UTK Free Friday 8/7/20

Big Flex, Scherzer, Betts, drug testing, and more

We’ve had over 30 pitching arm injuries in the first two weeks of the season. Normal? About 11.5. Yes, 2020 is different.

The rash of flexor muscle and flexor tendon — often called the flexor mass, together — is hurting baseball now. It’s tough to do any apples-to-apples comparisons of numbers because of how the season is playing out, but big names like Justin Verlander, Shohei Ohtani, and several others are having this problem, shutting them down and changing the game.

So I went to another gamechanger. Gary McCoy is a sports scientist originally from Australia that has worked with several major league, Olympic, and high level foreign teams, including one that went a full season without any non-traumatic injuries. (More on that one in the near future.) I asked Gary for his ideas and he kindly allowed me to publish them here:

The amount of forearm/flexor strains in MLB ( assuming an accuracy of diagnosis, and a public transparency of injury reporting and yes, go ahead and unpack that one) enables the externally derived theory postulation of "muscular load imbalances" between lifting sessions, isolation activities (both postural and communication based) and poor ramping to “intentional acute throwing” as a possible culprits.

Most injuries are multifactorial. In fact - if data was available - we’d leverage a multivariate analysis of factors leading to the injury and determine the risks. Flexor/Pronator strain is nothing new in the cited epidemiology for throwing athletes. The key aspect of this muscle and associated connective tissues is the dynamic support against valgus stress. In fact, it may be the second to last domino to fall prior to the dreaded UCL tear. (Will’s Note: This is often cited incorrectly as a flexor strain “leading” to UCL sprain. This is incorrect; Gary’s right.)

The fact that common flexor pronator strains often present from repetitive gripping moves us to ask the question: “how much and what lifting” occurred with the individual athlete from the pause through to the resumption of play? A number of players publicly reported greater amounts of weight room use due to a reduction in baseball activities. This may be just one of the reasons but an important one - excessive grip overload of this muscle group.

In isolation (and we can all attest to this): Two associated to injury variants from a dynamic baseball lifestyle occur.

First, sedentary postures result in an adaptive redistribution of alignment. Increased kyphosis and hip external rotation due to increases in sitting will maladapt an elite moving machine such as a pitcher. All it will take is a 1mm internal shift in kinematics - applied to a center of mass or weight increase- to exacerbate load at distal structures. It often amazes me how our industry seems to isolate adaption to only planned structured athlete activities. If only - we had an adaptive off switch we could toggle!

Zoom Fatigue is a “new-normal”, as is increasing utilization of keyboards and cell phone technologies. Increased kinematic actions of ulna deviation coupled with wrist extension can exacerbate loading volumes in the elbow region - specific to the flexor pronator and associative structures.

For a pitcher ramping up for a season- this has been historically similar road map- almost identical annually to the day an athlete begins his offseason and his report to spring training. This year's schedule shock means resilience - a factor unlikely measured by MLB medical staffs - has stressed the pitching process to faster increases in acute "intentional throwing" loads. Kinematic sequences must have a harmony of activation, inhibition, lengthening and integration from an adapted schedule.

Couple all of these potential factors and we're painting a picture of a kinetic scaffold that had weak points, an inability to compensate, and thus, had to collapse.

Muscles weren’t ready. Joints weren’t ready. Connective structures were at new stress levels and creating a new baseline for an adaptive "on-ramps" as Sports Performance Scientists have created for teams in Soccer by assessing historical athlete resilience per game could have been designed for pitchers.

Knowing the load ramping for an individual athlete has little to do, if anything physically, to innings count and pitch count. A “strain per-pitch” adaptive ramp is what was needed, continues to be necessary, and was likely under-designed for the injured pitchers.

Hindsight to injury, however, is always 20/20. This is an acute and strange season that, if anything, enables teams to evaluate not only their athletes but the systems in which they are managing them.

That’s a lot to think about, but I think Gary’s on the right track here. I’m curious to see how baseball will address this problem … and I’ll discuss the biggest issue with that response in Monday’s UTK. But now, let’s look back on the biggest injuries of the week:

Max Scherzer SP WAS (strained hamstring)

Just as the Nationals are ready to get Stephen Strasburg back, they may have to skip at least a start from Max Scherzer. Scherzer was pulled after an uncharacteristic first inning where he looked to be laboring. After the game, the team admitted he’d been pitching through a sore hamstring for the last couple outings. I went back and looked at a bit of his last start and I don’t see anything, but we’ll take their word for it. This time around, the hamstring was more of an issue so they pulled him to make sure it got no worse. Let’s hear from Scherzer himself:

The downside here is, it obviously got worse from one start to the next and that a few days off with treatment didn’t clear it up, assuming he was dealing with this previously. That means his next start, at the very least, is in jeopardy of a delay or even an IL stint. If this is just a low-grade hamstring strain, the Nats would be smart to get this cleared up now. It shouldn’t be an extended absence and Scherzer in form is clearly key to their hopes.

Roberto Osuna RP HOU (sprained elbow)

We haven’t had a lot of Tommy John surgeries since baseball re-started. No one’s really sure why, but my explanation is that most pitchers kept throwing over the pause. Even if they weren’t on a specific program designed to maintain their workload at a certain level, they did enough to not let it drop so much that a restart threw them into a danger zone.

Then again, just because we see a general trend doesn’t help specific problems. That’s where Roberto Osuna is and call it karma if you like. Osuna had an MRI that told team doctors that he would need Tommy John surgery. Between that and manual tests, it’s pretty easy to say “yep, that UCL is torn”, so a second opinion usually comes in when the pitcher is shopping for a surgeon more than hoping for a different diagnosis.

The question with this and with all major arm surgeries right now is timing, in two ways. First, 2021 is essentially wiped out by a rehab. While I’m on record as saying I think the rehab time could be reduced, those things aren’t happening and the standard 14-16 months puts Osuna into a ‘22 return if he has the surgery by December. That’s the other part - assuming no nerve involvement, Osuna could wait to have the surgery in hopes that the world gets a bit more normal and flying to LA for surgery isn’t risky.

Mookie Betts OF LAD (sore finger)

This is beginning to feel like more than just a “sore” finger for Mookie Betts. This is a world class athlete with world class care at his fingertips (forgive me), yet there’s no word here of any detail on how this happened or what the root of the issue actually is. No leaks is the mark of a good organization in some ways, but it’s also frustrating in that I feel teams should be open and honest with their fans. Even if there’s no fans in the seats, there’s no value to hiding injuries.

That’s not to say there’s anything nefarious going on here. Non-specific can mean something as simple as “we’re not sure” and with someone like Betts, you definitely want to be sure. Fingers can be oddly problematic because they have a lot of small structures that have to work together. Get one of them out of alignment or functioning just a bit off and the whole thing can go literally non-functional and very painful.

To top it all off, Betts came in as a defensive replacement. That would seem to indicate that the Dodgers don’t think there’s a risk defensively and perhaps that gripping the bat is the bigger problem. This one obviously bares watching, but I’m not sure we’re going to get much more info absent a leak.

Nick Madrigal IF CWS (separated shoulder)

There’s video of Nick Madrigal’s awkward slide (and Avisail Garcia’s great throw) on this page. As you see, Madrigal comes up holding his wrist, which notably has a wristguard. The more I look at it, the more it appears that Madrigal essentially lands on his elbow, jamming his humerus (upper arm) into his shoulder.

And then word came out Wednesday evening that that’s exactly what happened. That force dislocated his shoulder, which certainly explains the discomfort and the way he acted. The medical staff was able to reduce the dislocation quickly, so now the question is what kind of damage happened inside. If it’s a simple stretch of the structure, he should be back relatively quickly, but the Sox don’t need to rush Madrigal back at this stage. He’ll go to the IL, make sure the shoulder is stable, and be back when his shoulder is structurally sound.

This is a flat out fluke injury. Madrigal probably doesn’t slide like this normally and I’ll bet he makes sure he doesn’t again. He landed funny, just a bit wrong, and an injury happened that could have been much worse than what it is.

Forest Whitley SP HOU (unknown arm injury)

There was a time not long ago when Forest Whitley was going to be the next great Astros ace, stepping in when Gerrit Cole left. That hasn’t happened and might not for a while. He’s been shut down and the next step is to see “a doctor,” per Brian McTaggart of MLB. There’s no clarity on the arm soreness and less about the doctor, which could tell us a lot about the issue.

Whitley has been injured or limited since 2018, when he popped for adderall. Oblique, arm, back … it’s all kept him down, while the Astros have had some hard innings caps on him in the minors on top of that. A new arm injury would be different but hardly good. I’ll be watching to see what and where the injury is, with a lot of worst case scenarios running through Astros fans minds in the meantime. The next clue will be whether the Texas native goes to a team doc or to one of the super surgeons.

As you can see in the video, Whitley is a tall (6’7) over the top pitcher who uses plane to generate misses, along with plus velocity. The downside, as you can also see, is he has long limbs to control and a lot of timing issues. Watch his foot land and see where his arm is at that point? It’s different on almost every pitch. He’s still young and tall pitchers often take longer to develop, but they have to stay healthy in order to do that.

Kent Emanuel SP HOU (positive drug test)

Astros minor league pitcher Kent Emanuel tested positive for a “performance enhancing drug”, specifically DHCMT. This same drug has shown up since 2015 in samples and while I’m seldom in the camp of buying “I had no idea” excuses, this is the one drug that seems to regularly pop into supplements. Nats catcher Tres Barrera popped for it earlier this season, perhaps in the same round of random testing in camp.

This is no excuse for me. If an athlete is taking a supplement, not only should they be buying only NSF-rated supplements, but they should be saving and marking a portion of each bottle for precisely this purpose. If a supplement is tainted, an athlete could show that through that saved portion. Others have done this, specific to DHCMT, and had suspensions reduced. Athletes are still at risk for anything they put into their body, so again, I’m not excusing Emanuel. I’m just surprised that this particular drug keeps showing up when it is relatively ineffective and easily detectable.

Quick (New) Cuts:

Aroldis Chapman continues his ramp up, but a source tells me it’s going slower for one easy reason. “COVID. He’s still not 100 percent in terms of strength. Don’t be surprised if he has to pitch more this season rather than just throw it by people” … George Springer came out of Thursday’s game with a worrisome wrist injury. X-rays were negative, but the Astros are calling this a strain, meaning muscle or tendon. Wrists for hitters can linger, so this bears watching for more detail … In a hello/goodbye, the White Sox get Tim Anderson back from his groin strain, but lose Nomar Mazara to a foot bruise after HBP. The Sox are already thin in the OF and no, Luis Robert can’t play all of it himself … Triceps inflammation is pretty non-specific, but unusual for pitchers. The question is whether the inflammation is at the shoulder side or the elbow side, but for Yonny Chirinos, it means he’s headed to the DL while the Rays work on this. Trevor Richards takes his spot in the rotation, but I expect the Rays might get more creative with their rotation as well … Elbow inflammation isn’t more specific either and that’s what sends Trent Thornton to the IL. He’ll have more imaging while Chase Anderson comes off the IL to take his slot … The Pirates need to read today’s part on flexor strains and arm injuries. They just lost Michael Feliz to a flexor strain and are awaiting word from doctors on Nick Burdi. Teams with financial limitations get the most bang for their buck if they get smarter. Just sayin’ … Jo Adell barely had time to say Hello (sorry, had to) before injuring himself. His quad strain isn’t thought to be serious, but he will miss a couple days to heal up.

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