Friday, August 27, 2010

Phenom Pitcher Stephen Strasburg likely to undergo Tommy John surgery

Add Strasburg’s name to the long list of pitchers that have had Tommy John surgery. The Washington Nationals’ number one overall pick in 2009 was 5-3 with a 2.91 ERA and 92 strikeouts in 68 innings before being shut down for the season with a torn UCL. Tommy John surgery can be a great thing for some pitchers. It has saved the careers of Mariano Rivera, Chris Carpenter, John Smoltz, Rick Ankiel, AJ Burnett, Ryan Dempster, Tim Hudson, CJ Wilson, Francisco Liriano, Billy Wagner, Joakim Soria, Rafael Soriano, Kerry Wood, Carl Pavano, Anibal Sanchez, and of course, Tommy John.

So why is this surgery so frightening to baseball fans? Well, for one thing, it’s being performed way too often. But more importantly, the 10 to 15 percent failure rating for Tommy John surgery mainly occurs in younger pitchers. Most fans fear their favorite pitcher having this surgery because he will be out at least one season and then it will take a couple years more for them to pitch at the level that they did before the surgery. However, there are many prospects that have had this surgery that leave us wondering what they could have accomplished. Additionally, Tommy John surgery has relegated most of those success stories to the bullpen, which in many minds means a failed pitcher to some extent.

So why has this injury become more common today than it was in the 1960’s and 1970’s? During this time it was normal for pitchers like Tom Seaver, Juan Marichal, and Nolan Ryan to rack up 280 to 330 innings pitched every year. The pitchers were able to achieve these high totals because they pitched every fourth day, but very few were slowed down by injuries. Obviously a torn UCL (the injury that requires Tommy John surgery) still happened before the surgery was invented, but they simply called it "blowing out your arm" and it meant that you had to go home and find a real job. But the point is that they were pitching much more often and had much longer outings (there were about six times more complete games per year in the 1960’s and 1970’s than there have been in the 2000’s). Pitch counts really didn’t exist back then. Now fast-forward to the year 2010. Possibly the most hyped pitcher in baseball history has been kept on a strict pitch count since the day he stepped onto the mound for Class AA Harrisburg and he is looking at a surgery that will keep him out of action for 12 to 18 months. It appears that even the most protective approaches to keeping a pitcher healthy can fail. Could it be that the Nationals babied him too much? How durable can an arm be when it is kept on a strict pitch count that restricts the very same activity that he is supposed to be doing to build a stronger arm?

There are two articles that I recommend reading if you are interested in this “pitch count” phenomenon. The first one was written in Sports Illustrated earlier this year about the Rangers’ approach to handling his pitchers without “coddling them” and restricting them to a pitch count. It seems that Nolan Ryan has had a really positive impact on that pitching staff, which has started to strengthen their pitchers’ arms by long tossing much more than most other MLB pitchers. Another excellent read is Tim Kurkjian’s piece last year on the “magic number 100,” which analyzes the history of the pitch count.

One thing is for sure, there is overwhelming evidence that has shown sliders usually cause elbow injuries and curve balls are more known for damaging a pitcher’s shoulder. The stress that these breaking balls cause on a pitcher’s arm just isn’t natural. It is widely regarded to be unsafe to throw a curve ball or slider before the age of 16, although some say 18 is a much safer age to begin throwing these pitches. Another interesting theory on how pitching injuries occur was presented in the hit book Moneyball. Billy Beane claims pitchers that play in college will blow out their arms more frequently throughout their career. His reasoning is pitchers have to throw too many breaking balls because batters can foul off fastballs too easily with aluminum bats.

There is one theory that I have not heard enough about though. It all goes back to the year of the pitcher, 1968. The AL hit .230, the NL hit .243, Bob Gibson set a modern era record with a 1.12 ERA, and Denny McClain became the last pitcher ever to win more than 30 games. Since almost every change in the history of baseball has favored the hitter, this offseason would be no different. The strike zone was cut down and, more importantly, the mound was lowered from 15 inches to 10 inches. In 1999, former Pittsburgh Pirates General Manager, Cam Bonifay, made a great point that lowering the mounds after the 1968 season has created more stress on a pitcher's arm. The Cincinnati Reds’ team doctor had this to say about the subject, “Throwing a baseball is one of the most strenuous things you can do to your body, it's a very unnatural act. Having the mound higher puts the pitcher at an advantage because the ball naturally wants to go down. Now he can do that better with less stress on the shoulder. The lower the mound, the more stress that goes on your back, your shoulder and ultimately your elbow for the same result.”

There are a number of things wrong with baseball right now. The Yankees are spending $216 million, the All Star Game counts for something, Tim McCarver is still calling games on FOX, and Bud Selig is somehow still the Commissioner. But I really think this should be the number one priority. Stars are dropping like flies and it’s hurting the game. When Strasburg hit the Major Leagues, games that he was scheduled to start were immediately selling out wherever he went. I even traveled to Altoona to see him pitch his first AA game and it was absolutely worth it to drive five hours to see a minor league game. Pitchers like Strasburg don’t come along very often and he might never be the same again. Maybe it’s just how he throws the ball and this would have happened regardless, but I think there are many beneficial measures that can be taken by pitching coaches (more long tossing to strengthen the arm) and the Commissioner (raising the mounds to reduce stress on the arm). I really hope the best for Strasburg, but to me his future doesn’t look all that bright. It’s really sad when you think about it. He went from being an untouchable pitcher with the nickname of Jesus to a guy that’s going to be watching baseball from the suites until 2012. Get better Stephen. You were the best thing that has happened to baseball since the home run race in 1998. Well, maybe if you stayed healthy you would have been. We might never know.


  1. This post was all kinds of fantastic and +6 for all the medical references. I spent almost an hour between your post and the baseball prospectus article. It helps my interest too that my anatomy exam last week covered this. If you want me to translate any of the jargon on the procedure, I think I might be able to help you out.

    I think you absolutely nailed everything in this. I love how you brought up the college vs. high school pitcher debate. A lot of teams are moving to drafting high schoolers so that teams can monitor types of pitches earlier to help manage stress and strain on the elbow/shoulder ligaments and the rotator cuff.

    I honestly feel that raising the mound would cut down on the arm injuries. I don't know if we'll ever see that though, since MLB would prefer to sell better hitters numbers/offense than better pitchers numbers.

    That article referenced a study from earlier in the decade. While basically all of that is still applicable today, the procedure itself has gotten better. The 85%-90% success rate is now more towards the 90% end. The younger pitcher failure rate is more for high-school/early college age where the kid is still growing. I'm cautiously optimistic he should be fine eventuallly, although it may be around this time 2 years from now he would be in full form. He may take 1-2 MPH off his average fastball in the future just to protect the elbow, but if all goes correctly, he should still be able to top out at 100 MPH.

    And one last thing: the only thing Tim McCarver does worse than call a baseball game is lounge singing, and he's getting paid for both.

  2. Thanks Zanic. Glad you enjoyed it.

    I'm also glad you could share some of your knowledge about the recovery of pitchers who have had Tommy John surgery.

    I completely forgot about McCarver's career as a lounge singer. No words can really describe that.