Found July 04, 2013 on MLB Injury News:
Matt Harvey is having a fantastic second season for the New York Mets. He has pitched so well, and gone deep into so many games, that he is on course to throw well over 240 innings this year. As a result, they have already started talking about how they're going to make sure the 24-year-old doesn't get overworked. Although they're not committing to a 'hard shutdown', the Mets would like to find ways to reduce Harvey's workload between now and the end of September. In today's game, teams have a lot of money and resources invested in players. The top pitchers in the game are getting contracts worth upwards of $20 million a year, but even before players reach the majors, the organisation will have invested thousands of hours and perhaps a significant bonus in scouting, signing and developing top prospects. The question of how best to prevent injuries is something that front offices, general managers and medical staff would love to answer. For pitchers in particular, the stress put on their bodies every start is the catalyst for a multitude of DL trips across the league every year. There's still a lot of debate over the best way to reduce the risk of pitcher injury and thanks to Stephen Strasburg, the issue of young hurlers getting shut down early to prevent them putting too much wear and tear on their arm is at the forefront of that debate. The Washington Nationals drew a lot of fire for imposing a strict 160 inning limit on their ace last season, despite the fact that they were making their first playoff appearance since the franchise moved to Washington. The Chicago Cubs did the same with reliever-turned-starter Jeff Samardzija a week into September, a move that drew considerably less media attention than the Strasburg situation, although the Chicago Sun-Times, for one, wasn't particularly pleased with the decision with the Cubs on course to lose over 100 games. This kind of reaction, and the negative response by many Nats fans to the Strasburg decision, is one of the major problems that teams face when trying to manage young arms. At the end of the day, people still want to come and see a team win, and to watch their best players when they do that. David Wright aside, Harvey is the Mets' main draw right now. Perhaps the best-known rationale for shutting down pitchers early comes from baseball writer Tom Verducci, who has argued for the theory that an increase of more than 30 innings puts young pitchers at increased risk. The 'Verducci Effect' has given rise to the notion that we can predict which pitchers will get hurt by looking at such increases. However, Russell Carleton of Baseball Prospectus refuted the theory earlier this year with his extensive statistical analysis of pitchers who meet the Verducci criteria. Carleton found that pitchers in the Verducci group were actually less likely to go on the DL than those in his control group. There was also no correlation between those meeting the Verduci criteria and a decline in performance. As Carleton writes, the 'effect' is perceived to exist because pitchers in general sustain injuries a lot, not because of any predictive value an increase in innings might have: "The real story is that pitchers in general tend to get hurt. If about a quarter of young pitchers spend time on the DL, then any list of young pitchers made before a season, even one drawn at random, will have several victims of injury. It's not being under 25 and overworked. It's being a pitcher that's the problem." In a subsequent article, Carleton looked at what really predicted pitcher injuries and found that a previously injured body part was by far the most predictive factor for future injury, followed by raw pitch count. Although the statistical significance of previous injuries is striking, Carleton acknowledges that generally speaking, this doesn't tell us a great deal other than what we already know: “An injured body part is more likely to get hurt again. A pitcher who has thrown a lot of pitches is more likely to have a lot of wear and tear on that arm.” So can we even know whether shutting young pitchers down early makes a difference to their long-term health, and if so, when is the right time to do it? These questions are all the more relevant for a franchise like the Mets, who are looking to the future and will probably have the opportunity to manage a pitcher like Harvey carefully without the pressures of a divisional race or postseason appearance. The cautionary tale of Mark Prior is an oft-cited example of how overuse can really kill a talented young pitcher's career. Most of you will know the story: the 22-year-old Prior had an outstanding 2003 season for the Chicago Cubs but was heavily worked by manager Dusty Baker, averaging a huge 113.4 pitches per start in just his second major league season. After 211 1/3 regular-season innings, Prior went out and threw another 23 1/3 in the postseason. It was an increase of more than 60 innings over the previous year and he was never the same again. After a string of injuries over the next three seasons, pitching 329 innings in those years combined, he underwent shoulder surgery in 2007 and has not pitched in the majors since. Now 32, he was recently released by the Cincinnati Reds. Prior's story is a harsh reminder to be sure, but it doesn't tell us an awful lot when it comes to the specifics of limiting pitcher usage. ESPN's Jayson Stark spoke to three prominent members of the sports medicine community when debating this very issue and it was clear that all three were pleased to see the Nationals take a stand by trying to protect Strasburg. They also pointed out that fatigue played a key part in players picking up injuries and rest periods were incredibly important in protecting young arms. This was backed up by sports medicine expert and MLB Injury News contributor Dr Ray Solano, who told us that from a medical perspective, it's crucial for teams to limit young pitchers like Harvey to prevent overuse injuries. "I think it's essential to shut down young pitchers with a pitch-limit. Putting a limit on the number of pitches will prevent what we call an 'overuse injury' in the medical world. Overuse injuries develop slowly over time due to repetitive stress on tendons, muscles, bones or joints. Overuse injuries are difficult to diagnose because the pains caused by repetitive microtrauma often go unreported or are overlooked by young pitchers during the initial progression of the injury. “Many pitchers ignore minor aches and pains because they are subtle and minimally affect function in the initial stages. This can set up the perfect storm for velocity loss and a general decline in the sport.” Dr Solano also pointed out that it's important for pitchers to be proactive in terms of protecting their arms and not simply responding to an injury after it has happened. “It's time for young pitchers to become more proactive in allowing their arms to recover, instead of waiting to be reactive after an injury has occurred. Following this key concept will not only prevent injuries, but will also increase longevity in the sport." The planned shutdowns of Strasburg & Samardzija demonstrate that teams are being proactive by developing a strategy for how to deal with certain situations. The Nationals already have history with this: Jordan Zimmermann was held to the same 160 inning limit as Strasburg after coming back from Tommy John surgery. To paraphrase Dr Conte in Olney's article, even though we don't know whether this approach is right or wrong, it's good to see teams trying something new instead of following the same paths that lead to the same issues. Part of the problem with these situations is it takes a very long time for fans and analysts to be convinced that such preventative methods have worked. It's easy for an observer to see a pitcher break down a short while after throwing too many pitches and draw a link between the two things. It's much more difficult to convince people that shutting exciting young pitchers down is the right thing to do when you might not see the main benefits of that for several years. So is there anyone like Harvey who has really pitched at the same level, and been used in the same way, in just their second season? Using Baseball Reference's Play Index and Harvey's on-pace numbers, I looked for pitchers who had thrown over 220 innings and thrown 3500 pitches in their second year. Pitch count data is only available since 2000, and only one player season matched both criteria: Tim Lincecum in 2008, his first Cy Young season. Like Harvey, Lincecum was in his age-24 season. Although his wildly unorthodox delivery looked like an injury waiting to happen, he was known for having a remarkably durable arm, including never needing to ice it after starts, but there was no way of really knowing how that would transfer to pitching a full major-league season or whether age would affect it. Here's what Bruce Bochy told Henry Schulman of the San Francisco Chronicle prior to the 2008 season, when contemplating Lincecum's innings rising to 200: "We want to err on the side of caution...He threw 175 innings last year. The jump to 200 is not inconceivable. There is research that guys who throw 200 innings early in their careers are more susceptible to injuries. We're aware of that." On September 13, 2008, Lincecum had already pitched 198 2/3 innings on the season. That day, he pitched his first complete-game shutout, striking out 12 Padres on just four hits and throwing - amazingly - 138 pitches. He was making his 31st start of the year and had just hurled 127 the start before, and here the Giants were, letting him toss 138 when they had absolutely nothing left to play for. There were only 8 starts in all of 2008 in which starters threw at least 130 pitches, and Lincecum made two of them. Bochy's decision to leave Lincecum out there raised some eyebrows and, as his quotes in this article by Chris Haft indicate, he was thinking about Lincecum's Cy Young chances as well as furthering his development by letting him get his first shutout: "When he came in after the eighth inning, you knew how bad he wanted to finish it...It's like kids growing up. Sometimes it's the time. You extend the curfew, [let them] get on a bike, whatever. And I thought it was the time. If I had taken him out, he would have felt he didn't have a good game...I didn't want that in the record when they talk about Cy Young votes." It's crazy to think that a manager would jeopardise his ace's health because he thought a complete game shutout, instead of simply 8 scoreless innings, would tip the scales for the Cy Young vote, and yet that's exactly what Bochy did. Terry Collins could have to make a similar decision in September this year. As we know from Johan Santana's no-hitter last season, given the right situation, the Mets have also left starters on the mound far beyond what might be considered ideal. Mets manager Terry Collins recently admitted he still has conflicting feelings over letting Santana stay on the mound that day, 11 starts after returning from extensive shoulder surgery. Although there's no definitive evidence to suggest that Santana re-injured his shoulder that day, many believe that it was the tipping point. Collins said, 'I know it didn't help'. Only time will tell if that situation will make the Mets more sensitive to overusing pitchers, but it certainly ought to. What's undeniable about Lincecum is that he does not have a significant injury history. He has never been on the DL and has continued to pitch a significant number of innings - last year's 186 was the first time he has been under 200 since his rookie season. Performance is a different matter. Lincecum's fastball no longer sits in the 93-94 range; now it's around 90, and he can't blow hitters away with it any more. He also walks closer to four batters per nine rather than three and is a lot more hittable, averaging almost a hit per inning since the start of 2012. I asked Dr Solano if pitchers who built up their usage slowly were more likely to be durable and have a long career than those who were overused early, or if it was really a case-by-case issue. “I definitely think its more of a case by case issue. However, a majority of the time developing slowly over a period of time does allow for special attention to properly warming up and evaluating mechanics. In addition, athletes that develop at a slower pace usually become more in-tune with their body.”  Our resident medical expert, Stuart Wallace, explained that the complexity of Lincecum's delivery means that his timing and body awareness have to be perfect in order for his pitches to be effective. We'll never know if Lincecum would have developed in such a way that would have allowed him to perform at a higher level for longer if he hadn't been used quite so much, but to quote Collins on Santana, it didn't help. Bochy's failure to cut short Lincecum's starts at the end of that 2008 season emphasises the responsibility the manager and the backroom staff have in deciding when a starter is done. Pitchers never want to be taken out of a game and, as Dr Solano highlighted, they're also likely to simply pitch through pain, especially when they're younger, more durable and seemingly recover more quickly. It's the team's responsibility to look at a pitcher's usage and situation and make a rational decision, not an emotionally-charged one. Harvey has signs that bode well for his future health. Wallace says that Harvey's mechanics are excellent and his action puts minimal stress on his body, wasting very little momentum during his delivery. He has also been used more sparingly in individual starts relative to Lincecum: 103.7 pitches per start thus far compared to Lincecum's 109+ in each of his Cy Young seasons. Those two things combined mean that 220 innings from Harvey should involve far less stress on his arm. It's also a reminder that an innings limit is an inherently flawed concept: an inning isn't a set number of pitches and each player will have different mechanics, and throw different pitches, that put varying amounts of strain on a range of muscles & joints. The crux of the matter is whether overuse early in a player's career is really likely to make a significant difference to their injury risk or future performance. We can't know whether it would have made a difference to Prior or Lincecum if they had thrown 20 or 30 less innings, or a few hundred fewer pitches, but teams can develop strategies to manage and monitor pitcher usage going forward. Video technology, Pitch/FX data, analysis of pitch type usage - these are some of the resources that teams have available to them now. Wallace told me that he'd be much more interested in seeing how the Mets analyse Harvey's performance and respond to that, rather than simply shutting him down at a pre-defined point. There's a balance to be achieved here and it isn't going to be arrived at by using a simple pitch count or set innings increase. If Lincecum teaches us anything, it's that every pitcher is different and there's a lot we can't predict when it comes to injury risk. Most would have said that his delivery and usage made him more likely to get injured, yet despite his struggles, he has remained remarkably healthy for a major league pitcher. Teams shouldn't be assuming that every pitcher should be shut down after a certain number of innings or pitches. They should be monitoring their health and performance closely, using the medical expertise and wealth of data available to them, and making decisions based on that player's progress. The more teams focus on the details, the more useful the information becomes in a wider sense for managing future problems and the less we have to rely on basic generalisations like saying a 30-inning increase is bad for a pitcher's health. The best summary might be Carleton's words in the conclusion of his Verducci article: “Maybe the real frontier here is in breaking players down into sub-groups based on how they got onto [the Verducci list] to begin with. It's much more complex, doesn't fit nicely onto the page of a magazine, and it's the way that real research is done.” It's definitely not as simple, but injuries are like that. Even when they have the same injury, players don't recover at the same speed or respond to treatment in the same way. By treating players, their mechanics and pitches as unique, and by carefully monitoring all of the potential risk factors, teams can ensure that they get optimum performance without compromising anyone's future, and learn more about what really puts pitchers at risk at the same time. Matt Harvey will hopefully be a star for the Mets for years to come. Injuries happen, especially to pitchers, but Harvey is in as good a position as a pitcher can be to throw well over 200 innings for multiple seasons. It's a good sign that the Mets are thinking about his usage without committing to a shutdown yet, because it means they're being proactive without making a decision months in advance that doesn't take all the facts into account. How they deal with his usage and respond to the way he pitches in the second half will be key to his long-term health and performance. Thanks to Dr Ray Solano (@DrRaySolano) and Stuart Wallace (@TClippardsSpecs) for their valuable insight on this issue. Follow @mlbinjurynews Looking for fantasy baseball advice?

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