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Charting the rise of Tommy John surgeries

May 13, 2014, 8:23 AM EDT

jose fernandez getty Getty Images

Still reeling from the news about Jose Fernandez. I know a lot of pitchers get Tommy John surgery, but this thing in which an exciting young pitcher bursts on the scene and wows all of baseball for a while and then goes down just when we’re really starting to enjoy it all is really getting old. Stephen Strasburg, Matt Harvey, Fernandez. There were others. There will be more.

Many more if this chart from Bill Petti — put together using data from Jon Roegele — is any suggestion. It shows the steep rise in Tommy John surgeries over the years. Sure, some of it is probably a function of doctors and teams being more willing to pull the trigger and have the surgery done where, a few years ago, the pitcher’s elbow may have been rehabbed instead. But the mainstreaming of TJ surgery is not the only factor. Guys are throwing harder, throwing longer when they’re kids and they’re paying the price for it in elbow ligaments.

Based on what James Andrews had to say about it last month, there isn’t a whole heck of a lot Major League Baseball can do about this, as the damage being done to pitchers’ elbows is largely being done before they ever sign their first pro contract.

  1. renaado - May 13, 2014 at 8:39 AM

    What a phenomenal jump from 2011 to 2012 of Tommy John surgery numbers durin that time, same to what I can say from the decrease 2 years after that. The reason on why we thought pitchers have that many TJ surgeries this year though is probably of their high profile status.

  2. skeleteeth - May 13, 2014 at 8:43 AM

    How exactly is this (playing a sport year-round at such a young age) so widely accepted which does actual physical damage to a developing body and can alter quality of life down the road (structural/shoulder injury) and we’re so scared about the impression PEDs make on kids? Blows my mind.

    • yahmule - May 13, 2014 at 9:17 AM

      Traveling teams are the huge elephant in the room that nobody seems to want to discuss, but you’re wrong if you don’t think PED’s play a large part in this problem as well. This was the steroid era’s true legacy and that genie’s never going back in the bottle. Not with multi-million dollar signing bonuses in play. High school pitchers and their parents are hiding arm trouble until after the kid is drafted and signed as a routine way of doing business. Think about it for five minutes and you can see how easy it would be to rationalize that course of action.

      And, yes, the slider is a deal with the devil.

      • paperlions - May 13, 2014 at 12:17 PM

        …because TJS was rampant during the steroid era?

        Salaries didn’t increase because of steroid use, they increased because of all of the new ways that MLB teams can make money, more income = more ability to spend.

        Feel free to explain how anyone can “hide arm trouble” until after a pitcher is drafted. First, players have to submit medicals. Second, players have to continue to pitch well, which is just not possible with actual arm trouble.

    • Old Gator - May 13, 2014 at 9:22 AM

      There’s always some lag time between figuring out what’s wrong and responding to it across the board. I suspect there’ll be some adjustments and changes made as the data builds up. It will probably take parents suing school systems, or athletes suing their own colleges, before economic pressures enforce new guidelines and limitations on the entire process. That will all take some time. I’m afraid it’s become utopian to expect high school and college coaches, not to mention school boards and boards of college trustees, to become proactive merely because they recognize that a greater good is at stake.

      • yahmule - May 13, 2014 at 10:11 AM

        I guess you disagree with the part about that genie not going back in the bottle. If they even had the inclination to test all these kids for every new designer drug that comes down the market, where are school districts going to find the money?

        And, no, I don’t believe the answer will be found in a bunch of lawyers suing on behalf of parties that share complicity in the problem.

      • Old Gator - May 13, 2014 at 10:28 AM

        I see I wasn’t clear enough. No, I don’t think the drug genie is going back into the bottle, either. What I think will have to happen is that school districts, school leagues, colleges and college based leagues, and even youth leagues will be pressured to limit the workloads on young pitchers.

        I also believe these leagues and schools will eventually be found legally liable, in the not too distant future, when kids hurt themselves following the instructions of their coaches or, if under, say, 18, due to the “negligence” of their coaches. The precedent has already been set by liability judgments against or settlements with school districts over heat stroke deaths of student athletes during practice or games. In the grand guignol circus world of the American civil courtroom, daylight logic doesn’t necessarily apply very well and from heat stroke to torn ligament is a perfectly lawyer-logical progression.

    • pappageorgio - May 13, 2014 at 10:56 AM

      I’ve got a 9 year-old playing right now who I’ve shut down twice already. The pitch count rules were basically not enforced and he’d been pitching 2 times per week the entire season (plus practice…and Dodge-ball at school as I found out later) and SS when he wasn’t pitching.

      The coaches looked at me like I was just being a silly and over protective when I announced he wouldn’t pitch. But what am I supposed to do when my kid is telling me his elbow is sore and I can tell by his posture when he throws that something is off?

      Part of the problem with year-round baseball……If you live in a warm climate you almost have to put him in all year to stay competitive. The other kids aren’t taking winters off. I know a guy in our league who’s got his kid in 3 leagues (not a pitcher in 2 of them). Some of the club teams are a bit of a joke….the competition doesn’t seem so high to me. But those are the leagues that have fathers convinced your kid will never be anything if they don’t play 200-300 per month plus a mandatory cage membership of 100/mth….plus batting/ptching clinics and mandatory clothing/equipment.

      It’s a big racket. And a big lie…sold to fathers who buy in that if they join these leagues it’s a ticket to the pros.

      • [citation needed] fka COPO - May 13, 2014 at 11:01 AM

        But what am I supposed to do when my kid is telling me his elbow is sore and I can tell by his posture when he throws that something is off?

        Good on you and your kid for speaking up about this. This is what Dr. Andrews points to the biggest precursor to elbow injury(ies), pitching while tired.

      • Old Gator - May 13, 2014 at 11:09 AM

        Indeed, good for you. Coaches like that are part of the global problem. And if they’re not observing the pitch count limitations, it’s up to you to make a stink about it to the school or the league. Help protect everyone else’s kids from these idiots too.

      • pappageorgio - May 13, 2014 at 1:49 PM

        Another big problem as I see it……lack of fundamentals in early baseball. I see a ton of kids who are big and strong….but they throw with these funky/violent deliveries. Because they throw hard and can find the strike zone the coaches/parents don’t want to teach/fix their throwing….and their arms are done by 16-17.

      • skids003 - May 13, 2014 at 1:57 PM

        I’ve seen and heard kids tell their coach (parent) their arm hurts, and the coach (parent) make them stay in and pitch. When I’m umpiring I have seen it, and actually shamed someone into pulling the kid out. I’ve had a couple who told me to umpire and they’d coach. It’s unbelievable.

    • paperlions - May 13, 2014 at 12:14 PM

      The difference is mostly in the timing of effect and how humans learn. We learn like every other animal, which is to say by consequences. The longer the delay between the action and its consequence, the less likely we are to learn or to respond to the consequence even when we know the relationship.

      For example, the reason credit card debt is so pervasive is because the reward to spending money you don’t have is immediate, and the consequences are delayed, sometimes for months or years. Even though everyone knows the relationship between spending and defaulting on debt, the delayed punishment results in people learning slowly, or simply choosing to not change the behavior. In addition, the long delay in consequence gives people an opportunity for our favorite past time: denial.

      Because people can’t see the damage being done, and the damage often takes years to manifest, the people primarily responsible for the damage can go merrily along ruining young pitcher after young pitcher.

      The steroid hysteria is mostly emotionally charged (CHEATING!!!! ARGLEBARGLE) and has no bearing whatsoever on the actual effects on the field or to health (both of which are much less than people think they are).

      • yahmule - May 13, 2014 at 6:03 PM

        paperlions: …because TJS was rampant during the steroid era?

        Salaries didn’t increase because of steroid use, they increased because of all of the new ways that MLB teams can make money, more income = more ability to spend.

        This is what you took away from my post? Do you deliberately misinterpret things because you just have nothing relevant to add?

        I feel like I’m wasting my time explaining something to someone who can’t debate honestly. Of course, you’re a PED extremist who is on record as saying all PED’s should be legal and any player who refuses to take them is comparable to an athlete who refuses to work out and stay in shape.

        Anyway, reread this multiple times until you get it: Signing bonuses today are so large that a certain percentage of high school players are on PED’s with the full knowledge of their parents.

        Your dissembling nonsense about “where” you believe MLB has come up new sources of income has no relevance. Again, why is it so hard for you to discuss this topic honestly?

        Feel free to explain how anyone can “hide arm trouble” until after a pitcher is drafted. First, players have to submit medicals. Second, players have to continue to pitch well, which is just not possible with actual arm trouble.

        “If a 24-year-old in the pros blows out an elbow, then the question is, did it start when he was 15?” says Glenn Fleisig, a biomechanics expert who works in conjunction with noted orthopedic surgeon Dr. James Andrews. “And the answer is, probably.”

        There is absolutely no way to know what kind of PED’s a kid is dabbling with until he gets to college or the minor leagues and college players are still able to use once their season ends. The dramatic increase in muscle and strength in these kids stresses the tendons and ligaments unnaturally, because those are still developing at a normal rate. After a while, the stress caused by the additional muscle and power damages the tendon until it weakens/frays/tears.

        Let me see, how can a pitcher hide arm trouble. Gosh, let me think. Maybe by not telling anyone his arm is hurting after his games? If he’s not complaining about an injury, what medicals are you talking about? Do you think that every high school and college pitching prospect submits to a precautionary MRI to be perused at the leisure of every major league medical staff?

  3. apkyletexas - May 13, 2014 at 8:45 AM

    Another pitcher who was brought to the big leagues too quickly. At age 19, after only 27 starts in two years in the low minors, without ever facing AA or AAA batters, he was thrust onto the big league roster as the savior. Eerily similar to Strasburg with his 17 minor league starts, including one at AA and one at AAA.

    The minor league system is there for a reason – not to stifle them, but to prepare them. MLB is a grind, and there’s no way a 19-year old out of A ball is going to be adequately prepared to handle it.

    • dohpey28 - May 13, 2014 at 9:51 AM

      Thats not a factor, look how slow the Mets were with Harvey.

    • Detroit Michael - May 13, 2014 at 10:05 AM

      Yes and no.

      Pitching in the majors is a good deal more stressful than pitching in the minors, so there is a greater injury risk compared to throwing the same number of pitches in the minors.

      However, I don’t know how you could reasonably conclude that Jose Fernandez was rushed given that his level of dominance in his MLB career. If a pitcher is ready for the majors, you’ve got to play him there and take your chances with injuries.

      • apkyletexas - May 13, 2014 at 11:15 AM

        No you don’t. Two or three months with your best pitching coaches at AAA could have taught him some valuable lessons about how to pace himself and protect his arm while still pitching effectively. He was basically thrown into the spotlight as the savior of the franchise as a 19-year old with no preparation, and that’s just too much of a burden for any teenager.

      • [citation needed] fka COPO - May 13, 2014 at 2:51 PM

        So you’re saying there’s instruction he only would have received from his AAA coaches, and not the MLB ones? Do the Marlin’s coaches just go out there and say “throw damnit, throw” and that’s it?

    • Reflex - May 13, 2014 at 1:55 PM

      And Griffey was brought up ‘too soon’ right? Seriously, will you ever get off this idiotic bandwagon? Lots of the guys getting TJ this year and last actually pitched normal minor league times, and yet they are going down with torn UCL’s. Matt Moore is a good example. There is zero correlation between ‘rushed to the majors’ and ‘torn UCL’ which is what this article is about.

  4. indaburg - May 13, 2014 at 8:49 AM

    Interesting to see the breakdown by team, also linked from that article: https://pbs.twimg.com/media/Bnei4v5CAAAhkdk.png:large.

    Atlanta with a high of 31, CWS with a low of 11. It’s difficult to draw much of a conclusion though, since much of the damage may be done as kids, before these pitchers even get signed.

    • renaado - May 13, 2014 at 8:54 AM

      Damn… I can’t believe the Braves are a big magnet for this.

      • supitsdan - May 13, 2014 at 9:03 AM

        but the Braves have good starting pitching AND a very good bullpen for many years. When you’re conditioning your starters to throw harder for 6-7 innings, and you’ve got dynamite arms in the pen, throwing single innings (or less)… I think that the way bullpens evolved has contributed a lot to pitching injuries.

      • renaado - May 13, 2014 at 9:09 AM

        Definitely, can’t deny that. The Braves so far are puttin up amazin pitching stats so far this season, all in all their bullpen and starting rotation both combined a magnificent 2.66 era.

      • Old Gator - May 13, 2014 at 9:52 AM

        Interesting piece by Phil Rogers on the Feesh homepage today, featuring this info:

        “At last count, 16 pitchers on 40-man rosters have had the Tommy John ligament grafting procedure this season, including starters Matt Moore, Patrick Corbin, Jarrod Parker, A.J. Griffin, Ivan Nova, Kris Medlen, Brandon Beachy and Josh Johnson.

        Pitchers are dropping in college, too, with highly regarded prospects Jeff Hoffman (East Carolina) and Erick Fedde (UNLV) getting the dreaded diagnosis within the last week. They were regarded as potential top 10 picks in June’s First-Year Player Draft. No wonder White Sox fans are watching Chris Sale’s recovery from a tender elbow so nervously.”

    • ctony1216 - May 13, 2014 at 11:20 AM

      It would be interesting to compare stats like these with the Japanese leagues. I wonder if they’re having the same problems with TJ surgeries, and if not, why not.

      Clearly, the Japanese leagues can produce major league pitchers. Are they doing it without the same rate of injuries? It would be worth looking into.

    • Reflex - May 13, 2014 at 1:57 PM

      The Braves also have a large number of guys using the Inverted W in their throwing mechanics. As for Jose Fernandez, he was predicted just this spring to go down this way due to his timing problems.

      http://www.chrisoleary.com/projects/PitchingMechanics101/Essays/PitcherElbowInjuryEpidemic.html

      • indaburg - May 13, 2014 at 5:10 PM

        Not the Dreaded Inverted W.

        I’ve read O’Leary’s work before–when Strasburg became injured and the inverted W was all the rage–and while it makes sense from an orthopedic perspective, I am curious to know exactly how many pitchers with this throwing mechanic have UCL surgery compared to pitchers with a more traditional motion.

      • Reflex - May 13, 2014 at 8:27 PM

        I agree I’d like to see more rigor done. O’Leary has done a pretty good job calling out guys who will have it at some point, but even he does not claim this is the only cause of a UCL tear, or even the most common one, but he does claim that the timing issue the motion creates will almost inevitably lead to UCL and later shoulder problems.

        He seems to be mostly correct on this point, at least based on what I’ve read so far. For players who have careers he can analyze he also is pretty good at predicting when they will break down as well (ie: US born players with college careers he can usually call it within a season, foreign born players not so much).

        I’d love to see someone actually categorize the common pitching motions and problems, then start linking them to injuries in a rigorous and systematic fashion.

  5. koufaxmitzvah - May 13, 2014 at 8:57 AM

    I bet Mike Marshall has something to say about this.

    • Old Gator - May 13, 2014 at 9:29 AM

      Good point. Last I heard he was a practicing therapist / kinesiological specialist somewhere in Michigan. He was the guy who counseled Tommy John to go ahead and have the then experimental ligament replacement surgery that now bears John’s name. He also suggested that pitchers do something differently than most do now, having to do with an earlier rotation of the elbow so that the rotation won’t occur simultaneously with the “snap” of releasing the ball. I haven’t heard a peep out of him for many years – but then, he was famous for his reticence even while he was playing.

      • koufaxmitzvah - May 13, 2014 at 9:42 AM

        I did a small Google search and he has a basic website where he lists himself as a Doctor. The last article I read about him basically zeroed in on his estrangement from MLB with the impression that his approach to pitching is too radical. Which I don’t get. That doesn’t seem like a reason to possibly ostracize someone.

      • Old Gator - May 13, 2014 at 9:59 AM

        I think his estrangement began while he was pitching – I recall that he once said he wouldn’t sign autographs for kids who couldn’t also show him the autographs of a teacher or anyone else who did work more inherently meaningful than being a sports star. He was savaged by the spawrtsriters of the time, especially Dick Young of the Daily News which was the New York knuckledragger’s tabloid of choice back then. Marshall was always a bit cranky that way, though I admit to being sympathetic to his larger point. He was never your quotidian jock.

        Still, I agree – too radical? Dear Buddha, this season alone, pitchers have looked like a bunch of Eloi marching into their surgical Morlock domes.

      • yahmule - May 13, 2014 at 10:23 AM

        Mike Marshall’s estrangement began immediately because he was a very intelligent man who spoke his mind about issues of the day. In his 14 year major league career, he played for nine different teams, five of them dumped him after only one season.

        Few pitchers have better personal experience of being misused as Gene Mauch and Walter Alston ran him out there 198 times, spanning 387 innings, during the ’73 and ’74 seasons. It takes the average closer about six or seven years to rack up that many innings in today’s game.

        http://www.baseball-reference.com/players/m/marshmi01.shtml

      • 14thinningstretch - May 13, 2014 at 11:05 AM

        Marshall got a Ph. D in kinesiology in the offseason in 1978. I always got the sense that he kind of straddled that line between being “outspoken and intelligent” and “arrogant and condescending”, and that he didn’t go out of his way to make friends during his career. It also seems like he doesn’t really go out of his way to collaborate with and talk to other pitching mechanic researchers, which is a great way to have people ignore you.

      • Old Gator - May 13, 2014 at 11:14 AM

        Ackcherley, Marshall seems to me almost like a fictional character the great Michigan-born and bred novelist Jim Harrison might have dreamed up. Smart, irascible, self-consciously rural despite his sophistication, cranky, a bit of a loner. The episode where he threw a lady dog catcher off his property in an argument over whether a black lab was or wasn’t his in the first place could easily have been one of Harrison’s “Brown Dog” stories.

        Seven, Uncle Moses – do either of you guys know Harrison? You definitely should….oh and while we’re at it, Craig, kudos for the Howl reference.

  6. gothapotamus90210 - May 13, 2014 at 9:07 AM

    One theory is pitchers not throwing enough between outings, for starting pitchers at least. They’re going out there every 5th day and throwing 100 pitches with their complete effort, but aren’t doing much in between to strengthen the muscles surrounding the UCL

  7. pitchingmechanicstips - May 13, 2014 at 9:10 AM

    Reblogged this on Pitching Mechanics Tips.

  8. unlost1 - May 13, 2014 at 9:18 AM

    just get tommy john surgery before anythng goes wrong and get it over with

  9. jm91rs - May 13, 2014 at 9:25 AM

    Here’s my question, and I’m completely serious…HGH helps recover from injuries, right? Will it get pitchers like Fernandez & Harvey back sooner? If so, why is that a bad thing?

    • Old Gator - May 13, 2014 at 9:31 AM

      You’re not the only one who’s asking this question. It’d be nice to have someone who actually understands how that works come on here and say something about it.

      • jm91rs - May 13, 2014 at 10:49 AM

        I’m about to have shoulder surgery because I can’t toss a ball with my kids without immense pain the next day (like can’t even get my arm up high enough to wash my hair kind of pain). If the doctor says HGH will help me recover from the surgery faster, with minimal side effects there’s no way I’m turning it down. I guess everyone just hates these things because they aren’t natural and traditional?

      • Old Gator - May 13, 2014 at 11:43 AM

        Nope, I think a lot of it is just bandwagon mentality. Hope all goes well with the surgery.

  10. jimmyt - May 13, 2014 at 9:38 AM

    Often wondered about that myself. If a pitcher with a pefectly healthy are were to have Tommy John, would it not make his arm stronger? Could unnecessary surgery become the new PED (PES)?

    • unclemosesgreen - May 13, 2014 at 9:42 AM

      Wait, you mean guys should have another UCL attached to their current UCL? Hmm … double UCL’s would be tougher to snap. You could be on to something here.

      • Old Gator - May 13, 2014 at 10:02 AM

        The principle works wonders for sharks. They have extra rows of teeth just waiting to drop down and pick up the slack each time the shark leaves a few in some walruses ass. Me, I keep a spare supply of sarcasm handy for moments of high seriousness.

      • unclemosesgreen - May 13, 2014 at 10:05 AM

        Just beneath the surface of the mud – there’s more mud here.

    • [citation needed] fka COPO - May 13, 2014 at 12:15 PM

      If a pitcher with a pefectly healthy are were to have Tommy John, would it not make his arm stronger?

      There’s two problems with this:

      One, having UCL replacement surgery, or TJ surgery, doesn’t “make” the ligament stronger or “make” the pitcher’s arm stronger. What usually ends up happening is the player feels better due to a combination of rest and exercises designed to increase the strength in that area. As I think PL has mentioned multiple times, these aren’t sudden tears of the UCL, it’s slight tearing the continues from use. Getting rest during rehab helps the ligament repair itself, so the player “feels” stronger.

      Two, per this article by Russell Carleton at BPro, the best indicator of a future injury is a previous one. Not sure how it would work with an elective TJ surgery, but this data would give me pause were a player considering it:

      http://www.baseballprospectus.com/article.php?articleid=19653

  11. shawndc04 - May 13, 2014 at 10:01 AM

    Don Cooper of the White Sox seems to have a good track record with his pitchers. Putting aside for a second whether the damage is done before the kids get to the majors, does anyone know whether Cooper does anything different in handling his staff?

  12. toodrunktotastethischicken - May 13, 2014 at 10:16 AM

    What is it about throwing sliders/cutters that people say that has something to do with the elbow problems?

  13. kevjones75 - May 13, 2014 at 10:38 AM

    Pitch counts. Nuff said

    • renaado - May 13, 2014 at 10:44 AM

      If this were the reason then guess kids in highschool Baseball in Japan are the only ones unaffected by it.

  14. TBaySlim - May 13, 2014 at 11:12 AM

    theres a runnning stat that shows pitchers who throw a slider over 30% of the time tend to tear up the UCL and have TJ as well has having reducing velocity on the fastball. The torque that pitch puts on the arm is well documented an when a pitcher is tired the risk is even greater for injury. So some young pitcher comes up starts throwing alot of innings that they are not used to, get tired worn down as the season goes along an bam, Arm torn up. There are many examples, but a few i can think of is Kerry Wood, Fransico Liriano, Stephen Strasburg, Matt Harvey and now Fernandez. All of these guys burst on the the mlb stage very young with blazing fast balls an sharp off speed stuff ( slider, slurve or hard curve) and all underwent TJ. just some general thoughts about it

  15. wpjohnson - May 13, 2014 at 11:18 AM

    There don’t appear to be too many pitchers like Warren Spahn and Robin Roberts out there anymore. Those boys never heard of Tommy John surgery. In fact, they never heard of Tommy John. All they did was start and finish games and pitch around 300 innings each year. And, of course, Spahn and Roberts are in the Hall of Fame.

    • [citation needed] fka COPO - May 13, 2014 at 12:27 PM

      All they did was start and finish games and pitch around 300 innings each year. And, of course, Spahn and Roberts are in the Hall of Fame.

      Roberts pitched for 19 years, and broke 280 IP in only 7 of those 19 years. He was a great pitcher in the beginning, from ’48 to ’55 he had a 131 ERA+ with six straight years over 300 IP. Then he pitched for another eleven years with a 99 ERA+. Maybe all those innings added up and he wasn’t as effective?

      Spahn pitched almost the same time, and while not as many innings each year, he pitched more far more consistently. They also pitched with the higher mound, and didn’t have to throw as hard because of the weaker lineups compared to today. When you can cut it back to 70 or 80% for the 7/8/9 hitters, you can give your arm a break.

    • Reflex - May 13, 2014 at 2:16 PM

      There weren’t that many pitchers like Spahn and Roberts in their day either. That is why they are memorable.

  16. kastout11 - May 13, 2014 at 12:01 PM

    I agree with Dr. Andrews. A lot of coaches in the junior high and high school level do not know how to manage their pitchers, and that is how their arms are ruined early in their pro careers, if they make it that far.

  17. mustbechris - May 13, 2014 at 1:32 PM

    Shouts for the “best pitchers of my generation” reference caption. I’d like to think more people caught it than I might assume would.

  18. Dr. Dodger - May 13, 2014 at 1:48 PM

    I was excited to see him pitch on Wednesday at Dodger Stadium but looks like that won’t be happening anytime soon now. Anyone want tickets? haha

  19. shyts7 - May 13, 2014 at 2:26 PM

    This is an extensive problem that is landing at MLB’s feet. You can’t expect expect MLB to do something when the ticking timebomb lands and their feet. I think the problem starts at a young age. Year round play and the constant traveling teams put a strain on young arms. They never have time to rest. I have a feeling that if their was a mandatory offseason, you would see a lot let TJ surgeries. If they would take at least 5-6 months off when they are younger and 4-5 months off as they get older, you might have a chance to help the problem. Kids today are expected to perform, perform, perform. They need to take time to rest their arms and work on strengthing the muscles around the elbow. The ligaments are tearing mostly due to tired arms in my opinion. As their arms get tired, arm speed and strength will change the way a pitcher delivers a pitch. They try to compensate. The rise of pitchers using the slider could also help. Thowing sliders with a tired is basically a matter of time before the arm blows up. I remember a couple years ago, Justin Verlander detailed his off season throwing schedule of throwing exactly zero times. It’s a shame that MLB has to be hurt with the injuries to Hernandez and Harvey because of the sins of past coaches/administrators/officials etc.

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