Zimmerman's Tommy John Primer

Ulnar Collateral Ligaments
are fragile when you throw
really hard.

The Reds have fortunately managed to largely avoid entanglement in ulnar collateral ligament repair surgery this year, but it is a major topic of interest in baseball because of the recent spike in the surgery that we are seeing.  Jeff Zimmerman penned the first part of an excellent primer on Tommy John Surgery at Hardball Times.  Of note: 20% of pitchers who have the surgery just don't make it back, velocity does NOT increase in the years following the surgery, and pitchers typically struggle their first year back.

The latter is probably well-known.  But the first point is not well appreciated, and the second is an important myth.  A few month ago, on Effectively Wild, Stan Conte, the VP of Medical Services of the Los Angeles Dodgers, was on for an interview about pitcher injuries.  One of the points he made is that the myth of increased velocity resulting from Tommy John surgery has resulted in some ridiculous scenarios.  Among them are stories of fathers requesting the surgery for their completely healthy sons in hopes of helping them to add velocity.  Can you imagine?

Zimmerman's next piece will investigate probable causes of the injuries.  The biggest culprit in conversations I've read and heard are fastball velocities, which continue to rise.  I'm looking forward to seeing the data on that, and whether those claims hold up.

Update:
I received this tweet last night.  It provides two great links to Jon's work that addresses my last paragraph:

@jinazreds I looked at TJ surgeries and pitch velocities at BtBS in two parts: http://t.co/enLjjKZHqG and http://t.co/LDLTlR3rI4
— Jon Roegele (@MLBPlayerAnalys) July 1, 2014

Update #2:
Here's Zimmerman's second part, with an excellent summary of his findings (all of which I agree with):

1. Pitchers are developing their shoulders better. This leads to a pitcher’s elbow giving out before his shoulder.
2. Pitchers are throwing at a higher velocity, which means more stress on the elbow. More stress means more of a chance for a snap or rip.
3. Younger pitchers are putting undo stress on their arms at too early an age, with too many innings and not enough rest time. The pitchers are damaged goods before they make it to the majors.

Joey Votto's Injury

Get well soon, Joey Votto.
Photo Credit: Keith Allison

John Fay's article this morning on Joey Votto's injury was a little disturbing.

First, this quote from Bryan Price, which appeared in another article yesterday (I think?):

"The soreness – I can't say it's completely gone – but it's much more controlled," Price said.
"But the strength deficit is still a concern. To me, it made more sense to get Joey as close to 100 percent – that may not be possible this year – but as close to it as we can and give him a better foundation on which to play as opposed to getting him back at 50 percent because we didn't give him an extra week to 10 days to get that stability back in in his leg."

I teach a human anatomy & physiology course, but I'm certainly not qualified to provide medical analysis. So take the following with a grain of salt: this just seems weird to me. If it's just a quadriceps strain, as was originally reported, it seems like this is something that should be able to heal with rest. But this sounds more like ligament/tendon/fascia/cartilage troubles, which are notoriously slow to heal because they don't receive good blood supply.

And then there's Votto's own comments on the injury:

Asked what he could do now that he couldn't do because of the injury, Votto wouldn't go into specifics.

"That's really none of your business," he said. "I'm not going to tell you that. I'm getting stronger. I don't really want to tell you what I couldn't do before and what I can do."

...

Again, it's Votto's right to keep quiet about the injury to the media. A couple of days before he stayed back on the trip, he was asked if he was healthy.

"I feel fantastic," he said.

We know that wasn't the case.

"I like to lie a lot – I usually just tell people I feel great," Votto said.

I get that he's frustrated, and that he's a private guy. But as a fan, this kind of thing is hard to read without becoming alarmed. Something about it reminds me of Albert Pujols' struggles with plantar fasciitis. While Pujols has been quite good this year, his leg issues dogged him for at least a full season...and there was talk that it might never go away.

So, I worry that Joey Votto is dealing with chronic troubles with his knee.  He's already had part of his meniscus removed, and then had a second surgery to repair some sort of additional damage.  Yes, he was healthy all of last season.  But now, he's suffering from soreness and weakness from the same general area.  Hopefully, this is just a matter of temporary inflammation that can be brought under control.  But ...well, yeah, I'm worried.

Cingrani to the DL

Tony Cingrani had a rough game yesterday.  He didn't give up a ton of runs in his 4 innings of work, but he threw a lot of pitches and clearly wasn't sharp.  Furthermore, in the 4th inning, his velocity started to really slip.  After that inning was over, I wrote this on the twitter:

Cingrani also sitting 87-89 mph on his fastball... umm.. RT @ctrent: That’s 79 pitches for Cingrani through 4 innings #Reds
— Justin inhisbasement (@jinazreds) May 1, 2014

Here that is graphically:

Big drop, right?

Seconds after my tweet, I started seeing reports that Nick Christiani was warming in the bullpen.  Cingrani was lifted.  It ended up being a pretty bad night for the bullpen, but sending Cingrani out there to pitch again would have been risky...not just because he wasn't throwing well, but because it seems likely that pitchers throwing when they're tired are at risk for injury.

Then, this afternoon, we got word that Cingrani was being placed on the DL:

Cingrani was clearly unhappy with the move. "I don't know why they do a lot of things. I don't agree with it," he said. "But if they don't want me to injure myself, I understand. I think I can keep throwing, but they're exercising caution."

I commend Bryan Price and his staff for acting quickly on this.  They are protecting a young pitcher from himself.  It might well be that Cingrani would be fine in his next start.  But this break will allow him to (hopefully) recover, and to build some arm strength so that he can get back to being himself.  Furthermore, it has the additional benefit of helping to limit his innings.  Cingrani only threw 135 innings last season after throwing 150 the year before.  I would guess that the Reds won't want him throwing more than 180 innings this year (or thereabouts).  If 15 days means three starts, that's potentially around 15-20 innings that Cingrani will log onto his arm.