Stephen Strasburg: Injury and Innings Pitched Outlook for Nationals Ace

Will Carroll@injuryexpertSports Injuries Lead WriterFebruary 22, 2013

The incredible 2012 season of the Washington Nationals came well short of a fairytale ending.

Two years after having Tommy John surgery, the Nats shut down their ace, Stephen Strasburg, at the 160-inning mark in an effort to preserve his golden arm for future seasons.  

They then promptly lost in the opening round of the MLB playoffs. 

Would Strasburg's presence at the top of the rotation have changed the outcome of their series against the St. Louis Cardinals?

We'll never know for sure, but his status for the 2013 season begs several questions that need answering.  

What Are Strasburg's Projections and Expectations for This Season?

Strasburg heads into the 2013 season healthy, just as he was last season. There's no talk about an early shutdown or even a guideline for this season.

But Strasburg's health is just as important this season as it was the last three for the Nats—perhaps more so, as the team's expectations have been raised. The Nats are in the conversation for best team in the National League and are a popular preseason World Series pick. 

Projections are mixed on where Strasburg will end up this season. Looking at, the projections range from an ultra-conservative 113 innings to an optimistic 208. Steamer, long believed to be the most accurate projection engine, has Strasburg at 190, which lines up with the fans' thinking.

But while the innings projections for Strasburg are mixed, all of them agree that he will be dominant.

There's no reason to believe that Strasburg can't have similar results as last year—aside from increases in the counting stats—largely because there's no reason to believe that Strasburg isn't exactly the same pitcher we saw last season.

How Risky Is Strasburg Heading Into This Season?

Strasburg remains one of the best, but riskiest, pitchers in all of baseball.

Without giving too much away, Strasburg will carry a red risk rating (the highest) into 2013, just as he did last year. All the hand-wringing, innings limits, pitch counts and ink spilled haven't changed the risk of each and every pitch.

While we won't know the effect, if any, on Strasburg for years, let's assume he makes it through the early years of his career without further injury. He is scheduled to become a free agent in 2017, but will reaching that point—and the monster contract that is sure to follow—have anything to do with what the Nats did in 2012?  

There's simply no way to know. 

In fact, the only way we will know is if the best young pitcher in the game breaks again. We'll know that everything the Nats did was a failure—not once, but twice. All the good intentions and lost opportunities would have gained nothing for the team or for the player.

Something as small as a new focus on a sinker could lead to a new injury in a new body part.

Did Last Season's Limits Help Strasburg Going Forward?

The Nats went into last season openly sharing the fact that Strasburg's innings would be "managed." By the middle of spring training, general manager Mike Rizzo was cornered into saying that the pitcher's target was the 160-inning mark.

What he wouldn't say were specifics about why that number was chosen or how the team intended to get him there. It left plenty of room for speculation, and the media went wild

The innings limit on Strasburg was thought to be based on the amount of innings that Jordan Zimmermann was able to go in 2011, his first season back from Tommy John surgery. Zimmermann came back in 2012 and put up 195 innings with no arm problems.

If that's the model, then it's a logical one. The downside is that Zimmermann and Strasburg aren't comparable pitchers. They don't have the same body type or pitch selection, let alone mechanics or velocity. 

By handling Strasburg in this way, the Nats were trying to gain the long-term advantage when they should have been more focused on the short-term results.

The underlying concept is to manage fatigue and not to allow a pitcher to throw pitches, either in games or in-season, when the muscles might be tired, transferring some of the load to the ligaments and tendons.

Unfortunately, the Nats didn't have any direct measure of Strasburg's fatigue. They can look at his velocity and results the same way as the rest of us, but they could have done much more than just looking at him and asking him how he felt.

The measures could have gone anywhere from a simple comparative hands-on test to something much more complex and direct. A needle EMG probably isn't the right tool for this job, but the fact remains that the Nats were guessing, not measuring.

There was some evidence that Strasburg was fatiguing. In his last start, his velocity was off significantly, and the Nats were very quick not to only pull him from the game but to shut him down.

Many reports had Strasburg going at least one more start, although some thought that Rizzo didn't want it to appear that the 160-inning mark was the hard limit. 

The Nats also managed Strasburg on a micro level. He was pulled quickly in many games, keeping his in-game pitch counts much lower than appeared necessary. The Nats didn't cost themselves much there, but it's unclear if there was any gain. Worse, they constructed these limits around general measures and allowed Strasburg to go five innings to chase the win stat

The problem is that he's exactly the same pitcher. We know nothing more about Strasburg than we did last season, and neither do the Nats.

There's no science involved in this management of a valuable asset. The Nats have never had Strasburg checked in for a biomechanical analysis, one that will tell them what forces he's generating on that golden right arm. Worse, there's no science that tells us that limiting his innings will help keep him healthy.

Remember, this is the same organization that did everything "the right way" bringing Strasburg through the minors. The Nats were patient, deliberate and conservative. They didn't accelerate his schedule, even as he dominated the lower minors.

His innings count and pitch counts were low then as well, but just a few starts into his major league career, all that was for naught and Strasburg was headed for elbow reconstruction.

Is There a Year-After Effect?

For years, baseball has watched innings increases for young pitchers. The Year-After Effect was the term that Tom Verducci of Sports Illustrated coined for his annual list of pitchers to watch after innings increases.

I even had a variation on it, a "Rule of 30" that was focused more on pitching development but functioned under many of the same principles. Strasburg's 2013 season, under this concept, would end around the 190-inning mark. 

The problem is that while people have questioned the efficacy of the Year-After Effect for years, the final nail was put in it by Russell Carleton, a psychologist who formerly worked inside baseball and is now writing at Baseball Prospectus.

Carleton methodically takes apart the Year-After Effect piece by piece in this article, destroying what could be the key concept behind how Strasburg has been handled. To be fair, I have been one of the biggest proponents of this effect and now have to tip my cap and acknowledge Carleton's research.

Previously, the innings increase, especially for young pitchers, was a factor in how my system calculated risk. I have had to redo the model significantly to account for Carleton's research, and in backtesting, it appears that the results are much more in line with Carleton's findings than my previous method.

Are the Nats Missing an Advantage?

Strasburg is two years out from Tommy John surgery. Several years ago, I discovered another principle—pitchers from one to five years out from surgery have a significantly lower likelihood of damaging the ligament.

An unpublished MLB study from last year confirmed this effect, extending it to seven years. During this period, the transplanted tendon is physiologically changing, becoming a ligament in a process called "ligamentization."

It appears that this process, along with the undamaged tendon that reconstructs the elbow, gives the elbow additional strength. I call this period the "Tommy John honeymoon." 

This means that Strasburg, innings and pitches aside, is physiologically the safest he may ever be. He was last year as well, so the limits may in fact be counterproductive.

If Strasburg fatigued at the end of last season, what's different this season when his in-game pitch counts are likely to be expanded somewhat?

In the end, all the hopes and dreams for Stephen Strasburg, all the science and speculation come down to one simple conclusion: No one knows what to expect.


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