It seems like quite the roller coaster, going from the No. 1 overall pick in the 2014 MLB draft to being told that your pitching elbow didn't pass the team's physical. That's what Brady Aiken is facing, according to Jon Heyman of CBSSports.com. The lefty from San Diego with the All-American looks may have an all-too-common elbow issue and could be facing Tommy John surgery in the near future.
Beyond the shocking headline and the $1.5 million difference between what Aiken was going to get and what the Houston Astros want to pay him now—which is admittedly quite the difference—this isn't that worrisome. Tommy John surgery simply doesn't scare teams the way it once did, and in many situations it barely moves the needle. If anything, the Astros may see the physical issue as a way to save money more than a reason to be particularly concerned about Aiken.
One indication is the reported $5 million offer. Under the current collective bargaining agreement, the Astros could offer Aiken (or player that does not pass the physical) as little as 40 percent of the original bonus, per Ken Rosenthal of Fox Sports. That would be $2.6 million or almost half of what the Astros actually have offered. The agreed to $6.5 million is under the slot value, so some reports have the needed offer higher, at 40 percent of the $7.9 million slot.
Confused? Don't be, because at either value, it's clear that the Astros came in knowing they could get a good young pitcher at a below-slot value, once again appearing to go cheap in the draft. With both previous No. 1 picks, Carlos Correa and Mark Appel, the Astros signed them well below their slot value. They were able to use the extra money to sign other players, so it's not a purely cheap strategy.
Aiken did have a heavy usage pattern in the last two seasons. He pitched two full seasons at Cathedral Catholic in San Diego, as well as playing for the Under-18 National Team and participating in several showcase events. This isn't uncommon, but there wasn't much of an offseason for Aiken leading up to the draft either.
For what it's worth, Aiken's personal trainer is refuting reports, as noted here in the Houston Chronicle. It should also be noted that Paul Flores is not a certified athletic trainer as he was initially identified in the Chronicle article. It was corrected. While Flores could speak to Aiken's physical conditioning, there is no note in his bio of medical training. As with the Chronicle, both the Astros and Aiken's agency refused comment on the issue.
One scout I spoke with gave me his report on Aiken, done early in the scouting process:
"He has a distinct 'back and uphill' motion. That indicates a soft core. Easily correctable, but it will change the timing. We normally see this with adolescent pitchers who are growing into their bodies. I would be curious to know more about his conditioning and overall strength levels. The Hamels comp is pretty solid, but Hamels doesn’t have any of these flaws and didn’t as a HS senior."
The comparison to Cole Hamels is an easy one. Any good lefty from Southern California is going to get that, but in this case, it's not a bad one given their similar motions.
The "back and uphill" motion is not necessarily a negative. Work done by Alan Jaeger, a top pitching consultant, points to this type of move, seen in the picture of Hamels here, as something of a positive. The front shoulder is slightly higher than the back shoulder, though they level out at release. There haven't been biomechanical studies to prove this move is good or bad, but it is common and shows no correlation to elbow injuries.
However, two teams that I spoke with said that they had concerns about Aiken. "We didn't red-flag him," said one scouting official from the AL, "because we knew he wasn't getting to us. If he had, the workload he had in high school and showcases was a bit worrisome. Maybe he'd have passed, but we'd have checked."
Another scout, who watched Aiken closely heading into this year's draft, had another concern. "There were a lot of stories about the kid being a workhorse, but he's skinny and developing. I don't know how all his crossfit [stuff] fits into baseball. It's too new and our strength guys don't like it for our major leaguers. Did he hurt himself pitching or playing with ropes?"
The Astros are in good position to make a sound medical judgment. Dr. Thomas Mehlhoff is an orthopedist for Houston and has become one of the few surgeons that teams trust to do Tommy John surgery. It is unlikely that the Astros would have ignored Mehlhoff's opinion in this process, though it is not known officially whether Mehlhoff is involved.
If Aiken does have a compromised ulnar collateral ligament, he would hardly be the first or even the best pitcher in this situation. Lucas Giolito, another hard-throwing Southern California kid, was a top pick of the Washington Nationals a couple of seasons back. Baseball Prospectus recently ranked Giolito as the top pitching prospect in the game.
Giolito's mechanics were very questionable. (Giolito's father, Rick, heartily disagrees with my assessment.) Giolito almost immediately tore his UCL and headed for surgery. He's back and dominating Single-A as expected, so the loss of a year of development doesn't seem that bad compared to his upside if he can stay healthy.
Several pitchers over the past few years have followed a similar pattern. One pitcher that was watched closely this year was Bryce Montes De Oca. The Kansas fireballer missed his junior year after spraining his elbow and having Tommy John surgery. He came back very well in his senior year, and while he was used judiciously, his fastball tempted many teams. He ended up going in the 14th round to the Chicago White Sox, largely because of high bonus demands rather than the injury.
All this comes from the experience of the Los Angeles Angels. Former scouting director Eddie Bane, now a special assistant with the Boston Red Sox, thought enough of a high schooler who was facing Tommy John surgery to take him in the 14th round for about $700,000. Bane believed that Dr. Lewis Yocum, then the Angels' team physician, could get Nick Adenhart back on the mound. The Angels ended up with a great young pitcher who was tragically killed before he could reach his full promise, but the gamble definitely paid off for the team.
Compare this to Mark Appel, a right-hander who just a year ago was the consensus best pitcher in the draft. He had almost no injury concerns coming out of Stanford and got regular comparisons to Mike Mussina. He's had trouble adjusting to the Astros development system and dealt with thumb injuries in his first full season, so there's never a guarantee.
That development system, which is a modified tandem system, could help protect Aiken when he comes back. The team is conservative with its usage and workload patterns, so Aiken will have plenty of protection both before and potentially after surgery.
Even if Aiken needs Tommy John surgery immediately, this is hardly a major problem for him or for the Astros. While the return rate from Tommy John surgery is not perfect, it's conservatively marked in studies at 85 percent. Aiken has a lot going for him physically and on talent, so this is likely to cost him money, not his baseball future.