Tommy John

TJ, Japan and the Six Man Rotation

by JDCam 05.05.15

The epidemic of Tommy John surgeries sweeping the major leagues shows no signs of abating. Already in 2015, the Mets Zach Wheeler, Rangers ace Yu Darvish and the Royals Tim Collins have undergone the procedure, to name but a few.

While the long term effects of procedure do not compare, the prevalence of elbow issues for pitchers in the major leagues are starting to draw comparisons to the long term effects of concussions in the NFL. What remains clear is that the number of pitchers undergoing TJ remains high, approximately 1.1 per team in 2014.

The implications TJ surgery has on various levels of the game is a fascinating discussion. At a youth level there is a need for a greater breadth of creditable research on how to develop and maintain arm strength in a sustainable way, when to introduce young pitchers to offerings that put a greater strain on their arm (such as breaking balls) and arm conditioning regimens which can be followed at all levels of youth baseball to begin to decrease the risks of TJ.

A useful starting point and road map for this conversation can be found in the differing models of youth baseball in the United States and Japan.

Year TJ/Team NPB TJ/Team MLB
2012 0.833 2.30
2013 0.667 1.63
2014 0.083 1.10

At the major league level the particulars and possibilities are no less fascinating. A starting pitcher in 2015 and a starting pitcher in the 1960s have very different roles, naturally. It is easy to overlook how the statistics have traced the arc of the starting pitching role, the introduction of the ‘quality start’ being the most striking example of this (not to mention its alteration from 7 innings with 2 runs or less conceded to 6 and 3).

Pitching is an increasingly specialized trade with innings shared in greater and greater numbers between the rotation and bullpen (ever see a MLB team break camp with 13 pitchers in the 1970s)? With the combination of career threatening injuries to pitchers at a consistently high level and the explosion of power arms in recent years, one wonders if MLB teams could ever field 6 man rotations consistently?

Jose Fernandez in another pitching start rehabbing from season ending surgery

Jose Fernandez in another pitching start rehabbing from season ending surgery

This is a popular practice in Japan, where despite overusing and overexposing young and talented arms at the youth level through tournament play, the clubs of the Nippon League ere on the side of caution with starting pitching. Typically Japanese teams feature a 6 man rotation, with a season typically featuring a day off per week; the idea of a particular pitcher generally occupying a spot on a particular weekday is not uncommon. This raises interesting economic questions around the subject of a 6 man rotation. The most exceptional starters would probably be lined up on weekend days when more fans have an opportunity to attend games. This would however, create a divergence in pitching quality between weekdays and weekends, with the Kershaws and Scherzers of the world being trotted out on Saturday and Sunday while the J.A Happs and Trevor Mays perhaps occupying the Thursday matinee.

A further intriguing possibility would be a more extreme reduction in work load for back of the rotation starters and splitting innings between two or more multi-inning bullpen options, much like a traditional spring training game is handled. There are several problems with this notion (length of game, matchups)

Whatever the path forwards, there are certainly disturbing trends emerging in the status of pitchers who have undergone TJ surgery. According to a recent article from ESPN’s Stephania Bell ‘since 1999, of the 235 MLB pitchers have undergone TJ surgery, only 32 have undergone a revision – but one-third of them have occurred in the last year’. This data disturbingly points toward the misnomer that TJ recipients somehow miraculously strengthen their arms through their rehab and end up pitching at the same level and with the same effectiveness as they did prior to their surgery.

The bottom line here seems to be that despite an increasing willingness of pitchers to have and/or repeat the procedure the long term effects are still incredibly unpredictable. MLB seems to be moving forwards with a number of different research studies, educational programs and even technology aimed at reducing and limiting the number of pitchers that require TJ surgery, including obtaining data as specific as which pitches place the greatest long term biomechanical strain on various parts of the throwing arm.

MLB needs to continue its own in house research about the logistics of a possible 6 man rotation (expanding rosters, the potential stress placed on relievers, the potential for extra jobs creating some good will with the players union to name but a few).  While positive steps are being taken, pitchers are not yet carefully protected by major league baseball and out understanding of the specific relationship between work load and arm health will continue to limit this understanding, to the detriment of the most important players on the diamond.