Will Carroll Chat - 2004-May-03

[Tim]

North Side Baseball welcomes Will Carroll, who is here today to talk about the Cubs, keeping pitchers healthy and what the various teams in MLB are doing to improve in that area.

 

If you have additional questions during the chat, please enter them in the "Questions for Will Carroll" thread.

[Will Carroll]

Will,

 

I'll start off with the first question. You spend a lot of time talking with industry luminaries like Dr. James Andrews, Dr. Tim Kremchek, etc. What are people like that saying about how to keep pitchers healthy?

 

 

First, thanks for inviting me in Tim. I'll try to get as many questions in as I can. I hope everyone reads UTK and the rest of the great content at BP. I also hope everyone enjoys Saving The Pitcher. It was really a great process and one I hope will live up to the title.

 

Dr. Andrews set up ASMI to "put himself out of business" as he says. He believes his legacy will be preventing injuries through research and education. With ASMI and other places like the National Pitching Association, we're working to get the scientific information out to all pitchers. As far as what doctors do day to day in prevention, it depends on the doctors and the team. Most do what they can, but they don't have much say in on-field decisions and end up as reactive rather than pro-active. Few teams take a truly holistic approach.

[Will Carroll]

Thanks for your time.

 

Do you think pitch counts are overrated? Do you think that there should be a set pitch count, or do you think observation and gut feeling should be used? What do you think is the best system?

 

Also, do you think it really depends on the pitcher? Someone like Kerry Wood is capable of going 120+ pitches per outing, but does that mean he should? Do you think he's being abused?

 

Thanks again.

 

Pitch counts are important, but putting them in context gives them meaning. As you say, each pitcher is different and pitch count alone doesn't tell us much. Was it hot? Was this the second or third high-stress outing? Was his mechanics holding up? Was he pitching more breaking stuff?

 

PAP (Pitcher Abuse Points) does the best job at giving context independent of being in the dugout, but pitchers still must rely on their coaches and themselves to monitor their workload individually.

 

I think the word "abuse" is a bit loaded. It's not like child abuse where it's all bad. There's a fine line a team must walk between protecting their pitcher and getting maximum effective usage.

[Will Carroll]

Of the cubs young starters, which ones do you think are most likely to have elbow or shoulder surgery someday?

 

Tough question. I worry more about the guys in the minors than I do Zambrano or Prior. Nate Silver and I did some research and the injury nexus is actually lower than previously thought, but also more predictive.

[Will Carroll]

Thanks for taking the time.

 

This has happened to me, and I'm sure it has happened to you. What do you say to someone who is unwilling to believe that throwing 130 pitches is a bad thing for a pitcher to do, beyond just ignoring them and moving on? Is there any certain argument that you know of that tends to get people to at least consider having an open mind?

 

Some people can't be saved.

 

Science shows us that there's a breaking point. Sure, there are freaks and its hard to see cause and effect when there might be years between them. I'd show him my book - I think I make a pretty good case in there. Most people see the dollars lost to the DL and freak out pretty good.

[Will Carroll]

1 quick question, do many pitchers use steroids?

 

Yeah, thanks for the loaded question! :)

 

Do ANY pitchers use steroids? The numbers indicate that some probably do. There were 87 positive tests and recent developments might give us the names of those, despite the explicit privacy agreements. It's an important case beyond the baseball implications.

 

Steroids for a pitcher wouldn't so much help velocity as it would recovery time, done properly. I'd guess that the number of pitchers is very low, on the order of 1 or 2 %, but that's just a WAG.

[Will Carroll]

Hello and thanks for taking the time to answer questions. It means a lot to us. My question involves Carlos Zambrano. He had a terrific first full season last year, flirting with a sub-3.00 ERA most of the season. Towards the end of the year however, he seemed to falter a bit, which carried on into the playoffs. In NLCS Game 1, he gave up 3 home runs to 4 batters, when he had only given up 9 all season prior. How much of that do you think was related to fatigue, pitching way more innings then he had in any other season to this point, and how much of it was Carlos' much discussed emotions? If it was fatigue, is it possible to see any long term effects down the road (especially if he pitches 200+ innings again this year)? Thanks again!

 

Carlos - and Kerry and Mark - were clearly fatigued at the end of the season. All those pitches they threw caught up with them at the worst time. One of the least understood elements of pitching is recovery time. Rany discussed it in passing in his article about the Rockies today on BP, but it's probably the next great frontier. Prior has a big advantage in recovery time and with more and more research, that could be an advantage we see moving around.

[Will Carroll]

Thanks for coming on the site Will!

 

How would you handle a high school pitchers workout schedule off season and during season? How about Pregame?

 

That's a better question for Tom House than me. Research shows that its important to rest. Jim Andrews says that any pitcher under eighteen should take at least two months out of the year off with NO THROWING. That's extreme, but understandable.

 

I like drills like Tom's towel drill and knees drills that take stress off the arm while still throwing and working on mechanics. Short answer: watch what Prior does and do that!

[Will Carroll]

Mr. Carroll, if you would be so kind, please just generally discuss Ben Christianson, his injuries and the prospect of any possibility that he could be a major league pitcher. He has had injuries to both his shoulder and elbow (from what I understand) which have been devastating to his career. Should we be holding out any hope that he can be a contributor at Wrigley at some point in the future?

 

Thanks in advance for any response.

 

First, I feel that he's taken way too much abuse for one bad decision. He's far from the only pitcher I've ever seen throw at someone for timing him. I'm not saying he's right, but that he's not the monster the media makes him out to be.

 

I think Christianson has a big challenge. The best upside comparable would be Gil Meche, who was able to fight through a couple surgeries to become a big league pitcher. This year is huge for Ben considering how stacked the minors are with good, as-yet uninjured prospects like Blassko, Nolasco, and so on.

[Will Carroll]

Do you think Scott Chiasson has any realistic chance of recovering from his injuries and becoming a productive major league pitcher?

 

Chance? Sure. As a reliever, he's not asked to overstress the arm, but he'll have to fix his mechanics or he'll be right back on the table. Guys like Chiasson are very replaceable - sounds cold, but it's part of baseball, so he'll need to be effective quickly to get another shot.

[Will Carroll]

I am writing this a day after throwing seven-innings in an adult baseball league. I know exactly where I am sore. Does modern medicine allow us to focus on such soreness to determine joint and muscle stress and perhaps allow us to address each pitcher's fatigue point and physical potential separately? I ordered your book and Core Performance on your recommendation. I look forward to them both.

 

Yes and no. The technology exists, but no team I know of is going to let us stick some needles in their pitcher in between innings. We're learning a ton in the high-speed video chambers about kinetic forces on the arm and there's more to be found there. One of the more exciting studies I know about is ultrasound imaging of the elbow. It could concievably be done in between innings, but that seems like overkill. Having quick easy ways to determine injuries or just monitor health is very important.

 

I'm sure you'll enjoy both books. Mark's book is killing me, but I'm having less lower back pain after just a couple weeks.

[Will Carroll]

Serious shoulder injuries are now considered to be much more difficult to recover from than serious elbow injuries. Are there any new procedures for specific shoulder injuries (torn labrum, rotator cuff) that might one day gain the success rate of TJS?

 

My April Fool's article aside, there's tons of advances in labrum surgery. Opus Medical is a firm doing a lot of really interesting work on labrums. Jim Andrews and ASMI hold a conference each year where they discuss the state of the art and this year, I was lucky enough to attend. Labrums are getting a LOT of research and I think we're getting closer to learning how to fix them. Tommy John didn't become routine overnight - it took 15 years of work.

[Will Carroll]

Thanks for taking our questions.

 

I was wondering if you could comment on Angel Guzman's injury. When pitchers have these small tears in the labrum, are they more likely to suffer instability in the shoulder joint? When do think he may be called up, etc.

 

Thanks again,

 

Wade

 

Yes, labrum tears are usually the effect rather than the cause. Strengthening the muscles and tightening the shouler are two big parts of the rehab. Guzman's tear was very small and he's made what seems to be a good recovery. I don't think they'll rush him, given their current pitching and contender status. I think the Cubs look at him as Clement insurance.

[Will Carroll]

In your opinion, which team has the best program (that you know of) to keep pitchers healthy? What do they do differently than other teams?

 

Oakland immediately comes to mind. Their work on prehab has given them a big advantage. In the past two seasons, they've had ONE minor pitching arm injury. Toronto is close behind, with a similar system. The Rockies have been good at monitoring their staff. Tampa does a surprisingly good job.

 

Mostly, these teams decided to keep their pitchers healthy and committed resources to it. They have an organizational mandate to follow the program, from majors to rookie ball. Not many teams can do that on any issue.

[Will Carroll]

This question was going to have to be asked: When is Mark Prior going to return and how soon will he be working at full strength?

 

The Cubs won't commit to a date but if I had to guess, I'd say around the first Houston series. He did well in his first simulated game, has another on Wednesday, and I wouldn't be surprised to see him in a rehab start next week.

 

Full strength? Absolutely. He's actually added velocity.

[Will Carroll]

What's wrong with having Wood or another starter throw 9 innings every once in a while as long as their mechanics and velocity are sound?

 

Nothing.

 

This is assuming he's efficient with his pitches, his mechanics and velocity remain sound at all times, and that he's given sufficient rest. So far, Wood isn't approaching Maddux's or even Halladay's pitch efficiency. Strike out pitchers use more pitches, plain and simple.

[Will Carroll]

Will,

 

How much of a factor is recovery time between starts? Does the latest research find any significant health advantages to a five man rotation over a four man?

 

Recovery is HUGE. It's something I mentioned earlier, but as Jack White says, "it bears repeating now."

 

A pitcher starts at a theoretical 100%. He throws to "failure" - where he can't pitch any more effectively - and let's say he's at 25%. He has X days - today, usually 3 or 4 - to get back to as near 100% as possible. If he doesn't, he has less to work with before failure. Fatigue is cumulative and as we saw with Wood at the end of the season, he was out of gas quickly.

 

Rany Jazayerli has done great work on proving why the four man could work. I'd seriously recommend everyone head over. He has a BP article (free) with links to his research.

[Will Carroll]

Mr. Carroll, are you familiar with Oakland's "Prehab" program? If so, can you explain anything particularly special about it that you think is beneficial to a pitching staff?

 

Thanks again.

 

Very familiar. I think the proactive approach and holistic methodology is of value to any staff. It just takes an organizational commitment. I'll save my wrists here and recommend that you check out Saving The Pitcher or any number of places that have detailed Oakland's program.

[Will Carroll]

While injuries can't be predicted, which of our up-and-coming pitchers with loads of talent are more likely to experience injuries based on their mechanics, workload, age, etc?

 

Who says injuries can't be predicted? I did pretty well with my Team Health Reports and the system is getting worked on constantly. We're only a couple years away from an injury system nearly as accurate as performance predictions.

 

I think all young pitchers are at risk. I'm most worried about Andy Sisco. He's still learning how to pitch with his long frame and that amplifies mechanical problems. It took Big Unit years to learn his kinesthetics.

[Will Carroll]

Do you see a better statistical system to identify abuse in the future? I know you talked about fastball velocity in the past, so is this ever going to happen?

 

We're working on V-Loss and it's detailed more in STP. I think we'll get a system that works in concert with PAP, but the "holy grail" will be a system that allows assessment of mechanics in-game. That's probably years away, so we'll work on proxies in the meantime. PAP, for now, is the gold standard with pitching coaches needing to take more responsibility. Why isn't a coach judged on health as much as he is performance?

[Will Carroll]

When pitchers undergo TJ surgery, are they more at risk for developing shoulder problems later, same risk, less risk? And what about vice versa?

 

There's an increased risk of problems as pitchers come back from TJ, but its because they're adjusting their mechanics, often to protect their elbow. Its natural and has to be guarded against. Kris Benson really struggled with this. It's just another part of the rehab process. I haven't seen many cases where shoulder surgery put more strain on the elbow, due to the mechanics of the kinetic chain, probably.

[Will Carroll]

If you were able to have only one Cub baseball card, who would it be and what year?

 

Wow. I have my Ryne Sandberg rookie cards - and meeting him last year was such a thrill - so I'll say a Ron Santo rookie card. I really admire Santo more for what he's done off the field than on.

[Will Carroll]

Will,

 

On the front page of the site, I drew an analogy between making pitching changes after a preset pitch count to making an oil change every 3000 miles. The point I was really trying to make with the analogy is that by the time you see visible wear in an engine by going too long before making a change, you've already created excess wear on the engine.

 

How valid is the analogy that by the time you see the pitcher changing their mechanics, reducing velocity, etc. that some amount of more rapid fatiguing of the structures has taken place?

 

Valid analogy. I may steal that :)

 

We're still learning where the point is that damage is occurring. We know it works geometrically or even exponentially, but we're not sure the exact point. Worse, it's individual so some might be damaged by working to averages. Again, it's the pitching coach's responsibility to know and properly use his pitchers.

[Will Carroll]

If you could set up an "enlightenment scale" that ranked teams by how well they understood how to keep pitchers healthy, where would the Cubs rank?

 

Hmmm ... no one in the Cubs front office reads this, do they? :)

 

Average. They're conscious of it, which is more than some teams, and the nature of their staff forces them to be aware. I'd like to see them lay off the horses some, but it's tough to pull someone so good and keep the focus on the long term.

 

Maybe Dusty and Larry could get contracts for life ... with the condition that it is voided if a pitcher gets an arm injury.

[Will Carroll]

When still on willcarrol.com you wrote an article against the PAP system but now you are in full support of it. Could you explain your reasoning for such a 180 degree turn?

 

I promise this is the last question I have left to ask.

 

Last question and thanks for all the substantive questions. We'll have to do this again sometime.

 

My "Pitch Counts Don't Matter" article was a bit of a stretch. It was an article more intended to question the pitch count orthodoxy than to attack PAP, which is how many interpreted it. As I said, pitch counts need context. As I've worked on V-Loss and worked with geniuses like Rany and Keith Woolner, I realize just how good the system is and how well tested.

 

In short, I wasn't wrong in what I wrote, but I've learned more since then. If I ever get to the point where I'm not willing to learn, please stop reading me and send me on my way.

 

Thanks again and go buy my book!