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Injured Pitchers Are MLB’s Other Big Pandemic Problem

You’re not imagining things: There has been an uptick of pitchers on the IL. It most likely has something to do with the start-and-stop nature of this abbreviated season.

Getty Images/Ringer illustration

“I’m so excited for baseball. I’m excited for the fans. I’m excited for my babies to watch their daddy,” Lauren Mikolas tweeted on the afternoon of July 24, shortly before first pitch in the St. Louis Cardinals’ season opener. Lauren Mikolas is married to Miles Mikolas, the Cardinals starter she tagged at the end of her tweet. Mikolas, who pitched in an exhibition game against the Royals on July 22, was scheduled to start a real game last Wednesday, but his babies will have to wait a while longer to watch him pitch competitively. Last Tuesday, Mikolas was placed on the injured list with what was classified as a forearm strain. Sometime soon, he’ll have season-ending surgery to repair a damaged flexor tendon.

Mikolas, a 2018 All-Star who made 32 starts for St. Louis in each of the past two seasons, is one of several prominent pitchers who’ve been placed on the shelf early this season, including Cole Hamels, Corey Kluber, Justin Verlander, and Clayton Kershaw, who returned from back stiffness on Sunday. All but a few of the ailments are arm-related. Triceps tendinitis took Hamels out of action, biceps tendinitis debilitated the Twins’ Homer Bailey, and forearm strains have claimed not only Mikolas and Verlander (who may or may not be out for the season as well), but also the Blue Jays’ Ken Giles, the Pirates’ Michael Feliz, the Tigers’ Dario Agrazal, the Pirates’ Clay Holmes, the Royals’ Foster Griffin, and the White Sox’s Jimmy Lambert. “Forearm strains” are often euphemisms for elbow injuries, which have plagued the Yankees’ Tommy Kahnle, the Reds’ Matt Bowman, and the Astros’ Austin Pruitt, Chris Devenski, and Roberto Osuna. Six other pitchers, including Rays reliever Colin Poche, underwent Tommy John surgery (or revealed that they’re soon slated to) in the second half of July, with Kahnle likely to join them. And on Sunday, the Angels sent Shohei Ohtani for an MRI after the two-way Tommy John surgery survivor suddenly lost velocity in his second start and subsequently complained of discomfort in his pitching arm.

MLB’s pitcher arm issues extend above the elbow. Kluber, his Rangers teammate José Leclerc, the Dodgers’ Alex Wood, the Astros’ Joe Biagini and Brad Peacock, the Rockies’ Wade Davis, the Pirates’ Kyle Crick, the Royals’ Mike Montgomery, the Cubs’ James Norwood, the Giants’ Sam Coonrod, and the White Sox’s Reynaldo López have all been felled by shoulder problems. And those are only the hurlers who’ve gone on the injured list since the season started: Others, like the Mets’ Robert Gsellman, the Reds’ Anthony DeSclafani, the Brewers’ Ray Black, the Rangers’ Rafael Montero, the A’s A.J. Puk, and the Orioles’ Hunter Harvey and John Means were added to the IL with arm-related complaints shortly before Opening Day. Still others have avoided that fate thus far but have still been sidelined day to day, including Nationals ace Stephen Strasburg, who’s missed his first two scheduled starts because of a nerve issue in his right hand.

It’s easy enough to explain any one, two, or 10 of these injuries: Pitching is hazardous to one’s health, and plenty of these newly injured pitchers have put a lot of mileage on their arms or accumulated lengthy injury résumés. Put them all together, though, and a pattern presents itself. As it reels from the pandemic that may force its late-starting season to stop prematurely, MLB also seems to have a pitcher injury epidemic on its hands—and its elbows, shoulders, and assorted other barking body parts.

Astros skipper Dusty Baker has seen a lot of pitcher injuries during his decades in the game. (Years ago, he may have contributed to a few.) This summer, he’s encountered many more than he’s used to: His Astros have lost Verlander, Biagini, Peacock, Pruitt, Devenski, and Osuna, as well as another righty, Ryan Pressly, who suffered a sore elbow and didn’t debut until Saturday. Dusty doesn’t think it’s a coincidence that these injuries have struck his roster after an abbreviated ramp-up to the season in summer camp, which followed a shortened spring training and a pandemic-dictated layoff of more than 3 1/2 months. Last Monday, Baker said, “A lot of the hitters are ready, probably, in about three weeks or so. The pitchers need that extra time. They need that five or six weeks of spring training. This has been abbreviated, and you see it. It’s all around baseball. It’s everywhere.”

It’s possible that Baker’s perception is skewed because of the Astros staff’s injury woes. Or maybe this apparent pitcher injury spike is a product of selective memory, compounded by the disorienting experience of a season starting in July. As I’ve noted before, spring training and the first month of the season are always the worst time of year for injuries that lead to Tommy John surgery—even when the first month of the season is April, not July.

“In a regular year—and this is far from that—there are essentially two injury seasons,” says baseball biomechanics and pitching injury expert Glenn Fleisig, the research director of the American Sports Medicine Institute. “One is spring training/beginning of regular season, and the other one is end of regular season. The second spike is the guys who are essentially running out of gas and fatiguing over the season, whereas the March/April injuries have to do with ramping up and lack of preparation.”

Before we speculate about what could be causing this summer’s spate of pained pitchers, then, we have to determine whether this season has actually inflicted an abnormal number of injuries relative to the elevated early-season baseline. To do that, we can compare the total number of new IL stints on Opening Day and the 10 days that followed—from Thursday the 23rd through this past Sunday—to the corresponding spans of equal length at the start of previous seasons (dating from the domestic Opening Day in seasons when the schedule officially started with an early international series).

The graph below shows the number of combined pitcher IL stints, pitcher IL stints related to arm injuries only, and hitter IL stints on Opening Day and the next 10 days of each season dating back to 2010, according to MLB transactions data collated by Baseball Prospectus. This sample excludes any 2020 stints presumed or confirmed to be caused by COVID-19, as well as stints in all years in which a player was described as recovering from an earlier injury or was placed on the IL retroactive to a date before Opening Day.

Injury data is difficult to work with, and it’s likely that a few transactions stemming from unspecified preexisting injuries slipped into the data set. But that wouldn’t account for the massive increase in pitcher injuries this summer, which backs up Baker’s observation. Although injuries to position players aren’t up from recent years, 2020’s total of 39 non-COVID-related pitcher IL stints since Opening Day is more than 50 percent higher than in any previous opening period, and the 2020 tally of 30 pitcher arm injuries is 150 percent higher than the record in any previous season’s opening stretch (12). The count could climb further if Ohtani or any other pitchers go on the IL because of an injury incurred prior to Monday.

Granted, the structure of this season could be goosing those stats slightly in an indirect way. For one thing, expanded rosters have deepened the pool of pitchers with the potential to get hurt. For another, established pitchers may be less likely to hide injuries and pitch through discomfort during a season they view as less legitimate. “To be frank, this season is kind of a mess to begin with, so I got to think big picture here,” Strasburg said on July 25. “It’s my career. I know that in the long run it’s important to try to make as many starts as you can, and by putting yourself in a compromising position now, I don’t really know if it’s the best way moving forward.” Strasburg might not be the only pitcher who was motivated to come clean and take time off because of a conscious or subconscious sense that this small-sample season wasn’t worth turning a nagging injury into long-term trouble.

But those explanations don’t seem sufficient to account for the increase, and a bump that big is unlikely to happen by chance. It’s even less likely to be random considering the unique conditions that players have faced this year, which fostered fears of an approaching pitcher injury wave well before the season started. “I have been concerned that pitcher injuries [would increase] because of the abnormal routine of start/stop spring training and a relatively short ramp-up on Spring Training 2.0,” says Stan Conte, the former Dodgers VP of medical services and Dodgers and Giants head athletic trainer, who now operates sports performance and injury analytics companies. Reds director of pitching initiatives and pitching coordinator Kyle Boddy concurs, opining that in light of the long layoff, the pitcher injury spike “isn’t too surprising, unfortunately. Hard to get pitchers to stay in top game shape.”

To explain why pitchers are dropping like flies in front of Nick Castellanos, we should start with why it’s customary to work one’s way up to regular-season strength slowly. “The purpose of spring training or preparation is twofold: One is to work on your mechanics and fine-tune your skills, and the other one is to get the muscles conditioned or prepared,” Fleisig says. Muscles can be built up, but ligaments and tendons can’t be strengthened to the same degree, which leaves them extra-susceptible to strain in ill-conditioned athletes. “The ligaments are the last line of defense,” Fleisig continues, “so if the muscles don’t do their part, then often the ligaments have to do more than they normally would.”

When spring training was suspended in mid-March, about two weeks before Opening Day, pitchers hadn’t yet reached their peak power. Over the next few months, as labor battles and COVID case counts dominated the discourse surrounding the sport and the prospect of a season grew increasingly uncertain, some pitchers may have surrendered their spring gains and gone back to square one—or close enough to square one that they couldn’t get up to top speed safely in the span of a three-week summer camp.

“It’s quite possible that athletes who did not build up appropriately during the COVID lockdown may have had to ramp up their throwing workloads rapidly as they progressed through the condensed spring training and through the early portion of the season,” says Driveline Baseball sports scientist and strength and conditioning coach Dan Adams. Assessing pitchers’ current risk of injury, then, “becomes a question of which athletes actually took advantage of the lockdown vs. athletes who treated it like a vacation.”

That’s not to say that we can tell which players and teams took training during the lockdown seriously based on who does and doesn’t get hurt. Injuries are much too mysterious and multifactorial to identify the cause in any particular case. (Unless, like José Quintana, you slice your thumb while washing dishes, in which case the cause is pretty clear.) “You’re undoubtedly going to have some athletes who did next to nothing over the shutdown stay relatively healthy throughout the entire year, and others who progressed their training intelligently throughout the shutdown go down with an injury,” Adams says. “And by extension, you’re going to have some organizations who didn’t have much of a process in place to monitor and progress their players during the lockdown remain relatively healthy, while other orgs who had great procedures in place will end up with a handful of freak injuries and skewed injury rates.”

Plus, pitchers’ access to training facilities, equipment, and technology varied in unavoidable ways that willpower alone might not have been able to overcome. Although teams tried to coordinate workouts remotely during MLB’s shutdown, only some pitchers had home gyms and throwing partners.

“A lot of this comes from pandemic-related external factors,” says one front-office member with a background in health and human performance, who mentions a litany of obstacles that conspired against pitchers post-spring training: “little/no access to their usual routines, uneven adherence to/execution of their workouts, far less competitive pitching situations, changes to sleep/nutrition routines. … Less throwing, less day-to-day routine, and a lot of interrupted/ad hoc training routines all coalesce into an odd mix of detraining and some overtraining as well. Add to it uncertainty of spring training reboot logistics and less time to ramp up, and you have a recipe for injuries.”

The sources I spoke to say it’s somewhat surprising that we haven’t yet seen a corresponding increase in soft-tissue injuries—such as oblique and hamstring strains—among hitters. But as the front-office official points out, position players were bound to be at reduced risk compared to pitchers, because “there’s definitely less runway needed for them to take off.”

On top of all the other impediments to health, players are coping with another difficulty endemic to 2020: a constant concern about the state of the world, the well-being of friends and family, and the dangers of traveling and playing in proximity to others during a pandemic. For some players, those worries could manifest physically. “These are not robots, these are people,” Fleisig says. “And the extra stress of worrying about the coronavirus could affect some athletes. Your mental and your physical [conditions] are connected, so psychological wariness might be a factor for some people, an intangible type of thing.”

Teams can try to mitigate the effects of an abbreviated ramp-up by implementing lower-intensity workouts performed more frequently, giving position players off days or days at DH, and keeping pitchers on a shorter leash early on. We have seen some signs of that last tactic. Through the first 10 days after Opening Day of the 2019 season, MLB starters averaged 5.2 innings pitched, 22.1 batters faced, and 86.8 pitches thrown per start. This season, they’ve averaged only 4.6, 19.4, and 76.4, respectively.

That may be partly a product of the league’s rapid embrace of openers, more liberal bullpen usage thanks to 30-man rosters, or even injury-shortened outings; Kluber’s grade 2 tear of a teres major muscle forced him to exit his start after one inning, which dragged down the overall average. But there may be more to it: Although 10 starting pitchers have attained triple-digit pitch counts, others have been limited to unusually low totals. Angels starter Andrew Heaney, for one, was pulled after 67 pitches and 64 pitches in his first two starts, despite allowing only seven hits and three runs with 12 strikeouts and one walk in 9 2/3 combined innings. Heaney expressed surprise at the quick hook in his second start and said he wasn’t tired, but the Angels may have taken extra precautions with a pitcher who missed a few months of last season with elbow and shoulder inflammation.

Twins manager Rocco Baldelli acknowledged last week that this year’s off-and-on schedule is probably at least partly responsible for the excess pitcher casualties. No Twins starter had gone more than five innings deep into a game until Kenta Maeda went six on Saturday, and thus far, that prudence has appeared to pay off: The only injured Minnesota moundsman besides Bailey is Jake Odorizzi, who strained an intercostal muscle in summer camp and hasn’t hurried back. “I think it’s worrisome for not just me coming back from a minor blip on the radar but I think everybody in general, even healthy guys,” Odorizzi told the Pioneer Press. “I think that’s what we’re mainly seeing is you don’t know when it may or may not flare up. … It just goes to show you that when things are different and your body’s not used to that, there’s still time for something to go bad even when you’re in good shape and you’ve done what you need to do, so that’s what we’re training to avoid and that’s why we took the time now to rest and be 100 percent.”

The problem with the plan to pull managers’ feet off of pitchers’ pedals is the urgency of this campaign’s compressed schedule. In a 60-game season, Conte says, “The need to win quickly puts the intensity even higher than usual and could cause injuries.” Conte also cautions that some pitchers who go on the IL could rush their rehab in order to return in time to help out in a playoff push, which could lead to reinjury. As one MLB pitching coordinator puts it, “When new competing stresses (under a sense of urgency) are introduced, it allows more opportunities for injury. More opportunities with athletes who may have suffered from detraining during a quarantine who are elite competitors and push their bodies and minds to extreme end ranges just isn’t the most comforting situation for anyone when you look at it from an injury expectancy lens.”

We can offer some slight comfort. For one thing, the decreased length of the season will inevitably lighten cumulative workloads and spare some pitchers fatigue-related injuries. For another, some pitchers may have benefited from the extra rest that the pandemic imposed. One reason pitcher injury rates rise during and right after spring training is that undetected or unannounced injuries sustained in the previous season get aggravated after pitchers report to camp, or can no longer be ignored. Although the long layoff may have made healthy pitchers more likely to get hurt, it also “bought people time for lingering injuries that they knew about or lingering injuries that they didn’t even know about,” Fleisig says, which may have “allowed some minor injuries to recover naturally without being the start of a serious injury.” In theory, Mikolas could have been a beneficiary: His faulty flexor tendon bothered him back in February, when he felt soreness that he said was similar to some he experienced last season. But either the layoff wasn’t long enough, or too much damage was already done.

Injuries like Mikolas’s have already altered the playoff picture. And as COVID-19 clusters have caused postponements and reschedulings, some players and personnel, including Phillies pitching coach Bryan Price, have warned that the prolonged inactivity of the most affected clubs could worsen their pitchers’ predicament. Agent Scott Boras, who has also attributed the arm-injury scourge to this year’s training timeline, has proposed extending the season into November so as not to push pitchers harder to make up games. At this point, though, the season is far from certain to survive into September.

For any pitcher who’s facing the prospect of surgery and rehab because of an injury brought on or exacerbated by a deviation from traditional training, the impact of the pandemic-interrupted season will reverberate beyond this summer—another good reason the players stood firm on receiving prorated pay for this season. Pirates pitcher Trevor Williams speculated that the effects could be felt for years to come, saying, “I think there’s going to be a rise in arm injuries for pitchers over the next couple of years because of the lack of innings this year, carrying into 2021, especially in a full season, and then carrying over to the next season. … I think staff and players league-wide are going to be talking to each other: ‘What are you going to do this offseason? How are you going to prepare?’”

The good news in the short term is that the period of greatest vulnerability is about to be behind most unscathed arms, even if the season proceeds. “The injury will manifest or start in the next couple weeks if it’s due to the accelerated spring training,” Fleisig says, adding, “I don’t think the short summer training means that a month later someone has a higher risk of injury. It either happens or it doesn’t.” Soon enough, then, the pitchers who’ve made it this far should be out of the danger zone—or back in the marginally less dangerous zone where any human being who hurls baseballs for a living habitually lives.

An earlier version of this article incorrectly stated that Homer Bailey plays for the Cincinnati Reds. He is on the Minnesota Twins.

Thanks to Lucas Apostoleris of Baseball Prospectus for research assistance.