What MLB Must Do to Change Philosophies, Stop Wave of Pitching Injuries

Will Carroll@injuryexpertSports Injuries Lead WriterMarch 18, 2014

In 2006, I wrote an article about developing pitchers. I was frustrated that there was no reduction in injuries after years of watching pitch counts and innings workloads drop. The promise of Pitcher Abuse Points was starting to fade as the orthodoxy of Dr. Rany Jazayerli and Keith Woolner's work became book. Pitchers were no longer going 168 pitches, like Al Leiter had just before injuring his arm. In fact, pitchers were barely going 120 pitches anymore.

But the injuries weren't reducing. You can imagine how I felt this week. Several pitchers, including Kris Medlen, Brandon Beachy, Jarrod Parker, Cory Luebke and Patrick Corbin, were all checked for elbow injuries. More, like Cole Hamels, Taijuan Walker and Anibal Sanchez, were behind schedule due to shoulder problems. 

Last year, in the course of writing a piece on Frank Jobe's work, I asked Tyler Brooke to go through the list of current pitchers to see how many of them had undergone Tommy John surgery. I was stunned when he came back with the one in three figure. Remember, that's just elbows! Pitchers hurt shoulders, backs, knees and everything in between, so the "health rate" we have is abysmally low, yet teams do next to nothing.

I'm not maligning the hard work of medical staffs here, who do their best despite being overworked and underpaid to keep their players on the field. Nor am I ignoring the work of people like Stan Conte of the Los Angeles Dodgers, who has tried to quantify injuries, or the biomechanical work of Dr. Bill Raasch in Milwaukee. The problem is that these are exceptions.

Baseball has a problem. At the major league level alone, MLB has taken billions of dollars and burned it over the last decade. In just the last five years, pitching injuries alone have cost owners more than $1 billion in salary for players who are on the disabled list.

MLB owners are titans of industry with successful businesses in everything from real estate to software. In any of those businesses, a billion-dollar loss would be quickly addressed and remedied. In baseball, they seem to shrug their shoulders and collect frequent-flyer miles to Birmingham.

It's time that changed. I interviewed several pitching coaches, researchers, doctors and other experts in the pitching field looking for suggestions about what might work. While none of them would commit to the suggestions actually working, they all believed there was a chance they were on to something. In some combination, I do believe these suggestions to be among the best possibilities for saving pitchers. 


Tandem starters

Several teams have used a tandem system in the minor leagues, and we've even seen some variations in the major leagues. The basic idea is to pair two "starters" into one starting pitcher and use a strict pitch or inning count to manage fatigue. 

At the minor league level, the tandem system appears to have both reduced injuries and developed pitchers, but there is resistance. It is tougher for the starter to get wins, a meaningless stat that my colleague Brian Kenny has done his best to kill. Team wins are important and the tandem system doesn't reduce that. 

The downside of the tandem is that it does limit pitchers very strictly and requires eight "starters." At lower levels where teams are shotgunning their pitchers, this isn't an issue, but at the major league level, it's more of a problem.

No team that I am aware of has used a tandem above the Double-A level, so a test at Triple-A would be interesting and easily handled. Teams have used a "shadow" system at times, where a pitcher coming back from injury or being inning-limited has a second pitcher come in early, showing that a tandem setup could work at least in the short term.


Six-man rotation

There are many calls for adding a man to the rotation, or going to a so-called Japanese rotation. The problem is the sheer lack of pitchers. The quality of the fifth man in most rotations is significant and takes starts away from the ace. In a four-man rotation, the best pitchers get more starts.

In a six-man rotation, the ace would get 28 starts if healthy all year, limiting someone like Justin Verlander to between 160 and 170 innings a year and handing them off to...well, for the Detroit Tigers, that would be trading 50 innings of Verlander for 50 innings of Kyle Lobstein. The loss there could well counteract any value from reduced injuries. 

As for the Japanese, there is a reduced rate of Tommy John surgery there, but it is more cultural. American baseball might be better off looking at their training methods and obsessive throwing, as well as their rejection of pitch counts, than their rotation.


Progressive development

Progressive development is a simple system that would call for individual limits for each pitcher based on demonstrated ability to pitch and recover. Detailed in this article from 2006, a progressive-development system would need to be paired with a tandem system. 

We use progressive development in many other areas. No one tries to bench 225 on their first try. No one tries to run a marathon on their first run. You work up to it, slowly and steadily. My 2006 article goes into the system in more detail, but it's simply a baseball version of what we're already doing. Instead of tossing a ball to a kid and saying "go 100 pitches, full go," it's worked up.

This is already done to an extent in spring training, but this is a much more organized system that builds a pitcher and discovers his limits as much as it prepares him for pitching to the point of failure. Indeed, the system could find pitchers that could safely and regularly go 150 pitches, something I feel is reasonable but is lost in the modern game.

Shifting to a progressive model would take a long-term commitment since it would need to start at the lower levels. That alone would make it difficult for most organizations who cannot commit to anything over a decade. For this to work, we'll need ownership-level commitment. I think a team like the Los Angeles Angels, with an involved owner and a struggling minor league system, could be the one to try this. The Toronto Blue Jays also fit, but I'm unsure how their corporate owner could be brought on board.


10 starters

In football, there's a defensive formation where the players all stand up, milling about to create confusion about their position and function to confuse the quarterback pre-snap. It's been called "11 Angry Men" and one MLB front-office type suggested a variation that he called "10 Starters." 

Basically, it's a full-season equivalent of a "kitchen sink" game where every pitcher is available. Instead of having a division between starters and relievers, the suggestion is that all 10 would be able to go as starters and could be mixed and matched as needed. While there would be a defined rotation, it wouldn't be as simple as going one through five and then rinse-repeat. 

Instead, the rotation would be adjusted based on availability. There are already days where a reliever is designated as out due to previous workload, so this 10-starter system would be a variant of that. On any given night, a manager should have no less than six pitchers, not far off from what is available in a standard system. 

Several of my experts had objections to this system. The first is that "pitchers like roles." They might, but we've taught them those roles and could teach them new ones. The second is stronger and implies that pitchers would have a hard time shifting from starter to reliever and back.

However, throughout baseball history, we've had swingmen, pitchers who did exactly this. Earl Weaver was famous for his use of them, especially for young pitchers breaking into the league, but he was hardly the first. This is difficult to research, but there's no cursory sign that swingmen broke down at a rate any higher than other pitchers. 


Quantification of fatigue

We are seeing a vast expansion of the so-called quantified self. Devices like the Nike FuelBand and various flavors of Fitbit have given people some measure of their activity level. It would be easy to extrapolate a similar system into quantifying fatigue. Direct measures of fatigue could come through simple physical tests or a more direct high-tech measure like this device

Being able to quantify exactly how a pitcher is dealing with both a start (pure fatigue) and recovery at any given time should be able to let baseball teams individualize programs. The downside here is that with set roles and expectations, it's difficult to individualize anything from a management standpoint. Maybe newer managers and new data will change that.


Quantification of injury

Many on the medical side are excited about the possibilities offered by new imaging and diagnostic tools. It's perhaps more realistic to think that we could monitor injuries more proactively than doing a complete change of how baseball manages its games. 

New technology is making ultrasound imaging hand-held. Many soccer teams, including most of the MLS, have some of these portable scanners on the sidelines for quick checks. The same could be done in the dugout or locker room. Between innings or at least between starts, a doctor could do a quick, noninvasive visualization of the elbow and shoulder so that we'd know the player is intact. 

What we do with that information is an unknown, but with more data, we could find patterns and predictors for when a pitcher is about to break down. A red flag raised prior to the injury could trade a 12-month rehab for a couple days of extra rest.

As of yet, no major league team is using this kind of technology regularly despite a very reasonable cost and ability to use it. One team official said the pitchers themselves were very resistant to this, feeling like it reminded them of their mortality and could be used against them in negotiations. I think that's silly and could be altered and explained to make it a major positive, especially for early adopters.

This is hardly an exhaustive list. There are certainly other approaches that could work. Even in the broken current system, some teams, like the Tampa Bay Rays and Seattle Mariners, have had better success than most in avoiding the most serious pitching injuries. Trying to copy that approach might work, but it would be better to build a solid scientific foundation through research.

Worse, all of these systems would only work at the professional level. We know that much of the damage on arms is coming at lower levels.

Dr. Glenn Fleisig often compares pitching arm injuries to smoking, saying that kids don't get lung cancer on their first puff nor Tommy John after their first curve. However, we know enough to discourage kids from smoking at all. We don't do the same for pitching. In fact, in many cases, parents and coaches are doing the opposite. MLB can be a thought leader and let their research (and dollars) trickle down.

The team that builds a better mousetrap will have a Moneyball-style advantage that could be huge. Think injuries don't take a toll? Just watch where the Atlanta Braves end up this season after losing two of their five expected starters. The simple cost is a $14 million deal for Ervin Santana, but it's likely more, especially if you consider the cost of a win or a playoff appearance.

Baseball teams have had 40 years since Frank Jobe developed Tommy John surgery and 15 since the Pitcher Abuse Points system was developed to figure out how to reduce pitching injuries. Now, it's time to demand change and to drive it. Maybe it's time to rewrite the book


    Acuna Exits After Hurting Knee, Back Running Through First

    MLB logo

    Acuna Exits After Hurting Knee, Back Running Through First

    Joseph Zucker
    via Bleacher Report

    Tanaka Bests Ohtani as Yankees Beat Angels

    MLB logo

    Tanaka Bests Ohtani as Yankees Beat Angels

    Chris Iseman
    via North Jersey

    Leake, Healy Power Red-Hot M's to Sweep Over Twins

    MLB logo

    Leake, Healy Power Red-Hot M's to Sweep Over Twins

    via thenewstribune

    Kershaw (Biceps) Rejoins Dodgers to Start Thursday

    MLB logo

    Kershaw (Biceps) Rejoins Dodgers to Start Thursday

    Timothy Rapp
    via Bleacher Report