The doctor will see you now
Marlins' Alcantara is among the long list of big league aces stuck on the sidelines in the final weeks of the season
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If you read my post last week when Sandy Alcantara went on the IL with what was called a “right forearm flexor strain,” you weren’t the slightest bit surprised to hear manager Skip Schumaker announce Wednesday that the Marlins’ ace has a sprained ulnar-collateral ligament in his right elbow.
Announcements of “forearm flexor strains” often precede announcements of ulnar-collateral ligament sprains. It’s shorthand for, “He’s got a problem in an area that concerns the heck out of us, but we don’t know anything for sure yet. So we’re going to tell you it’s a forearm flexor strain so as not to panic anyone, let things settle down for a bit and hope for the best. But we reserve the right to come back to you with really bad news in the not-too-distant future.”
So Wednesday’s announcement merely represented the predictable next step in that process. The “forearm flexor strain” has become an “ulnar-collateral ligament sprain.” (A strain is an injury to a muscle or tendon. A sprain is an injury to a ligament.)
It’s the degree of that sprain that will determine whether or not the 28-year-old Alcantara will return to action with mere rest and rehabilitation—prior to the end of the season or next spring—or whether he will ultimately require Tommy John surgery, a ligament reconstruction procedure that would cost him all of 2024.
As I told you last week, Sandy would rest for a bit (as he did), then test out his arm (as he has in light throwing sessions in Milwaukee the last 2 days). Then, the Marlins will re-evaluate. How does he feel? What does new imaging show? And where are the Marlins in the Wild Card hunt?
Anyone who has been around Alcantara knows how badly he wants to return to the mound. And his desire burns even hotter with the tight race among the Marlins, D-Backs, Giants and Reds for what looks like one remaining NL Wild Card spot.
While it wouldn’t be anyone’s preference, having the Marlins fall out of the race would make it easy to decide to shut Sandy down. Staying in the mix ratchets up the urgency to hopefully bring him back at least for a couple of starts, although no one in the organization would want to see Sandy take the mound under any circumstance if he were to risk further long-term medical issues by doing so.
For now, all the Marlins can do is hope for the best. Hope the team keeps the heat on Arizona, San Francisco and Cincinnati and hope Sandy feels good as they gently ramp up the intensity of his throwing sessions.
As I wrote last week, even if surgery is inevitable—and at this point we cannot definitively say that it is—there’s no harm in waiting, as having the surgery today or in November has no impact on when he would return barring an unforeseen setback, in the spring of 2025.
THE BIGGER PICTURE
While Alcantara’s elbow issue is a concern for the Marlins and their fans, it’s merely a small part of a league-wide epidemic that ought to trouble everyone who cares about the Game.
Pitchers—and prominent ones at that—are dropping like flies.
According to Sportrac, 375 pitchers have combined to miss 28,124 games due to stints on the injured list in 2023.
With 30 clubs, that means the average team has placed pitchers on the IL 12.5 times this season and those pitchers have combined to miss an average of 937 games per club. And those numbers are climbing daily.
The Dodgers will win the NL West and own the 2nd-best record in the league despite being the run-away leaders in IL stints by pitchers (20) and games lost by injured pitchers (1,662, the equivalent of 10 pitchers missing the entire season…and then some).
The Reds, Yankees, Braves and Rockies round out the top 5 in missed time by pitchers.
The Reds have ridden a wave of young talent to remain in the Wild Card hunt. The Braves have overcome their issues by having a prolific offense and by having some young pitchers step up, most notably Cy Young contender Spencer Strider (17-5 with a 3.73 ERA and a ML-leading 259 strikeouts in 29 starts) and All-Star Bryce Elder (12-4 with a 3.38 ERA in 28 starts).
Meanwhile, the Yankees are enduring their worst season in more than 30 years, and the Rockies are buried at the bottom of the National League.
Sportrac’s IL data goes back to 2015. In that span, the last 3 seasons rank 1, 2 and 3 in IL stints by pitchers and 2, 3, and 4 in games missed by pitchers behind only 2019.
Nearly as big an issue as the “how many” is the “who.”
ESPN’s Alden Gonzalez recently tweeted a list of prominent pitchers whose 2023 seasons have ended prematurely due to injury. Among them: Shohei Ohtani of the Angels; Max Scherzer and Jacob deGrom of the Rangers; Yu Darvish of the Padres; Dustin May and Tony Gonsolin of the Dodgers; Shane McClanahan, Jeffrey Springs and Drew Rasmussen of the Rays; Robbie Ray and Marco Gonzales of the Mariners; Nestor Cortes and Frankie Montas of the Yankees; Lance McCullers Jr. and Luis Garcia of the Astros; and German Marquez of the Rockies.
There are more. That’s not a complete list. But it’s long enough.
This is a problem for Major League Baseball. You want your best players on the field all season, but especially during the frantic final weeks and into October.
It’s not good for the Game when its biggest superstar, Shohei Ohtani, is unable to pitch down the stretch in 2023 or at all in 2024—wherever he may sign—because of a likely procedure on his elbow.
It’s not good for the Game when Jacob deGrom signs a 5-year, $185 million deal with the Rangers then makes 6 starts all season or when the same Texas club acquires Max Scherzer at the trade deadline, then has to shut him down for at least the remainder of the regular season after only 8 starts. That’s 5 Cy Young Awards in the training room, not on the mound, as the Rangers try to reach the playoffs.
The Rays were Baseball’s best story in the opening months of the season. Then they lost their top 3 starters for the year.
You get the point.
It’s impossible to miss the problem.
Finding the cause and fixing it is more complicated, depending on who you ask.
Is it as simple as too much emphasis being placed on velocity in recent years? More pitchers are throwing harder than ever before.
Is it too much emphasis on spin rate? Pitchers are putting added stress on their arms as they try to generate additional spin on their pitches, the end result being better movement.
Are pitchers putting extra strain on the arm to get spin and paying a price for maybe not having as good a grip on the ball as they previously may have had, before MLB mandated checks for foreign substances that historically aided some pitchers’ grip?
Has the introduction of the pitch clock added strain to elbows and shoulders by giving them less time to recover between pitches?
Are some pitchers paying the price for ramping up too early this year to compete at a high level in the World Baseball Classic weeks before Opening Day? (See: Sandy Alcantara, Shohei Ohtani, Luis Garcia and Nestor Cortes among others).
I wrote previously about some of the advantages today’s players have over those from the past:
“They have access to better science and technology as it relates to training and to never-before-imagined information as it relates to preparing to play the game on a nightly basis. Teams employ staff nutritionists and clubhouse chefs to ensure players are properly fueled. From a medical standpoint, injury prevention programs, daily recovery regimens and even sleep monitoring and load management give the modern player advantages that players 20 or 30 years ago, let alone 50, 60 or 70 years ago could not even fathom. Teams travel more comfortably today. And in recent years, additional days off have been built in to the schedule, and you see more day games on travel days, leading to fewer red-eye flights, another example of ways, large and small, players are being put in better position to be fit and prepared to have success.”
Despite all of that, pitchers are breaking down at a higher rate than ever.
Above are several theories why. Some would suggest the increase in injuries is coincidental and has nothing to do with any of the aforementioned factors.
I don’t know what the answer is. I’m inclined to think it’s some combination of all of the above.
Regardless, the fact that we even have to have this conversation amid at least 2 exciting division races that could go down to the wire while 10 teams battle for 6 Wild Card spots in the 2 leagues isn’t great for the Sport.
When the games matter most, you’d like to see Baseball’s best pitchers on the mound instead of on the shelf. And no where is that more true than in Miami, where all eyes are on Sandy Alcantara’s elbow as the Marlins look to chase down a trip to the playoffs.
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I have thought about this issue from different perspectives. You answered negatively regarding a related - if modern players are better than their older counterparts. It seems to me that the modern metrics are misplaced in that pitchers are examined by chase rate, barrel rate, hard hit rate, and the like. Pitching to contact, that is, inducing contact over swings and misses, is a key ingredient. In theory, pitch counts are reduced and it rewards good defense. Pitchers eschew this approach because it isn't sexy and , to my mind, there is still systemic inconsistency with the strike zone. Perhaps ABS will help using the traditional definition of the individualized strike zone, which is now possible, according to an article I read about MiLB testing. ABS also supposedly works with the other critical strike zone component - any part of the ball touching any part of the zone. Are these two machine-generated standardizations enough to allow the return to a pitch-to-contact strategy, which also addresses some of the physically taxing problems you mentioned? Since MLB average batting hasn't improved much since the DH, it's certainly possible, even to though pitchers aren't Greg Maddux-caliber. The stats over the last fifty years do not appear to support a significant offensive improvement no matter what rule changes are made, no? But, the combination of ABS and a pitching to contact philosophy could mitigate injuries by changing the success standard away from the risky spin/K/velocity template.