I like sports. You like sports. We like sports.
And baseball. BASEBALL! Everyone wants to fix baseball. Steroids, strikeouts, a broken hall of fame voting system, some more steroids, long games and a commissioner trying to ban a basic game strategy, all are issues being dealt with in the sport.
But there is one issue in baseball that is gaining steam, but continues to fly under the collective outrage radar: elbow injuries and Tommy John surgery.
Pitchers are getting hurt. A lot. Last year over 80 players underwent Tommy John Surgery to replace torn ulnar collateral ligaments (UCL) in their elbows. In 2014, we saw young pitchers Jose Fernández, Matt Harvey, Pat Corbin, and Ivan Nova miss all or most of the season to recover from the surgery. This year, Zack Wheeler and Yu Darvish already went under the knife.
For young pitchers these days, elbow surgery is not just a risk, it’s almost an expected part of development. Which brings us to Masahiro Tanaka.
This past week, noted Yankee-basher, Pedro Martinez incited a bit of controversy voicing his thoughts on the state of Masahiro Tanaka’s elbow. He implied the Yankees made the wrong call avoiding surgery last year and believes the Yankees right-hander is not healthy right now. He cited a drop in velocity, hanging breaking balls, and some perceived tentativeness to “let it go” during spring training as reasons Masahiro Tanaka won’t make it through the year. Pedro did everything possible to suggest Tanaka will need surgery, short of actually volunteering to perform the procedure himself.
I would love to spend the rest of this article planning ideas for the pilot episode of “Dr. Pedro, MD”, this fall’s hottest medical drama (tagline: Who’s your daddy doctor?). However, exploring the validity of his suggestions, both implicit and explicit, regarding Masahiro Tanaka’s elbow might be a more worthwhile exercise.
Flashback to opening week, 2014. The Yankees rolled out CC Sabathia, Hiroki Kuroda, and Ivan Nova en route to a 1-2 opening series in Houston. Making his first start that Friday in Toronto was rookie Masahiro Tanaka. At that point, what did we know about him?
Certain players have a penchant for lying about such information, but Masahiro Tanaka was by all accounts, 25 years old. He started pitching professionally in Japan at the age of 18 and by the time he left was absolutely dominant. During his final three years in Japan he compiled an ERA+ of 236, a number better than anyone else the three years before moving to the MLB. In his age-24 season, he went 24-0 with a 1.27 ERA on his way to the NPB equivalent of the Cy Young Award.
So he was good, probably really good. He was paid a lot of money to be good in America — $155M to be exact. A large investment for a team familiar with large investments.
From that first start in Toronto, Masahiro Tanaka showed he was worth the money. In his first 17 starts last year he went 12-3, with a 2.27 ERA, 0.97 WHIP, and found himself in contention for the AL Cy Young Award. He established himself as a premiere pitcher and set a new standard for Japanese pitchers.
In his 18th start, though, disaster struck for the Yankees. Tanaka had an uncharacteristically poor outing against the Indians and after some deliberation with team physicians was diagnosed with a partially torn UCL.
“Here we go again!” “Oh god not him!” “(Series of expletives)” However you personally reacted, the sentiment among fans when Tanaka went down was a collective groan. And sure, the injury was disappointing, but it was not unexpected. Even before the Yankees signed him, the professional baseball world considered Masahiro Tanaka an injury risk.
In keeping with the general rule in all sports to only compare guys who look similar, Masahiro Tanaka was compared to Daisuke Matsuzaka and Yu Darvish before he got to the MLB. All three are Japanese, started pitching professionally at 18 years old, and threw more types of pitches than I can count on one hand. A year later, we can also say that all three suffered the same elbow injury — a torn UCL.
Pitching professionally from the age of 18, Tanaka, Darvish, and Matsuzaka enjoyed a developmental head start on many American pitchers, but began accruing significant innings earlier than they did. As a result, each had a LOT of mileage on their arms when they arrived stateside.
For Tanaka in particular, stories about his past also began to trickle out that seemed implausible. He threw 742 pitches in a high school tournament and once closed a game out a day after throwing 160 pitches. If not overworked, reckless seemed an appropriate description of Tanaka’s usage in Japan.
A lot of Tanaka’s success last year before his injury came because of his split-fingered fastball. It quickly emerged as one of the top pitches in the game, but a splitter can be an extremely tough pitch on a pitcher’s arm. Tanaka also threw his splitter more frequently and faster than almost anybody else.
Combine high high innings totals, reckless pitch counts at a young age, and extreme reliance on a split-fingered fastball into one Tanaka-sized package and you very well might get an elbow injury.
The surprising part is what came after the injury.
We’ve all seen the movie before. A pitcher has an uncharacteristically poor outing and walks off the field talking to the team trainer. After the game we hear reports of “forearm tightness” or “discomfort in the elbow.” The next day the pitcher gets an MRI on his elbow. By the end of the week, the pitcher is on the operating table being instructed to “count backwards from ten” by Dr. James Andrews.
But Tanaka and the Yankees deviated from the script. Tanaka’s UCL was about 10% torn, somewhere around 15-20% under the typical threshold to necessitate surgery. At the recommendation of three separate medical doctors and the aforementioned grim reaper of elbows, he elected to receive PRP (platelet-rich plasma) injections, an alternative, non-invasive treatment to heal soft tissue injuries. For the people out there who want to bash the decision or think his poor outing on opening day means that the sky is falling (Paging Dr. Pedro), I invite you to entertain the rationales behind each option at the time.
Get PRP Therapy!
First and foremost, three separate doctors recommended the treatment – medical professionals that know more about the human body than you and I. This should trump everything but wait, there’s more!
Avoiding invasive surgery should always be preferred. A simple injection is much safer and while Tommy John patients these days have about a 90% recovery rate, that still means 1 in 10 patients don’t make it back. Cory Luebke of the Padres, Brandon Beachy of the Dodgers, and Daniel Hudson of the Diamondbacks serve as examples of pitchers in that 10%, each of whom needed a second surgery either during recovery or shortly after returning to the mound.
PRP therapy is still a somewhat experimental procedure and doctors are still performing studies to determine its effectiveness. And while this set of pitchers doesn’t inspire a whole lot of confidence, PRP has worked for other soft tissue injuries and Takashi Saito’s elbow. As Ben Lindbergh, the former editor-in-chief of Baseball Prospectus, explains here (Hi Ben!), we instinctively associate elbow injuries with season-ending surgery but just because PRP hasn’t paid off so far doesn’t mean we should stop trying. And hey, worst case scenario…
Maybe Tanaka was diligently researching his injury online, when he came across a picture of Kyle Blanks’ awesome scar tattoo and muttered “That’s cool – I want that,” but thankfully Joe Girardi overheard and slapped some sense into him.
In reality, the case for surgery revolved entirely around the idea that surgery was and will forever be inevitable, so Tanaka might as well get it over with as soon as possible. But if the PRP treatment backfires, Tanaka has the surgery and returns at…exactly the same time. For Bundy, Billingsley, and the rest of the pitchers in that SI article, the PRP treatment failed and they had surgery sometime within two months after the initial diagnosis, followed by 12 – 18 months of rehab.
Masahiro Tanaka injured his elbow on July 8th of 2014. So even if he had surgery immediately, with a 12 – 18 month recovery window, the Yankees probably would have given him the Matt Harvey treatment and kept him out the entire 2015 season. Adding an extra two months to that timetable assuming PRP failed, Tanaka would have had surgery in September of 2014 and missed the entire 2015 season anyway but been ready for the 2016 opener.
Knowing that he made it through those two months, a few starts, and the entire offseason, surgery now would push his return date towards the middle of 2016, later than if he had the surgery to begin with. But just because that is a possibility doesn’t prove the wrong decision was made. PRP therapy was the right answer. If the worst result of Option A is Option B, then you choose Option A first and that’s exactly what the Yankees did.
Cooling off the Hot Takes
Pedro made his comments before opening day. But in light of Tanaka’s poor outing on Monday, I can’t imagine his sentiments will recede. In fact they will definitely reappear, stronger and stronger, over and over, anytime Tanaka steps on the mound.
Any bad outing, any run allowed, any bad pitch will be discussed at length and treated as the sign of the apocalypse for Yankee fans everywhere. In the words of the immortal George Michael, “Time can never mend the careless whispers of a good friend.” The injury/non-injury, story/non-story will follow him for the rest of the year and there’s nothing he or anyone else can do about it.
And who am I to stand in the way of anyone’s opinions and overreactions? For all I know, Masahiro Tanaka could be on the operating table before this article even gets published. But I implore you to watch diligently and patiently. Attempt to qualm your instinct that every pitch will be his last of the year.
Read articles like this one by Ben Lindbergh (Hi again!) to understand how Tanaka may change his repertoire a bit to mitigate the stress on his partially torn UCL. Tanaka never threw an exceptionally hard fastball to begin with (see chart up top with fastball velocity rank) and threw it much less frequently than other pitchers (same chart). He’s a phenomenal pitcher who works off of two plus off-speed pitches, great control, and a superb understanding of how to pitch.
If he can be the exception to PRP’s brief and checkered history in baseball, the Yankees will be much better off for it, this year and beyond.
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