A Wholly Unscientific Look at Matt Wieters's Defense Post-Tommy John

Before I get into this, I should stress that — as the title states — this is an unscientific article. As such, it shouldn't have any huge effects on anyone's appraisal of Matt Wieters, much less for the Orioles in 2015 overall. Unlike erstwhile Depot contributor Stuart Wallace, I don't study medicine, nor do I have any experience with injury analysis. I simply wish to compare Wieters's plight to those of players who have dealt with similar adversities.

In the campaigns preceding 2014, Matt Wieters had one of the better arms in the majors: From his debut in 2009 to 2013, he accrued 16 rSB, the most in the American League. Gunning down one in every three attempted base stealers, he provided as much value as he could behind the dish.

In the early going of last year, he began to show signs of wear. Of the twelve men who took off against him, eleven arrived safely; had he compiled enough innings to qualify, every other major leaguer would have topped that rate. He didn't qualify, though, because his season went from bad to worse: A damaged ligament in his right arm sent him under the knife, and put his future in doubt.

Many pitchers have undergone Tommy John surgery, and many people have written of its effects. (Their findings have tended to contradict each other.) But what about the hitters who have done the same? To the best of my knowledge, only two people have looked into the latter group: Jeff Zimmerman at RotoGraphs, and wafflechip27 at the FanGraphs Community blog. Both of those looked at hitting performance, though; I'd like to focus on the other side of the ball — throwing. What does the operation's history tell us about players' defense before and after it?

Because very few position players have undergone Tommy John surgery, I had a very small sample size with which to work. From Jon Roegele's Tommy John surgery database, I found 24 catchers (Wieters included) who had it. Of them, a few — Matt Clark, Dustin Houle, Matt Reistetter, Andrew Knapp, and obviously Wieters — have had the surgery within the past year-plus, and thus haven't had enough time back. Moreover, 12 of them didn't play much prior to having the procedure. Thus, I limited my scope to the five who remained.

What did I find? Well, only two of the guys accumulated significant major-league innings both pre- and post-surgery, and both of them fared pretty well going forward:

Player	Pre Innings	Pre CS%	Pre rSB	Pre rSB/1000	Post Innings	Post CS%	Post rSB	Post rSB/1000
Todd Hundley	5782.1	25.9%	---	---	2822.2	23.8%	---	---
John Baker	1538.0	19.4%	-10	-6.5	1032.1	17.7%	-3	-2.9

While neither Hundley nor Baker was particularly adept at throwing out runners after Tommy John, their rates of doing so didn't diverge much from their rates before it. Plus, they were of a similar age to Wieters when they had it done — Hundley was 28 (like Wieters), and Baker was 29. So this tells us that Wieters will come out of this as good as ever, right?

Well, no. Aside from the fact that two people don't exactly make for a large sample, this means of analysis has one fatal flaw: survivorship bias. By only looking at the catchers who made it back to the show, we get an incomplete picture. Instead, we should take into account all of the catchers who had major-league time beforehand, regardless of if they made it back or not. And bringing in the three other men changes the conclusions a little bit.

Ben Davis had 3631.1 innings and a 33.9% caught-stealing rate before falling victim at age 28. Returning to the minors the following year, he threw out a mere 20% of base stealers over the last five seasons of his career. Vance Wilson — he of the 2388.2 innings and 40% CS% across eight seasons — went under the knife shortly after turning 33. He would endure the surgery again a year later, and would only play 18 games at AA (in which runners went 20-for-20 against him). And Chris Coste, who owned a considerably more mediocre 22.1% clip in 1641.2 innings, took an early retirement once he went through the procedure (albeit as a 37-year-old). Taken together, these three detract from the relative optimism inspired by the previous two.

The ages of the five men (and the fact that, y'know, there were only five of them) obviously add some pretty significant caveats to this. Nevertheless, one shaky point remains: When a catcher has Tommy John surgery, his future value takes a hit. If Wieters hits the free agent market after 2015, will the Orioles bring him back? Considering the things I've learned in writing this, I'm not too sure.

Bud Norris' Groin Strain

Bud Norris' quietly successful 2014 campaign was briefly brought to a halt last week when magnetic resonance imaging (MRI) results confirmed a right groin strain injury. Norris, currently enjoying a 7-5 record with 0.7 fWAR and 89 ERA-, left his June 21st start against the New York Yankees after five complete innings pitched after complaining of right leg discomfort; a bullpen session later in the week with continued groin pain prompted the MRI and his current placing on the 15-day disabled list.

Not often associated with disabling injury in baseball, the muscles of the groin—collectively known as the hip adductors (and here on out called 'adductors')—nonetheless can become painful and uncomfortable when strained or torn. A collection of seven muscles that originate from the pelvis that insert into the inner aspect of the femur and tibia,  they are responsible for stabilizing the pelvis and moving the leg towards the midline of the body (adduction), which is where they get their name. Broadly, they are active especially when changing direction during running and in kicking.

Muscles of the groin: adductor brevis, adductor magnus, adductor longus, adductor minimus, pectineus, and gracilis. Obturator externus not shown. Image courtesy of Wikimedia Commons.

With regards to the mechanism of injury, tension is placed on the adductors when they are contracted. When this tension is excessive from repetition or high forces being applied in a short amount of time, one or more of the muscles can tear. Tears can range from a small partial tear with few muscle fibers torn with minimal pain and loss of function, to a complete rupture of one or more muscles, resulting in severe pain and marked loss of function. While there is no universally accepted grading system for muscle strains and tears, the most widely accepted system includes a grade 1 to a grade 4 strain, classified as follows:

• Grade 1: a small number of muscle fibers are torn; some pain/tenderness but with full function.
• Grade 2: a moderate number of muscle fibers are torn with moderate loss of function. Tenderness with swelling, possible hematoma and palpable defect.
• Grade 3: a large number of fibers torn with significant tenderness, swelling, hematoma and partial detraction of muscle. Increased loss of muscle function.
• Grade 4: all muscle fibers are ruptured resulting in major loss of function, substantial retraction of muscle and corresponding pain, swelling, and hematoma.

The majority of groin strains are grade 2, with the most commonly affected muscle strained being the adductor longus muscle. Factors that could predispose a player to adductor injuries include weakness and/or tightness of the area, perhaps arising from a previous injury in the same leg. For Norris, a right hamstring strain earlier this season, as well as a right hip strain in 2012 and additional right hamstring tightness in 2011 could have possibly put the righthander at greater risk for the adductor strain.

From a pitching biomechanics perspective (and with Norris being a rightander taken into consideration in the following descriptions), the right adductors play a large role in the windup, providing balance at the top of leg kick as well as initiating transfer of power to the upper body by stabilizing the lower extremity and pelvis when the right foot is planted. Through the latter phases of the pitching motion—through stride, arm cocking, arm acceleration, arm deceleration, and follow-through—the right adductors draw the thigh toward midline, pulling the back leg through the delivery and in turn, rotating the hips towards the plate as the pitcher releases the pitch. An electromyography study of the lower extremity in pitching showed that the adductors are the main source of energy that is eventually transferred to the upper extremities, while also contributing to the stabilization of the torso and deceleration of the shoulder and arm in follow-through. As such, insults to the adductors, creating discomfort and a decreased range of motion, can manifest themselves further downstream biomechanically, resulting in shorter stride lengths, leading to poor command of pitches (leaving pitches up in the strike zone) as well as increased stresses put upon the shoulder joint during deceleration and follow-through.

Thankfully for Norris and the Orioles, the groin injury sustained appears to be mild and will resolve with time and the use of one or all of the many physiotheraputic approaches to recovery, including RICE, massage, ultrasound, and stretching. More recent treatment approaches using platelet-rich plasma injections to the offending area are inconclusive, but anecdotally show some acceleration and improvement of the healing process, which can be protracted in lower grade strains. Given the mildness of the injury, Norris should return to the mound without much issue; however, given his history of right upper leg injuries, care will be taken to monitor the righthander's leg health and strength in order to prevent injury re-aggravation.

***

References: Dines, J. S. (2012). Sports medicine of baseball. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

In 2013, FA Hitters More Often Hit the DL and Had Worse Injuries than Pitchers

Yesterday, Brewers General Manager Doug Melvin said this on MLB Radio:

Melvin on Garza: "Last year, 67% of all FA pitcher signings ended up on the DL, and you always need to be aware of it, and cautious."
— MLB Network Radio (@MLBNetworkRadio) January 29, 2014

It is an interesting statement.  Two out of every three free agent pitcher signings ended up on the DL.  You always need to be aware and cautious.  However, I would challenge a few things with this statement:

1. I assume all free agent pitchers includes relievers as well as lowly paid starters with enough questions behind them that they have a high fail probability.  If we are talking about a starting pitcher like Garza, do we really want to include all of these other players in the mix.
2. 67% sounds like a lot, but what is the DL rate of position players?  Did pitchers disproportionately wind up on the DL?

Thankfully, these are all things we can count with ease.  I do need to define a few things though.

Population: I included starting pitchers and position players who either signed a multi-year deal in excess of 10 MM or a single season in excess of 5 MM.  This left me with 16 starting pitchers and 23 position players.
Disabled List: This may not really need to be defined, but I wish to be explicit here.  I am only counting trips officially on the DL and I am not counting a player leaving the team for a funeral, a birth, or some other personal reason.  This may be somewhat unfair as some position players may be able to hide on the bench with an injury while a starting pitcher typically needs to pitch or will go on the DL.  One example of a player who misses a lot of games, but does not find himself on the DL is Marco Scutaro.  Last year, he missed 22 games due to day-to-day issues, but never gave up his active roster spot.

2013 Starting Pitcher Free Agents
Below is the list of pitchers we are including in this post:

PLAYER	AGE	TEAM	YRS	DOLLARS	DL	GAMES
Zack Greinke	30	Dodgers	6	$147,000,000	Y	29
Anibal Sanchez	29	Tigers	5	$80,000,000	Y	24
Edwin Jackson	30	Cubs	4	$52,000,000	N	0
Hyun-Jin Ryu	26	Dodgers	6	$36,000,000	N	5
Ryan Dempster	36	Red Sox	2	$26,500,000	N	0
Jeremy Guthrie	34	Royals	3	$25,000,000	N	0
Brandon McCarthy	30	Diamondbacks	2	$15,500,000	Y	57
Joe Blanton	33	Angels	2	$15,000,000	N	0
Hiroki Kuroda	38	Yankees	1	$15,000,000	N	2
Hisashi Iwakuma	32	Mariners	2	$14,000,000	N	0
Dan Haren	33	Nationals	1	$13,000,000	Y	14
Andy Pettitte	41	Yankees	1	$12,000,000	Y	19
Kevin Correia	33	Twins	2	$10,000,000	N	0
Brett Myers	33	Indians	1	$7,000,000	Y	116
Scott Feldman	30	Cubs	1	$6,000,000	N	0
Scott Baker	32	Cubs	1	$5,500,000	Y	141
		On DL	7	44%
		>50 games	3	19%

Among these pitchers, only 44% wound up on the disabled list.  That seems to me to be quite a departure from the 67% Melvin cited.  To be fair, I imagine he also included relievers and pitchers below the 5 MM mark.  I think it might be fair to provide some conjecture here.  I would imagine relievers are injured more often than starters because relievers tend to he hard throwing pitchers with violent deliveries.  Those characteristics tend to mean that mechanics are somewhat poor and that probably leads to a higher injury rate.  Additionally, I imagine starting pitchers who fetch less than 5 MM have significant questions attached to them and health might be one of those.

That all said, Melvin made that comment in context with Matt Garza.  That seems to me to be an unfair comparison.  Pitchers who teams think are worth significant contracts tend not to suffer an injury rate as high as the quote suggests.  But, is it high?

2013 Position Player Free Agents
Using the same contract stipulations, here is the position player list:

PLAYER	POS	AGE	NEW TEAM	YRS	DOLLARS	DL	Games
Josh Hamilton	RF	32	Angels	5	$123,000,000	N	7
B.J. Upton	CF	29	Braves	5	$75,250,000	Y	18
Nick Swisher	1B	33	Indians	4	$56,000,000	N	9
Michael Bourn	CF	31	Indians	4	$48,000,000	Y	23
Angel Pagan	CF	32	Giants	4	$40,000,000	Y	87
Shane Victorino	RF	33	Red Sox	3	$39,000,000	Y	34
Torii Hunter	RF	38	Tigers	2	$26,000,000	N	4
Cody Ross	LF	33	Diamondbacks	3	$26,000,000	Y	56
Adam LaRoche	1B	34	Nationals	2	$24,000,000	N	6
Marco Scutaro	2B	38	Giants	3	$20,000,000	N	22
Russell Martin	C	30	Pirates	2	$17,000,000	N	7
Melky Cabrera	LF	29	Blue Jays	2	$16,000,000	Y	72
Ryan Ludwick	LF	35	Reds	2	$15,000,000	Y	116
Ichiro Suzuki	RF	40	Yankees	2	$13,000,000	N	0
Jeff Keppinger	2B	33	White Sox	3	$12,000,000	N	13
Kevin Youkilis	3B	34	Yankees	1	$12,000,000	Y	132
Lance Berkman	DH	37	Rangers	1	$11,000,000	Y	52
Jonny Gomes	LF	33	Red Sox	2	$10,000,000	N	0
Maicer Izturis	2B	33	Blue Jays	3	$10,000,000	Y	36
Stephen Drew	SS	30	Red Sox	1	$9,500,000	Y	25
A.J. Pierzynski	C	37	Rangers	1	$7,500,000	Y	14
Mark Reynolds	1B	30	Indians	1	$6,000,000	N	0
Mike Napoli	1B	32	Red Sox	1	$5,000,000	N	6
			On DL	12	52%
			>50 games	6	26%

For this season, both the percentage of players who spent time on the DL and the percentage of players who spent lengthy stays on the DL were greater than those for pitchers.  The quote now seems to break down on both of the points I suggested.  Of course, this is with my stipulation of only considering players with large investments being made by the team.  In other words, Melvin is probably being 100% truthful, but he may be altering his population to fit his needs.  For instance, it might be more beneficial when talking to an agent to bring up a statistic that suggests that pitchers are incredibly brittle.

Conclusion
All in all, this might be a situation where the cart might be leading the horse.  What I mean to say is that players who appear healthy wind up get a large salary because teams are confidant they will get proper value out of the player.  That probably is not true all of the time, but it likely is a major factor when teams think about how much money to offer.

A second point not explored in this post is what exactly happens after year 1 in a multi-year deal?  We would need more seasons of data, but it would be interesting to see how much value is retained into year 2, 3, 4, and 5 as a contract progresses.  Is there a higher injury rate for pitchers over several years?  Do hitters tend to retain their performance to a higher degree than pitchers.

Regardless, the take home here is that you might want to reconsider repeating Melvin's quote because it certainly appears misleading.

Concussions in 2013: A Brief Overview

While sports such as football, hockey, and soccer bear the brunt of most of the concerns and outrage over player concussions, baseball does have its share of the injury, in spite of its reputation as a non contact sport. In particular, catcher concussions appear to be on the rise in recent years; however, they are not limited to just those who wear the tools of ignorance, as the injuries to Tampa Bay Rays pitcher Alex Cobb and Baltimore Orioles second baseman Alexi Casilla this past season can attest. Despite the plethora of statistics in the game, the publicly available data detailing the incidence of concussions and even head injuries in general is scant, with most of it dedicated to catcher concussions. When data from collegiate and youth baseball circles are included, we still find that catastrophic head injuries are rare, but that concussive injuries arising from contact with another player, ball, bat, ground, or base are the most common of head and face injuries sustained on the playing field.

Part of a long list of maladies whose long term effects remain poorly understood in the neurological world, a concussion is defined as a complex process involving the brain secondary to trauma; this trauma can be a direct blow to the head or neck or something that is transmitted to the head from elsewhere in the body. As a result, a rapid onset of impaired neurologic function occurs, sometimes with a loss of consciousness, but often without impaired consciousness. Symptomatically, a person who has sustained a concussion can suffer from deficits in emotional, cognitive, and physical function that will typically resolve in a short period of time, on the order of seven to ten days; while not as common, concussive symptoms can persist for months or even remain permanently. For a more detailed description of what is commonly encountered symptom-wise by those felled by a concussion, John Sickels has a fantastic account of his own struggles with concussive symptoms that you can find here, with the caveat that the symptoms he describes are not exhaustive. A list of the more frequently encountered symptoms at presentation of a concussion are provided below:

Signs and symptoms of a concussion, courtesy of cdc.gov.

A systematic approach is taken when evaluating a player who is believed to have suffered a concussion, with a medical professional on hand to witness the injury ideal in order for a rapid response to be undertaken. Initial assessments are comprised of the basic ABCs of medical emergencies -- airway, breathing, and circulatory processes and fitness being evaluated. If a player is not in any sort of immediate distress related to their breathing or blood circulation, then evaluations to determine if they have lost consciousness or otherwise compromised neurologically are begun, with particular attention paid to the potential for spinal injury. Once cleared, the focus is then turned to getting the player off of the field in order to perform a thorough evaluation and use of an assessment tool to acquire data to evaluate the concussion, such as memory assessments. Questions related to a player's ability to orient themselves to place and time are older and more widely known methods of evaluation, but have been found to be unreliable compared to memory testing. There are multiple forms of memory tests, but recent changes to MLB policies related to concussive injuries included the formal adoption of the SCAT2 -- Sport Concussion Assessment Tool, version 2 -- which assesses a player's current symptoms in relation to their symptom severity while also focusing on physical and cognitive function post-injury. With SCAT2 results, medical staff can better determine the proper disposition plans for a player and whether more rigorous evaluations and interventions are warranted for management and treatment of the concussion.

2013 saw 20 concussions suffered by 19 players, up from 13 suffered in 2012. As expected, catchers dominated the data, accounting for 58% of the players and 60% of the 450 games lost due to concussion:

Player	Team	Games Lost	Position	Career Concussions*
Wilkin Ramirez	Twins	69	LF	1
David Ross**	Red Sox	68	C	3
John Jaso	Athletics	60	C	1
Alex Cobb	Rays	51	P	1
Joe Mauer	Twins	39	C	1
Max Stassi	Astros	30	C	1
Carlos Corporan	Astros	19	C	1
Austin Romine	Yankees	17	C	2
Alex Avila	Tigers	16	C	1
Justin Maxwell	Astros	12	OF	1
Domonic Brown	Phillies	11	OF	1
Placido Polanco	Marlins	10	3B	2
Ryan Doumit	Twins	8	C	6
Yorvit Torrealba	Rockies	8	C	1
Stephen Drew	Red Sox	7	SS	1
Trevor Plouffe	Twins	7	3B	1
Salvador Perez	Royals	7	C	1
Alexi Casilla	Orioles	6	2B	1
Didi Gregorius	Diamondbacks	5	SS	1

* information courtesy of baseballprospectus.com; includes MLB and MILB data
** Ross' 69 games lost to concussion are from two concussions suffered in 2013


Along with the catcher leanings, we also see a few repeat offenders, with four of the 19 players of 2013 having previously suffered a concussion in either MLB or MILB play, with Minnesota Twins receiver Ryan Doumit suffering a shocking six concussions as a professional.

Let's now briefly discuss the effects of the concussion on our concussed players. In the following graphs, we will look at pre and post concussion data for those players who sustained a concussion during the season and returned to play afterwards. For this exercise, we have 12 players' data, with the remaining eight players sustaining concussions that ended their 2013 season:


First, position players and the difference in OPS pre and post concussion:

For this chart, we find that five players performed worse post-concussion, with Boston Red Sox catcher David Ross being an interesting case study, given his suffering two concussions last year.

Since we do have a pitcher in our data, this next chart describes pre and post injury RE24 differences, with negative values meaning that the player performed worse (per RE24) after returning from concussion:

Again, we don't see a drastic difference in the number of positive/negative performances after concussion, but we do see that the effects of the injury were significant to the production of Twins' Trevor Plouffe and Philadelphia Phillies' Domonic Brown, with two catchers -- Salvador Perez and Alex Avila -- actually playing better post injury. Why this trend is seen is no clear and additional data would be necessary to parse out whether this 'improvement' is significant.


...and last, the number of games played pre and post injury for each player to reference when looking at the OPS and RE24 data:

Much has been done in the last couple of years to better evaluate and treat concussions in baseball; in spite of these interventions, we find not only an increase in the number of concussions suffered, but tangible evidence of the effects the injury can have on the play of those afflicted. While there still remains much to be learned and researched with respect to the long term effects of concussions on players, the data as presented shows that while the raw number of injuries sustained in baseball is not extravagant as compared to other sports, the need for increased awareness and vigilance of concussions is warranted.

***

All data courtesy of Baseball-Reference.com unless otherwise noted.

Reference: Dines, JS, Altchek, DW, Andrews, JR, ElAttrache, NS, Wilk, KE, Yocum, LA. (2012) Sports Medicine of Baseball: Philadelphia, PA.

Manny Machado's Knee Injury: Diagnosis, Treatment, and Future Prospects

"When you hear hoofbeats, think of horses, not zebras."

One of the more famous and memorable sound bites from the medical field, the above quote comes from a former University of Maryland School of Medicine physician, Dr. Theodore Woodward. It was a catchy warning he used to advise his young trainees on the pitfalls of thinking of the exotic instead of the commonplace when looking to diagnose patients.

In some ways, the knee injury Manny Machado sustained was the hypothetical zebra Woodward warned his fellow practitioners against labeling, in place of the more frequently seen horse. It isn't often this way, but for Machado, it really was a zebra, and that is a relief.

As reported earlier today, Machado sustained a tear of his left medial patellofemoral ligament (MPFL) and not either the anterior cruciate ligament, medial collateral ligament, or meniscus, which was originally feared by many and more commonly seen injuries. While the diagnosis is still a significant injury, it is one that is exceptionally rare in baseball, and brings with it a treatment protocol and recovery period that don't typically include surgery or a lengthy rehabilitation. While not seen as frequently as the horses, this zebra of a diagnosis is pretty encouraging and one that should have Machado ready for 2014 spring training without having to go under the knife.

With collective sighs of relieved breathed with the less daunting diagnosis finally divulged, let's turn our attention to what exactly is at hand for Machado and further discuss the MPFL tear and the prognosis. While we previously discussed some general knee anatomy yesterday here at Camden Depot, with the exam results in, we can finally get down to brass tacks and discuss specifics.

 

 

Image courtesy of musculoskeletalnetwork.com

As seen in the image, the MPFL runs in an east-west fashion across the medial portion of the knee between the medial border of the patella and the distal portion of the femur at the adductor tubercle; this is immediately superior to the femoral attachment of the MCL. Its primary function is to prevent the lateral migration of patella, providing 50%-80% of the restraining force to lateral patella dislocation. Simply put, the MPFL prevents the patella, or kneecap, from being dislocated outward.

For Machado, this MPFL diagnosis is one that makes sense, especially when his previous injury history is considered, in particular, the left patella subluxation injury he suffered in 2011 while at Class A Delmarva. A subluxation of the patella occurs when the patella is pulled towards the outside of the knee and out of the groove in the femur that it rests on -- called the trochlea -- causing pain and instability of the knee. Often, it can lead to a more severe patellar dislocation and is commonly seen with large valgus external rotation forces on the knee. With patellar subluxation and dislocations also comes increased rates of MPFL ruptures, with rates quoted as high as 90% to 100%*. 

While there have been instances of success with an immediate surgical repair of the MPFL, especially in the professional athlete and in patients with recurrent patella dislocations, surgery does not appear to be indicated in Machado's case. Considering a number of studies looking at surgical versus non-surgical treatment route success rates have show no difference in outcome, the more conservative, physical therapy oriented route that looks to strengthen the muscles in the area, in particular, the quadriceps, and restoring hamstring flexibility is one perfectly suited for Machado, and a return to action, pain and injury free, come spring training.

Overall, the injury to Machado could have been much worse and one where the horse you're expecting isn't as welcome as the zebra you aren't. 



*Reference: Dines, JS, Altchek, DW, Andrews, JR, ElAttrache, NS, Wilk, KE, Yocum, LA. (2012) Sports Medicine of Baseball: Philadelphia, PA.

Stephen Strasburg and the Verducci Effect

I sometimes think some ideas are firmly illustrated to be wrong and then become surprised when I see that there are back wellings where the idea still holds.  One of these ideas is the Verducci Effect.  The Verducci Effect specifically is about how with pitchers 25 years old and younger who throw more than 30 IP in comparison to their previous year pitcher will be at a greater risk for injury.  The term is often broadened to mean really anything to do with giving a young pitcher too much work before he gets older.  The idea had a lot of traction at first as it made some logical sense.  Young arms are growing arms and young arms are less experienced arms.  Like anyone at the gym or running, you slowly build up your strength or stamina over time with increasingly great feats.  This makes sense to us.

However, time and time again, the Verducci Effect has been shown to not be real at all even though he delivers a column or two on it every year (though now it looks like he is transitioning over to injured closer stories).  The earliest study I can find is from David Gassko in 2006 that found "overworked" pitchers appeared to pitch more, not less, innings the next year.  Jeremy Greenhouse wrote a column on injuries and the Effect...once again finding nothing to the notion.  I am sure there are many, many other articles by amazing writers who went on to be employed by Major League Baseball franchises.

That said...the Nationals claim they have evidence that shows in their favor the need to end Stephen Strasburg's season even though he is one of their best arms and they will be entering the playoffs.  From my qualitative perspective, it has seemed that this application of the Effect pleases Tom Verducci.  I figured to give the idea another look and measure the general idea in a slightly different (but incredibly simple) way.  Are the Nats using data over several years, not just one?  They have control of Strasburg's rights in 2013, 2014, and 2015.  In a marathon sense, keeping him healthy over that period is more important than the result of four games in September and, arguably, a couple games in October.  In a Keep-Your-Eyes-on-the-Prize sense, well, he should be pitching.

To test this, I took every pitcher from 1998 to 2007 (a ten year period) who threw more than 140 IP t age 23 and within his first three years of pitching at the MLB level.  I then proceeded to sub-divide these players into 20 IP allotments.  For instance, 140-159, 160-179, 180-199, 200-219, and 220+.  I then individually compared their current season to the accumulation of their next three seasons.  I compared how many innings they pitched as well as creating a metric for this study, vFIP.  To measure vFIP, you divide a pitcher's age 23 FIP by the next three year accumulative FIP.  A vFIP over 100 shows improvement and vice versa.

The first thing to look at would be injuries.  Half of the ten pitchers in the 140-159 class suffered injuries over the next five years (Ricky Nolasco, Josh Beckett, Roy Oswalt, Daniel Cabrera, and Ken Cloude).  This sounds like a great deal of loss, but every innings group roughly had the same injury effect rate, which would agree with previous studies. 

Perhaps better would be to compare actual work loads over the age 24 to 26 seasons.  In terms of innings pitched, there was no significant difference between the 140-159 group and the 160-179 (p=0.78) and 180-199 (p=0.66) groups.  However, significant differences were found between that group and pitchers who threw more than 200 innings (0.03 and 0.04, respectively).

140	160	180	200	220
135	128.1	147.1	191.1	194

There is likely to be a selection bias in play here as if a pitcher was given the opportunity to throw 200 innings in a season then he is likely to be a very good pitcher (or considered to be one) and earn or be given the opportunity to pitch a great deal over the next three seasons.  At the very least, it appears that pitching fewer than 200 innings changes what will happen much at all.

The final aspect to look at is performance.  This is where I will break out the vFIP metric and here is the data set:

140	160	180	200	220
123	118	104	100	108
111	83	103	83	92
87	102	93	113	87
76	104	100	96	122
131	82	98	106	65
120	106	124	83	98
99	90	98	92
130	101	86	114
96	85	94	105
96	129	80
116	106	111
	105
	82

The groups are not significantly different from each other.  However, there appears to be a slight improvement in performance from the 140-159 group.  Again, this is not significant and likely requires a larger data set to see if this trend can be more firmly established, but the 140-159 pitchers improved their performance by 16% as a group.  The other four groups were consistent with improvement ranged from 1 to 3 % better than their age 23 seasons. 

Again, there may be some selection bias in these groupings because if you are tossing over 200 innings then you have probably pitched very well and it will be difficult to improve upon that.  Here are the raw FIPs for the groups.

	140	160	180	200	220
Age 23	4.64	4.73	4.4	4.24	4.18
24-26	4.01	4.65	4.28	4.17	4.16

The data suggests that the 140-159 group pitchers saw great improvement in their performances.  However, I would temper those differences with the idea that perhaps a pitcher who throws 140-159 innings at age 23 and proceeds to do poorly is more likely to be replaced in the rotation than a pitcher who tosses more innings.  There may be a prejudice that benefits pitchers who threw more innings during their age 23 season.

That all said, I am not sure how this informs us about Stephen Strasburg.  There is no evidence from the above methodology that injury rates decrease.  It appears that pitchers who log in more innings during their age 23 season wind up throwing more innings in the future at about the same level of performance.  Pitchers who are worked for 140-159 MLB innings tend to show improvement as a group in terms of performance, but not in innings pitched.  This may be the result of less desirable pitchers being able to be discarded more easily when they have less of a track record.

Pitchers Probably Should Wear Helmets, Too

Easton-Bell's Pitcher Helment

I have never really been a proponent of pitchers wearing helmets.  I have never given the idea much thought and it reminds me of how silly guys like John Olerud looked wearing a helmet.  Olerud suffered a brain aneurysm in college, so it medically made sense.  Otherwise, the practice seems like overprotection.  It also harkens back to Steve Tasker, who wore an extra large helmet.  That seemed silly to be as well, but with the increase of information about potential brain injuries in football...it makes much more sense to better protect the head.

That change of thought about football...keeping an open mind as new data or experiences challenge my perspective makes me more open to the idea that baseball can be dangerous.  Base coaches wearing helmets had also seemed silly.  Then someone had to die for people to take those risks seriously.  That is how our society operates.  Our rules and regulations require blood before action is taken.  A textile plant needs to burn down before sweatshop conditions were dealt with.  One out of every five tunnel workers have to die from silicosis before that is handled.  The Cuyahoga had to burn 13 times before people thought maybe that we should take better care of our drinking water supplies.  And now, we wait for global warming (aka climate change) to somehow show us more explicitly that bad things are happening.  For many shrinkage of ice coverage, reduction in coral, movement of planting zones, pH changes in high latitude seas, increased understanding of how carbon dioxide fits into global ecological/geological cycles.  It is simply how we are.  We see immediate things that are right in front of us that are hard to ignore.  I mean, how long did people ignore cigarettes or leaded gasoline?

This roundabout thought process leads us to pitcher head injuries in baseball.  A pitcher gets hurt at each level every single year.  This year, the notable bull's eye shot happened to Brandon McCarthy.  Just a quick internet search brought up these incidents:

• In 2002, Kaz Ishii suffered a skull fracture.
• In 2005, Kyle Denney at AAA suffered a skull fracture.
• In 2009, Darin Downs at AAA suffered a skull fracture.
• In 2010, a high school pitcher was placed in a medically induced coma for several weeks due to brain swelling from a skull fracture.
• In 2012, a high school pitcher suffered a severe skull fracture.

So, it happens and it is a dangerous event to occur.  It is relatively rare.  In the professional ranks maybe a handful of headshots happen each year and only a couple at most result in a serious fracture event.  Similarly, batters were plunked on occasion before helmets were issued with some serious beanings, but it took Ray Chapman to die for anyone to consider doing anything about it and it took a long time for them to actively do something about it.

The positives are clear...in the incredibly unlikely situation a pitcher is unable to defend himself on the mound and is hit in the head with a ball, he is substantially less likely to suffer a severe injury or death.  The negatives are...well, that the pitcher looks silly.  Pitchers simply get hit in the head and get injured.  Something should be done to protect them.  It makes sense, it is cheap to do, it likely has no effect on performance, and the only true cost is people getting over it looking silly.

On the links . . .

Another National screw up.
Esmailyn Gonzalez is not the 19 year old who broke out in his second year of the GCL. He is actually Carlos Lugo who at 23, repeated the GCL and tore it up pretty well. He was, on average, 5 years older than his competition. It is unclear who perpetuated this fraud. Jim Bowden was adament to Stan Karsten back in 2006 to sign this kid/adult to make a cannon shot letting baseball talent in the Latin America know that the Nationals meant business. They gave him 1.4MM as a signing bonus (twice what rival Rangers were offering) and he immediately became one of their best minor leaguers. We had him rated 8th this past offseason. With this new knowledge . . . he is off our top 30. Bear in mind the Nats also have a thin farm system. A 23 year old repeating GCL just is not that impressive. This fraud case may have a deeper story coming out as the top brass of the Nationals were investigated for embezzling last year though nothing concrete has come out of that. Add that to the Aaron Crow debacle and senseless recharacterization of that ordeal . . . Washington does not seem to be the place to be at the moment.

Pitching Injury
This one slipped through the cracks a few weeks back, but I thought it was interesting enough to hit it. The guy at Razzball has developed criteria to identify pitchers at risk:
1. % of Curves+Sliders. The idea being that the more you rely on your breaking balls, the more strain you put on your arm. A third of pitchers who threw more than 27% C+S wound up pitching less than 2000 pitches the following year. A fourth of them saw an increase in their FIP (defense independent ERA) by 0.50.
2. An increase of 700 or more pitches from 2007 to 2008. This is a variation of the 30 inning increase rule. Pitchers over this level rated the same as those who threw more than 27% breaking balls.
3. Rookies throwing more than 2,700 pitches in their first year. The idea behind this is that extensive throwing at a higher level of competition could tax an arm. The numbers from 2007 and 2008 show that a third pitch less than 2,000 pitches their second season and that a fifth see their FIP rise 0.50.
Razzball IDs these as the top 5 guys to worry about:
1. Armando Galarraga - the reason why I hope we let Chris Tillman take his time to reach the majors.
2. Ricky Nolasco
3. Gavin Floyd
4. Brett Myers
5. Ryan Dempster

Baseball Prospectus' Baserunning Indices
The Orioles best base runner last season was Jay Payton. He was ranked 67th in the league. Overall . . . the team was pretty awful on the basepaths. In fact, we only had four starters who were above average:
Adam Jones (0.83 runs; pretty average at everything)
Brian Roberts (0.7; slightly above average at making most of his stolen base opportunities, his other baserunning skills actually produce a negative value)
Melvin Mora (0.47; awful at stealing bases to the tune of over 3 runs a season . . . decent with regard to advancing on base hits)
Luke Scott (0.2; OK at all things)
Markakis (52nd worst), Millar (13th worst in baseball), and Hernandez (23rd worst) were in total responsible for wasting about 15 runs or 1.5 wins last year. Markakis' probably is that he seems to get caught stealing at a decent clip.

Top three baserunners?
1. Ichiro 12.7 runs (a gain of over a run per season due to his base running skills)
2. Willy Tavares 11.9 runs
3. Ian Kinsler 9.2 runs

Bottom three?
Dionnar Navarro -8.0 runs
Magglio Ordonez -8.0 runs
Prince Fielder -7.1 runs