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The Tommy John Epidemic: “Babying” Doesn’t Work

Miami Marlins phenom José Fernández is the latest young MLB pitcher to require ulnar collateral replacement (Tommy John) surgery. Though it’s unclear as to why there has been such an increase in these procedures on young pitchers, one thing is clear. Coddling these pitchers by invoking arbitrary innings limits is not helping. Here are some numbers to prove that an overly conservative workload does not help protect young pitchers.

 
José Fernández had an amazing rookie season, winning the National League Rookie of the Year award along the way. He started 28 games in which he averaged 6.2 innings per start. He didn’t reach 8 innings in a game until his 16th start and never pitched 9 innings in a game. The Marlins let him loose a little more in 2014, allowing him to average 6.5 innings per start and reached 8 innings in 2 out of 8 starts in 2014 as opposed to 8 innings pitched in 3 of 28 starts in 2013. Despite Miami’s fairly conservative approach, Fernández still went down. There are more glaring examples if young pitchers being overprotected and that plan backfiring.

 
Stephen Strasburg could serve as Exhibit A. The Nationals tried very hard to keep his innings down when he debuted in 2010. In 12 starts, Strasburg averaged a modest 5.7 innings per start and was never allowed to exceed 7 innings in any start. Despite that, he still had to be shut down on 21 August 2010 and ended up needing Tommy John surgery. Matt Moore is a much more recent example. From 2012-2014, Moore made 60 starts and averaged just 5.6 innings per start. In those 60 starts, he only went 8+ innings 3 times and didn’t pitch a 9 inning game until his 52nd start. Two starts into the 2014 season, Moore is on the shelf despite being babied by the Rays. The Braves were extremely conservative with Brandon Beachy and Kris Medlen. In 28 starts from 2010-2011, he averaged 5.6 innings per start and never pitched 8 innings in a single start. He finally was allowed to cross the 8 inning threshold in 2012 in his 36th start, and increased his average start to 6.2 innings for the season. Still despite a modest workload, Beachy had to undergo Tommy John surgery in 2012 and again this year. Atlanta was even more conservative with Kris Medlen, often using him out of the bullpen to keep his innings down. Medlen pitched less than 4 innings in 33 of 37 appearances in 2009, and pitched 3 innings or less in each of his first 12 appearances in 2010. Still, he ended up undergoing Tommy John surgery in 2010 and again in 2014. All of the pitchers named so far had been held back and limited by their respective organizations for protection, and all of them needed UCL replacement surgery at age 25 or earlier.

 
None of the pitchers mentioned above ever pitched 180 innings in a season before their elbows gave out. Compare that to a workhorse pitcher like Félix Hernández. He first reached 190 innings in a season when he was just 20 years of age, and has pitched over 200 innings in each of the last six years. For his career, he averages 6.8 innings per start, and was not affected by averaging 7 innings per start as a 19-year old in 2005. Clayton Kershaw would be another example of a pitcher who wasn’t hurt by a big workload at a young age. His innings count was low as a rookie due more to ineffectiveness than anything else, but starting in his age 22 season (2010) he has pitched over 200 innings for four straight years and averaged 6.9 innings per start over that span. Justin Verlander also successfully shouldered a heavy workload early on. In his first full season as a starter (at age 23) he was allowed to pitch 186 innings, averaging 6.2 innings per start. Verlander has gone on to pitch over 200 innings for seven straight seasons, maxing out at 251 innings in 2011. Over that span, he has averaged 6.7 innings per start. There are other examples of pitchers who have thrown a lot of innings at a fairly young age, such as CC Sabathia and Tim Lincecum, without dealing with significant elbow or arm injuries.

 
While there is no concrete answer as to what is causing the Tommy John epidemic amongst young MLB pitchers, one thing is clear. There is no correlation between how many innings a pitcher throws as a young major leaguer and ulnar collateral ligament damage. My advice – take the reins off of these young pitchers. It’s clear that imposing pitch counts and innings limits does not reduce the likelihood of injury. If anything, it might be what causes these pitchers to go too hard, knowing that they’re only going to be in the game for so long no matter how they pitch. Taking preventative measures such as keeping pitchers under 100 pitches per start and shutting them down with three weeks left in a season clearly don’t work. Perhaps a crazy concept like actually observing these pitchers and talking to them to see how the feel rather than using arbitrary numbers to gauge their pitchers might be more effective.