Pitch counts are now an acknowledged part of baseball. For all the sabermetric advances in the game, the one that's made the most inroads into the consciousness of baseball fans and the actions of baseball teams is the simple pitch count.
The problem is, it's not helping.
Baseball has stuck to something simple, sticking to clickers over research. While the Moneyball revolution has taken over front offices, the old-school mentality is still allowed to manage and mismanage health with a minimum of information. Often pitching coaches have nothing more to go on than a number on a clicker and a cliched response to "how do you feel?"
Injuries continue to trend up. While it's well known that Tommy John surgeries are up over the first few weeks of the season, already over the total of all of 2013, it's not just elbow reconstruction. Injuries have cost MLB a billion dollars over the last five years, and worse, that total has held over any rolling five-year period, according to data in my proprietary injury database and confirmed with MLB and independent data.
Pitch counts and systems of counting were first popularized by Craig Wright in his seminal work The Diamond Appraised. Wright, along with Dr. Tom House, theorized that high usage would be problematic for both performance and injuries. While House was famous at the time for his work with Nolan Ryan, he's long been an advocate of pitch efficiency and agreed with Wright. However, there wasn't much change at the major league level.
In 1999, Dr. Rany Jazayerli of Baseball Prospectus (and now Grantland) introduced a better measure, called Pitcher Abuse Points (PAP). That system was improved upon by Jazayerli and Keith Woolner, now a top executive with the Cleveland Indians. Both systems measured the exponential increase in damage of pitchers above 100.
It's key that the 100-pitch mark, first stated as a rule of thumb by baseball legend Paul Richards, held up to Jazayerli and Woolner's research. However, there's actually nothing special about the number itself. Moreover, it's clear that the response to hitting that mark is individualized. While their research showed that there is increasing risk, there was no clear correlation to injury.
Over the last 15 years since Jazayerli's research was published, pitch counts have become orthodoxy. As a pitcher approaches 100 pitches, managers get the bullpen going whether or not a pitcher appears tired. It's key to PAP that the research was focused on short-term results after high pitch count games rather than longer-term injuries, though it goes without saying that the two should go hand in hand.
It could be argued that other factors reduced pitch counts from their historic levels to their modern equivalent, such as the La Russa model of bullpen management, increased power around the game that necessitated increased effort/velocity on every pitch, the Jobe "Thrower's Ten" exercises that reduced shoulder injuries among other factors. That said, the widespread reduction of pitch counts coincident to the Jazayerli/Woolner research seems causative.
Conversely, modern managers have resisted using a "quick hook" when pitchers are in trouble early as well, so as not to extend the bullpen. Starters have become simply another role, just as the closer, the setup man and the LOOGY (lefty one out guy) have become defined, even rigid, bullpen roles. The starter is now designed to go six or seven innings, more or less 100 pitches, every start regardless of any other circumstance.
Jazayerli acknowledges that in today's game, as a result of his research and baseball's response to it, high pitch counts matter less, simply because they so seldom happen. "[T]he difference between 100 and 120 pitches is so much less meaningful than the difference between 120 and 140 pitches. It's not that pitch counts don't matter - it's that pitch counts at the level they are in 2014 hardly matter anymore," Jazayerli told me by email.
Remember that this is all focused on major league pitch counts. Pitchers at this level are the elite of the elite and have already not only survived the long path to the big leagues, they have largely remained injury free. What is reasonable to expect from physically mature pitchers making millions of dollars is nothing like what we should expect from high school athletes or younger. However, over and over, we're reminded that this is exactly what we're doing.
I could link to story after story about pitchers at the high school or college levels that are going 150 or more pitches. I could link to story after story about youth pitchers that play for two or three travel teams and pitch several games a week, often at high pitch counts.
This is in spite of Little League taking a proactive stand on pitch counts. Little League commissioned Dr. James Andrews and Dr. Glenn Fleisig of the American Sports Medicine Institute to research the effect of pitch counts on youth pitchers. Their research, done over a period of years, led to Little League adopting strict pitch count rules in 2007. In a one-year followup, Dr. Fleisig said they did see a reduction in injuries, though he has not done a longer-term study on the effects.
Unfortunately, these regulations have had an unintended consequence. At the same time that Little League was taking a stand, there was a rise in travel teams and showcase events. In both of these, there is a lack of regulation and a surplus of radar guns. The combination is often cited as a major cause in the rise of pitching injuries.
In the absence of an athletic trainer or other trained medical professional, pitch count is a reasonable tool to be used. When I wrote Saving The Pitcher in 2004, we tested the ability of several groups—scouts, ATs and moms—to detect fatigue. All of them tended to be close and matched well with pitch count. The pitch count had to be individualized, but in the absence of better measures, pitch count regulation or monitoring is likely the best available option.
"Pitch counts are an artificial control," said Dr. Glenn Fleisig. "We know that overuse is accumulated and that pitching when fatigued is damaging, so this works for a broad population. It's not individualized. Some pitchers could go 100 pitches and some could go 50, but we set the limits to do the most good possible. It's up to the coaches and athletes at some point."
However, the best available option for youth players with no professional supervision should be far from the best available option for million-dollar arms. Sadly, that's not the case even in 2014.
Indeed, the problem is that at the major league level, we learn nothing from the pitch count. If it was merely a linear fatigue problem, relievers would never get injured. What we have is a multivariate issue that goes well beyond what a simple counting stat could ever hope to accurately measure. So why are we stuck on something so simple and ineffective?
Alan Jaeger, one of the top pitching instructors in the country who has worked with many pro pitchers, thinks that the culture itself is the problem. "There is no question in my mind from 24 years of both training arms, and having a pulse on how arms are trained in the amateur community (more throwing/conditioning), compared to the professional community (less throwing/conditioning) that the most fundamental reason why we have so many arm problems is conservatism and restriction at the professional level."
Jaeger thinks that what we're seeing is a symptom, not the cause. "The pitch count is simply a by-product of this mentality. So until we deal with the foundation of why arms are breaking down, I feel strongly that we aren't going to unearth the real answers by ascertaining the role of pitch counts."
What baseball needs is an accessible direct measure of fatigue. While pitch count is a reasonable proxy, it only works in the aggregate. Greg Maddux may be effective for 85 pitches, but for those, he's a Hall of Famer. Livan Hernandez could go 150, but no one's expecting him to head for Cooperstown. Both can be useful, even leading a staff, but neither pitch count on its own tells us much about the pitcher.
Instead, we need a measure of both fatigue and recovery. Baseball in 2014 has no direct measure and few teams are even seeking out this kind of measure. While recovery is understood as a key point, even in a five-man rotation, few teams are doing anything to measure this. We have a descended wisdom only a few decades long, and in those decades, we've seen injuries increase.
We do have to consider that at some level, pitch counts do work. They may not reduce overall injuries, but for a certain important subset they work. Jazayerli points out, "I also did a simple study when I wrote about Stephen Strasburg for Grantland back in 2012, looking at the attrition rate of 22-year-old starting pitchers in the majors five years later. Prior to about 1998, roughly 50% of them were still starting regularly five years later; since 1998, that rate has jumped to two-thirds. Maybe it's a coincidence; maybe it's not."
At the same time, we're seeing a major increase in severe injuries to youth pitchers. Many of the Tommy John surgeries that the top orthopedists do will be on high school pitchers or younger. With the increase in revisions (second or third Tommy John surgeries), the decrease in the incidental age is going to increase the number of revisions we see if the pitcher continues to overuse or overstress his arm.
SI's Joe Sheehan also believes that we are seeing some effects. "I think we've reduced injuries or ineffectiveness due specifically to short-term overuse. Pitchers definitely used to get broken by their managers, and that just doesn't happen any longer." Given the lack of 120-plus pitch starts, this is reasonable, which means we're likely seeing more high-effort trauma.
The next step is a more direct measure of fatigue. "There's no such thing as a fatigue-o-meter," said Fleisig with a laugh, "but if there was one, every team better have one." There are possibilities on the horizon for such a device. Right now, there are available proxies like heart rate variability and direct measures like the use of portable ultrasounds that could check the integrity of muscles and ligaments very quickly. While it's unlikely a team would do this between innings, doing it between starts would be a very low-cost solution.
There is also the new baseball tracking system that is expected to come into play this year. While the system is still being developed, it is often referred to as "OMGFX" given all of its information. One possibility is that it will be able to give us in-game, real-time measures of fatigue and pitching mechanics. If so, baseball will have a powerful tool, though one that would be impossible to get out to even minor league stadiums.
What this comes down to is a failure of imagination and execution. Pitching coaches are working from what they did "back in the day" and seldom the best research. They're certainly not conducting any research or being given the proper support from their organization. This is a system failure, but one that could be easily corrected given the will of the organization, some of which have made strides.
Angel Borrelli, a top kinesiologist who works with and analyzes MLB pitchers, says it best. "Nothing could be more impersonal than dealing with pitch counts (a number) when not firstly dealing with the pitcher (a human and not a machine)." The system is failing pitchers by not treating them as individuals, and that would be easy to change.