Under The Knife 9/18/24

Tulsa Time

Ken Rosenthal is one of the nicest guys in baseball, so when he comes down strongly on the Dodgers for all their injuries, you know it’s because he’s well sourced and tightly documented. I want to focus on one area - Tulsa - where Rosenthal points out that the Double-A club was at one time the hardest throwing rotation in baseball, but now has four of their six key starters on the mend from arm surgeries.

The Dodgers are hardly alone here. Everyone has drafted and developed for velocity for one simple reason: it works. It has a cost, but it works.

The interesting thing here is that we have two sides of the same coin: a bunch of ready velocity at lower levels that succeeded when forced up, but also some immature arms that broke down alongside older arms that wore down. All at once, in an injury stack unlike one I’ve seen in twenty years of doing this. It feels kind of like climate change. A lot of little things happened, built up, and now everything is different. We have to adjust, or fail.

Too many people are willing to simply fail, or rather, watch others fail and whisper “next man up.”

One key issue for the Dodgers (and many others) is just how limiting they are with their minor league pitchers. There’s a grand total of 34 pitchers in the Triple-A International League that have gone 100 innings or more this season, as of Tuesday. In the PCL, it’s only 14. In Double-A Texas, it’s 17. The Southern is 15 and the Eastern is 26. I’m not sure why we see higher numbers for east coast-ish teams, but you can look at almost any organization and there’s going to be a handful of pitchers in the whole org over 100. It’s not reducing injuries, so what exactly is this doing?

I’ve also been staring at this page on Baseball Reference for about an hour. I have the concept of a plan here, but there’s so much unknown there. Which is one issue every team has. Even when teams can know so much more - biomechanics, sleep data, nutrition, throw count, etc - they’re still not good at synthesizing it into a program that works, largely because it would require change. The alignment for major change simply isn’t there, and won’t be until someone shows how to save arms and win.

For years, I stole a line from Dr. Glenn Fleisig, who once compared pitching arm injuries to smoking. Most don’t get lung cancer the day they light up, but there’s consequences and exceptions. I’m not sure that metaphor is apt any more, as we’re seeing higher and higher forces, younger and younger breakdowns, so just as the game is changing, we need new metaphors and new tools.

Because this isn’t changing and there’s not going to be less injuries to write about. For now, let’s get to them:

SHOHEI OHTANI, DH/P LAD (sprained elbow/rehab)

Buster Olney had some news. If you’ve been reading along this year, this should not be news to you, so play my theme song:

TYLER GLASNOW, SP LAD (sprained elbow)
TONY GONSOLIN, P LAD (sprained elbow/rehab)

Dave Roberts told the media that weekend scans show a sprained elbow for Tyler Glasnow. How sprained is unknown, nor is what’s next. It could be another elbow surgery, which would cost him much if not all of next season. If so, it would be the first known MLB revision of an InternalBrace procedure and Glasnow’s third elbow reconstruction. None of those sentences are good.

I do have to point out that this is close to sui generis, at least at this level. There are times when InternalBrace procedures have needed revision, but not at this level and usually they happen with much quicker timelines. Players trying to get to their senior season are more willing to take risks and with risks come consequences. There are no known pro-level revisions, but we also don’t know the exact number or style of operations, so I can’t give any sort of percentage.

This is still a new procedure with variations in technique, so we don’t know exactly what happened or if there was any sort of “failure.” An InternalBrace elbow was never supposed to be invulnerable, but this does raise the specter that we’ll have more, in some number. Yes, this is different and we don’t yet know how or why.

Remember that Glasnow not only was traded and accepted after the surgery by the Dodgers, but had a second and very complete physical before signing his extension. Add in that the Dodgers medical staff is led by Dr. Neal ElAttrache and I’ll defy anyone to say that they truly predicted Glasnow’s breakdown so soon, if at all. The Dodgers are left with a shorthanded rotation that’s exposing their younger pitchers in the now, but next year? As I said above, this year’s cake is already baked in terms of what they’ve done with developing pitchers, including with guys like River Ryan and Justin Wrobleski, as they had with Emmett Sheehan the year before. Changing it now is impossible, but 2025 is where they have to adjust. That means another year that could look a lot like this one.

Before we leave the Dodgers, let’s add to the intrigue a bit. Tony Gonsolin will have one more rehab appearance in Oklahoma City before returning. He went 2 2/3 in his last outing so let’s say he could get three, maybe four innings. Does that make him a playoff starter or at least a bulk piece that could follow a Clayton Kershaw open? My guess is that we’re going to see more creative uses of pitchers in the playoffs, with the old school “reward starters!” kicking and screaming through October.

So I’ll ask the DePodesta question: if we weren’t already doing it this way, is this the way we would start? Starters are a relic of an era where lower effort was required and smaller forces were placed on arms. Do we want less injuries, or more starters, Mr. Manfred?

Remember, no UTK on Friday due to travel, so read about Francisco Lindor, Mike Trout, and much more by subscribing. I’m also on the latest episode of Downstream with Jason Snell, if you’re into that sort of thing. (Watching sports on TV? I bet you are.)