Injury Nexus
by pedrophile on Nov 18, 2007 7:27 PM EST
31 comments
This comes up in conversation quite often. And many times it's used improperly. I'll try to shed some light.
The original article comes to a conclusion that the "injury nexus" is a real event. The one possible reason was felt that the ligaments, tendons, joints, etc. have not fully formed. And the actual date of the injury nexus was believed to be before age 23.
While this article principally talks about age they do talk about maturity - in that each person's body will mature at different ages. The age they quote is by no means intended to be exact.
The study shows the worst point in time for pitchers is age 21 and at, or around, age 23 is the best point. But since the study is only on MLB players then for a 21 year old to qualify he would have needed a successful MLB season at age 20. Quite a rare feat. And easily understandable while we wouldn't see age 20 on the chart. There would not be enough 19 year olds to make it valid statistically.
What was not really discussed in the original article was other causes for the damage. In particular the ascending innings pitched and higher pitch counts. Pitchers that are either allowed to accumulate much higher innings pitched from one year to the next (ie 115IP to 190IP) or simply the players that just can't handle the longer season and are affected by injury.
Since the article BP has talked more about these phenomena and they have also moved from a specific nexus (if they even perceived it that way) to something more generic. They discuss the age as a factor, the physical maturity, and the levels of innings pitched the pitcher has weathered.
Is a 27 year old pitcher that has always had low innings (ie late start to baseball) and not exposed to MLB past his injury nexus?
IMO he is not. While he is past the physical maturity issue he still has not taken the beating that a significantly larger workload will put on him. And he has not proven in successive seasons that this hasn't affected him. I'm not dismissing the physical maturity issue. I just believe it is only one of many factors.
I would really like to see some studies that look at minor leaguers based on the same rules as the original study. And I would also love to see some studies based on IP progression.
btw: I hope I'm not giving the impression that BP's work is flawed or that I know much more about it than they do.
Links:
http://www.baseballprospectus.com/article.php?articleid=1658
http://www.baseballprospectus.com/article.php?articleid=6720
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hm
by PujolsJunkie on Nov 18, 2007 7:29 PM EST reply actions 0 recs
Thanx, Pedro
by rhd on Nov 18, 2007 7:36 PM EST reply actions 0 recs
The way I've looked at pitchers...
As a prospector, what really interests me is: How does teenage workload affect injury risk? The way I've viewed it, just through 15 years of prospecting experience, is that a young guy with a heavy workload gets a slight downgrade in my book because of an increase in injury risk. The closer they are to about 22 when they break through, the better. This is only based on experience and anecdotal data, nothing scientific.
Ped, when I have a chance, I'll read over those BP articles.
by beastball on Nov 18, 2007 7:49 PM EST reply actions 0 recs
I hear you
But ...
If you look at their graph you can see the wear & tear occurs and gradually increases over time.
What really is being studied is who will become the Pavano's and who will become the Mussina's. All pitchers, even the most durable, will accrue wear & tear on their arms.
by pedrophile on Nov 18, 2007 8:14 PM EST up reply actions 0 recs
great stuff thanks
There is a lot of vagueness in this but I bet in a few more yrs the picture will be much clearer now that most org.'s are on board with this kind of work. I work w/ youth (16u) so I find this very useful, not so much for me (I know kids can be overworked easy) but for their parents (who all think their little Johnny all-star is the next Nolan Ryan).
by dew on Nov 18, 2007 7:49 PM EST reply actions 0 recs
fyi
Another thing to keep in mind is there are other concepts out there about pitching and injuries. Hardball Times believes pitching many more innings actually helps prevent pitchers from getting hurt - or at the least doesn't limit their ceiling in how much they can pitch. This is very difficult to judge because their study was completely generational and of course this has many other factors.
btw - BP does in fact look at stress which isn't solely based on pitch counts. We all know each pitcher will tire at different times.
by pedrophile on Nov 18, 2007 8:20 PM EST reply actions 0 recs
tough subject.
So I'd like to see all these studies done, and I think it would be useful. But I don't think I'm being forward to presume what they would in all likelihood conclude... that the younger and less experienced you are, the more likely you are to get hurt... and that ideally, you want to start a young pitcher off with a very limited workload, gradually ramp his maximum IP up year by year, and not take the limits off until he hits his mid-20s.
I think the real question is, to what extent do you go to preserve that? I have already heard that the Yanks are going to try to limit Hughes, Joba and Kennedy to 150 IP or so each. Is this even possible, to have three guys in your rotation who are all limited to five innings a game? How many pitchers are you going to carry to make this work? If they can't practically be asked to start, would it be better to make them long relievers? If you go that route, would it eventually get to the point where you have to be 30 years old to be in a starting rotation? Is there any way that we can distinguish the more durable pitchers from the ones in the most danger, as opposed to using the same rules for everybody and seeing what happens? These are the tough questions, IMO.
by Mean Dean on Nov 18, 2007 8:32 PM EST reply actions 0 recs
point about the 27yo
I do agree with the experience part. But a 27 with very little innings on his arm hasn't been tested yet. And neither has the 20yo.
by pedrophile on Nov 18, 2007 9:02 PM EST up reply actions 0 recs
Caroll
"Pitching is an unnatural act that invites injury."
Seriously, we've been doing it since cavemen could throw rocks at rabbits. My 4 year old picks up a ball and throws it as "natural" as can be. There is nothing "unnatural" about the pitching motion, throwing an object overhand is one of the most natural acts a body does outside of the bathroom. Will is great at spouting off things someone else tells him but when you get right down to it, his analyzes lack depth and understanding. The fact that he even mentions that nut job Marshall in the article loses all creditibility in my mind.
IMO, # of inning pitched and except for extreme cases pitch count have absolutely no bearing on whether a pitcher gets injured. The linked article in there that uses the ridiculous PAP shows several pitchers, of those only 1 in my mind is attributable to workload (El Duque). Most on that list have never even had a significant arm injury.
I really want to get into this more but the baby is crying........
by HuskerBob on Nov 18, 2007 8:35 PM EST reply actions 0 recs
innings pitched
But that those unable to handle it, for whatever reason, will be separated early. This would be the injury nexus. And after this period would have lower injuries because there is less wear & tear and the pitchers are younger and the body heals faster.
I'd like to hear your comments on this. And of course your comments on the injury nexus in general.
by pedrophile on Nov 18, 2007 9:07 PM EST up reply actions 0 recs
I think
Beyond that, I just don't see workload and number of pitches as significant factors in and of themselves. I think it is important to understand that the workload itself is almost NEVER the cause of catastrophic arm injury. When was that last time you saw a guy leave a game in the 9th inning after 130 pitches with a rotator cuff tear? I've never seen it happen. Arm injuries are almost ALWAYS in the first few innings or even first few pitches of a game and even then its usually clear from the very first pitch if you are watching closely that something is wrong. I will never forget watching Kerry Wood the outing after his 20 K's and I knew something wasn't right. He threw 3 or 4 more games but you could see his stuff and arm speed deteriorating before your eyes.
My major point is REST and RECOVERY. Damage is not done by the work itself, these bodies in particular (elite athletes) are more than capable of throwing 130 pitches in an outing at close to max effort. The problem as I see it is in terms of their ability to rest and recover from the work. When a pitcher takes the mound with some swelling in the joints that is when catastrophic injuries come. Pedro, Slurve, you guys know, how many times did you go down the bullpen for your next start and still have some stiffness? By the time the bullpen was done you had loosened it up and were ready to go, but what we all didn't know at the time was the swelling was still there. Those starts were the ones that killed us. How many freakin times did I pop 2 or 3 advil on the way to the park? geez, young and ignorant.
The question is then how does this relate to the "injury nexus". I agree in the young bodies heal faster to a point. I have become a firm believer in metabolism and maintaining muscle mass. IMO, younger pitchers struggle with a higher metabolism to maintain their strength over a long season and recovering muscle mass in between starts. Complicating things is these are usually the guys that are eating fast food and drinking red bull. A 30 year old with a slower metabolism carries his weight easier (hell I gain 5 pounds just sitting in the drive thru). I think this ability to maintain weight is important for pitchers. There is a cutoff point where the metabolism has slowed the point that they can't re-generate. I think this correlates pretty clearly to the nexus graph in that article.
I think the discussion of college pitchers below is an interesting one. If you look at the Rice pitchers they had very heavy workloads in college and yet didn't breakdown until they hit the pros, why? I think its because in college they threw once a week with plenty of rest. In the pros when they had to switch to every 5th day it became a problem.
Like I've always said though, arms break down, that's just what they do. You can do everything right like Mark Prior and blow your arm into a million pieces or you can be a fat retard like David Wells and pitch into your 40's. As a player evaluator I think I you take as much of the quantifiable things into account, but at some point its a damn crap shoot and the best scouts out there are the ones that have the best gut feelings.
by HuskerBob on Nov 18, 2007 11:50 PM EST up reply actions 0 recs
workload & stress
Here is where I see the problem:
Pitcher A throws 100 pitches.
Pitcher B throws 120 pitches.
Pitcher C throws 135 pitches.
All of them come back on normal rest. Pitcher A is fully rested and is pitching fine in his next start. Pitcher B has slight swelling that isn't easily detectable. If he pitches his next game with only 100 pitches or so then there really isn't a problem. If he again throws 120 or so pitches then the swelling is increased a little.
Pitcher C has quite a bit of swelling and is at a more severe risk of injury his next game.
IMO it's all about the extremes. For example the 145 pitch game. Or about continuously having higher pitch counts slowly but steadily building up fatigue/swelling in the arm. The actual injury may come in a harmless situation but the lead-up usually isn't.
Yeah - I've felt at times extremely fatigued and reached back for more and did very well. And wasn't too bad the next day. But the next time pitching around the 2nd or 3rd pitch felt totally gassed.
by pedrophile on Nov 19, 2007 2:50 AM EST up reply actions 0 recs
Totally Agree
If I were in player development there are a few things I would do.
Pitch count wouldn't be that important to me except extremes obviously, but particularly at the lower levels I would consider having every pitcher skip a start once a month. Completely skip, and get 10 days off.
I would even go to the extreme of putting an MRI at every level that you use in between starts. Not an arthrogram obviously but stick em in there for a half hour, make sure the swelling is acceptable or get them rest when its obvious they need it. A kid can lie about how he feels but he can't hide swelling on an MRI.
by HuskerBob on Nov 19, 2007 9:27 AM EST up reply actions 0 recs
Husker Jr.
http://www.minorleagueball.com/comments/2006/1/19/212746/712/20#20
by slurve on Nov 19, 2007 10:45 AM EST up reply actions 0 recs
That seems a bit like...
Sure, maybe being babied is causing the injuries, but I think injuries caused them to baby the pitchers.
Remember how much heat Rice got for riding their pitchers? Who were the three, Humber, Niemann and Townsend? Given all the injuries those guys have duffered, do you think they changed the way they use their pitchers? I wouldn't be surprised if they did.
So, I don't know. Part of me believes that pitching is a very taxing and complex position, physically, and I could see injuries happenning as the body finishes trying to grow.
On the other hand, it's impossible to tell, maybe the guys who got hurt would've gotten hurt regardless of how they were handled. Matt Bush certainly didn't blow his elbow from overuse.
by beastball on Nov 18, 2007 10:07 PM EST reply actions 0 recs
Not worried about Price
by HuskerBob on Nov 18, 2007 11:53 PM EST up reply actions 0 recs
Re:
I've always been skeptical of the idea that you're risking major damage to your arm if you pitch over a certain number of pitches in a game regardless of other factors. Back in the days of 4-man rotation (about 25 years ago and before), pitchers routinely threw 120-135 pitches a game if they were pitching well; coaches didnt start getting concerned until they had thrown over that amount. A good starter would get at least around 20 complete games a year and the league leaders would get over 30. Quite often, a starter would pitch 10 inn. if the game was tied, and sometimes longer. Nobody's arm fell off and pitchers had long, productive careers. There would be several pitchers each year that had over 300 IP. I dont recall that pitchers had more severe injuries back then and have never seen any stats that indicated this either. I think there is something to the idea of building up your arm strength by throwing more pitches, if it is done correctly.
The other thing about pitch counts that I'd like to see data on is the effects of high pitch counts per inning and high inning pitch counts later in the ballgame. These factors supposedly are as important as the total pitch counts in the game.
by rhd on Nov 18, 2007 10:53 PM EST reply actions 0 recs
To the point about the old days...
First, I thought that sliders and split-fingered pitches came into prominence in the modern era. I could be wrong there, but from what I've read that's the case and those pitches are hard on arms.
Second, I think that the game has sped up in the modern era as well, so I think pitchers have to pitch with max effort more often than before. Whether its internationalization of the sport, superior training and nutrition or PEDs, from what I understand, the game is full speed now, when it wasn't so much that back then.
Of course Mazzone, again if I remember correctly, had his guys throw more on the side, not less, to build up strength. I think that's what they do in Japan as well. It would be interesting to see their injury rates compared to ours as well.
by beastball on Nov 18, 2007 11:21 PM EST up reply actions 0 recs
Good ol days
I have never looked hard at it but I seriously doubt the average career length for a pitcher has changed much in the last 50 years.
by HuskerBob on Nov 18, 2007 11:56 PM EST up reply actions 0 recs
In the 60's
by HuskerBob on Nov 18, 2007 11:57 PM EST up reply actions 0 recs
heres why pitch counts are important
As a youth coach I know a lot of the things I deal with aren't really applicable to what we discuss here. Most HS coaches will say it is my job to teach kids the basics of proper mechanics so when they get them they're ready to perform. For some their job depends on results. Is this the same with collegiate coaches? I know their jobs depend on results so how much will they tinker with a kid who is getting great results but has obvious flaws in his delivery? Most HS coaches here won't do much if anything at all, particularly if the kid has no interest in it. In part because there are more coming right behind him. What about minor league instructors? How much will they mess with success? Are they willing to take a step backwards with a prospect like Joba or Kershaw to eventually move two steps forward? I guess a lot depends on the prospect himself, I've been told more than a few just won't listen, especially if they are doing well in games.
There is a big stink about banning curveballs in LL; it might be a good idea on the surface (because very few kids can throw one properly and very few coaches can teach them how). But if it is thrown correctly it doesn't put any more stress on the arm than a fastball. Innings pitched are almost irrelevant to me, and how many pitches a kid throws is almost as inconsequential as long as they are throwing w/ proper mechanics. Its when they get tired that they "lose" their mechanics, and begin failing at the basics (keeping elbow up, following thru, not staying closed, etc.). I believe pitching under stress or fatigue will be the number one cause of arm injuries when all this is said and done, even with proper mechanics. Probably not a great revelation to most here, especially if I can figure it out. The key is when and how to recognize it (something I need to work on).
by dew on Nov 18, 2007 11:05 PM EST reply actions 0 recs
I do agree with what you say...
Having said that, it doesn't feel like much of a stretch to say that it would be hard to remain mechanically sound as your body may be going through significant growth.
And in terms of mechanics, that breaks down too. I was suckered in by a great Marlin prospect Wes Anderson. Reportedly had awesome mechanics, smooth motion, he was a great prospect, mid-90s heat, 3 plus pitches, blah blah blah. He threw almost 140 innings as a 19 year old, and got injured at 20 never to be heard of again.
Of course, we all have stories about players who had great mechanics and got injured, or have terrible mechanics and excel. I would be interested in the injury rate between college and high school draftees. Maybe that's in one of those BP articles I've yet to read.
by beastball on Nov 18, 2007 11:16 PM EST up reply actions 0 recs
Yes, but
That is the point that gets lost IMO.
by guru4u on Nov 19, 2007 12:21 PM EST up reply actions 0 recs
+1 on the theory
The issue of innings, etc comes into play when you talk about fatigue. When a pitcher gets tired, that is when the mechanics start to become flawed. THAT is why you like to see that nice, steady increase in innings pitched with a pitcher. Sudden jumps in innings increases the likelihood of fatigue, which in turn increases the likelihood of injury. The actual mileage on the arm in and of itself does no harm. But if a pitcher puts mileage on that arm while throwing the ball improperly, it can cause tons of damage.
I think that is what has been lost in the whole argument. People have lost sight of the fact that proper throwing is GOOD for the arm. Instead, teams just see these pitching prospects go down to injury, and they associate the pitch counts and innings to the rash of injuries. But if a pitcher threw every single day, under the watchful eye of a coach that is concentrated on the mechanics, I think we would see the injuries drop dramatically.
Unfortunately, this does us no good when trying to analyze the risk of injury in front of a computer.
by guru4u on Nov 19, 2007 12:17 PM EST up reply actions 0 recs
GOOD?
I do agree mechanics plays a part. But to say it's the sole reason or to say it helps the arm is fallacy imo.
by pedrophile on Nov 19, 2007 7:16 PM EST up reply actions 0 recs
Nexus
- You're reading something that's four years old -- five? -- and lots changes. While I think the work was and is solid, it's still something that doesn't have the benefit of five more years of data, learning, and research.
- HuskerBob makes a common mistake. Throwing is natural. Pitching is not. The motion to throw a ball or rock or whatever is something we all can do. Doing it at major league velocity 100 times with five days rest is not.
- Mechanics are important, but guys get by with bad mechanics and good results up until a point. BJ Ryan signed the big contract and pow, finally got hurt. Mechanics, genetics, conditioning, and more are all important.
- Did I say thanks for reading and hope that you'll check out the rest of the things we do at BP. There's a lot of good stuff we've done in the five years since this one!
by injuryexpert on Nov 19, 2007 9:34 PM EST reply actions 0 recs
Point #2
"Doing it at major league velocity 100 times with five days rest is not. "
If your article had qualified the original statement like this I wouldn't have had a problem with it.
I am curious, have your views of Dr. Marshall changed over time? Have your basic views of the "injury nexus" changed much since this article?
Thanks again for taking the time.
by HuskerBob on Nov 20, 2007 10:35 AM EST up reply actions 0 recs
I'd also like to know
by HuskerBob on Nov 20, 2007 10:41 AM EST up reply actions 0 recs
that Dr. House...
Just my opinion.
by Mean Dean on Nov 20, 2007 11:49 AM EST up reply actions 0 recs
Clarity
Marshall's intractability and inability to show any results have moved me from a "maybe his stuff works" to a "wow, he's got some good stuff, but it's getting lost in the rhetoric."
The nexus hasn't moved and more data has only served to confirm Nate Silver's work on it.
There's no balance between House and Marshall. Two different guys with two different ideas. I listen to a LOT of pitching coaches and try to be a neutral party. When I teach, I know what I believe and have a bias towards injury prevention, but that's different than being a reporter.
by injuryexpert on Nov 22, 2007 11:39 AM EST reply actions 0 recs
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