Blown Arms and other Ghost Stories(06/08/00)
Part 2 of 2 on Pitch Counts

Just the other night, Dusty Baker left Livan Hernandez out on the mound for 143 pitches.  It marked the 5th time this season the 25-year old Hernandez has thrown 120+ pitches in a game.  He followed that up by throwing 121 pitches his next outing.  Considering he's started only 12 games this year, that's a brutal pace.  Only 4 other pitchers have as many as 4 games of 120+ pitches.  One of those guys is Hernandez' 26-year old teammate Russ Ortiz.

In Part 1 (Pitch Counts), it was pretty clear that there was a correlation between excessive usage and early burnout: of the 100 most promising arms in major league history, only about 10% reached their potential.  There were other factors at work for some (Ruth became an outfielder, Eckersley, a reliever) but the vast majority fell short of expectation, largely due to burnout.

Since 1988, STATS, Inc has been tabulating pitch counts.  Rany Jazayerli took those pitch counts and created a subjective system by which abuse could be measured in points, based on the number of pitches per start and the age of the pitcher.  What he discovered was similar to the results of my chart: that the most abused pitchers invariably end up on the disabled list and fail to reach their potential.

As an example, in 1988, Bobby Witt pitched 13 complete games in just 22 major league starts.  Just 22 years old, his fastball and slider were compared with Nolan Ryan's in both velocity and movement.  Unfortunately, he also racked up very high pitch counts with his wildness.  The next year, his ERA jumped by nearly a run and a half.  He rebounded with the best year of his career in 1990.  But again, he racked up enormously high pitch counts.  This time, he didn't bounce back.  A rotator cuff tear and several elbow surgeries later, he lost his velocity and has been bouncing around the majors ever since.  So even though he didn't rack up high innings totals, his high pitch counts effectively accomplished the same result: injuries that prevented him from ever coming close to his staff ace potential.

In one of the great tragedies of the game, his story is relatively common.  So just what happens to guys who blow out their arms?  Well, until recently, most of them didn't fare too well when they returned to the majors.  Tommy John and Frank Tanana were successful after their surgeries, but they completely altered the way they pitched in order to do so.  Most pitchers simply aren't able to make such drastic adjustments.

But in the last 5 or 6 years, advances in medical technology and procedure have improved a pitcher's chances for complete recovery.  Ligament transplant surgery, also called Tommy John surgery, named for the first pitcher it was ever performed on back in 1975, is becoming a fairly common sports surgery.  Like arthroscopic surgery, it's close to becoming an outpatient procedure.  For those not familiar with it, the surgeon extracts a tendon from the pitcher's non-pitching hand, wrist or forearm and uses it to replace the damaged ligament in his pitching arm, threading the healthy tendon through holes drilled into the bone above and below the elbow.  It usually takes 12-18 months of rehab to get the arm back to pre-surgery  strength

Several former patients have said that doctors are getting so skilled at performing the procedure that it has made their arms even more resilient than it was before the surgery.  Toronto closer Billy Koch had the surgery just after he was drafted from Clemson in 1997.  In college, he could get his fastball up to the high 90's on occasion.  Now he occasionally tops the century mark on the gun.  Whether that's due to the surgery or the natural maturation of his arm is debatable.  But more often than not, the pitcher recovers most of his arm strength and resilience.  Darren Dreifort, David Wells, Steve Karsay and Cal Eldred have all had the procedure and, after sufficient recovery time, have resumed their careers.

The question then is: what is sufficient recovery time and how much abuse can the reconstructed arm take.  It's hard to tell at this point about the recovery time required, but there are plenty of indications that rehab can't be rushed.  Jose Rijo, one of the best pitchers in the majors in the early 90's, tried to come back within 6 months of the procedure and ended up ruining his arm.  Most of the other recipients have taken the recommended 12 months off and have come back quite nicely.  Still, caution and vigilance should be the course, as the knowledge of  the  rehabilitation process is still in it's infancy.

As for the resilience of a reconstructed arm, who knows?  Not too many guys have had the opportunity to blow out an arm twice.  Since  tendons generally have 3 times more collagen than ligaments, one would have to conclude that the arm would be stronger and able to withstand greater use.  As long as managers like Dusty Baker are around, I'm sure we'll find out just how much they can take soon enough.