Are teams' injury crises down to bad luck or bad management?

Ian McMahan
Noah Syndergaard is the latest New York Mets pitcher to go down with an injury. Photograph: Al Bello/Getty Images

Death, taxes and injuries to Mets starters – a few of life’s certainties. Just when the furor over the Mets’ parade of injuries had seemingly reached a climax with news that Yoenis Cespedes’ strained hamstring would put him on the 10-day disabled list, Noah Syndergaard was pulled from Sunday’s game after lasting only 1 1/3 innings. In an era when arm problems frequently shelve baseball’s best young pitchers – often those that throw the hardest – this is troubling news, especially given Syndergaard’s record of past resilience.

But while the Mets appeared to have poorly managed Syndergaard’s injury, allowing him to refuse an MRI after biceps pain scratched him from last Thursday’s start, who’s to blame for the Mets’– or any other team’s – injury troubles?

Perhaps unfairly, when injuries seem to hit some teams harder than others, questions are raised about the injury prevention and management policies of the coaching and medical staffs. This isn’t limited to baseball either; in the Premier League Arsenal are often attacked for their lengthy injury list.

Emphasizing that he wasn’t speaking about any one team in particular, Dr Glenn Fleisig, one of baseball’s leading injury experts believes that coordination and communication is important. “I do see certain teams that have more or less injuries than expected, and those that do a good job of preventing and managing injuries have good communication between coaches, medical staff and analytics people.”

According to Dr Gary Green, Major League Baseball’s medical director, critics too easily draw conclusions from limited information. “People are looking at too small a sample size,” says Green, “it’s too early to draw conclusions because you need to look more long term to determine a trend.” In other words, statistical bad luck will sometimes cluster injuries in a short period of time, rather than evenly distribute them over a season or longer.

While it might be little consolation, the Mets’ are not alone in their spring misfortunes, as April is historically the month with the most injuries to MLB players. In fact, a 2010 analysis of MLB injuries found that almost 75% of injuries occurred prior to the All-Star break. Adding to that, research has been unable to correlate workload (number of games pitched, total pitches thrown, total innings pitched, innings pitched per game, and pitches thrown per game) and injuries in MLB pitchers.

Of course, injuries aren’t simply dictated by the calendar. In fact the holy grail of sports medicine is trying to determine all of the factors that lead to injury. “I’ve spent my career trying to answer that question,” says Fleisig.

Unlike acute injuries – like fractures, concussions – it’s difficult to come up with silver-bullet preventative factors for overuse problems like Tommy John injuries or shoulder strains. “When our data showed that many of the concussions in catchers was caused by collisions at home plate, changing the rules to prohibit those collisions almost entirely eliminated that as a cause of concussions,” says Green, “but preventing overuse injury can be more complex.”

Changing a single factor may not have as much impact on overuse injuries, problems that can be caused by months, even years of microtrauma. Making it more difficult to assign blame to teams is the fact that pitchers don’t come to the big leagues with fresh ligaments and tendons. By the time players make a major league roster, shoulders and elbows have already been stressed from throwing and hitting in high school, college and travel baseball.

Without an odometer to indicate past usage, players can be ticking time bombs, exploding with injury even when treated carefully by their major league teams. “When looking at ways to prevent injuries one of the biggest risk factors is previous injury and a lot of pitchers come to MLB with pre-existing problems,” says Green.

“Because of differences in mechanics, it’s difficult to compare risk between players,” says Fleisig. “What is easier is understanding an individual’s risk of injury.”

For instance, a pitcher who throws 95mph is not more likely to become injured than one that throws 85mph. Absolute velocity is only weakly associated with injury but throwing a greater number of pitches at high velocity – ie more fastballs – does appear to put a pitcher at greater risk of injury. Studies indicate that MLB pitchers who have suffered Tommy John injuries threw on average 7% more fastballs than pitchers who had no surgery.

Other than velocity and mechanics, Fleisig cites pitching through pain and fatigue as an additional risk factor for injury. “Velocity, mechanics and pitching through pain are all risk factors for elbow injuries in baseball.”

This seems to be a red flag violated by Syndergaard and the Mets when disregarding the arm pain of last week. Soreness so significant that Syndergaard told reporters that, “Once it gets cold, I couldn’t really lift my arm above my shoulder.”

Though it comes too late for this year’s Mets, according to Green, a large-scale study of MLB draftees is currently underway. With that data, sports medicine experts hope to determine what factors are associated with injury. Until then the solution for baseball’s injury problem may very well lie in the players’ pasts.

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