Inside the Phillies: Seeking a solution to wave of elbow injuries

Marlins ace Jose Fernandez is the latest pitcher to go down with an elbow injury that requires Tommy John surgery.
Marlins ace Jose Fernandez is the latest pitcher to go down with an elbow injury that requires Tommy John surgery. (Getty)
Posted: May 19, 2014

The Marlins, manager Mike Redmond said, protected Jose Fernandez. They restricted his innings while in the minors. They did not permit him to pitch in the ninth inning of any major-league game. They shut him down in September last season. The 21-year-old Cuban with a dynamic right arm threw 100 or more pitches in just 11 of his first 36 starts, yet he fell to Tommy John surgery last week.

"I wish we could find a reason for it, because it's sad," Redmond told reporters. "I wish we could figure out a way to keep these guys on the field."

Fernandez's torn ulnar collateral ligament in his right elbow spawned countless reactions to an "epidemic." The attention is greater than ever. Pitching injuries have not declined despite an abundance of new data and theories. That is reason enough for an industry that counted $8 billion in 2013 revenue to make a significant investment in preventative measures.

Finding a statistically valid answer could take years, and there may never be an answer. That should not dissuade clubs from devoting more resources to a solution. The next great competitive advantage in baseball will come to the team that develops a strategy.

There is progress in defining the problem, said Glenn Fleisig, research director at the American Sports Medicine Institute. His colleagues, along with other entities, including Major League Baseball, have researched UCL injuries for 15 years. That is when the surge of arm injuries in Little League and high school pitchers prompted pitch-count rules.

"The young pitchers in baseball who are having Tommy John surgery now, they're the first group who grew up with this year-round baseball problem we noticed 10 to 15 years ago," Fleisig said. "The problem has grown up."

The solution, though, is absent.

"You can't tell people to play less baseball," Fleisig said, "and you can't tell people not to throw as hard as you can."

Throwing a baseball thousands of times at a high speed is an unnatural act for the human body. Fleisig said advances in science and medicine have wrought harder-throwing pitchers. The trick is finding commonalities among major-league pitchers who have needed Tommy John surgery.

That should make at least a few executives wonder: Why are we doing it this way? The team that challenges predisposed notions about the arm could be the one to find a solution. Fleisig said at least half of MLB's teams now study their pitchers' biomechanics.

Just two Phillies have required UCL replacements since the start of the 2010 season. One, Jamie Moyer, suffered his injury at age 47. It is possible he pitched for years with tears in his elbow. The other, David Herndon, blew out his elbow in April 2012.

There are but two Tommy John survivors on the Phillies' 40-man roster. A.J. Burnett needed the surgery as a 26-year-old pitcher in 2003. Jeff Manship underwent the procedure prior to his freshman season at Notre Dame.

Perhaps, then, there is a lesson about how the Phillies scout pitchers. Some studies have suggested the best predictor for injury is whether a pitcher suffered a previous catastrophic ailment.

There are other possible explanations. Phillies pitchers rank 22d in baseball with an average fastball velocity of 91.1 m.p.h. since 2010, according to Baseball Info Solutions data. The Phillies have fielded one of the oldest pitching staffs during that span, and it is believed arms have a higher chance of exploding at a younger age.

There is a definite element of luck, too. They offered Ryan Madson a significant contract prior to the 2012 season, only to sign Jonathan Papelbon for $50 million. Madson, 33, has not thrown a pitch since 2011 because of Tommy John surgery, and his career could be over.

The Phillies have not drastically altered their arm exercise and strengthening program in the last five years. They maintain some of the same principles from the previous decade. It is worth noting that, in recent years, shoulder injuries were as much of a problem for their minor-league pitchers as elbow ones. Shoulder woes, especially ones that require surgery, are considered far worse than elbow issues.

When Cole Hamels threw 133 pitches last Sunday, he became the first pitcher to reach the 130-pitch plateau in 2014. It happened 133 times in 1998 and 236 times in 1988. Hamels, a few months removed from biceps tendinitis, told his coaches he could keep pitching in that game.

Fleisig cautioned against teams' establishing one standard for their entire pitching staff, and that could be the important lesson in a pitch-count-crazed game. A 32-year-old pitcher may warrant a different approach from a 22-year-old one. The currency, he said, could be in the teams who use their athletic training staffs to closely evaluate every pitcher in the organization on an individual basis to create specific plans.

That, of course, costs money.

"The problem is the human body is wonderfully complex," Fleisig said. "The teams with good athletic trainers, coaches, and analytics people are doing their best. But there is a science and art to it. The science is understanding how the injuries happen and proper mechanics. The art is knowing that person and getting feedback.

"I don't think anyone has the magic formula. I don't know what the future holds. I know we're all working to try to figure this out."


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