Consider what happened to Stephen Strasburg last year. Fearing the fragility of their star pitcher’s right arm—the 24-year-old multimillion-dollar phenom was just two years removed from Tommy John surgery, the go-to procedure for fixing pitchers’ injured elbows, named after the former Dodgers and Yankees star—the Washington Nationals shut Strasburg down on September 7, after he reached a total of 159 innings for the season. Although the Nationals had the best record in the majors, thanks largely to Strasburg, that meant that they, and the rest of us, would have to experience the postseason without perhaps the most exciting young pitcher in the league. The Nationals ended up losing their playoff series to the St. Louis Cardinals in five games, and many have argued they would have won if they’d had their ace. The thing about the Nationals’ decision was that it was arbitrary: They have more information than we do about Strasburg’s health, of course, but they also had no assurance that Strasburg would be more healthy because of his innings limit. They were, effectively, just guessing. It might have cost them the World Series.
The medicals on pitching aren’t terribly complicated. There are two major issues. One is with the joints; the major pivots in a throwing motion are the shoulder and elbow, and the unusual motion of throwing a baseball causes undue stress at both places. The other is with muscles, ligaments, and tendons. When a pitcher throws a baseball, he causes millions of tiny tears in those structures, from the shoulder down to the elbow. Arm soreness is the body’s way of telling a person it needs to rest so all those tears can heal. (That’s why many pitchers, and not just hitters, use performance-enhancing drugs; they can speed healing as well as build bulk.)
The modern quest to prevent injuries starts with the search to identify pitchers who are less likely to get hurt in the first place. During the scouting process, teams often watch a player’s biomechanics, comparing him on video to successful, healthy players to see if his pitching motion is potentially dangerous. Some look for certain “checkpoints” during a delivery to identify warnings signs. But those methods vary from team to team and, sometimes, from doctor to doctor. Often what teams use is basically folk wisdom. According to one theory, it helps to be tall. Pitchers like Randy Johnson and CC Sabathia are said to be able to leverage their height to generate torque so their arms don’t have to do as much work. A smooth, good-looking delivery is also thought to be desirable—pitchers with unusual or complicated motions (think Tim Lincecum) are thought to put undue stress on the arm. Scouts also look for pitchers with big asses. The more power in the lower body, or so the thinking goes, the less stress on one’s arm.
Once a pitcher is signed by a team, he is treated with the obsessive care of a prize Thoroughbred. Several Yankees pitchers I interviewed, from Dellin Betances to Adam Warren, talked about how the minute the Yankees drafted them, their whole training regimens changed. In addition to scores of precise stretches, exercises, icing sessions, and the like, that can mean intricate and often confusing throwing schedules. At one point during spring training, David Robertson, baffled by a chart in the clubhouse, threw up his hands and said, “Someone just come grab me when they want me to pitch, and I’ll pitch.” There seem to be as many protocols as there are teams. The Rangers CEO and Hall of Fame pitcher, Nolan Ryan, who was known in his playing days for his powerful (and injury-resistant) arm, prefers his team’s pitchers to play long toss often, something usually discouraged until recently. The Orioles have banned certain minor-league pitchers from throwing so-called cut fastballs. The White Sox, who have lost fewer innings to injury than any other franchise, have famously kept their methods a secret.
Pitch counts (and innings limits), meticulously tracked for every pitcher in the game, are perhaps the most valued metric in the injury-prevention business. Back in 1989, Yankees manager Dallas Green, in order to “stretch out” 23-year-old phenom Al Leiter, forced him to throw 163 pitches on a damp day at Yankee Stadium in April. He pitched three more games that season (all losses), went on the disabled list, and pitched in a total of eight games over the next three campaigns. By the time he was a major-league regular again, he’d had three surgeries, and it was 1993. “That was just abuse,” Leiter says. “Two starts later, I could barely lift my arm. That derailed my entire career.” Today, though, you’d never see anything even close to that. Only once since 2005 has a pitcher logged as many as 149 pitches in a game (and that was a no-hitter by Edwin Jackson, a special circumstance). The Yankees’ Sabathia, considered one of the most durable pitchers in the game, never went above 121 last season.