Pitching Through Pain Rarely Works Out Well

Diamondbacks lefty Patrick Corbin suffered a partial tear to his ulnar collateral ligament over the weekend, and will almost certainly require Tommy John surgery. Obviously, that’s a big blow to Arizona’s playoff hopes — and, as with Matt Harvey last year and Stephen Strasburg before that, just a huge downer to any baseball fan who enjoys watching talented young pitching — but we’ll get back to that in a second. What really caught my eye about Corbin’s injury was this quote from the MLB.com story:

Corbin said he had been feeling tightness in his forearm through much of the spring and during his Saturday start, but the pain went to a next level with the final three of his 91 pitches in Saturday’s game. He said he felt “a little shock” but no pop in his elbow those last few pitches, and he decided to shut it down.

“It was just the same tightness I kind of had the first three starts, but nothing out of the ordinary,” Corbin said

That’s because Mets lefty Jon Niese said something similar after leaving Sunday’s game with what is being termed “elbow discomfort”…

“I told them I felt fine, but obviously they don’t want to take any chances,” Niese said, noting that he first felt discomfort in his elbow during an intrasquad game last week, which was his first game action since a bout of shoulder pain in late February.

…as did Dodgers prospect Ross Stripling earlier this month

He first noticed something was wrong with his elbow early in spring training after pitching to former minor league teammate Joc Pederson during batting practice.

Stripling said the competition got the best of him and after he threw a series of cutters to Pederson, he felt a tearing sensation. He continued to pitch but his elbow felt sore the rest of the week. After an MRI exam, the Dodgers’ medical staff said surgery was necessary.

…and A’s starter Jarrod Parker, who has the dreaded “visit to Dr. Andrews” on his calendar:

The early days of spring weren’t bad, but the more he threw, the more he had trouble getting comfortable or even throwing without pain.

He tried to pitch through it, hoping things would clear up, but on Thursday’s side session, both pitching coach Curt Young and manager Bob Melvin noticed his struggles. Melvin called him into his office, and it was then that Parker admitted the pain was back.

Notice a pattern there? When the human body is asked to do something that it’s perhaps not built to do — say, repeatedly throwing a baseball at a high velocity thousands of times — and there are already clear warning signs, continuing to perform that same activity generally only continues to add stress, until the stress reaches such a point that the body can’t take it any longer. Something breaks. Seasons end.

And those are just in the last few weeks. If you delve into previous years, there’s undoubtedly dozens, if not hundreds, of similar examples of pitchers attempting to push through pain, only to find that the outcome wasn’t a positive one. Tony Cingrani hid a back injury last season, eventually landing on the disabled list when it worsened, or as he put it, “I really couldn’t even stand up any more.” In 2006, Eric Gagne tried to pitch through pain, and after it became clear something was wrong during spring training, he admitted to it and found that the damage was such that the valuable portion of his career was essentially over at age 30.

You get it, of course, and we don’t know for sure that the teams weren’t aware of any of this (though Parker’s and Stripling’s seem to be clear that their clubs did not). Professional athletes are groomed to be “warriors,” to “play through the pain,” to “leave it all out on the field,” or whatever other description works best for you. No one wants to be injured. You want to play, right up until the point where it’s absolutely not possible for you to do so. Some don’t want to be seen as being weak or risk their standing in the clubhouse by appearing too often in the trainer’s room, as this excerpt from former major leaguer Dirk Hayhurst‘s most recent book shows all too well. For a younger player, there’s the worry that the chance in front of them is the only one they might get, which Rockies pitcher Franklin Morales all but admitted to in 2008, when he hid a back injury all season long. Morales didn’t end up causing himself further injury, but he did hurt himself in another way — after a nice 2007 debut, he pitched so poorly in 2008 while hurting that he ended up spending most of the season in Triple-A. For Daniel Hudson, he kept elbow discomfort to himself because he was weeks away from completing a long rehab from Tommy John and was eager to return; he’s now currently attempting to rehab his second elbow operation.

Intuitively, this makes sense. There’s obviously a certain amount of ego that goes into being a professional athlete, that belief that you are the best at what you do, that you are indestructible. And as any athlete will tell you, there’s rarely a time where you feel 100 percent — there is always some sort of ache to work through over a long season. Objectively, however, you wonder how some of these injuries might have played out had they been dealt with immediately. If Stripling, for example, had stopped pitching when he first felt soreness, perhaps he might not have blown out his elbow. If he hadn’t continued to pitch for the remainder of the week after feeling “a tearing sensation,” it probably wouldn’t have prevented the Tommy John — it’s pretty easy to assume the damage was done by that point — but maybe he would’t have had to undergo a preliminary elbow surgery just to prepare for the Tommy John, because since he still hasn’t had the zipper done yet, his 2014 season isn’t just gone, his 2015 outlook is in peril too.

This isn’t limited to pitchers — there are similar examples among position players — but with the recent spate of pitching injuries this spring, with Kris Medlen, Brandon Beachy, Cory Luebke, A.J. Griffin, and Joe Wieland all suffering serious arm trouble, we’ve been talking a lot about what can be done to keep pitchers healthier. Perhaps a good first step is attempting to improve the communication and the culture around being open with what a player is feeling internally. That certainly won’t solve every issue, because pitchers are always going to get hurt. Any pitch could be their last, and it doesn’t always come with a warning. But many do, and an atmosphere where it’s not necessarily seen as “weak” to disclose and report trouble might save arms in a way we could never really measure.

Back to Corbin, he hasn’t decided yet if he’ll have the surgery, and we also don’t know the exact sequence of events that he did or did  not discuss with his training staff. But it definitely doesn’t sound promising for him, sadly, and with Bronson Arroyo having made only a single spring appearance while battling back trouble, this cascades down the Arizona rotation. Instead of having enough depth to send Archie Bradley to the minors to start the year, they now may need to rush him and start his clock. Instead of the 2-3 WAR Corbin was expected to provide, they now need Wade Miley to be more than he is, and to wonder if they’ll need to resort to Zeke Spruill or Bo Schultz or Alex Sanabia or Josh Collmenter in the rotation.

It’s bad for both Corbin and his Diamondbacks, who spent this winter in order to contend right now. The events of the last few days make that seem less likely. Mostly, it’s bad for baseball. No matter how you feel about Arizona, no one wants to see a pitcher coming off a breakout year go down, and with the number of injuries we’ve seen recently, it’s become more clear than ever that the next great breakthrough in baseball — the one that will be worth millions or even billions — will be the one that helps figure out how to preserve some of these arms. It’ll take work on both sides, though. The first step has to be honesty.

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Mike Petriello lives in New York and writes about the Dodgers daily at Dodgers Digest, as well as contributing to ESPN Insider. He wrote two chapters in the 2014 Hardball Times Annual as well as building The Hardball Times site, and was an editorial producer at Sports on Earth. Find him at @mike_petriello.

47 Responses to “Pitching Through Pain Rarely Works Out Well”

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  1. Steven says:

    Sure. But we only hear of this happening when things get much much worse.

    Why would these pitchers continue to pitch when catastrophic injury seems so nearly inevitable? Perhaps amongst themselves, just about every pitcher is feeling these pains and worries about their careers. But as long as most of the successful ones make it through the pain with the rest of the league watching, we’re going to have other players try to emulate that.

    I want there to be fewer pitcher injuries just as much as the next guy. I just think we need to try to understand the issue a little better than this.

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    • SimonSays says:

      It’s not about working through the pain necessarily. It’s about the contract and competitiveness.

      A lot of these guys are young and on their first contract. If they do well, they get a big contact. There’s a huge motivation right there to power through whatever pain you may have to make the big bucks. A lot of these guys have spent their lives training to be baseball players – they need to big contract or else everything they’ve worked for is for nothing.

      Competitiveness is also a huge and more immediate factor. I pitched in high school and college through arm pain because the thought of taking time off was that depressing. I was there to play, so sit on a bench and do stupid rehab. A year of not playing the game I loved was a terrifying thought.

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  2. matthegarty11 says:

    I wonder how injuries to pitchers affect their strikeout rates after being cleared from the disabled list. Clay Buccholz strikeouts experienced a heavy decline in strikeouts after recovering from a shoulder/neck injury last season. He also pitched less innings per start.

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  3. John C. Calhoun says:

    Kind of an important question I’m left with: How much “soreness” and “pain” are MLB pitchers supposed to put up with? Because if the answer is “zero”, then there won’t be many pitchers left to play at all. Obviously, pitchers have to deal with soreness and pain, but I’m wondering if, on top of the ego etc, some guys just aren’t as good as others at determining what’s bad pain and what’s normal pain.

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    • I was going to comment but this one basically captures what I was thinking: pitchers pitch with pain all the time, so it could be hard to determine what is normal pain and what is “oh my gosh, you better see a doctor” pain. Hence why most pitchers ice their arms after games, the pain is so much that the arm gets inflamed.

      I’m sure the ego is part of it, so is the competition, and the the need to stay out there and not miss your chance to reach the majors. That’s what happened to Foppert and unfortunately he blew his arm out so bad that he never made it back to any semblance of what he was showing just before his injury.

      Still, how does a pitcher distinguish between pain that is normal and pain that signals you better shut it down?

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    • Kyle says:

      As a player, there are some kinds of pain that you play through and others that you don’t. For example, you don’t play through elbow pains (throwing side forearm pains are also bad because of the connection to the UCL), hamstring pains, lower back pains, and deep shoulder pains. These areas have always been a red flag to me and seem to be the most common injuries that are DL related. On the other end of the spectrum I have always played through any lat, calf, quad, or back side of the shoulder pains. We all want to play as much as we can, but you have to learn to listen to your body and know the difference between a reg flag type of pain and regular pain, soreness, or stiffness.

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  4. clevelander says:

    How long until postgame MRIs become as common as the ace bandage and ice pack for pitchers? Cut out the middle man if he wont tell you about his pain.

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    • MrKnowNothing says:

      I’ve long thought this is a big missing key for a team. They’ve got untold hundreds of millions invested in some individual pitchers and in the staff as a whole. By taking an MRI every day of the entire staff they could begin to develop a baseline for all future pitchers. They’d have more data available than almost anyone and could begin to start seeing major injury issues, maybe well before they finally manifest, allowing them to potentially address them before the major UCL injury.

      A high end MRI machine can cost $1mm which isn’t chump change per se but it’s A LOT cheaper than losing a $20mm/year pitcher for 12 months.

      (But maybe some teams already do this.)

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      • Jason Powers says:

        If an MRI is only a millon, that is money well spent, assuming it can provide the info needed to establish a good working baseline. As pitcher avg velocity rises and they feel the need to go max effort (always at the limit) there is only so many fastballs or sliders or pitches in general. If a doc wanted to be an MLB star, design a way that limits breakdowns or predicts it like a tornado…either is useful.

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      • Travis L says:

        A lot of damage won’t show up on an MRI, especially in the early stages of an injury. (Source: I needed pitching shoulder surgery even after several clean MRIs.)

        I was taught from an early age to differentiate between pain and soreness. Pain is something that will probably worsen without rest. Soreness is something that’s an acceptable result of performing a high intensity, unnatural motion.

        I think the way forward is to train the athletes to understand the value of themselves as a long term asset. Teams need to convey the impression that they don’t want to pump-and-dump a pitcher, especially one as talented as Corbin. I wonder if one of the positive side effects of these recent young player extensions are to convey that focus on long term value.

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        • Richie says:

          So how do/did you diffentiate pain from soreness? Did nothing for a few days to see if it went away or not? Not an option for a MLB pitcher, who can’t let plain ol’ soreness stop him from his normal between-stints workout, never mind actual games.

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        • MrKnowNothing says:

          Even if it’s not all showing up, basically having every possibly non invasive deal known to man to look at guys seems like a great investment. The team that is able to “crack” the Tommy John issue will have an astronomical advantage over everyone else.

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      • emdash says:

        It isn’t just the cost of the machine – you also have to pay for the time of a specialized doctor who’s able to read the MRI for players whose arms are probably always a little damaged. If you do it for every pitcher after every outing, teams would each have to hire someone with expensive skills fulltime.

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  5. Hurtlockertwo says:

    I disagree, my arm used to be sore every spring when you start throwing again. That’s kind of a sign your out of shape. You have to take it easy, get your arm used to throwing again. The fact thst some guys get seriously injured is more about a person being more injury prone, not that they had pain when starting to throw again.

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  6. ChuckO says:

    As a Braves fan, I’ve been wondering why they seem to have had so many arm injuries in recent seasons. When their pitching coach was Mazzone, they weren’t similarly plagued. That could be luck, but there was one difference in the way Mazzone handled things. He had his pitchers throwing a lot between starts, though only at about 75% effort, something he learned from Johnny Sain. He likened it to a runner training between races. When Mazzone left, the Braves stopped doing this, and went back to the traditional way of doing things. Is there something to be learned there?

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    • jdbolick says:

      I think you’re forgetting about John Smoltz and Steve Avery having significant injuries. If it seems like the Braves had less, that probably has more to do with Maddux and Glavine being durable than any throwing program.

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      • ChuckO says:

        I didn’t mean to suggest that the Mazzone approach is a panacea, but I have to wonder. True, Smoltz and Avery had their problems, but look at the current and recent Braves, Medlen, Beachy, Venters, Hanson, Jurrjens, and that’s just five. I know there are at least three or four other well-thought-of minor leaguers.

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        • vivalajeter says:

          I’m not a Braves fan so my recollection might be fuzzy, but didn’t Wohlers and Rocker have arm injuries too? If you went through the roster during Mazzone’s tenure, I’d assume that you’d find several more people with an arm injury that you’ve forgotten about.

          Maybe Mazzone’s philosophy worked, and it kept people healthier. Given his reputation, I’m surprised more teams haven’t thought to try it. But I’m thinking we might be pretty far away from being able to pinpoint the best approach to avoid injuries.

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    • Given that it’s a sabermetric site, it might be better to see some stats on this, even if it is just SSS, regarding Mazzone vs. after.

      After all, I think we can all agree that pitching is an abnormal motion for the human body and, except for oddities like Lincecum, causes a lot of pain to the arm, so to expect Mazzone’s methods to result in no injuries is not a reasonable expectation.

      I think the reason Mazzone’s methods has not been tried more is because of the BP reign of terror with their 100 pitch limit and stuff, it’s easier for clubs to toe that line and be conservative than to challenge it and risk blowing out your rotation’s arms. Kind of like “you can’t go wrong with IBM” except that you can.

      But Bill James rebuttal to their theories (in his book on pitching) makes sense to me. It’s a muscle and in life muscle’s get stronger with usage, not by using it less. I sometimes wonder if it’s a downward spiral effect: warning to pitch less causes arms to weaken due to less usage causes more injuries causes more warning to pitch less causes arms to weaken due to less usage causes more injuries and so on.

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      • jdbolick says:

        There is abundant evidence that throwing lots of pitches raises the risk of injury. As far as I know, there has never been any evidence anywhere that throwing too few pitches raises the risk of injury. That smacks of the “tough guy” mindset where old school baseball fans insist that teams baby players today, exactly what this column is arguing against.

        While others are far more knowledgeable about physiology than I am, I can’t figure out how more muscle would help produce less strain on the UCL. It seems that the only things you can really do are to use a motion that puts the least stress on the ligament, throw sliders infrequently if at all, and then cross your fingers that you’re genetically blessed with good health.

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      • pft says:

        Actually, too much usage makes you weaker as the catabolic effects of too much cortisol production in response to too much inflammation (this inflammation causes the muscle soreness after a workout) actually breaks down muscle. Just ask any serious body builder or athlete.

        Pitching through pain and soreness is likely causing your muscles to breakdown and become weaker and not stronger

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  7. The core of the problem you’ve laid out is that players, trainers, teams need to discover the dividing line between pain and injury. Unfortunately,

    1) this line is going to be different with every pitcher
    2) their subjective thresholds of pain, not to mention varying willingness to admit to what pain they do feel, will make detection very much a guessing game, and
    3) given that muscle pain often comes from the slight tearing caused by exertion that the body normally knits up on its own, that dividing line arguably may not even exist.

    This is a serious problem in baseball, one that seems (admitted weasel-word) to be worsening even as more effort is expended in trying to rectify it. We may be reduced in the short term to just looking for what’s worked before (one example of which ChuckO noted above), emulating it, and hoping. It’s empirical when we’d rather be analytical, but what works, works.

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    • ankle explosion hr celebration says:

      This is way far out there, but I wonder if there’s a way to objectively determine pain/likelihood of injury by measuring concentrations of stress and inflammation chemicals in the blood. You could do a test every once in a while, and if it spiked, ask the player why. The trouble would then be dishonesty. But if the spike coincided with some increase in soreness or something like that, maybe it could serve as an early warning system for injuries (and then lead to further tests, or perhaps just skipping a start or something like that).

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  8. Sparkles Peterson says:

    Not pitching through pain = giving up pitching at age 19.

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  9. jdbolick says:

    My first thought on hearing about Corbin was how much he relies on his slider.

    As for the column, I agree with the premise, but that attitude probably has to start in high school where there is even more pressure to pitch through arm pain.

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    • That’s a good point to bring up. Romo’s known for his slider and his elbow seems to bark at him forever. I feel that it’s like a ticking timebomb.

      Still, out of all the pitchers the Giants had who pitched in the WBC last season, he was the only one not to either get injured or have a down performance season, and he seemed healthy all season.

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  10. Steve says:

    How much of this is a result of the D-Backs seemingly top-down org initiative to be tough guys?

    Pop in the elbow? Rub some dirt on it and make sure you hit that HBP quota we set in ST.

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  11. The Stranger says:

    I think there’s a little bit of selection bias here. Whenever a pitcher hits the DL, we hear about how he was pitching through pain. But I have to assume that when a pitcher pitches through pain and doesn’t hit the DL, we don’t always hear about it. Which isn’t to say that pitching through pain is a good idea, but it may not be as hopeless as it seems.

    As others have noted, it’s probably fair to say that there’s a some amount of unavoidable muscle soreness that goes along with pitching, and the line between “normal” and “warning sign” is razor-thin. It’s a lot to expect a ballplayer to be able to tell the difference. Not only is the pain probably minor to start with, these guys are mostly still at the stage of life where they think they’re bulletproof.

    Maybe it would help if you gave young pitchers a serious education in anatomy – really educate them about what goes on in their arms so they can identify what they’re feeling. Or maybe that would get in their heads and cause a new set of problems.

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  12. Moppe says:

    I don’t think a fangraphs writer is really qualified to judge, based on newspaper snippets released after the fact, what qualifies as “clear warning signs” of an impending UCL tear, or what procedures Corbin would have required or not.

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    • Richie says:

      Yeah, pretty much this, I’m afraid. The absolute obvious undeniable initial step is to distinguish normal pitching soreness from ‘wait, this does hurt just a bit more or differently’. I don’t see anywhere that we’ve accomplished anything there.

      And having had an elbow MRI; 1), it was unpleasant as all hell (maybe it was an old MRI machine, I don’t know); 2), it still didn’t tell the elbow specialist all that much. I don’t know that an MRI can tell you anything as to whether you’re 10 pitches or 10,000 pitches from shredding your elbow. Maybe only that you have or haven’t yet.

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  13. jfree says:

    I think these injuries are proving the shortsightedness of the leaguewide move towards pure one-inning guys in the bullpen and the separation of ‘the rotation’ from the bullpen. Monetarily, there is a huge incentive to pitch through pain – and be silent about it – in order to get the long-term contract (or the bigger arbitration award). Psychologically, it should be a ‘no duh’ that competitive athletes lie about their health to everyone (including themselves, their doctor, their team, and their wives) – always have, always will, every sport.

    But the teams are the ones who create the environment here – the ‘career path’ so to speak. They are the ones who structure their roster and their long-term contracts into high-paid starter-onlys v everyone else. What is the option for a pitcher who is throwing in pain? There is no job in most MLB bullpens today for ‘a pitcher’. All the jobs are strictly defined and there is no crossover among jobs. Indeed, MLB is so constipated into this strict definition mindset, that they become almost paralyzed when one of those strictly defined jobs (eg ‘the closer’) isn’t being filled by a pure specialist doing that specialty well.

    Back when MLB had a ‘four-man rotation’, the reality is that that rotation was almost always temporary/fluctuating over the course of a season. The average team actually had three or more swing SP/RP’s (who started and relieved more than five games) – and multiple pitchers who pitched 100+ innings. Today, there is one swingman per team – and pitchers are either expected to pitch 200 or so innings – or they are expected to pitch every other day (no recovery time there) and max out at 60-70 innings (and never get the longer contract unless one falls into the ‘holy closer’ role – max one per team).

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  14. Steve says:

    Good thing they have solid pitching depth in Skaggs. Oh, wait…

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  15. Yehuda Hamer says:

    Would three pitchers per game work over the course of a season?

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  16. Jon L. says:

    Thanks for this article. I really wish someone would do a more thorough article on players playing through pain in general. Unfortunately, it’s probably not possible because players, trainers, and teams are all prone to keeping various injuries quiet, for different motivations. But I have the impression that everyday players very frequently play through a level of pain that makes them not useful to their teams. “Oh, [our star player] is still feeling his [whatever injury], but it’s very important to the team that we have him out there providing leadership and sub-replacement level performance.”

    Often, a player is terrible for weeks, and then has to go on the disabled list anyway. I remember thinking this when Ike Davis admitted he was playing through injuries last year. Does he not understand how terrible he was? Was he experiencing so much cognitive dissonance about his performance that he not only hurt his team, but hugely diminished everyone’s expectations for his career, rather than just admitting he was hurt? But this is just one recent instance of a longstanding pattern.

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  17. Scott J Marcus says:

    I’m wondering why it seems like we are seeing so many pitchers needing their second Tommy John (ulnar collateral ligament replacement surgery) now.

    Is this just my subjective view — Corbin, Beachy, Medlen all in a week or two — or can it be backed up by data? That is, is the number of pitchers going back for their 2nd TJ surgery really trending up?

    And if so, could someone look into the reason for this trend, from an analytic viewpoint?

    My non-data-based guess is that it has to do with pitchers feeling invulnerable after their first TJ surgery. Similar to the way the addition of airbags has made for a lot more aggressive driving. The theory is, “I can throw as hard as I want, for as long as I can, now that I’ve got my new ligament.”

    And, again, all of this is based on my subjective view — maybe the percentage of pitchers needing their second TJ surgery is not really trending up.

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    • SoCal Metfan says:

      Interesting thought, I’ve wondered the same thing myself. Additionally, it seems that we’ve seen the recovery time from TJ surgery go from 18-24 months to 12-18 months. Maybe players “rushing” back from surgery is a contributing factor?

      Anecdotally, we’ve heard stories of players actually throwing harder after coming back from TJ. Not always, but I’ve heard that said enough to wonder if perhaps the additional strain of intense rehab to return from the injury is a contributing factor to a second recurrence?

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    • emdash says:

      The incidence of TJ surgery has gone up sharply over the last few years, so it could be there are more second surgeries simply because there’s a larger pool of pitchers for whom a second surgery is possible.

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  18. Steve d says:

    Why March? I understand every situation is different. It for the most part are these new injuries or maybe something from last season that ey dealt with. Like in the case of Harvey. He said he felt it for a while and was shocked when he got the results. Does the offseason of inactivity have anything to do with it? Thanks

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  19. boomer says:

    Identify the pain…figure out what causes the pain…Fix the problem and eliminate the surgeries.
    Strasburg was a Tommy John waiting to happen as he continually opened up too wide with his glove hand leaving his pitching arm quite a distance to travel to catch up with the body. This caused the elbow to bang against itself repeatedly putting stress on the elbow. If he doesn’t fix this now post TJ surgery, he will be back under the knife and going through rehab.
    Voglesong for the Giants is another pitcher that is living life on borrowed time as his body is not connected. Is he effective? Yes, but so was Matt Harvey and Harvey went under the knife. Vogelsong is the next big name to be on this list. If anyone is close to the Giants and has the opportunity to ask Voglesong (and he is honest), he has got to be pitching in pain or very close to it.
    Kazmir for the Indians was able to regain the form and velocity by reducing the pain. How? he changed his pitching mechanics to eliminate the pain by staying connected rather than flying open. Thus, he was able to land a nice contract with the A’s.
    We’ll see over time who has the longer career and who avoids the injuries, but one has to be honest with themselves about the pain first and foremost.
    The pitchers in recent memory that have sound pitching form that stay connected were Maddux, Ryan, Randy Johnson, Clemons.

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  20. Max says:

    As a Diamondbacks fan I’m going to drink heavily tonight.

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  21. If I am a pitcher, that’d be a very big hassle in my pitching but if you could identify what’s the problem or the causes of that pain maybe you could evaluate your self and make necessary adjustments. Try visiting this site for more arm pain issues. http://www.healthyarms.net

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  22. I think pitching while suffering to any shoulder problem is really a bad idea. You might end up hurting yourself. Maybe some shoulder exercise (mild exercise) could help though?

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