On a warm, windy day in Tampa, everyone—fans, coaches, other pitchers—stops what they’re doing to watch Brett Marshall throw. It’s just a warm-up, with no actual game action scheduled for a few more days, so he’s not really letting it fly, but he doesn’t have to. Everyone is still staring.
It’s not the velocity, although that’s there. It’s not the distinctive thump of the ball hitting the catcher’s mitt the way it does only for those blessed with such lightning arms. It’s how easy it looks. Each motion looks like the last motion, which looks like the last motion, which looks like the last motion. The fastball comes in at a consistent 94 mph, but it’s the changeup, widely considered his best pitch, that you have to keep an eye out for; the arm action is perfectly deceptive for being so repeatable. Marshall looks fluid and simple, like he could throw forever. To watch him pitch is to think that throwing a baseball is the most natural thing in the world. When he finishes, a group of fans standing on a walkway above burst into applause. He has simply been playing catch.
In the clubhouse afterward, Marshall is taking a sip of water and checking his iPhone with his non-throwing hand. He is 22 years old and seems unaware of the show he’s just put on. The display is over, just another workout session in a career full of them. Marshall has been in the Yankees organization for five seasons, and has climbed through the team’s minor-league ranks at the exact pace you’d want him to. He will likely spend this season in Triple-A Scranton, one stop from the bigs, where guaranteed contracts and the major-league-minimum salary of $490,000 a year, at the very least, await. If he puts up the kind of numbers scouts think he’s capable of—double-digit wins, with a 4.00 ERA, 175 innings a season, say—he could well earn $10 million a year or more. He’s on the verge of becoming a millionaire and playing for the New York Yankees in front of the entire world. And he knows it could all blow up in a second. “You just want your arm to hold up,” he says. “You have to not think about it. I do not, man. Not at all.”
There’s something strange about almost every snapshot ever taken of a professional baseball pitcher while he’s in his windup or his release: They look grotesque. A pitcher throwing, when you freeze the action mid-movement, does not look dramatically different from a basketball player spraining his ankle or a football player twisting his knee. His arm is almost hideously contorted.
“It is an unnatural motion,” says former Mets pitcher and current MLB Network analyst Al Leiter, who missed roughly three years of his career with arm injuries. “If it were natural, we would all be walking around with our hands above our heads. It’s not normal to throw a ball above your head.”
Ever since Moneyball, baseball has had just about everything figured it out. General managers know that on-base percentage is more important than batting average, that college players are more reliable draft targets than high-school players, that the sacrifice bunt is typically a waste of an out. The game has never been more closely studied or better understood. And yet, even now, no one seems to have a clue about how to keep pitchers from getting hurt.
Pitchers’ health has always been a vital part of the game, but it’s arguably never been more important than it is today. In the post-Bonds-McGwire-Sosa era (if not necessarily the post-PED era), pitching is dominant to a degree it hasn’t been in years. In the past three seasons, MLB teams scored an average of roughly 4.3 runs per game. The last time the average was anywhere near as low was 1992, at 4.12. In 2000, the heyday of Bonds & Co., it was 5.14. A team with great pitching is, in essence, a great team. Pitchers themselves have never stood to gain, or lose, as much as they do now. The last time scoring was this low, the average baseball salary had reached $1 million for the first time and the minimum salary was $109,000. Now that average salary is $3.2 million. Stay healthy, and you’re crazy-rich. Blow out your elbow, and it’s back to hoping your high-school team needs a coach.
And yet, for all the increased importance of pitching, pitchers are getting hurt more often than they used to. In 2011, according to research by FanGraphs.com, pitchers spent a total of 14,926 days on the disabled list. In 1999, that number was 13,129. No one is sure why this is happening, or what to do about it, but what is certain is that teams are trying desperately to divine answers to those questions. Figuring out which pitchers are least likely to get hurt and helping pitchers keep from getting hurt is the game’s next big mystery to solve, the next market inefficiency to be exploited. The modern baseball industry is brilliant at projecting what players will do on the field. The next task is solving the riddle of how to keep them on it.
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.
So why the rise in injuries? Here, too, the theories are based more in apocrypha than science. Nolan Ryan is among those who have floated the idea that pitchers, with their pitch counts and innings limits and specialized roles, actually aren’t throwing enough. This belief is often steeped in a kind of nostalgic machismo. “When I pitched, you had one mentality: When you started the game, you wanted to finish the game, no matter how long it took you,” the former Red Sox pitcher Luis Tiant has said. (Tiant, it’s worth noting, had his fair share of injuries in his career.) Others blame the injury epidemic on the modern fashion for power over finesse pitching and the riches that now await a kid who can hit the mid- to high-nineties on the radar gun. Young players’ fathers sometimes pay hundreds or even thousands of dollars to a small but growing number of for-profit companies that promise to evaluate videotape of a player and offer insight on how he can change his mechanics to throw hard but still avoid injury. But youth injury rates are as alarming as those for professional players. The American Sports Medicine Institute, a nonprofit research group, has found that five percent of all kids pitching at the age of 12 will have either had some sort of surgery or quit baseball because of a serious arm injury by age 22.
According to Baseball America’s 2013 Prospect Handbook, Brett Marshall is the No. 6 prospect and the No. 2 pitcher in the Yankees system (behind 20-year-old Venezuelan Jose Campos). He “profiles as a durable, sinkerballing No. 4 starter—not the Yankees’ prototype prospect but a useful trade chip,” the handbook reads. It also notes: “He struggled mightily before having Tommy John surgery in 2009.”
Marshall is a Texas kid (baseball scouts have long had a fetish for Texas pitchers, from Ryan to Roger Clemens) who exploded on the scouting scene his junior year in high school. The fact that he had started out as a shortstop made many scouts believe he would be less injury prone because he’d thrown fewer pitches (the “you only have so many bullets in the gun” theory). Marshall lost the last start of his high-school career when he hit a batter in the state semifinals to force in the deciding run. It was his 146th pitch. The Yankees drafted Marshall in the sixth round in 2008. He pitched a total of twenty games (poorly; his ERA was 5.21) before his arm started feeling sore and the Yankees shut him down. He then had Tommy John surgery. He was 19.
Developed by orthopedic surgeon Frank Jobe in the seventies, Tommy John surgery involves taking a tendon from the thigh or forearm and grafting it onto the elbow to, essentially, reconstruct the damaged ligament. Because the procedure has become so common—there are at least 40 Tommy John surgeries a year in MLB and the minors alone—and because a number of high-profile pitchers (from the Cardinals’ Adam Wainwright to former Yankee A. J. Burnett) have not only saved their careers but thrived after undergoing it, the surgery is often thought of as a panacea, if not a rite of passage. Marshall was almost happy to have it. “I saw all these other guys having it, and I knew I was gonna have it someday. I ended up having it earlier in my career rather than late. It really isn’t a big deal.”
In fact, the surgery takes at least a year of recovery and is far from a guaranteed success. The majority of players who undergo the procedure do return eventually, but while some of them claim they come back throwing harder, that’s mostly anecdotal information. While there are pitchers like John Smoltz, who was better after the surgery than before, there are also those like Francisco Liriano, who has never been the same since his operation in 2006.
Marshall was at least humbled enough by the surgery to take it as a teachable moment. “I was like, This is a time I can fix everything,” he says. “I watched tons of video comparing myself to other big leaguers to see what they do right. I knew what I was doing wrong, and I knew I had to fix it. If I didn’t, I was going to have to go through it again.” Now, he says, “I feel like I am healed. I feel like I will be good.”
Chris O’Leary is a St. Louis father who was coaching his 9-year-old son in 2005 when, inspired by his own childhood arm problems, he set out to find the perfect mechanics to keep pitchers healthy. After reviewing hundreds of major leaguers to see what the healthy pitchers were doing differently from the unhealthy ones, he discovered something strange. Many of the pitchers who kept getting hurt—Smoltz, the cursed Mark Prior, Jeremy Bonderman—had a similar motion, something he learned was called “the inverted W.” O’Leary defines the inverted W as “being more than 90 degrees of shoulder abduction with the Pitching Arm Side (PAS) elbow above the level of the shoulders combined with five or more degrees of shoulder horizontal adduction.” But what it really means is that at the midpoint of a pitcher’s motion, his elbows are above the shoulders, making a sort of sideways W. That technique can throw a pitcher’s timing off, which can, in turn, put undue stress on his arm. It was, to O’Leary’s eyes, a recipe for Tommy John surgery.
And it was precisely what was being taught to young pitchers. The idea was that pitchers who weren’t especially tall or strong could increase their velocity by essentially whipping their arm forward. In many cases, this worked. But O’Leary says it’s inviting a lifetime of arm troubles. “Naturally speaking, a lot of these guys shouldn’t be able to throw over 88 miles per hour,” he says. “They’re using the inverted W for fake velocity that will cost them in the long run.”
O’Leary went online with his theories. As much as anything else, O’Leary is a showman; on his website, he sells a business self-help book called Elevator Pitch Essentials: How to Get Your Point Across in Two Minutes or Less. Suddenly, he was no longer Chris O’Leary: He was the self-styled Pitching Mechanic. Suddenly, his site was being visited by young pitchers and their parents and even, eventually, major-league teams. One of the people who contacted him was Wiemi Douoguih, the head team physician for the Washington Nationals. One of the people O’Leary had predicted injury for was Stephen Strasburg. In O’Leary’s eyes, Strasburg was a classic violator of the inverted-W movement. “We hadn’t seen work like his,” Douoguih told me, “and it was relevant, we thought, to our situation.”
Chris O’Leary, mind you, is not a doctor; he is just a guy with a website. But it speaks to how bewildering the world of pitcher injuries is—and how desperate teams are for any sliver of understanding—that the Nats reached out to him. “It turns out that he or someone in their organization heard me talking on the radio to a D.C. station about Strasburg, and he actually commissioned a study to look at my conclusions on the inverted W,” O’Leary says. “It is not a hugely rigorous study, but the gist of what he told me is, ‘I see what you see in terms of the relationship between arm action and injury rates.’ ” O’Leary says he’s going out to D.C. to give a presentation to Douoguih and other medical professionals in May.
Another inverted-W believer: Brett Marshall. He attributes his past arm problems to being taught that style. “It was inverted W, it was totally that,” Marshall says. “I was bad. When I landed I was down, and I knew what I was doing wrong.”
Glenn Fleisig, a biomedical engineer, is the research director of the American Sports Medicine Institute and one of the men at the forefront of the study of pitching injuries. (His longtime research partner is the well-known orthopedic surgeon James Andrews, who has treated many professional athletes.) “I’ve dedicated my career to this issue, and let me tell you: There is no magic,” Fleisig says. “We’ve made great strides, but baseball pitchers will always get hurt. All we can do is reduce the risk.” Poor mechanics are certainly a factor, Fleisig says: “It doesn’t matter how many miles you put on a car. If the tires are misaligned, you’re gonna have a blowout.” But what he emphasizes to the teams he works with is that pitching is, by its very nature, breaking down. “Every single pitching injury is a cumulative injury,” he says. “Pitchers say, ‘Oh, it was a cold day, I felt something pop.’ But something was going on for a long time; the arm muscles had been eroding.”
Pitch counts and innings limits are probably a good idea, but no one knows exactly how much rest is necessary, Fleisig says. “Every person is different than every other person. That’s humanity.” The trick, he believes, is spotting when a pitcher is tired or hurting or getting him to tell you that—“human interaction,” he says. Human interaction, of course, is also complicated. Major-league and college teams, high-school and Little League coaches—even well-meaning fathers—all have incentives to push pitchers too hard, as do the pitchers themselves. Success, pride, and in some cases millions of dollars are on the line.
Even when a team and a pitcher have the best intentions, in other words, the pitcher still might get hurt. Pitching is an unnatural, violent motion. A pitcher probably will get hurt. All he can do is go out there, take the ball when it’s his turn, and hope that today’s not the day his number comes up.
“Every now and again,” Marshall says. “You get the thought of, What if it’s happening again? But you can’t think that way. You just have to put it out of your head.”