not when I was 8.

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    • Kevin says:

      And you also thought every scrape required a band-aid…maybe you weren’t as awesome at differentiating pain and discomfort as you th

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  40. Mike says:

    No Band-Aid for a sore arm, just heat and ice and rest.

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  41. Kevin says:

    there’s definitely an individual body component to this that is entirely unpreventable, but i’d wager mechanics are a very much a thing when it comes to injury prevention. Pitch selection and velocity are also likely to play an role. As the modern young pitcher continues to throw harder and harder every year, isn’t it inevitable that more guys are going to get hurt? the arm can only take so much, and they’re all pitching on borrowed time to begin with.

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  42. Swfcdan says:

    This has been a great discussion, well done fangraphees.

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  43. 96mnc says:

    I think it’s a combination of the following:

    1) Early Athlete Specialization

    I think that American kids are spending way too much time pitching in competitive situations before they reach the pros or college. Yeah round pitching is a mistake IMO (note I said year around pitching, not year around throwing). People used to be multisport athletes that only dedicated themselves to baseball in their senior year or once they went pro, not at age 11. Arms had a chance to recover while kids were playing other sports. Not anymore, kids are playing their high school season, summer ball, fall ball.

    2) Weight lifting
    Having lifted weights for an extended period of time and NOT lifted weights for an extended period of time I’m hypothesizing that our current focus on weight room athletes is detrimental to pitching as an unnatural increase in upper body muscularity can lead to imbalances. It’s one thing to build upper body strength by doing push-ups and pull-ups since all of the small muscles around the shoulder and elbow have to gradually increase strength at the same rate as your back or pecs. It’s another thing to do bent dumbbell rows and bench presses to increase those areas of strength in isolation. And as any serious weightlifter, at some point they’ve tweaked their elbow or shoulder benching.

    Again, I say this having never set foot in a MLB training or strength and conditioning room so I have no idea how much weight lifting pitchers are doing. But I feel strongly enough about this issue that when/if I have a son and he plays baseball there will be no weightlifting while he is still a teenager with the exception of maybe squats. He can long toss until he’s blue in the face though.

    3) Changes in “conventional” mechanics and loss of body momentum
    Think back to videos you see of Gibson, Seaver, Koufax, Tiant, Paige, Carlton, Ryan, Clemens, Gooden, or most pitchers pre-1990. All of these guys had either a super high leg kick (by today’s standards), the swinging arms full windup with hands over their heads, or some sort of other exaggerated twist or turn that resulted in them using their entire bodies to propel the baseball towards home plate. Now look at most pitchers throwing today. That full use of the body is gone and so is the resulting momentum placing more stress on the arm. I blasted the Mariners for changing Taijuan Walker’s mechanics reducing his leg kick and taking away his momentum. Again, this isn’t every pitcher then or now but the new pitching template definitely seems to reduce the use of the legs and entire body.

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    • jorgesca says:

      Re weight lifting, any professional athlete out should be basing his weight lifting in functional movements, squats, deadlifts, rows, that do not create imbalances and are engaging legs as well as core muscles. I have read most athletes do it, but could be something to look into as pitchers might think they need to work out differently.

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    • RichW says:

      Fergie Jenkins has said in a couple of interviews that he never lifted weights and that he threw every day to maintain his arm strength.

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  44. 96mnc says:

    Also, specifically as it applies to Jose F., former major league pitcher Justin Orenduff specifically said that Jose Fernandez was going to need to have TJ surgery in the article below. He states that his changes in his pitching mechanics due to his training regimen would lead to a UCL injury. He posted it on March 12th of this year.

    http://baseballrebellion.com/jorenduff/did-jose-fernandez-change-his-pitching-mechanics/

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  45. Satchel Paige says:

    Not sure if this was posted already but he changed his delivery this year, for the worse according to a former pitcher:

    http://baseballrebellion.com/jorenduff/did-jose-fernandez-change-his-pitching-mechanics/

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    • MALLOW says:

      Came here specifically to post this. Reading the article back when it came out the thought crossed my mind that the change in mechanics would be bad, but now we see how spot-on Orenduff was.

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    • chuckb says:

      It was mentioned … in the comment immediately above yours.

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  46. Ben says:

    Maybe someone else has already suggested this, but if we feel year-round pitching is a culprit, it would be interesting to look at injury rates for FL/TX/CA pitchers vs. Midwest pitchers…

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  47. GreenMountainBoy says:

    I’ve been saying this for 10 years. When will somebody listen? It’s all about mechanics. What they teach these days as being good mechanics (compact, tight deliveries) are actually BAD mechanics and MORE stressful on the elbow. In a nutshell, it amounts to this. The shorter the lever, the more stress on the elbow. The longer the lever, the less stress. I can identify 80% of the most likely guys to have TJS now just by watching their deliveries. And I’m right so often it’s amazing. It’s so obvious to me, but apparently unfathomable to MLB execs/coaches, who have tens of millions invested in these pitchers.

    Also, what the old-timers said has turned out to be true. I didn’t believe it then but I do now. The leg and butt muscles are the most important ones to a pitcher. They take stress off the arm/elbow when well-developed. Running, not lifting weights, is the best thing a pitcher can do. I also believe what Nolan said is correct. More throwing, not less, develops the arm/elbow muscles better for the long haul.

    The exception to all of this for me is Matt Harvey. He has beautiful mechanics, yet he still underwent TJS. But even there, I see a possible exception in the abusive pitch counts (140+) he was routinely allowed to endure in college.

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    • BDF says:

      Gives us the list! Let’s falsify your theory or not.

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    • 96mnc says:

      I agree and said much of the same in my post above yours. The way we are training our stateside kids, both mechanically and in the weight room, is really hurting them once they reach their early 20s.

      If you look around the http://baseballrebellion.com/ site I mentioned above you can see that they are teaching their young pitchers to throw with much longer levers, old school style, and getting them to use their entire bodies, especially their butt and legs.

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    • Steven says:

      I don’t believe you said a single true thing in your spiel, except that UNC worked Harvey too much.

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    • bob says:

      I’d also like to see your at-risk list.

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  48. jose fernandez jr says:

    obviously, in the past guys pitched thru more injuries. if a torn elbow ligament was the end of your career you are going to try to pitch thru it, rehab if its only partially torn, etc.

    but now TJ surgery is not really a big deal, you miss a year, still get paid and have a decent chance of throwing just as hard as before (obviously, there are some disaster stories, but some guys come back better, too).

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    • Mike says:

      I think you are underselling the magnitude of Tommy John surgery. While it does have a very high success rate, it is not 100%. Though rare, there are pitchers who never fully recover from Tommy John Surgery. Its also an issue when pitchers are requiring the surgery earlier and earlier in their career. Tommy John surgery was initially conceived as a way to extend a pitcher’s career by about 4 to 6 years. So, if you are already on the other side of 30, no big deal. Odds are you weren’t planning on pitching that much longer than another 4 to 6 years anyway. But for a young guy, this could be a problem as he progresses through his career. And as a Braves fan, I can attest, just because you recover completely from your initial Tommy John’s surgery, doesn’t mean you are suddenly immune to future arm problems, (Venters, Medlen, Beachy) Each subsequent Tommy John surgery decreases the odds of full recovery.

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  49. hp says:

    http://baseballrebellion.com/jorenduff/did-jose-fernandez-change-his-pitching-mechanics/

    I read this a few months ago, didnt know what to think, sick to my stomach now.

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  50. bob says:

    Fernandez struck out big league pitching just the same. It really wasn’t much competition for him. Even the great Troy Tulowitzki was dumbfounded at just how thoroughly Jose Fernandez dominated him.

    I think the pitching while tired thing applies here though. When he lost all that velocity in his last start, he was feeling sick and had thrown up in the dugout before making his start. I’d say that certainly ups the fatigue factor, maybe forced him to overcompensate and that blew his elbow out.

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  51. RichW says:

    This may be simplistic but if you look at the list of pitchers since 1984 who threw the most innings in their 18-24 age range you find only two TJS in the top 31. Jeremy Bonderman (2012) and John Smoltz (2000). Both had surgery some years after the period in question.

    Looking at pitchers with the most seasons of 200+ IP in the 18-24 age range, you find Smoltz again, Ben Sheets Ryan Dempster and Scott Erickson out of the top 34.

    So there doesn’t seem to be much of a connection between TJS and throwing lots of MLB innings when young.

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  52. Joanne says:

    It’s not about how much the Marlins have protected him from getting hurt. It’s about how much did he pitch his younger years, high school years and summer ball. He was the ace they probably abused his arm. This injury does not happen all of a sudden it’s years of abuse and curve balls at an early age. Parents take note don’t let the coaches abuse their arms. Follow the limits of pitches for the age group. I just saw this last week in the regional finals a 16 or 17 year old pitching 128 pitches in a game its insane.

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  53. Bill says:

    It’s all about the mechanics. And the post above about long lever is better for the arm is absolutely false. Ask yourself this question. How many QBs in the NFL, college or HS have had TJ due to throwing a football? None that I can thunk of. And in practice QBs are making a huge amount of throws. Heck some even throw 60+ balls in a game. Their arms are sore – but elbow problems are not part of that game.

    Jose changed his mechanics slightly this year as shown in the article on Baseball Rebellion. His arm was setting up late at foot strike – essentially a forearm flyout. Last year his arm was setting up earlier. Due to the increased power and velocity pitchers are going to need to get away from the inverted W and get the ball closer to their ear when the lead leg lands or we’ll continue to see many more TJ surgeries.

    I think Strasburg (and others with the inverted W that causes their arms to set up late) is in danger of getting another injury to the elbow.

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  54. TwinsfanTravis says:

    Why does the fact that kids are beginning to throw breaking pitches at younger and younger ages never factor into this discussion? I do private instruction for a living and I see kids as young as 9 and 10 already throwing a high amount of curveballs and sliders in games. This is an age when arms are developing the most and this must be doing a ton of damage to their arms. To me it’s no coincidence that this rise in the level of UCL injuries is happening along with this growing trend. When I was a young ball player, my father and coaches wouldn’t even show me the grip for a curveball until i was in middle school. But now there is so much pressure put on these kids by their parents and their coaches in these highly competitive leagues and there seems to be no regard for how they should be properly developed. I think we are now seeing the product of this mentality. I am not a doctor though, so I would like to see this issue addressed by a medical professional.

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