Jose Fernandez: The aftermath

The list goes on and on, young pitcher after young pitcher breaking down. Jose Fernandez will be the 19th major leaguer to undergo Tommy John surgery (and it appears as if the Rangers' Martin Perez may become the 20th). Only one season -- 2012, when 35 pitchers had the surgery -- has seen more surgeries and we're still in May. The average age of the pitchers is 27. Seven of the pitchers had their second TJ operation.

The reaction seemed to center on two theories for the rash of injuries: Guys are throwing harder than ever and all the games and innings pitched in youth leagues and travel ball are helping to lead to these breakdowns.

One interesting comment I heard came from John Smoltz, who said he never felt like he was "maxing out" while pitching. It's hard to look at a Matt Harvey or Fernandez and say they were holding back a bit; every fastball seemed to come in out top effort and velocity. Of course, Smoltz himself had Tommy John surgery when he was 33 and returned to pitch until he was 42, but as high school kids throw harder and harder to impress the scouts -- on top of often playing year-round baseball now -- you do wonder if there's some credence to Smoltz's theory.

Peter Gammons pointed out that Roger Clemens only threw 82 mph in high school. Is there a relationship between velocity and the elbow injuries? In the end, it's just speculation. You can always find outliers like Clemens or Justin Verlander to prove or disprove any theory.

Some thoughts from other writers:

Buster Olney, ESPN Insider:

This has been going on for the better part of a decade now, and the number of pitching injuries are going up. Are the restrictions actually helping?

"I think by now we should all realize that we don't have a clue," one highly ranked executive said.

As the official noted, teams have been applying one-size-fits-all rules on pitch and innings limits to pitchers without really having any scientific foundation.

"We're treating these guys as if they come to us as blank slates, and they're all starting from the same point," he said. "They're not. They all have different individual histories, different backgrounds in coaching, in what type of pitches of they've been throwing, how often they're throwing. They're all completely different."

Joe Sheehan, from his newsletter:

The most frustrating part about this cluster of injuries is that it comes in an era of greater concern for the health of pitchers. I've said this before, but we're just two generations removed from a time when teams would routinely use pitchers until they broke and then just go get another one. We're a single generation removed from pitchers throwing 140, 150 pitches on occasion, from David Cone throwing 844 pitches in six starts over 27 days. Seriously, pull up the 1991 or 1992 game logs for good pitchers to see just how far the game has come. We're just a decade removed from what may be the final case of overwork breaking a young hurler, that being Dusty Baker's treatment of Mark Prior in the second half of 2003. Pitcher abuse no longer exists in professional baseball.

Dave Cameron, FanGraphs:

Or maybe we just have no idea. After all, Rick Porcello made almost the exact same jump as Fernandez, throwing 125 innings in A-ball at 19 and then 170 in the majors a year later, and he’s yet to have any major elbow issues. CC Sabathia threw 145 innings between A-ball and AA at age-19, then threw 180 in the majors as a 20 year old, and he’s been one of the most durable pitchers in baseball over the last decade. Felix Hernandez threw 172 innings between Triple-A and the Majors as a 19 year old, and then 191 additional big league innings at age-20, and he’s shown no ill effects from his early career workload.

There simply isn’t enough evidence to blame Fernandez’s workload for his injury, and it’s not like the list of guys who have been developed more conservatively are avoiding surgery at a higher rate. Elbows are blowing out at the same or higher rates than they ever have been, even in the age of limiting pitch counts and innings totals. While Fernandez did have a larger workload than most 20 year olds, against better competition than most 20 year olds, it’s difficult to suggest that any other type of handling would have produced better results. There are a lot of teams trying a lot of different solutions to try to keep their young pitchers healthy, and everyone is failing. Everyone.

Tom Verducci, Sports Illustrated:

Now imagine all of that force on a teenage arm. Just the other day I spoke with another former first-round pick out of high school, Matt Cain. He was drafted in 2002. On the day a Giants scout discovered him as a senior at Houston High in Germantown, Tenn., Cain said he was throwing 89 mph. (He hit 94 by the end of that season.) Elite high schoolers today throw in the upper 90s -- and they do so more often in year-round competition under stress (travel ball, tournaments, showcases, etc.). And they are breaking down at an increased rate.

Last month I wrote about how pitchers are damaged even before they sign pro contracts and before they get the kind of kid glove treatment Redmond referenced. I found that high school pitchers drafted among the top 30 picks from 2010-12 were five times more likely to blow out their elbows than top 30 high school picks from 2002-09. And if Fernandez needs Tommy John surgery, the incidence will grow to six times more likely, with 38 percent of elite high school draft picks getting Tommy John surgery before age 22 (six of 16).

What used to be an injury of attrition (Tommy John was 32 and had thrown more than 2,000 major league innings before his groundbreaking surgery) has become an injury of too much too soon -- too much velocity and too much stress. The average age of the 22 major league pitchers to need Tommy John surgery this year is just 23.4 years old.

Wait, it gets worse: A study out just this month in the Journal of the American Academy of Orthopedic Surgeons found that year-round play in the amateur market has contributed to a 10-fold increase in Tommy John surgeries for youth pitchers.

What can be done? It's time for Major League Baseball to lower the mound -- and for the entire amateur market to follow its lead.

Ben Lindbergh, Baseball Prospectus

While the Rangers’ Martin Perez, who appears likely to be the next confirmed Tommy John case, signed a four-year deal with Texas last November, quite a few recent victims—Jose Fernandez, Jarrod Parker, Patrick Corbin, and many more—have yet to land their first multi-year commitment. If they hadn’t hurt their elbows, we (and their teams) would be talking about them as extension candidates. The lengthy rest and rehab regimen they’re facing (or have already begun) would seem to put that speculation and discussion on hold until they’re back on the mound in a major-league game. But maybe the long road back is exactly the right time for their teams to talk contract.

The commonly cited recovery rate for Tommy John patients is roughly 85 percent, although as Glenn Fleisig noted at this year’s SABR Analytics Conference , the percentage among major-league pitchers may be somewhat lower—perhaps as low as three in four. This creates an opportunity for teams, who are better equipped to absorb the risk that a pitcher never comes back at close to full strength than the pitcher himself is. The team’s player portfolio is diversified, so it can survive, and even thrive, if one asset sinks. The player’s financial security, though, is tied to a single stock.

We’ve seen many players sign extensions for less than they might have made otherwise, knowing that a major injury could wipe away their future earnings. How amenable might a pitcher be, then, to taking a life-changingly-large guaranteed payout after such an injury has occurred? He’d be selling himself low, but he’d also be avoiding the worst-case scenario that someone like Daniel Hudson (whose first TJ didn’t take) now faces: washing out without ever making much more than the major-league minimum. (Remember Ryan Madson? And Joel Zumaya? And Joey Devine? And Brandon Beachy and Cory Luebke and Kris Medlen and...)