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Mechanical flaw will be red flag for Strasburg even after return

The Nationals promise you will see a different Strasburg, but not in the mechanics of how he throws a baseball. Those mechanics are a source of some controversy that the Nationals dismiss as insignificant, even though a leader in the field of pitching biomechanics told me a very specific glitch in a delivery -- one that applies to Strasburg -- "is risky and dangerous. That's a red flag. Definitely."

Firstly, consider the changes the Nationals do endorse, including one that already has taken place. Rizzo said Strasburg "dropped 18 pounds of baby fat." It's the hidden benefit of Tommy John surgery: Pitchers, at least those with a strong work ethic, work on fitness and conditioning when they can't throw. Some pitchers throw harder post-surgery, but that is often due to the time developing their legs, core and shoulder more than it is the rebuilt elbow ligament.

"Guys like Stephen and Joe Nathan are competitors," Rizzo said. "And if they can't compete on the mound they are going to compete in their conditioning."

Like Nathan, the Twins' closer who had his own Tommy John surgery last year, Strasburg has returned to throwing, though he is simply playing catch at a distance of 70 feet. Every time he tosses a baseball a trainer is watching. When he does get back on a mound and in a competitive environment, the Nationals want to change how he attacks hitters, not the way he throws the ball.

For instance, despite throwing harder than any starting pitcher in baseball last year (average fastball velocity: 97.3), Strasburg threw his fastball only 58 percent of the time. He has the fastball of Nolan Ryan and yet he uses it less often that do soft-throwing lefties Zach Duke and J.A. Happ.

"We'd like to see him use his fastball more," Washington manager Jim Riggleman said. "Somewhere along his development he noticed that his changeup became a wipeout pitch for him. I can't tell you whether the catcher was calling for it or he was shaking to it. But we would like to get him back to a higher percentage of fastballs. I think he feels that way, too."

Strasburg also relied on his curveball often. He threw the 11th highest percentage of curveballs among pitchers who pitched at least 60 innings (25.5 percent). But trying to link his injury to curveballs is rooted in myth that is not supported by vast medical research. The curveball, despite long-held speculation, is not more stressful on the arm than high-velocity fastballs. A 2009 study of college pitchers found no difference in elbow and shoulder loads between curveballs and fastballs, and studies in 2008 and in 2009 of youth pitchers found greater joint loads associated with fastballs rather than curveballs.

While the Nationals want Strasburg to use more fastballs, they also want him to dial back on the intensity of those fastballs.

"He doesn't need to be throwing four-seamers at 98 miles an hour all the time," Rizzo said. "We think he can get more outs with 95, 96 miles an hour two-seamers. He can get those groundball outs early in counts. Getting those mis-hits will make him more efficient with his pitches."

The pursuit of "early-count grounders" at the expense of strikeouts is a strategy the Mets deployed -- to some controversy -- with a young Dwight Gooden. Strasburg, despite the strikeouts, is not an especially high-pitch count guy. He averaged the same number of pitches per inning last year as Matt Cain (15.7). His rate of pitches per plate appearance (3.92) was just two percent above league average.

Strasburg never threw 100 pitches in his 12 starts last year. Indeed, with the ubiquity of pitch counts and media coverage, the development of Strasburg probably was the most closely-watched and conservative development of any star pitching prospect in baseball history -- and he still blew out at age 22.

The answer to why Strasburg blew out -- and why his future is a risky one -- may lie in his mechanics. Several pitching coaches quietly predicted Strasburg was at risk before he broke down. He will continue to bear risky loads on his elbow and shoulder unless he changes the way he throws.

To understand the danger of the glitch, first you must understand the most critical point of a pitcher's delivery. The pitching motion is a kinetic chain of events, carefully calibrated and timed, like a Formula One car's engine, for maximum efficiency. But above all others one link of the chain is most important: the "late cocking phase," or the phase during which the shoulder reaches its maximum external rotation with the baseball raised in the "loaded" position (typically, above the shoulder) and ready to come forward.

"The late cocking phase appears to be the critical point in the pitching motion," according to a conclusion from a study by Dr. Brandon Bushnell of Rome, Ga., and colleagues and published last year in the American Journal of Sports Medicine, "where higher levels of torque at the shoulder and elbow can result in increased risk of injury. Manipulation of pitching mechanics to alter these torque levels or using these measures to identify pitchers at risk may help decrease injury rates."

Here is the key to managing the torque levels in the late cocking phase: timing. The ball should be loaded in the late cocking phase precisely when the pitcher's stride foot lands on the ground.

"If he's too early or too late he winds up with more force on the shoulder and elbow," said Glenn Fleisig, Ph.D., research director for the American Sports Medicine Institute in Birmingham, Ala. "The energy gets passed to the arm before it was ready, or after."

Without the energy from the rest of the body, the shoulder and elbow must bear higher levels of torque in what in even optimum circumstances is a maneuver that taxes the physical limits of what an arm can bear.

How important is this specific timing? I spoke with a key decision maker for one club last week who, speaking on the condition of anonymity, said his club will not consider any pitcher -- by draft, trade or free agency -- who does not have the baseball in the loaded position at the time of foot strike.

It is during this critical moment of the throwing motion when Strasburg fails. Most pitchers, after taking the ball out of their glove, swing the ball down and away from the body and then raise it in a way in which the throwing hand raises and then the elbow and shoulder follow. Think about the way you would draw back a whip before cracking it.

However, once Strasburg takes the ball out of the glove, down and away from his body, his right elbow, not his right hand, literally takes the leading role. Like re-writing a script, the roles in the kinetic chain are switched. Now it is the elbow that raises higher than the shoulder and the hand.

There is one moment in this sequence when both of Strasburg's elbows are higher than his shoulders, as if he were locked in medieval village stocks. Many people have frozen that moment of his delivery and assigned it as the point of risk. That's not entirely true.

The problem is the timing associated with that move, not the move itself. When Strasburg gets his elbows above his shoulders and the baseball is below or about even with his right shoulder, his stride foot is hitting the ground. The ball should be in the loaded position at that point, but because Strasburg uses the funky "high elbow" raise, he still has to rotate his arm above his shoulder to get it there. The energy from landing on his stride foot has passed too early to the shoulder and elbow -- before the joints are ready to use it.

"It's not a case of too much armpit angle," Fleisig said, referring to the moment when the elbows are raised. "It's that the arm hasn't rotated yet."

Fleisig spoke in general about the glitch some pitchers have with the raised elbow, not Strasburg in particular. When I asked him if this glitch puts pitchers at greater risk of injury, he said, "Totally. It is risky and dangerous. That's a red flag. Definitely."

I asked Riggleman and Rizzo if they considered Strasburg's mechanics put him at risk of injury and whether they intend to alter his mechanics when he returns to the mound. Neither one expressed much concern.

"I don't know much about the mechanics end of it," Riggleman said. "I'd be interested in talking to Tommy John himself. I do know that it would be a big challenge to try to change the way somebody throws. I don't know that it makes sense to change and I don't know that you could do it."

Rizzo did not draw a connection between Strasburg's mechanics and his injury. He called the tearing of the ulnar collateral ligament "a freak accident."

(Medically, this is highly unlikely. When people tear ligaments suddenly, in car accidents, for example, the tear is as clean as if cut with sharp shears. When pitchers, however, tear ligaments, the tear is worn and frayed. That's because every time a pitcher throws a baseball he incurs tiny tears in the ligament. The body, with proper recovery, constantly works to repair those tiny tears. Over time, and especially as the rate of incurring tears outpaces the rate of recovery, tears can lengthen and become even more frayed; think of what happens to that rip in your old pair of blue jeans. That's why the surgeons who perform Tommy John surgery, once they open up the elbow, find the tear of a UCL to be frayed and not cleanly cut.)

I then gave Rizzo a lengthy list of pitchers with the same mechanical glitch as Strasburg and what happened to them: Kerry Wood (Tommy John), B.J. Ryan (Tommy John), Joel Zumaya (fractured elbow), Jeremy Bonderman (shoulder), Shaun Marcum (Tommy John), Anthony Reyes (Tommy John), Jake Peavy (torn back muscle), Jordan Zimmermann (Tommy John) and, most recently, Adam Wainwright (Tommy John).

None of them -- at least those with enough of a post-surgery history -- were ever quite the same pitchers again. Smoltz might come closest, but he had his surgery at age 33 and, because a switch to closing was considered to keep him healthier, pitched only three more seasons as a full-time starter.

Rizzo mentioned that I could probably find another subset of pitchers who threw in a similar manner and have not been hurt. I admit my list is anecdotal and not meant to be comprehensive. But, now that Wainwright has gone down, it's very hard to come up with anybody who throws that way and is a beacon of durability.

(Some guys, such as Carlos Marmol of the Cubs, lead with their raised right elbow and may appear to be symptomatic, but manage to have the arm rotated up and into the loaded position by the time of foot strike. Young guys who get to the loaded position late who bear watching include Aaron Crow of Kansas City, Kyle Drabek of Toronto and Mark Rogers of Milwaukee, who already has had shoulder problems this spring.)

The good news for Strasburg is that he is progressing well with the many incremental steps in returning from Tommy John surgery. Pitchers typically return anywhere from 12 to 15 months after surgery. Nearly 90 percent of Tommy John surgery patients return to pitching, though to what level and for how long is the often unspoken or unmeasured gray area of such recovery.

Rizzo said Strasburg "possibly" could pitch in the big leagues before the end of this season, but that would be a best-case scenario that is getting too far forward. Washington doesn't have an exact timetable for Strasburg; that will become apparent much later as he proceeds increment by increment.

Until Strasburg blew out, he was a legitimate phenomenon and exactly what baseball needed for years: a true drawing card at home or on the road, perhaps the biggest one since Mark McGwire and Sammy Sosa, unless you count the more notorious appeal of Barry Bonds. It will never be that way again -- not in exactly the same way. Part of Strasburg's appeal was his lack of experience. The kid introduced himself with a cloud of smoke. He blew the ball by big league hitters from his very first day.

The element of the unknown helped make him such a sensation. Was he really this good? Did he really throw that hard? Greatness is never so captivating as when it first arrives, like the Beatles on the Ed Sullivan Show, before the cartographers of fame have arrived with their sextants and verniers to tell us so much that the unknown becomes so familiar.

In Strasburg's case, a little bit of mystery remains, though this time it concerns his second impression -- the comeback tour, if you will. Can he be that drawing card again? And if so, after we pay our money and marvel at the sequel, this time, unlike the first, will we also wonder how long the show can last?