Under The Knife 4/25/24

Double Up

Mason Miller throws hard. Really hard. 103 mph in a game hard.

Which naturally brings out the people saying that he’ll need Tommy John surgery any minute. Now, we know that elbow sprains and velocity correlate highly, so while I’m not saying they won’t be right eventually, I want to focus on why we can’t predict it more accurately.

Miller has pitched his entire career in the data era, but his unusual background makes him an interesting test for this. Miller attended Division III Waynesburg after having played as a home-schooled athlete in suburban Pittsburgh. It doesn’t appear he attended any showcases ahead of college, nor was he heavily recruited as a grad transfer. However, I contact Waynesburg’s head coach Perry Cunningham - who was a longtime assistant before taking over - and the small school didn’t have any of the technologies like Trackman or Rapsodo while Miller was there. (Mason, a donation maybe?) Cunningham did point out a video that was done where Miller hit 95. They did (and do) have a radar gun. In other words, the data that might exist for many pitchers doesn’t for Miller, at least until he got to organized baseball.

Add in that Miller already has had a significant sprain to his UCL. That happened last year (‘23) and along with pre-draft physicals, we would have at least a few good MRIs to tell us more medical info on his elbow’s condition and changes. Miller was checked more than most as his diagnosis of Type I diabetes during college was a big reason he made such rapid developments. Already 6’5, Miller added mass and strength, along with velocity into the mid-90s. Even as a draftee, MLB Pipeline only rated Miller’s fastball as a 70. I asked Jonathan Mayo about this who explained the 70 came “as a combination of lack of innings and track record, inability to stay healthy, and, perhaps most importantly, inconsistency in commanding it at the time.”

Prior to this season, Miller had missed time with a shoulder strain and the elbow sprain. The A’s shifted him to relief, which is where he’s showing even more velocity as he doesn’t have to worry about stamina. But is this better? Is max force less time better for someone in triple digits? The data here is equally mixed. While Aroldis Chapman has been healthy over his career as a converted starter, most others haven’t been as lucky. The list is long, but there doesn’t appear to be any real evidence that relieving is better, though the Athletics front office likely has reasons to believe it’s the case for Miller.

So we have a lot of information. High velocity. Significant injury history. The complication of diabetes that was only recently diagnosed. (All evidence is that it is controlled now.) We have at least four years of data, plus some that goes back further. All that and I’ll defy anyone here to make an accurate prediction on when or even if Mason Miller will injure his elbow. (To quote myself, never root for injuries, but I’m making a point here, certainly not rooting for an exciting young pitcher to miss time.)

Let’s say we did have all that data. Walker Buehler was a top recruit, went to one of the most progressive and successful D1 schools in Vanderbilt. Vandy was one of the earlier Trackman installations, though it was part of a controversial exclusive access program. Let’s pretend the data is available and could be read, plus all the minor league and major league data. Add in medical data for Buehler going back through college, two Tommy John surgeries, and Statcast level data reaching back to 2013 - better than a decade!

Buehler’s had two Tommy Johns, so predicting a third should be a piece of cake, if such things can be done. Ignore that his revision was done differently and modern techniques should change results, but suffice it to say that there’s no one out there, anywhere — at least not yet — that can predict injury with the kind of granularity that makes it useful.

Remember, when I say “injuries can’t be predicted”, I’m speaking as someone that’s been doing this for over two decades and have one of the most accurate systems to predict injuries. I can tell you which players are riskier, why they’re riskier, and how much worry you should have, but I can’t tell you that any single pitcher is going to break down. Even the reddest light I’ve seen from my “The System” is in the 80th percentile and you just know that that player didn’t get injured in that year. The risk was down the following year and yep, shoulder surgery. As Nate Silver recently said, 30 percent events happen all the time. So do ones that are much lower.

We cannot say with any certainty that Mason Miller will get hurt. It’s likely and I hope the A’s do everything in their power to keep Miller healthy for as long as they can. It’s been impossible to predict for 20 years and I’m not sure that Chat GPT-5 is going to get that much closer. It may not be impossible forever, but if we’re not rooting for injuries - and we shouldn’t - no one should be predicting injuries. Sure, some troll will tell you Miller will break down and eventually, he’s likely to be right, even when he’s wrong.

But he’s still a troll. And if we’re smart enough to use AI transformers to predict injuries, we ought to get advanced warning to prevent them even more quickly. The good outweighs the bad, if it happens. We have more and better data than we ever have before, but the state of injury prediction and management isn’t keeping up.

And because of that, let’s get to the injuries:

CODY BELLINGER, OF CHC (fractured ribs)

Cody Bellinger took a pitch in the ribs. This is a time-honored baseball occurrence, but players haven’t really responded. They could wear off the shelf padding from football or lacrosse, but I don’t remember seeing any player do that except in the immediate aftermath of broken ribs. Even then, it’s rare. Part of it is those stupid “unwritten rules” and that pitchers have less command now, if they’re intentionally putting one in your side or back instead of your head.

The pitch Bellinger took didn’t look intentional, so don’t think that’s what I’m getting at here, but with the increase in velocity and decrease in command, we’re likely to see more of these. Velocity isn’t only a problem for elbows, but for ribs, hands, and especially heads. Players can say they don’t need hand pads or rib pads, and I’m sure they once said it about helmets and C-flaps, but it’s still not smart.

For Bellinger, he hits the IL with a rib fracture and he’ll miss at least two weeks, depending on how the ribs heal. They don’t need to be fully healed to play, just enough to be functional. In the meantime, Pete Crow-Armstrong will bring his mom back to Wrigley.

TRISTON CASAS, 1B BOS (fractured rib)

And sometimes, a pad wouldn’t have helped. Triston Casas swung so hard (or so awkwardly, probably both) that he fractured a rib. There’s very likely cartilage and muscle involvement as well, in that if they’re not damaged, they’re still attached and moving. One of the issues here, rather than with a traumatic injury like Bellinger’s is the whole breathing thing.

Unlike most injuries, there’s no cast or immobilizer. Casas (and Bellinger) are both still breathing and both likely feel it with each in and out. They can be made more comfortable with various means, but there’s not much besides that and finding a position where it’s least uncomfortable.

As with most fractures, modern medical science still hasn’t found a better or faster way. There’s some interesting work on nanogels that seem to create a bone regeneration matrix, but it’s been focused on osteoporosis and bone grafts. There’s some Japanese research using irradiation that’s promising, but it’s not near human trials and even the biohackers don’t mess with radiation much. For Casas and the Red Sox, it’s just wait and breathe.

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