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Will the rash of pitcher Tommy John surgeries change baseball's incentives?

More pitchers are getting injured. Is it a correctable problem?

Jeff Curry-USA TODAY Sports

This week we learned that Miami Marlins phenom Jose Fernandez is heading to the surgeon’s table to have his ulnar collateral ligament (UCL) replaced via the procedure named for Tommy John. Fernandez makes it 34 pitchers who have torn their UCL to such a degree that they need a new ligament in their elbow. A Tommy John epidemic has been declared by the media, with calls for MLB to fund research into pitcher injuries so that the causes can be identified and eliminated—or at least mitigated to an extent.

Throwing a baseball overhand is one of the most unnatural things a human can do. Doing so thousands of times year in and year out is sending the injury bug an invitation to bite you. There is one surefire way to prevent a ballplayer from needing Tommy John surgery: Don’t pitch. But since that isn’t an option for professional pitchers, the focus shifts to other potential causes.

Whenever a pitcher requires Tommy John, his mechanics are often dissected in a post hoc fashion. There’s no question that mechanics are a factor in whether a pitcher suffers injury, but it’s equally true that there are many other variables that likely impact whether he blows out his UCL. To name a few: genetics, stamina, offseason workouts, in-season workouts, diet, past workload, current workload, velocity, and more. (Please feel free to bring up any other potential causes in the comments.)

Baseball Prospectus recently published a very interesting article by Russell Carleton in which he used the BP injury database to see which of a series of indicators correlated with future injury. (Remember that correlation does not equal causation.) His goal was to see whether innings caps are effective at preventing injuries for young pitchers. Carleton concluded that, while an increase in a pitcher’s innings total from 160 to 200 was a significant predictor of future injury, throwing 120 or more pitches in one start had a larger effect. And that’s for MLB pitchers who are in their early 20s.

After a player is drafted and signed, his MLB club typically imposes pitch counts on him as he ascends through the minors. But such limits are much less commonplace at amateur levels of competition. Pitch-count data from traveling teams is virtually nonexistent as far as I can tell. Additionally, playing ball twelve months out of the year (as warm-weather youngsters are doing more of in the era of youth-sports specialization) offers the young pitcher’s body little or no offseason in which to recuperate from the regular, unnatural throwing of a baseball at maximum effort.

Next, the pitcher goes to high school with mileage (that might be rather stressful) already on his elbow. While it’s difficult to find pitch-count information on high school games, it’s easy to look back on games watched in which high school coaches left ace hurlers on the mound to throw for pitch counts well into the hundreds. It’s also more common in college that I ever gave credence.

What’s more, as Dr. James Andrews has emphasized, studies show that the amount of stress a teenage UCL can take is in the 85-mph range. But what MLB scout even bothers to write a report about a high-schooler throwing a fastball below 90 mph? And this gets right to the heart of the issue: Incentive.

Baseball folk are all velocity hounds. If you’re like me, the first thing you want to know about a pitching prospect is where his fastball sits and touches—the higher, the better. Just watch the scouts during a draft prospect’s high school start or a top prospect’s Low-A outing; their radar guns are trained on each pitch. The trait that gives a pitcher the best chance to be drafted and make the majors is throwing hard because having pitchers who throw hard gives MLB teams the best chance to win. So, players who fancy themselves big-leaguers train to throw for as high a mph as possible. And, as the years have passed, training regimens have evolved to the point that more kids are throwing harder earlier in life, often while putting high pitch count mileage on their arms.

Is this a problem?

If you walked up to a high-school senior who sat 93-95 mph and told him that he needed to throw more slowly (perhaps by changing his mechanics) or he will be at an undefined but increased risk to undergo Tommy John surgery, what would his reaction be? This velocity-reducing change would lessen the chances that he gets drafted. It would also mean that he would likely get a lower signing bonus if he is drafted. What’s more, his climb to the majors would more likely result in failure (meaning his potential future earning potential would take a hit). I suspect the player would tell you to get lost because he fancies himself a future big-leaguer and throwing hard is his best chance at realizing his dream.

Now let’s say that you went to a team’s general manager. The club has a hot pitching prospect who throws 93-95 mph. You tell the manager that the pitching prospect is at an undefined but increased risk to lose a year to UCL replacement unless he throws more softly (perhaps by changing his mechanics). If you’re that GM and you have this player under MLB control for what effectively amounts to seven years, would you sacrifice his elite performance while sitting in the mid-90s with an increased but undefined chance of an injury that sidelines him for twelve months in exchange for a less effective 90-92 pitcher who has lessened but undefined chance of UCL replacement? If I were a gambler, I’d bet the GM would not require the pitcher to throw more softly.

Let’s bring this to a much more tangible level for the St. Louis faithful. As a Cardinals fan, would you have wanted Chris Carpenter to change the way he throws while he was in the Toronto organization? Or, in the alternative, move him to the bullpen to shield him from injury? Would you sacrifice the 2004 regular season, 2005 Cy Young campaign, 2006 World Series title, 2009 season, and 2011 World Series title for a non-injured Carp who likely would’ve been less effective? Would Walt Jocketty or John Mozeliak? Do you think Carpenter would have?

Players are unlikely to hurt their odds of getting drafted, making the majors, and enjoying success with its accompanying payday at that level in order to reduce the likelihood of injury by some undefinable percentage. It’s also improbable that a MLB club would proactively reduce a pitching prospect’s velocity (and effectiveness) for the same. To lessen the number of Tommy John surgeries, the structure of incentive in baseball needs to change. And that seems like an impossibility.