The Frailty of the Modern Pitcher

[Max Power]

It would be interesting to hear from physiologists/medical folks about different sorts of physical stresses. There's the stress that comes from maximum efforts, where the effort goes beyond some high threshold that can lead to breakdown (think of someone squatting a very heavy weight or sprinting at full-speed). And then there's the cumulative stress at lower levels, where the stress isn't so acute, but chronic in the sense of being performed over and over again (think of someone doing loads of repetitions or running long distances at slower speeds). The lines can obviously be blurry here (a starter looking to go 5 innings might be pretty different than someone pacing to shoot for 7+). However, the sheer fact that so many pitchers usually bump up their velocity when they shift from starting to relieving suggests a usual shift from lower thresholds of (maximal) stress to a higher threshold of max efforts. Either kind of stress can lead to breakdown, and perhaps there's no abstract answer to which stress is more perilous. Nonetheless, it would be interesting to see what the evidence would suggest (if there were some scientific data).

There was a study from around 20 years ago that elbow injury rates among starers and relievers were similar, but shoulder injuries were more likely with starters. Shoulder injuries seem to be workload related and elbow injuries are from the stress of max effort. That matches up to what we've seen over the last few years where shoulder injuries are rare since nobody pitches a ton of innings and anyone can get an elbow injury at any time.

 

[Sandy Leon Trotsky]

I suspect that certain injuries relate to certain types of pitchers physiology more than anything else. Some are probably fine to throw max effort for 100 pitches once every few days and others will injure themselves within a few turns through. Some will have bad shoulders, others a bad elbow and my suspicion is that any evidence is likely inconclusive and just noise.
It'd be an incredible breakthrough (however unlikely) to determine what types of body/arm structures would work best- max effort relief or long repeated motions. Obviously a bulkier type with larger amounts of muscle and fat around the joints, tendons, etc... are less likely to break down but I suspect that's also not a guarantee.

 

[nvalvo]

There was a study from around 20 years ago that elbow injury rates among starers and relievers were similar, but shoulder injuries were more likely with starters. Shoulder injuries seem to be workload related and elbow injuries are from the stress of max effort. That matches up to what we've seen over the last few years where shoulder injuries are rare since nobody pitches a ton of innings and anyone can get an elbow injury at any time.

Ooh, now we're talking. That sounds like a plausible and at least sort of testable hypothesis. It would be interesting to extend the analysis to other sorts of issues, like knee and hip strains, obliques and the like.

Do you remember any more about where this study was published or who did it or any other details that might me help track it down?

"For the good of the roster" is a really good point (amidst a really good post). In fact, I think it represents a subconscious underpinning of my own particular thoughts about "who should start and who should relieve" among those pitchers that might be either/or candidates, as well as the larger point of who stays and who goes. A related example for me -- and please do NOT treat this as a digression to re-litigate the trade -- was my attitude toward trading Sale. His uncertain availability was a disruption due to the re-shuffling factor. I dont believe it makes a difference for purposes of the above point that that was a trade instead of a shift in roles. And, of course, the overall point about the predictability of injuries remains, (mostly) no matter the pitcher, and no matter the role.
In hindsight, we may be able to say, "Wow, pitcher A was always hurt when he was a starter and flourished as a reliever" and maybe the opposite with other pitchers. Maybe studying *them* post hoc is a way to get some "whys" and then maybe some predictability. Lotsa maybes.

Yes, exactly! Sale is a great example in two senses.

First, in the larger context in which Breslow was trying to patch together a rotation, relying on an "injury-prone" pitcher like Sale would have had knock-on effects for the pitching half of the roster:

• We likely would have needed to option another pitcher from the group of Houck, Bello, Crawford, and Winckowski.
• Moving them to the bullpen may have made the roster situation even more worse, because it would simultaneously shift the roster crunch over to relief and we'd have needed to add even more non-40 SP depth (Fitts types) than we already did.
  • The problem with relying on depth from beyond the 40-man is that you end up needing to DFA players when the emergency is over.
  • This incidently, is why I think Winck is being stretched out in AAA. We need a pitcher on the 40 but off the 26 who can plausibly start MLB games, and is stretched out.
  • I'm not done with Naoyuki Uwasawa, but he'll need to show a bit more in Worcester than he has before I'd consider him depth, and Brandon Walter is hurt. So that leaves Winck.
  • And hey, in his first start Winck just threw a 4 IP allowing 2 runs against the Norfolk Tides — i.e., basically an MLB lineup.
• It would have made it harder to recruit depth FAs like Criswell, whom we got after the Rays non-tendered him; he doesn't come here if we can't offer a 40-man spot.
• And we wouldn't have had the spot to nab Slaten. Anderson, too, I guess.

And second, Sale's in fact held up! (So far.) Obviously, if we knew in advance what we know now — that Sale would be leading the National League in walk rate while starting every fifth day at the top of a contender's rotation in late May — we'd have kept him and found different fixes for the infield and bullpen and starting depth. But ex ante?

 

[Max Power]

Ooh, now we're talking. That sounds like a plausible and at least sort of testable hypothesis. It would be interesting to extend the analysis to other sorts of issues, like knee and hip strains, obliques and the like.

Do you remember any more about where this study was published or who did it or any other details that might me help track it down?

I don't recall, but I found this newer one that has the same information.

Hazard of Arm Injury in Professional Starting and Relief Pitchers - PMC (nih.gov)

 

[jon abbey]

Also sometimes it is the change of scenery and the player wouldn't have been anywhere near as good if they hadn't been traded. AJ Burnett and more recently Sonny Gray are two guys who went back to being great the second NY traded them to the NL.

We unfortunately only have the one timelime of events to observe (as far as I'm aware), a SSS of timelines.

 

[zenax]

Unfortunately, data on pitches by game is not available before 1988 but looking at overall pitches per plate appearance and strike percentage for 1988 through thus far in 2023, one sees 3.58 P/PA and 62.8% StrPct for 1988 as opposed to 3.73 P/PA and 63.4% StrPct for 2023 (I left out this year because of sample size; however, it fits the general rise seen throughout).

One thing to consider, and one I haven't completed, is breaking down the data by pitching role: starter or reliever: however, one sees in 1988 that starters averaged 6.4 IP/GS and 91 P/Start while in 2023, the average IP/G dropped to 5.1 and the number of P/Start dropped to 85. Going to relievers, one finds in 1988 they 4.5 IP/GR and 23 pitches while in 2023 these numbers changed to 4.5 IP/GR and 19 IP/GR. These numbers for relievers don't take into consideration their role in games: LHP brought in to face LHB. closer, , non-pitcher in blowout, relievers brought in to startet al.

The other thing to bear in mind is that these numbers (from baseball-reference) are from MLB data and represent averages, which means that one needs to dig really deeply into the data to get a fuller understanding. As an aside to this, the 1903 Boston Americans (as they were then known) played 141 games using six pitchers. They had 123 complete games (good for 3rd in the league) and 18 relief appearances. That works out to 35.65 batters faced per game Five of the pitchers combined for 122 complete games and the sixth one made one start. Things have changed and I doubt we'll see those days again.

 

[Red(s)HawksFan]

I'm not sure I understand the importance of who called who first.

It's about the desire some folks seem to have to shade every thing the Red Sox do as if they're the only party with agency in any given transaction. Maybe trading Sale wasn't about the Sox giving up on him or desperately wanting to get rid of him. Maybe it was about acquiring Grissom and Sale just happened to be the most acceptable price to pay.

 

[HfxBob]

OK.

So why did you fight this?

Because it doesn't mean Breslow wasn't the one who made the first call this time. He would have known the Braves might be interested, right?

As I said I'm not sure I understand why it matters who called who anyway. Both parties were interested.