Monday, September 9, 2013

0 comments Terence Moore, M.D. Discovers How to Prevent Major Elbow and Arm Injuries to Pitchers; Dr. James Andrews Shakes His Fist Violently at this Cruel Fate

I don't understand why MLB teams insist on hiring their own team doctors and trainers to monitor or diagnose players' injuries. It would be much more simple if each Major League Baseball just hired Terence Moore to be the doctor for every team in MLB. After all, he must have a medical license since he fancies himself a doctor. Terence must also be the greatest sports doctor in the world since he has knowledge on how to prevent major arm and elbow injuries to a pitcher. It turns out Terence Moore knows what no other doctors know, which is how to avoid injuries to a pitcher's elbow and arm, which prevents Tommy John surgery and a pitcher from having to sit out a full year. "How do we do this?" every MLB team asks in unison. Easy! Just pitch these pitchers as often and as much as possible. See, the human body responds to stress by preventing injury according to Dr. Terence Moore. His proof is that a few pitchers that are outliers managed to stay healthy during their career despite pitching a ton of innings. Well, as he is prone to do, Terence actually uses two pitchers who suffered major arm injuries as examples of pitchers who pitched a lot of innings and stayed healthy. Terence loves to submarine his own point.

The subtitle of this column is "Increase in arm ailments may be due to increase in clubs' cautiousness."

If Terence Moore were in a private practice rather than dispensing medical advice for free through I'm sure he would also tell us the key to avoiding a heart attack is to eat as many fatty, greasy foods as possible. After all, your heart can't get strong until you make it work really hard to stay beating.

Pitchers need to throw more. That's the problem, and that's also the answer when it comes to this epidemic of starters and relievers completing a cycle these days.

This is an opinion, not a scientific fact. Don't present it any other way. Pitchers don't necessarily need to throw more and Terence has no proof this is "the answer" to ensuring pitchers don't get injured. Back in 2011 Atlanta Braves fans made 10,000 "Dr. James Andrews will see you next year" jokes about Eric O'Flaherty, Jonny Venters, and Craig Kimbrel due to the amount that Fredi Gonzalez used them. Guess what? Two of those three pitchers will be having major elbow surgery. I don't claim to be a doctor like Terence does, so I'm not entirely sure why O'Flaherty and Venters had major arm surgery. If I had to guess, it would be because of the amount they were used over the past couple of seasons.

Now you say, "but Ben that is anecdotal evidence that doesn't really prove anything" and you would be right. Unfortunately, Terence is using the same anecdotal evidence to support his position and he gets paid to write stuff like this.

First, they have impressive outings. Then they encounter aches and pains out of nowhere. After that, they sprint to the disabled list before a trip to a surgeon's operating table.

Here's the latest: Matt Harvey.

Throwing a baseball is very taxing on a pitcher's arm and it isn't a natural motion. Pitchers in 2013 throw the ball faster and harder than pitchers threw the ball 60 years ago. Let's not forget this. Medicine has advanced to where now we know exactly what is wrong with a pitcher as opposed to 50 years ago when a guy just inexplicably lost his velocity it was just chalked up to a pitcher just losing velocity. I don't see a bunch of people running around saying the key to curing cancer is to breathe in as many coal fumes as possible while sitting on a nuclear reactor. I don't think the cure for arm injuries is to further tax a pitcher's arm. 100 years ago people would mysteriously get sick and die. In 2013 we can diagnose why these people have gotten sick due to medical advancements. This means what once was called "taking ill and dying" or some other generic term that doesn't explain what the real cause is (much like "dead arm" was used to explain why a pitcher lost velocity) can now be diagnosed by doctors.

Basically, Terence is using outliers to prove his point and ignoring the fact doctors couldn't attribute a pitcher's "dead arm" to any certain cause 50-60 years ago to further his claim that the more a pitcher pitches the less chance he has of sustaining an elbow or arm injury. He's using the fact there was less knowledge about arm and elbow injuries 60 years ago as a way of indicating pitchers 60 years ago didn't hurt their arms. It's just not true.

He also has a splendid 2.27 ERA to complement a 9-5 record. Not only that, his throwing mechanics are as fundamentally sound as they come at 24 years old.

Which is why Mets general manager Sandy Alderson and others associated with the franchise and beyond say they are shocked by it all.

They can shocked all they want, but again, throwing a baseball at 95 miles per hour 60 times a day is an unnatural motion for the human body.

But he sought to spin things toward the positive this week by telling reporters that he was "optimistic" he could avoid surgery through a vigorous rehabilitation routine.

What's Dr. Terence Moore's suggestion for this vigorous rehabilitation routine? Throwing a baseball as hard and as often as possible every day of the week. That elbow will right heal itself up!

I'm not shocked, and you shouldn't be either. From now until the unforeseeable future, the only time you should respond with raised eyebrows after reading a health report on a Major League pitcher is when it says that pitcher won't need surgery.

Let's not be dramatic about it. Pitchers today throw their pitches faster than ever, so that causes more stress on a pitcher's elbow, which could explain the supposed increase in pitchers who need surgery.

This is an epidemic, all right. Consider the Braves, owners of baseball's best record. They also are continuing their decades-long run as a prolific franchise for pitching. They are second in baseball in team ERA at 3.22 to the Pirates' 3.19, but get this: Within the last five years, the Braves have witnessed seven of their pitchers undergo Tommy John surgery, and that's just at the Major League level.

And why have the Braves had so many arm injuries? They baby their pitchers. This didn't happen when the Braves had John Smoltz on the roster---wait, nevermind.

As for those other Braves pitchers with significant arm-related pain, well, they were like Harvey. Young. Vibrant.

They didn't die. They just had arm surgery. If Terence is looking for an exact explanation on why some pitchers have major arm surgery and other pitchers do not, then he isn't going to find one. I guess that's why he makes up the solution that today's pitchers (unlike "back in the day") are coddled too much.

It's got to be that throwing (or the lack thereof) thing, not only for the Braves, but for everybody, because pitchers used to throw forever. I'm talking about in the Major Leagues, in the Minor Leagues, in Little Leagues and in sandlot leagues.

And pitchers that used to throw forever also got injured, but they weren't diagnosed with an elbow injury or weren't told they required Tommy John surgery because doctors couldn't diagnose the problem. So it was attributed to a pitcher just losing velocity or some other mysterious cause.

And let's get that ridiculous example out of the way in Walter Johnson. After he made his Major League debut in 1903, he pitched 200 innings or more 18 times in 21 years. He even went nine straight seasons throwing 300 innings or more. Two-hundred innings once was the standard for starting pitchers during a given season. Now, not so much.

It's a ridiculous example because Terence is using an outlier to prove his point. Nine straight seasons of 300 innings or more is ridiculous. Having done some research into Johnson, his fastball was once measured at 91 miles per hour which is a speed that most pitchers couldn't get to back in his day. Pitchers today routinely throw that fast. So while it is fun to remember the good old days and notice that starting pitchers used to throw 300 innings in a season, the real question to ask is how fast were these pitchers throwing, because that can tell us how much stress was placed on the pitcher's arm.

Again, throwing a pitch is not a natural motion for the human body and the faster a pitcher throws a pitch the more stress is placed on the pitcher's arm. The more stress placed on a pitcher's arm, the more likely his body won't be able to endure the stress on the pitcher's arm, which causes arm or elbow injuries to occur. So I don't think the comparison to Walter Johnson is a great one because he is an outlier in an era where pitchers rarely threw the ball as hard as pitchers do 100 years later.

So basically Dr. Terence Moore is full of shit that throwing more is the answer to preventing a pitcher from being injured.

Different times, you say -- you know, regarding that iron man era of Johnson, Cy Young and the rest? How about Tom Seaver, who spent his only year in the Minor Leagues in 1966 at 21 throwing 210 innings? That would cause today's pitching coaches to faint. Later, Seaver threw more than 200 innings per season in 16 of his 20 years in the Major Leagues.

Tom Seaver is one pitcher over the last 100+ years of baseball. He, like Walter Johnson, is an outlier. He isn't the rule as Terence so desperately wants to make him, he is the exception to the rule.

Not the stuff of Seaver. Or of Bob Gibson (12 seasons of 200 or more innings, including two of more than 300). Or of Sandy Koufax (who finished three of his last four seasons throwing 300 innings or more).

Oh, you mean the same Sandy Koufax who retired prematurely because he had an arthritic condition in his throwing arm? I'm sure Terence thinks this was caused by Koufax's lack of throwing enough innings the year before (he only threw 323 innings) and the fact Koufax ended up with an arthritic arm had NOTHING to do with the amount of innings he threw. Nothing to see here, move along.

Still not current enough for you? The Braves' Big Three of Greg Maddux, Tom Glavine and John Smoltz spent the overwhelming majority of their time during a given season hurling baseballs from a pitcher's mound, either in games or between starts. In addition to combining as a trio to throw more than 200 innings season after season,

Fine, I'll play this game with Terence. Of these three pitchers two of them didn't throw the baseball very hard, while one of them threw a hard fastball and a hard curveball, along with a split finger pitch. Two of these pitchers never had a major arm surgery, while one of these pitchers had shoulder surgery, Tommy John surgery, and various other arm injuries through his career.

Guess what? It was the guy who threw the ball hard, had a hard curveball, and a split finger pitch that ended up with the arm injuries, while the two pitchers who didn't throw the baseball hard stayed relatively injury-free. So Terence again uses a bad example in John Smoltz (the guy who threw hard) when discussing a pitcher who didn't suffer arm injuries, because while Moore holds Smoltz up as a guy who made it through his career by throwing a lot, Smoltz also had arm problems including Tommy John surgery. Smoltz threw his career high in innings during the 1996 and 1997 seasons (and was first in the majors in innings thrown both years) and when did he start having arm problems? That would be the 1998 season. I'm sure it is just a coincidence. It's just embarrassing for that Terence writes for them. He does very little research and just has really half-assed explanations for the topics he is discussing.

Leo Mazzone was their legendary pitching coach, and he learned his philosophy of having members of his staff pitch, pitch and pitch some more from Johnny Sain,

Mazzone had a regiment where pitchers throw long-toss in between starts to warm up and strengthen their arm. Maybe it worked, maybe it didn't work. I just don't think it is a coincidence the softer throwing of the Braves Big Three starters didn't have major arm injuries while the harder throwing pitcher did. Of course I'm not a doctor like Terence Moore so I'm not going to claim my opinion is fact.

"I look back, and I'm trying to figure out the Tommy John surgeries we've had, and I only can come up with Kerry Ligtenberg, and then we had Smoltzie over a period of time [since he fluctuated between starting and relieving], which you can understand that one," 

This is a lie. Smoltz's arm injuries started when he was a full-time starter and the Tommy John surgery is what necessitated his move to the bullpen. So his arm injuries occurred while he was a starter and not because he went back and forth from the rotation to the bullpen. Besides, under Dr. Terence Moore's theory of throwing the baseball for as many innings as possible wouldn't putting Smoltz back in the rotation help prevent an arm injury because he is throwing more innings?

Instead, during the eight years since Mazzone left the Braves, baseball has become strikingly more protective of pitchers. Among other things, managers yank starters and relievers at the slightest sign of trouble, partly due to the emphasis on bullpen specialists, but mostly due to a heavy dependence on pitch counts.

More velocity on pitches is harder on a pitcher's arm. That's how it works. Pitchers who throw harder seem to be more susceptible to arm and elbow injuries. Matt Harvey threw hard, Stephen Strasburg threw hard, Kerry Wood threw hard, and Mark Prior threw hard. It's not a proven theory by any means, but it's natural to believe the harder a pitcher throws the more stress on the arm which could result in an injury.

Once a pitcher reaches a certain number of pitches during a game or even a season, he's history, just like Stephen Strasburg last autumn.

That's a completely different issue. Strasburg hasn't gotten re-injured because of a pitch count. Rightly or wrongly, he has been held back because of his previous arm injury. Given the fact Strasburg has already had Tommy John surgery it is smart to hold him back a bit. Maybe it's not. All I know is sportswriters bitched that Strasburg got held back last year and now they are bitching the Mets didn't pay attention to the signs that Matt Harvey was injured. Everytime a pitcher's arm is sore it doesn't mean he has something wrong with him. 

I mean, how are these pitch counts working overall these days when it comes to keeping guys in the lineup?

Ask Harvey.

I mean, how does it make sense that the answer to pitchers avoiding arm surgeries lie in having the pitcher throw more innings?

Ask a doctor, Terence. It's managing stress on the arm, not putting enough stress on the arm to make the arm super-strong that is the key to preventing arm injuries.