Skip to main content
Menu
Tommy John Surgeries Are Down, And Nobody Quite Knows Why

Last week, Yahoo’s Jeff Passan reported that Angels ace Garrett Richards would miss the rest of this season — and at least part of next year — after undergoing Tommy John surgery. The loss of a talented pitcher who was off to a promising start provided the usual alarming reminder that any arm could be days away from a season-ending diagnosis. But we can serve some chicken soup for the baseball fan’s soul:1 Compared with totals through the same date in recent seasons, 2016’s Tommy John toll has been mercifully light. (Knock on the nearest ulnar collateral ligament.)

Historically, March and April have been the peak periods for Tommy John-inducing injuries. Not only does ramping up from a winter’s inactivity put pitchers at increased risk, but spring is also when pitchers who felt a twinge at the end of the previous season can no longer pretend rest will restore them. From 2005-14, 44 percent of injuries that led to elbow ligament replacements occurred in March or April. The last two springs were particularly costly, yielding record Tommy John totals and depriving fans of full seasons from such prominent pitchers as Yu Darvish, Zack Wheeler and Brandon McCarthy in 2015, and Matt Moore, Patrick Corbin and Jarrod Parker in 2014.

In 2016, however, the parade of early-season elbow injuries has slowed, as evidenced by Hardball Times analyst Jon Roegele’s list of Tommy John patients.

ArthurandLindbergh-TommyJohn-2

This year’s tally of 22 Tommy John surgeries through May 10 — across all professional levels — is the lowest since 2002.2 And that count includes very few prominent pitchers: Aside from Richards, the highest-profile big leaguer lost to the procedure in 2016 thus far3 is Carter Capps, the Miami Marlins reliever whose borderline-illegal delivery made him an attraction mostly in a circus-freak sense. This year’s big-league Tommy John casualties were projected by Dan Szymborski’s preseason ZiPS algorithm to produce only 7.0 wins above replacement in 2016,4 compared with the 13.3 and 23.8 WAR projected for Tommy John victims by May 10 of the 2015 and 2014 seasons, respectively.

It would be pretty to think this means that teams have solved the UCL scourge. Unfortunately, though, there’s no real reason to believe they’ve addressed all of the underlying problems that contribute to ligament tears. Pitchers continue to throw harder than they have in the past, and higher pitch speeds are associated with higher risks of injury. And as Passan reported in his recent elbow-injury opus, “The Arm,” the odometers on amateur arms are still creeping up quickly, thanks to year-round competition and the pressure to appear — and throw as hard as possible — in scout-packed showcase events.

In other words, this year’s reduced injury toll may come down to timing and plain old good fortune. As Kyle Boddy, founder of the pitching performance and research facility Driveline Baseball, told us: “The easiest and most likely explanation is that Tommy John surgeries were abnormally high last year and are somewhat low this year.”

Not that MLB clubs aren’t altering pitcher usage in an attempt to preserve arms. Between 2008 and 2015, the average number of pitches per major league start fell from about 97 to 93. Some of this decrease owes to swelling bullpens and an increased recognition that putting in fresh pitchers is often to teams’ benefit, but it also stems in part from an impulse Passan described to us in an email: “If throwing hurts pitchers, throwing less will hurt pitchers less.”


Listen to our sports podcast, Hot Takedown, discuss the drop in Tommy John surgeries.

Passan dismissed that thought process as “reductive.” As he pointed out, “no studies have proven decreased usage in major league pitchers does anything to stem blown-out elbows.” But he granted that there might be better health-related reasons to shorten the leash for minor leaguers. “There is a profound difference between an 18-year-old’s elbow and that of a 25-year-old,” Passan said.

Teams seem to be taking that mindset seriously. At a seasonal level, per-player pitch counts have declined by about 10 percent across the board in Double A and Triple A from 2013 to present (after increasing in 2011 and 2012). And prospects who’ve appeared in Baseball America’s top 100 rankings have seen their counts sink even more, by about 15 percent. According to Boddy, “the reduction in workloads is definitely a concentrated effort by teams to impact injury rates.”

One team in particular has treated its minor league starters like delicate flowers: the Los Angeles Dodgers under the Andrew Friedman regime. Although player development director Gabe Kapler (who was hired in November 2014) didn’t divulge any details about the team’s plan for young pitchers when we asked him for comment, Dodger starters in Double and Triple A last season threw about five fewer pitches per outing than the league average, and their staffs’ ratio of relief appearances to starts was 20 percent higher than that of the typical team — indicating that the Dodgers’ upper-level affiliates are signaling for new arms early and often.

ArthurandLindbergh-TommyJohn-1

The poster boy for pitch-count control is 19-year-old Dodgers starter Julio Urias, the minor leagues’ top left-handed pitching prospect and the youngest pitcher in the Triple-A Pacific Coast League by almost three years. Urias, who’s made 60 minor league starts, has never thrown more than six innings in any single outing as a pro; earlier this month, he no-hit the New Orleans Zephyrs for six innings and was still pulled after 77 pitches. According to game-by-game minor league data from Baseball Prospectus,5 only one pitcher who made the majors in that span — Rafael Dolis, who pitched primarily out of the bullpen and never started a big-league game — made more than 60 minor league starts before his MLB debut without ever recording more than 18 outs in any of them. If Urias makes six more starts without seeing the seventh inning before his Dodgers debut, he’ll pass Dolis on the light-workload leaderboard. If he doesn’t do it, it will probably be because the Dodgers decided to promote him to the big-league bullpen, a move they’re currently contemplating.

“Most doctors believe limiting usage the way the Dodgers have with Julio Urias gives his UCL the best chance to survive the stress and strain that comes with his sort of velocity,” Passan said. The catch, of course, is that Urias will eventually have to go deeper in games—unless Los Angeles implements an even more innovative approach to limiting workloads at the major league level, perhaps building on the tandem-starter schemes other teams have tried. If the Dodgers don’t handle Urias’s transition to the majors with care, they could inadvertently expose him to even greater risk. “Pitchers are most at risk later in the games when they are fatigued, so limiting workloads in the minors only to expose them to the traditional 180-220 IP and 100+ pitch count metrics in the big leagues doesn’t make a lot of sense,” Boddy says.

With all the brainpower in LA’s rapidly inflating R&D department devoted to injury research and prevention, it wouldn’t be a surprise to see them ahead of the arm-injury curve. But in the bigger picture, this year’s Tommy John reversal might prove as illusory as the global warming “pause.” Pitch-count protocols in pro ball probably won’t undo the damage done at earlier ages, and a lasting solution would require more sweeping changes than teams have had time to institute.

But even if what we’ve witnessed this spring is just a trough between Tommy John waves, we should still savor the lack of ugly MRI results as long as it lasts. The fewer pitchers paying visits to the dreaded Dr. James Andrews, the better off baseball will be.

Footnotes

  1. No, not that kind.

  2. We filtered out surgeries listed as occurring on Jan. 1 of a given year, since these were procedures for which Roegele didn’t know the exact date. We also ignored the surgeries of players who were drafted in the same year the surgery occurred, as their cases often weren’t added to Roegele’s list until after the draft. And finally, we added one surgery to the 2016 total: that of Richards, who was not yet included in Roegele’s data.

  3. Excluding Cardinals starter Lance Lynn, who went under the knife in November.

  4. According to data Szymborski provided us.

  5. Which goes back to 2005.

Rob Arthur is FiveThirtyEight’s baseball columnist and also writes about crime.

Ben Lindbergh is a former staff writer at FiveThirtyEight.

Comments