Why MLB's elbow problem, which now includes Yankees' Masahiro Tanaka, is worse than people imagine
It's too late to save this generation. At the highest levels of research into the pitching arm, almost all the top minds agree that baseball for the next decade, and probably more, is going to be a non-stop parade of injuries, disappointment and bewilderment. This horrifies them. It should.
And so they hold out for hope that this is the one, that maybe because it's Masahiro Tanaka's elbow, a $175 million hinge held together by a partially torn ulnar collateral ligament, the industry will start to recognize the crisis on its hands and do more than talk about it. Perhaps they'll even acknowledge that it's not just a crisis because of what's happening, because elbows are blowing out with such frequency. It's a crisis because of what's not happening.
Today, as Tanaka begins a six-week rehab filled with platelet-rich plasma (PRP) injections in hopes of avoiding Tommy John surgery, here is the truth about how baseball is handling a problem with a greater practical effect on its business than performance-enhancing drugs ever had: in a splintered, fractured, inefficient fashion that practically commodifies injury prevention.
Across the sport, the arm is treated like a cipher handed out to all 30 teams: They try to crack it by themselves. Injury information is a product, a piece of data that teams plug into their proprietary systems and try to interpret. The reality is that if a team figured out how to keep its pitchers healthy, it would win division titles, league championships, perhaps a World Series or two.
"Teams are hesitant to invest because they think they're going to seed the money and then everyone is going to share in the information," New York Yankees president Randy Levine said in mid-June. “We're all too selfish to do it."
Instead, this is baseball: Teams drop nine figures on a player, and they have absolutely no idea what's going on inside his body. It's lunacy. It's madness. It's like buying a used car with the hood locked. It may run just fine now, but if you can't see or monitor how the mileage affects it – if you haven't the slightest clue it's breaking down or why it's breaking down or when it's going to break down for good – then you wouldn't dare buy the thing, let alone spend $175 million on it.
The risk for the Yankees was worth taking because there's no alternative. That there's no alternative is beyond damning, a daily dereliction of duty, a problem the sport must remedy before it loses another generation. Matt Harvey and Jose Fernandez and Patrick Corbin and Matt Moore and Martin Perez and Jarrod Parker and Kris Medlen and Brandon Beachy and Jameson Taillon – uncle – are enough to lose over a six-month period, aren't they?
It's not just the teams banding together. It's the league and the players finding détente in a place that offers little. MLB and the union have tussled over the level of research that can be done on active players, and both sides' positions are understandable. MLB wants to know everything it possibly can to better ensure owners spend money on pitching wisely. The union sees a scary scenario creeping closer, and an injury to Tanaka only exacerbates it: With elbow injuries so prevalent, and practically impossible to foresee, the idea of spending nine figures on a pitcher gets less appealing by the day. It's practically an invitation to collude.
Think of that: a labor war wrought by a body part.
This isn't some baseball dystopia. It's the game right now. Commissioner Bud Selig called the Tommy John rash an epidemic, which was nice of him to acknowledge, and a number of smart people in his office are doing the best they can with limited resources to cobble together as much data and hunt for possible patterns. It would be far better – and more effective – were the brainpower of 30 teams working in concert with the commissioner's office and the union to come up with a plan.
Because then and only then will the lower levels of baseball start to take this seriously. MLB pours tens of millions of dollars annually into youth baseball programs, and if it could pass along the findings from its research onto another generation, perhaps it can be saved from the malady affecting this one.
This is almost a $10 billion industry, one that gets its most valuable asset – the pitcher, on whom teams spend $1.5 billion every year – without any idea how his most valuable limb was treated over the previous 18 years. It's not the bastion of efficiency, particularly for an industry that prides itself on exploiting every little inefficiency.
Baseball is evolving, and knowledge hasn't evolved with it. Researchers and doctors believe the correlation of high velocities and arm injuries may well be causative, and pitchers today throw harder than ever. It's not that simple, though; the ancillary pieces of a pitcher's work – his pre- and post-game exercises, for example – have not similarly progressed with most teams. The answer may well be we're looking at the wrong thing.
With Tanaka, the assumption was that he threw too many split-fingered fastballs, which are considered bad for the elbow. It's impossible to say whether that did it. Could be the difference in the ball used in Major League Baseball and Nippon Professional Baseball. Or that there are more high-stress pitches when facing hitters of a greater caliber. Or that, simple enough, it was just his elbow's time to go.
Tanaka, remember, once threw nearly 750 pitches over a two-week span as a high schooler. His pitch counts as a pro were similarly high. And though the verdict on pitch count is far from definitive – plenty of pitchers held to one in organized baseball still have blown out – repetition of a stressful motion can't help.
So he'll get his PRP, and the Yankees will cross their fingers, and Tanaka will wait. There really was no alternative. The timing on elbow injuries almost always determines the treatment. An April UCL tear means surgery; the player should be able to return by the middle of the next season. A July UCL tear means, best-case scenario, the pitcher is back the next July, and doctors now are erring more on the side of caution in Tommy John returns. Ideally, they'd like 12 to 18 months.
Surgery isn't a foregone conclusion. Adam Wainwright lasted half a decade with a torn UCL before it blew. Ervin Santana's right elbow shows no sign of a UCL defect these days after he rehabbed a partial tear five years ago, according to a source familiar with his medicals. PRP treatment worked for Takashi Saito's partial tear, and a study published in the American Journal of Sports Medicine last year called it "an effective option to treat partial UCL tears of the elbow."
Ultimately, every elbow, every arm, is different. Tanaka's weathered the years of massive use; the Yankees hope it can continue to do so. And whether it's them, or another team that has lost multiple pitchers to Tommy John this year, it's incumbent on baseball to do everything it can to keep this from happening. Researchers are looking at not just mound height but slope of the mound. They're trying new training programs to protect the shoulder and elbow. They're making progress. They're also playing catch-up.
They recognize baseball needs them more than anyone. As long as the sport acts like it's OK that a $175 million player may miss the rest of this season and all of next season, nothing will change. Too much is at stake for baseball to let that happen.