Revisiting the Tommy John surgery epidemic

Last week, I essentially seconded Tom Verducci’s long story about the epidemic of Tommy John surgeries for young pitchers, along with the notion that this epidemic might reasonably be blamed on excessive workloads and unnaturally hard throwing for said pitchers. Especially young American pitchers.

Kyle Boddy runs a pitching school near Seattle, and he’s also highly active (and opinionated) on Twitter. Shortly after my story was published, I saw this:

Well, giant would be a book and I suppose that’s probably in the works, but Boddy’s piece is long and reasonably comprehensive. And while it’s certainly a rebuttal of sorts, I don’t think it’s as critical of Keri’s and Verducci’s conclusions as this tweet suggests. One of Verducci’s arguments is that U.S.-born pitchers, for various reasons, are at far greater risk of Tommy John surgeries than pitchers born elsewhere; say, Venezuela or the Dominican Republic. He pointed out that of 20 major leaguers who’ve had TJS this year already, 19 are U.S.-born.

Here’s the problem, scientifically speaking: Tom Verducci and Jonah Keri aren’t scientists; they’re storytellers, and rarely the twain shall meet. If you’re a storyteller, you write paragraphs like this one (from Jonah’s story):

Unfortunately, limiting pitch counts and/or adhering to the so-called Verducci Effect — which Baseball Prospectus writer Russell Carleton debunked last year — doesn’t guarantee a healthy outcome. Kris Medlen and Brandon Beachy, the two talented Braves starters who underwent their second Tommy John surgeries this spring and thrust Atlanta’s season into doubt, had relatively few miles on their arms before cracking the majors. They were both converted infielders, as was their teammate Gearrin.

That’s only three pitchers, so hardly a representative sample. And of course we already knew there aren’t any guarantees. What we’re looking for are probabilities. But probabilities show up in graphs, and graphs aren’t in great demand by the readers of popular literature. So we get anecdotes, and anonymous quotes, and large dollops of small sample sizes. And by golly, we like ‘em.

Here’s the thing, though … THE BASIC MESSAGE IS THE SAME.

Look at the headline on Verducci’s piece:

Overuse of young pitchers fueling MLB’s Tommy John surgery problem

Which is essentially what Boddy’s saying, too. In fact, here’s what he actually says:

I can’t disagree with that – playing games and pitching competitively year-round is ridiculous and should be immediately stopped. I advise all of my warm weather clients to tell their winter ball coaches to kindly stuff it while they rest, recover, and train hard in the weight room or play a second sport.

Alas, Boddy’s favorite study seems to be eight years old, which doesn’t really allow for the possibility that something important has changed since then. That study, however, places one risk factor far above all others: how often a young pitcher has pitched with a fatigued arm. When he pitches just occasionally with a fatigued arm, that’s more risky than throwing harder than 85 or throwing more than 80 pitches per appearance, and it’s nearly as risky as pitching competitively more than eight months per year.

Pitching regularly with a fatigued arm? Well, that’s just begging for a serious injury.

But there are still so many questions unanswered. What about throwing more than 100 pitches per appearance? What about throwing faster than 90? It does seem that young pitchers aren’t just pitching more than eight months per year; it seems that some are pitching all the year-round; what does that do?

We don’t know, which makes me wonder about the usefulness of even a wonderful multivariate analysis. For Boddy, though, it seems to come down to one thing: “Uneducated, Ignorant, and Malicious Coaches” (and yes, bonus points for the Oxford comma) ...

If you play baseball, let me ask you a question: What would your pitching coach say if you asked him to cite his favorite research paper on pitching injuries?

Let me guess: Nothing. Or you’d be benched.

This is the real problem. Coaches at all levels simply don’t care about educating themselves on thrilling topics such as kinesiology, biomechanics, and research. The gold standard for coaching at higher levels of baseball is the fact that the coach played professionally or at a high college level, as if this is some good way to evaluate someone who will have a large role in keeping your arm healthy. It is, of course, the best example of falsely appealing to authority.

Yes, but someone has to be in charge. How many thousands of people are coaching teenaged pitchers in this country? And how does one propose to train more than a tiny percentage of those coaches in the fine arts of kinesiology, biomechanics, and half a dozen other disciplines? Sure, if you’re a particularly involved and intelligent and (let’s face it) reasonably wealthy parent, you might be able to steer your budding star toward a high-school program and a travel-ball team with particularly enlightened coaches. Which might really improve his chances of both developing as a pitcher and staying healthy enough to avoid the surgical table for at least a few years.

But for most parents and kids, that’s just not going to happen. I suppose Major League Baseball could spend millions and millions of dollars to disseminate the latest research, while strongly discouraging various entities from allowing teenagers to pitch more than eight months per year.

That’s probably not going to happen, either. I’m afraid that in the short term, we’re just going to see a lot more of what we’ve already seen: teenagers doing whatever they can to get bigger and throw harder and get noticed by scouts who might recommend a big signing bonus on Draft Day. Same as it ever was.