Effectively Wild: A FanGraphs Baseball Podcast - Effectively Wild Episode 455: Stan Conte on What We Need to Know About Pitcher Injuries

Episode Date: May 22, 2014

Ben and Sam talk to Dodgers VP of Medical Services and Head Athletic Trainer Stan Conte about the pitcher injury epidemic.

Gentlemen, we can rebuild him. We have the technology. We have the capability to make the world's first bionic man better than he was before. Better. Stronger. Faster. Good morning and welcome to episode 455 of Effectively Wild, the daily podcast from Baseball Prospectus presented by the BaseballReference.com Play Index. I am Ben Lindberg, joined by Sam Miller, and today we want to talk about what unfortunately has become one of the biggest storylines of this season. It seems as if every day we hear news of a new pitcher who is experiencing some sort of elbow discomfort, the latest being Cliff Lee, we've discussed this on the show before, but we don't know what we're talking about, so we want to bring in someone who does.

One of baseball's biggest experts in injury prevention and detection and treatment, the vice president of medical services and the head athletic trainer for the Los Angeles Dodgers, Stan Conte. Hey, Stan. Hey, good morning. How are you doing? Good. So can you explain the distinction between those two titles for people who don't know? Because people know about athletic trainers and assistant athletic trainers.

They might not know what a VP of medical services does because that's a relatively new position and one that maybe not every team has. Yeah well I think we're still trying to figure out we sort of make up titles as we go along as a lot of companies do but my background is I have my doctorate in physical therapy from Boston University and been a physical therapist for a lot of years, treating sports medicine injuries and working with giants. I'm also the head athletic trainer, which I'm a certified athletic trainer as well.

My job is kind of multifaceted in the fact that I work with a major league team. My job is treatment and rehabilitation for the major league team. And, you know, covering the game. When somebody goes down, I have to go out there and see what's going on. But we also do a lot of stuff behind treatment. The vice president title is one that kind of reflects some of the administrative stuff that I do as far as research and other activities to try to figure out where to put our resources on the medical side to keep players on the field and how to rehabilitate them.

Now, what most people don't understand is that there's a 25-man major league team, but there's about 220 minor league players that are running around the country that are part of the Dodger organization that I also keep track of through our physical therapist and athletic trainers in the minor leagues. So every night, last night when we got back at 2 o'clock in the morning after the game, I'm reading minor league injury reports and seeing what we're doing with the minor leagues as well. So it sort of reflects a bigger than running on the field and taping an ankle in between innings.

So that's the best way I can explain it, I guess. And a lot of what you do and what people in similar positions with other teams, the Astros and other teams have hired medical analysts or coordinators, a lot of the work that you do has been made possible, as I understand it, by improved record keeping, right? This is an area in which baseball as a whole has really taken large steps in the last few years. Yeah, in 2010, prior to 2010, there really wasn't an injury tracking system. Major League Baseball stepped in in 2010 and really helped us develop an electronic medical record system. And Major League Baseball stepped in in 2010 and really helped us develop

an electronic medical record system, an EMR, that has improved every year. And part of that is record keeping so that players that go from team to team have the same medical records and they're not sort of transferred through files and that type of thing. But also what it really is and what I was most interested in in EMR is it tracks the history of injuries, and therefore we have some analytics to go back on and be able to look at trends that are going on instead of guesstimating. We've used the disabled list, and I'm a big proponent of the disabled list up to 2010 because that's all we had as far as records to look at trends of injuries.

But now we're getting more sophisticated. But like with any database, you need years and years and years of databases to really look at overall trends. And we're now in our fourth year of this, and we're starting to extract some really good data, which is helping us look at, one, where the problem is, two, how we can have an intervention at some point and see if that intervention reduces the injury. So baseball is definitely coming into the 21st century.

MLB has put a lot of time, energy, and money behind this, and I think it's going to start paying off soon. But like with any database in its infancy, it has to grow. So to pivot to pitcher injuries, because this is such a recent innovation, do we even have enough information to say, to answer a question as simple as, are pitchers getting hurt more often now or less now? Because people will express opinions of guys are getting babied now. They're,

they're getting hurt more than they used to in the past. Other people will say, no, there are all sorts of career ending injuries. Pitchers used to get hurt much more, but we don't really have the numbers to answer that question. Do we do, do you have a sense of what the answer to that question is?

Yeah, I think the injuries are definitely going up in baseball. There's no question about that. The disabled list, you know, has a pretty good historic record. Although the disabled list is not an injury database, it is really a roster management tool. So, but we can get a lot of things because of the long period of time it's been kept. We can look at trends. because of the long period of time it's been kept, we can look at trends. And injuries, especially since 2007, have increased, and they've increased not surprisingly disproportional to the pitcher.

And, you know, last year, for instance, we had over 500 placements of players on the disabled list. More than half of those were pitchers. Of course, there are about half pitchers in baseball. But 500 is a marker. It's only been achieved four times, and that's in three of the last five years as far as number of players on the disabled list. It accounted for over 29,000 DL days,

which was a record last year, and accounted for $665 million in lost salaries due to players that were hurt, even if they were replaced by minimum salary players. So I don't know if you followed all that, but that actually adds up to a chunk of change about a little over $1.2 billion per year that's lost to Major League Baseball because of injuries. So there's no question that it's going up, but, of course, the real question is why is it going up, you know, and what are the different factors that go into that.

That's sort of what a lot of us in Major League Baseball and around the country are trying to figure out from an analytic standpoint and an objective standpoint as opposed to a knee-jerk reaction. I think he talked a little bit about, you know, were there injuries? There were no injuries before. There were injuries before. This is just a routine thing.

You know, injury statistics were not kept in the 60s and 70s. So when you talk to pitchers in the 60s and 70s, they say, well, nobody ever got hurt. That's a little bit of like the older you get, the better you were. I mean, people did get hurt there. We just don't know how many to be able to compare. But from the late 80s on, we do have some interesting trends, and they're not really great trends that we want to see. that we want to see.

So you alluded to the question, but that is the question. Why is it going up and what are the different factors that go into that? Because it really does seem like sort of the great paradox in this sport at this time, that the more you guys spend on this, the smarter you get, and the more valuable the players themselves are, the more they get hurt. How can this be? Why is this? Well, you know, there are a lot of factors in this. I think it's been talked about.

When you look at the Tommy John situation, it's a nice microcosm of all the pitcher's injuries and some of the things that people think might or might not be causing the increase. And, you know, we can just talk about some of those areas in general. You know, one of the big pushes in discussions is the youth baseball usage problem in middle league high school and even in college and what's happening to those pitchers who are pitching too much at a younger age and whether or not by

time they get to the professional levels they're damaged goods before they get here. And so there's a lot of talk about that. Dr. Jimmy Andrews, a guy named Glenn Fleissig has put a lot of work into studying youth baseball and found out that these kids are being pushed so hard to do two things, pitch a lot and pitch year-round, but also to throw as hard as they can. So that's one of the issues involved in this, and whether or not we have to go back to the youth baseball

and kind of fix that system so these kids are not wiped out by the time they get to the collegiate and professional levels. I can buy that one pretty good. I think it's really important to talk about that. I'm not sure how much that particular issue carries over to the professional level and the increase that we're seeing now. That's not a popular view, but I think it has to be looked at. Probably the biggest thing that's talked about right now is velocity, especially with the Tommy John situation. People talk all

the time about throwing being an unnatural act. Well, from my perspective, it's a very natural act. Your body's actually designed to throw. And I use the analogy of the Neanderthal who first found the rock to hit the bird and eat it. He didn't throw it underhand. He threw it overhand. And there's been some really good papers, a dissertation by a Harvard University student, looked at this and showed that really our shoulder and arm has developed in order to throw. But it's not designed to throw as hard as you can 120 times within two hours. And I think that's the difference. And in regards to Tommy John and the ulnar clavular ligament,

the stress on the ulnar clavular ligament when a pitcher throws is near failure almost every time when you look at the biomechanics of this thing. So, and velocity is mathematically related to the stress on the ligament. So, what happens is the harder you throw, the more stress you put on the ligament. The more stress you put on the ligament, you come closer to failure. And so velocity is definitely part of the formula. So now the question is, you know, if a guy throws 99 miles an hour, do you tell him he has to throw 93 miles an hour? That's a whole other issue. So velocity definitely has a part in this.

When you do talk to pitchers of another era, they threw hard, but they didn't throw hard all the time. And I think what you see in the major leagues and in the minor leagues is these guys are going out throwing as hard as they can on every pitch. Even if that pitch is a curveball or a slider, the velocity is decreased, but their arm speed is as much as they can get. I think that's part of the issue in regards to why we're seeing

more Tommy Johns right now. The velocity is definitely a part of this. Then, a third part of this is mechanics of pitching. Boy, there's a lot of talk about mechanics, what's good mechanics, what's bad mechanics. And there's been a lot of different biomechanical studies done out there that looks at how pitchers throw. You've got the inverted W, the infamous inverted

W mechanics, and does that cause a problem? We do know that a certain type of mechanics will put more stress on that ligament. And so the mechanics aspects are a big part of this too. You also have the usage issue, and this comes in the pitch counts. Now, I have not been able to find a study or do a study that has showed a direct correlation to increased pitch counts and increased injury. Intuitively, you think that the more a guy throws, the more chance he has to get hurt. But we really haven't been able to show that. And the question on usage mostly is what happens when a pitcher gets tired but we really haven't been able to show that.

And the question on usage mostly is what happens when a pitcher gets tired in the late innings? Does he change his mechanics and then therefore put himself at risk? So that's kind of what goes along with that. So those are some of the big areas. Some of the other areas that people are talking about is should the mount heights be changed is the mound the culprit um and should we lower the mound or should we raise the mound or should we change the slope of the mound and um you know we've got a lot of studies going on right now about that and um i don't think major league baseball is going to change the height of the mound, but this kind of goes into mechanics of what's going on.

There's some studies that show that the mound really doesn't cause more biomechanical problems. There's a couple studies that show it does. So, you know, people have to look at that. But the fact is, it's at the professional level. There's always going to be a mound there that people are going to have to deal with. So Ben and I sometimes talk on this show about the Peltzman effect, where people get riskier when they feel like they are more protected. And so when you talk about all these Tommy Johns,

and you mentioned the velocity, the increased velocity, is it conceivable, do you think at all that there are more Tommy John surgeries because there is Tommy John surgery that pitchers don't feel like it's a career wrecking thing anymore and that they're, because medicine is so good, they, they can throw harder, they can kind of engage in riskier behavior. And do you think it's conceivable that the injury rate is always going to be stable and that to some degree you're fighting a losing battle that no matter what you do, players will get riskier and adjust to play harder and to do whatever they can to win even if it means the injury risk stays the same?

I think it's a great point and it's an underlying thing that you can't put your finger on necessarily, but I think it's very, very real in a lot of different areas. One, I think if you're a high school pitcher looking for a scholarship and you're throwing 78 to 80 miles an hour and getting everybody out, good luck. You're not going to get a scholarship. Velocity is king in regards to moving up the ladder. And the players know that. That's what the coaches and the scouts are looking for.

So if you've got a guy who throws 88 miles an hour in high school, that guy's the greatest pitcher in the world. And that is promoted. So that's one of the things. So to tell somebody just to get players out, hitters out, is not going to be good enough. The velocity does have a big factor in that. And then the idea, of course, as he's saying, is, well, it's okay because if you blow out and you have a Tommy John surgery,

you're going to be okay. Well, that's a little bit of a myth, too. And we can talk about that for a second. And that is, you know, basically, even at the professional level, I hear all the time from front office people and other people as well, you know, if he blows out his elbow, it's, you know, it's 100% successful. He comes back in 12 months. He's probably throwing better than he was before, even throwing harder.

Okay. back in 12 months. He's probably throwing better than he was before, even throwing harder. Well, in that sentence, I lied about four times. One, it's not 100% successful. It is a very successful surgery. In the major leagues, it's about 75% successful, meaning the player comes back to the previous level of competition. He's a major league pitcher. He comes back 75%. That's a very good, and some studies show up to 80%, but it's not 75% to 80%.

Well, that means one in four don't ever come back. So it's not a slam dunk. Then there's this myth that's pushed out there that they're throwing harder afterwards. Well, there's been several studies that have come out, including one that we did, that shows that velocity does not increase after Tommy John surgery. Now, sometimes a guy is hurt the year before he has Tommy John,

and his velocity goes down from its average. And then he gets back to his average. But generally speaking, the velocity after Tommy John corresponds with the aging curve of velocity. In other words, as you get older, every pitcher pitches a little bit less velocity, and that goes along with it. So they don't throw harder. Occasionally there's one or two, but on the average, it's about three-quarters of a mile per hour less. So there's a myth that kind of goes along with it. Now, performance-wise, the

studies have shown that performance does come back in a pitcher compared to his previous level of performance, but it usually doesn't come back to the second year. And the last issue is this idea, every time you see a guy who goes to Tony John, they always say in the news reports, an expected recovery is 12 to 18 months. Well, does anybody remember the 18 months? They only remember the 12. And you see this with Matt Harvey right now trying to come back in 10 months. This is a long process.

The reason it's such a long process is that the healing of the graft of Tommy John takes about a year to mature and get going. And I'll go back to what I said earlier in this show, is that at every time you throw, you're close to failure. So until that ligament after the surgery is completely mature, you're at some risk. And when we start pushing the envelope and trying to get people back sooner, we're putting them at an increased risk.

And we're seeing a little bit of that with the second Tommy John's you know the Midlands and and Hudson's who have gone down within a year or two after the first time in John's surgeries so some of these myths are carried forward now again going on your other thing is that when when a guy has elbow pain, and we're seeing it a lot, you see that this guy's got forearm tightness. There's this rush to have a Tommy John surgery because it's a successful surgery. So nobody treats it conservatively. The standard of practice is to have a Tommy John surgery.

So there is a little bit of rush to get that done. Does that mean there's more people having Tommy John surgery because of that? That can be a factor. So when you talk about is it the success of the surgery itself that perpetuates the increased numbers, I think there's a portion of that that is true. the increased numbers, I think there's a portion of that that is true. I saw that you speak at the Medical Analysis and Injury Prevention panel at the Sabre Analytics conference in March, and that was unfortunately many torn UCLs ago. But at the time, you said that Tommy John rates had remained roughly constant, something like 18 to 20 per year, except for a spike in 2012.

Is it safe to say that what we're seeing now is the biggest spike yet? Or are we just putting too much emphasis on what's happened recently and forgetting what happened before? Well, baseball perspective is great about analytics and statistics. I mean, you guys are the website that really started the whole thing. And we know that one or two data points doesn't make the entire graph. So we'd be crazy not to say there's a sure trend upward. But when you look at this over really the last 10 years, the number of Tommy Johns has been fairly consistent at an average of about 16.

Little fluctuations up and down. And then in 2012, we saw this huge spike of 35. These are major league pitchers now. These are not all pitchers, but just major league pitchers. And we saw 35. And when I saw that, I went, oh, geez, what is this? Now, the question is, is this an anomalous year? Is this just an outlier? Is this just a weird year? Or is this the beginning of something? Well, the next year in 2013, it dropped back down to 18. So me looking at the graph said, oh, good, it's a weird year. But now we're at 20. We'll be at 20 next week at major leagues, and we're not even to June yet. So now if there's not another one that happens, I know we've got Cliff Lee

and we've got a couple other people out there, but let's say there's no more. And you can't assume that this is, you know, like clockwork. Every month you have X number. But statistically, you have to at least look at that possibility. And it looks like we're headed in the region of 30-plus again this year. So now that 35 in 2012 is not an anomaly. It's the beginning of a trend. How far this goes and where it goes, you know, if you go out 10 more years,

does this look like a blip on the screen or is this the beginning? So I think I've said this is that, you know, I don't know if this is an epidemic, but when I see clouds on the horizon, I'm going to grab an umbrella. So, I mean, I think we have to assume that this is going to keep going and study this more and more to see if we can put the brakes on it. And you also mentioned at the conference the concept of the stressful inning. And as you just told us, it's been tough to establish any correlation between pitch counts, raw pitch counts, and injury rates. But have you found anything in your various efforts to establish a connection between stressful innings or stressful pitch counts and injuries?

Well, we're working on it. How's that? You know, one is defining what you want to call a stressful inning. And initially, we were calling stressful innings an inning that, you know, had 25 pitches in it plus. In other words, the guy was throwing more pitches that particular inning. But we've kind of, at least I've kind of given up on that

and moved to leveraged innings. When you talk to pitchers, they seem to think that their arm works harder in high leverage situations, bases loaded, nobody's out, as opposed to just throwing a routine pitch with nobody on. Even if velocities are the same, because velocities are pretty much the same. So we're starting to look at some of the sabermetric analytics in regards to leverage innings and trying to put that together. But we're in the early stages of that.

And it makes a little bit more sense to me. But we haven't got to a point yet that we can say that a guy who throws 100 pitches and four of those innings are high leverage innings, that's a higher risk of injury. We haven't been able to get to that point yet, but we definitely are working on that and doing that to see if there's some correlation rather than just gross number of pitches. You know, and everybody talks about game pitches, 100 pitches, 110, 120 pitches.

But, you know, you also need to look at the spread. You know, 100 pitches in four innings is different than 100 pitches and seven innings. So there's that factor, too. But, again, I really, early in my career, I really thought pitch counts were the whole key to this whole thing. And that just has not panned out as far as a really statistical correlation to injuries. It sure would have been nice, but then we just would have set pitch count limits

and done this stuff, and that would have ended it all. But it's not going to be that easy. To the extent that you can tell us, where would you say the industry is as far as identifying problems or impending problems in real time with technology like PitchFX or TrackMan. It's something that people at BP and at other sites have done some work with, but it seems like at least in the public sphere, it's sort of a blunt instrument now with a lot of false positives.

And you can point to a guy suddenly losing velocity mid-start, but that doesn't always mean something. Has it reached the point that that's a reliable indicator of anything? Not yet. I think you said it well. I mean, we've got big data. Now we need to figure out what to do with it, I think. As far as real-time, I think that's coming. The technologies are improving. I mean, what we'd really love,

we look at pitch effects in regards to release points. I think a lot of people looked at that since you got X, Y, and Z coordinates. And I thought I could really look at that because I'm a big believer in repeatable mechanics, especially at the major league level. The key is to repeat them and stay in your arm slot and pitch FX because they have the statistics on that. But mound height and where they put their foot on the rubber changes that a little bit.

I think what we really want to go to at some point is where we can get real-time biomechanics during a game. And this would be some type of sensors that are put on the player, as opposed to these big electrodes that they use in biomechanical analysis, and be able to really look at the stresses as they occur. I don't know that the technology is that far off. I know people are working on that. So then you can basically see at a point where a guy fatigues and changes his mechanics

and know when to replace that player. That would probably be the ultimate goal from a biomechanical standpoint. And of course if a guy is throwing a shutout in the sixth inning and he's got 85 pitches to go tell the manager you have to take him out because his biomechanical

analysis showed he was going off a little bit. Might be a tough sell on the bench, I can tell you that. But I think that's where we're headed. And like all these things, PitchFX has been around since 2008. TrackMan is a more recent phenomenon. We like TrackMan. The Dodgers use TrackMan because it gives us a few other things that PitchFX doesn't, especially extension. And so I think these are blunt tools right now.

But the more we use them, the more we get familiar with them, I think that the information will improve exponentially. I don't think we have to go only 20 years to see this. The other thing that has been great, I just was in a meeting yesterday, a day before yesterday at MLB here in New York, where we had really the top physicians, Dr. Jimmy Anders was there, talking about this and the fact that we've got so many people zeroed in on this. There's going to be a lot of people who are working on trying to find these answers and the medical people for sure don't think these are acceptable numbers

and that we need to do something and we need to figure this out so I think I think you know with those with that technology with these statistics, and I think Saver Metrics as a group, as a general entity, has helped a lot in doing these things. And people are thinking of things more analytically, even on the medical side. So that's all good. It's all promising. At the same time, we've got another guy going next week for a possible Tommy John. Well, since you bring that up, I mean, who is or who should be leading this initiative to try to figure out what the problem is and what the solution is here?

Because you've got 30 teams who all, it seems like, have an incentive to keep some information to themselves, right? I mean, you talked about how many billions of dollars were lost by injured players last year. If one team could crack this code and keep all their pitchers healthy, I mean, that's a huge competitive advantage. And yet, it seems like there's a lot of information sharing that goes on. And we don't tend to have a lot of team employees on our podcast because we find that for very good reasons they're they're not typically very forthcoming but you i've i've found you know unless you're conducting a masterful misinformation campaign you you're very willing to share information about the studies that you've done

and what they've shown so i mean how do you balance that need to sort of have that obligation to your team, but also to just advance the industry-wide understanding of these issues? Well, I think fundamentally, the smarter you are, the better you are. I try to get smarter. I think I'm smart enough to know that I'm not very smart. So what I end up doing is talking to a lot of different people. And I think there is a lot of collaboration on the medical side in baseball. There is that so-called competitive advantage that you're looking for. But I know that if I'm in the mix and I'm at the table listening to people

like Dr. Andrews and other people from other teams who may be smarter than me, it may trigger something in my head that leads me into a way that will help the Dodgers. Me being smarter is only going to help the Dodgers. It's sort of like I always get a kick out of the money ball thing. After 2002, for a while, people were saying, well, everybody's got the data, so everybody's equal. Well, nobody's equal. It's how you use the data, how you use the statistics, and how you implement that in.

So the facts are necessary, but how you implement things are the key. So for me, I think the more people involved in this and the more good thinkers that we have will help me decide where to put my emphasis for the Dodgers. So I'm very much, in case any of our front office people are listening to this, I really care about the competitive advantage for the Dodgers, but I don't think talking about those things and sharing information is giving insight to the enemy, so to speak. I think it's really helping us.

But one of the biggest problems baseball has is getting data and then changing things because of data. Baseball is an institution that resists change generally. And so on the medical side, some of that carries over. And it's, again, tough for me to go up to Don Mattingly in the middle of a game and saying, I think that he is fatiguing and his right arm is dropping. You need to take him out even though he's throwing a shutout in the sixth inning. How do you do that? That's an extreme case, but

some of this stuff is, this is the way we've done it. This is the way we've always done it. This is the way we're going to continue doing it. I think we have more people in baseball and in the medical people who are trying to change some of that and saying, we have to step in here. These numbers are unacceptable. We have to do something. And it's in the best interest of the teams and the players to do that. So I think that's what we're trying to do.

So over the years, the Sabermetrics discovered a lot when data has been public for everybody to poke through and build on. But the trend is, of course, sort of for baseball to keep its data private and proprietary. As the league builds this database, is there any discussion or thought about making it all public so that there are more eyes on it and more brains working on it? Great question. You know, I don't know the answer to that you know you're right the

Sabermatic Society has been unbelievable about sharing data I mean almost all of our stuff I do want to give credit to baseballheatmap.com which is where we get a lot of our data from on our teams in regards to Tommy John

surgery they tracked it I use based on perspective and their which is where we get a lot of our data from on our teams in regards to Tommy John's surgery. They track it. I use based on perspective and their injury data almost daily, and that's all public. But there is still a tendency for teams to be close to the vest in regards to a lot of this stuff. And I don't know where the line is to totally free public availability. There's no question the more minds you have working on it, the better RFP you have a chance. And I think Major League Baseball is trying to incorporate outside of baseball people to come in and help with this problem.

So I don't know if that's probably sort of not a very good answer to your question, but it's kind of where I see it. When we, you know, Internet analysts try to say whether someone is making a good move by signing or extending or trading for a pitcher, I think we mostly just kind of throw up our hands on the injury angle. And if a guy has had serious injuries before, of course, we know that's a red flag. But otherwise, we might sort of speculate so-and-so says his mechanics are a red flag or something.

But it's really hard to come up with any kind of concrete risk factor. And you mentioned at the conference on the panel that medical input has become a really important part of the discussion process before making a transaction, that it's almost like scouting now that you bring in biomechanics and biometrics and injury history and you try to make some recommendation based on the guy's injury past and what you think his future will be, how confident can you be in a recommendation like that? How often is that the deciding factor that you say, well, we think he's going to break, so we're going to stay away?

Well, I think, first of all, we put it in terms of risk and reward. We try to do the medical risk aspects of this. And I am involved in pretty much every trade, every free agent signing. Our medical team works a lot on the amateur draft, looking at players in regards to what the risk is, as does every team do that. And so the recommendation really has a lot to do with your organization and how much emphasis they put on that. And so the recommendation really has a lot to do with your organization and how much emphasis they put on that. In other words, if a team puts a ton of value on scouting for Saber metrics, they're going to listen more to the scout than the analytic preparation. And so a lot has to do

with how much that particular team goes into medical. The problem in medical right now, and this is really where I started my research 15 or 20 years ago, is not knowing how to rate these risks. So when you see somebody who has a previous injury or has some biometric problem as an arthritic hip or a history of back injury, where does that fit in? Do you say, do not sign this guy? And what I found over the years is that the guys who are at very high risk, um, who do really well,

and you say this guy has no chance of staying healthy and yet he stays healthy and he's very productive. So that, you know, I think over the years what I've done is, you know, at some point you sort of throw darts at a dartboard and hope you're right. I've gotten closer to the dartboard with my research, but I don't know that anybody has that done there. We have several players on our team right now that I rated very high on the medical side who are doing very, very well. So if I told the GM to stay away from this guy and this guy went back and

pitched for another team and won 20 games, that's the issue. Now, what we try to stay away from, and I know this seems very common sense, but it's a guy who has a very high risk and a very low reward. Those are the guys we actually try to stay away from. But sometimes there's a player that a team likes, and you say this guy cannot stay healthy, he's proved he can't stay healthy, and he's a lower-level utility player. Well, you're not going to get much reward out of that.

But you're going to take big medical risks. So we try to stay away from those. So it's a combination of the things. We had a player many years ago, Hong Chi Kuo, a left-handed reliever, if you remember him. He had just an unbelievable, terrible medical problem. He was elbowing his shoulder. But his upside was so great that they were willing to take the financial chance to do this.

And we signed him in one year, and I rated him very, very high. He had really well publicly documented stuff. And he set a record on ERA for left-handed relievers for the Dodgers that year. And so then what we ended up doing is signing him again. And what we really would like to have done is not sign him again because statistically we knew he was going to fall down eventually. So the risk went up the next year, and he did, in fact, have a problem. So how you time this everything is the competitive advantage is not sharing the data doesn't give a competitive advantage. What it does, though, is how you put that into your risk assessment,

how it's integrated into the philosophy of the organization is really the key. And we're still at the infancy of that, I think, throughout. Some teams do it better than others. This damn Tampa Bay and Cleveland really tick me off all the time. They seem to know what they're doing. Very quickly, because you might be able to settle this for us, we get a lot of questions. There are a lot of columns written about how maybe these injuries are attributable to decreased PED use in some sense or increased testing. Is there anything to that?

Does that physiologically make sense? Well, yeah, I don't know which way to tell you on that. It's a very slippery slope in regards to saying PEDs prevent injuries or cause injuries. You know, and because we really don't know, even in the steroid era, how many guys were really on it or what they were on or what their dosages were, there's really no way to tell. Does PEDs affect performance and affect health? There's no question. There's no question of that. Now, which way it goes, there's no way to study it to really tell that.

there's no question of that. Now, which way it goes, there's no way to study it to really tell that. Now, let me give you my disclosure type of thing, or my disclaimer, I should say. I'm very much against PEDs and have been very much, because I believe that baseball should be a competitive sport and there should be an even playing field. That's just a philosophy I have. So I'm not very tolerant of the idea somehow of allowing some PEDs in or out.

I'm very much against that. But there's no question that when you see a baseball, one of the things that's great about baseball is that it's been the same really for 100 years, other than the DH, an artificial curve. The game has been the same, 60 feet, 6 inches, 90 feet. And from an injury standpoint, we should see the same type of injuries all the time. We may see an increase or a decrease, but we should see the same ones. And when we start to see more of one or the other, something has changed. Now, what are the possibilities of that changing? Well, one could be the ball's heavier or they've changed the distance.

Well, that hasn't really happened. You know, are we teaching a different philosophy of biomechanics or that velocity is king, this possibility? Or has the player changed? You know, and I think we saw that in the steroid era with statistics. All of a sudden we start seeing huge statistics that were abnormal for the game of baseball. And what we found later on was that something had changed, and it was the player who changed. And we saw a subsequent decrease in statistics when that was taken away.

So that shows a cause-and and effect relationship to the statistics. On the health standpoint, it's anybody's guess which way it helps or hurts and which ones help or hurt. But that said, I'm totally against all that stuff. All right. And last question because we are taking away too much time that you could be using to protect a pitcher somewhere. I'm hoping that we can end on a happier note, but we'll see. You mentioned at the conference that

I think over 50% of the time lost to injury in the majors is elbows and shoulders combined. We've talked a lot about the elbow injuries. We haven't talked about the shoulders. And Brandon McCarthy, who is someone with experience with shoulder injuries, was tweeting something recently about how it seemed to him like maybe there had been fewer of those or fewer serious shoulder injuries. Is that the case? Is there good news to report on that front, at least? Yes, there is. Shoulder loss time from shoulders has decreased. The question is why? Has the force been transferred down to the elbow some way and now we're seeing more elbows? Is there a cause and effect relationship with that?

Or one of the things that we have seen is a decrease in shoulder surgery. And one of the reasons that I think we've seen that, in addition to there being less injuries, is that shoulder surgery does not have the success that Tommy John surgery has. So we tend to shy away from having surgery. And surgery is, you know, you're changing the anatomy or fixing the anatomy, if you will. And shoulder surgeries and pitchers have just not been very successful.

So we're doing a little bit more conservative work. And I think there's a lot of strength and conditioning that has gone over in the last five or six years that really has helped the shoulder and rotator cuff and scapular exercises. I think that that is paying off. But I also think we're avoiding some of the shoulder surgeries. And there definitely is good news on that level. I mean, we've seen the lost time, we talk about DL days, go from a high of 9,000 down to 4,000 in a year.

So we're definitely seeing a decrease. But we still see the combination of shoulder and elbow being over 50% of the total amount of injuries, and that's not surprising. It's a throwing sport, so you'd expect those things to happen. Do you want to be a full-time co-host? Well, I keep saying this over and over. A very smart person many years ago told me there are no simple solutions to complex problems. People want to simplify things and they want one thing. And one of the biggest problems in this issue on medical is the number of potential variables.

And you really do need to do a multivariate analysis, which is not very easy to do, and see which ones are really causing the problem. And I think the Sabermetrics Society in general has really done a good job. I'm a little put off at this point about somebody sitting at home and writing an article that they don't follow up and find the facts on. There are certain things, and they're columnists, and they're things that just, it's my pet peeve, where they say, this is what the problem is, this is what's going on,

and they haven't really looked at it. And they don't have the science behind that. That irritates me. We're about to launch a huge thing, which you guys will get. There was an article written in 2012. They did a survey to coaches and parents and athletes about what their perception was of Tommy John's surgery. It caught my eye. It was in a medical journal, so nobody really knows about it. This is scary stuff for us.

This is the Physician in Sports Medicine Journal? Right. Yeah, I'm looking at it right now. Chris Amon, the take-home thing that really struck me more than anything else was 30% of coaches, 37% of parents, and 51% of high school athletes believe that Tommy John surgery should be done on players who don't have elbow problems to improve performance. In other words, if you're throwing 82 miles an hour,

and Dr. Andrews talks about this constantly, parents come into him and say, listen, my kid's fine. He has no problems. He throws 82. He needs to throw 87. Can we do the Tommy John so he can throw 87 to get the scholarship? This is insane. This is absolutely, this takes a little league father to a whole new level.

That somehow he can have a surgery on somebody who doesn't have a problem. So I started thinking about this and said, well, where did the coaches and parents and high school people get their opinions on this? And well, the answer really is the media. So we're about within about 10 days from now. high school people get their opinions on this. And, well, the answer really is the media. So we're about within about 10 days from now. We just actually got all the approvals and all the science behind it to launch this survey. We're going to send out an electronic survey to every possible media person who covers baseball.

I think it's about 10,000 people. And we're going to send it out through the teams to everybody. Baseball perspectives. We'll get, get one that we're going to send it to every email we have. And we're going to ask a series of questions about Tommy John to get the idea of where the knowledge base is for the media, Tommy John surgery and see where that their opinions are.

I think it's going to be very fascinating. And we've kind of broken into different demographics, and I think there's going to be a difference in opinions on the questions that we ask from sabermetric people versus front-line broadcasters to ex-pitchers who are now sportscasters. And I'm very fascinated to see this. It's like a six or seven-minute survey that you take electronically and just ask you a bunch of, there's 30 different questions, and most of them are demographics.

But to see kind of where we are with this thing from an opinion standpoint from the media. are with this thing from an opinion standpoint from the media. You guys have so much power to influence people's opinion. And it filters all the way down to the little league father or the little league

mother who wants her kid to be Nolan Ryan. There's only one Nolan Ryan. So we were smart to have you on now then because I don't want to embarrass myself on this survey. No, I know. I want to win this thing.

Yeah. Well, we thought about guys like you who will actually spend hours researching this before you answer. It's not that kind of survey. It's not that kind of thing. It's not a right or wrong thing. It's just a thing about where you are in regards to this. And we've sent this out. I sent this out to about 10 different reporters to do it.

And one of the comments we got back was, I thought I knew more. And if we can educate the media on what the real truths are statistically, then they can put it in whatever spin they need to put it in, but at least the facts are right. My perception of this is that the ex-ballplayers, one of the questions that we have on the demographics is, are you or have you ever been a professional baseball player? Because as you watch MLB Network, for instance,

they have nothing but x players on there so i'm anxious to see how those guys do but more of this whole thing is i think the kind of programs you guys put uh put on um uh that try to get some of the facts out people can believe them or not believe them or look into it a little bit more or disregard them. But I think it's good to put that out. And that's just go for the sexy stuff. So although my wife thinks I'm sexy, I think probably my lectures are not as sexy. Yes.

I'm sure all of our listeners think we're sexy. Yeah. It's all about the voice, right? I hope not. It's just got weird. Yeah, we digress. All right. Well, thanks very much for joining us.

I wish we could say that we had gotten to the bottom of the problem here, but we've at least defined the problem a bit better for people, and it's been very informative. So thank you very much for all your time. All right. My pleasure. Thank you for having me. All right. And please support our sponsor, Baseball Reference. Go to baseballreference.com, subscribe to the Play Index using the coupon code BP to get the discounted price of $30 on a one-year subscription. That is it for today. We will be back with a new show tomorrow.