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As most of you know by now, Michael Pineda (RHP, NYY) is out for the season due to a shoulder injury. Pineda reportedly suffered an anterior labrum tear and his velocity was significantly diminished in Spring Training for the Yankees. GM Brian Cashman reportedly subjected the young hurler to an MRI before agreeing to complete the trade that sent Jesus Montero and Hector Noesi to Seattle, but saw nothing negative on the MRI.
Allegedly, the second MRI done to diagnose the labrum tear (better known as a “SLAP” – superior labral tear from anterior to posterior) showed significantly increased structural damage in the shoulder when compared to the first MRI.
Both Yankees’ and Mariners’ fans want to know: What happened here?
Forcing a Change-Up: Mechanical Problems
All anyone could talk about from 2011 to 2012 was the “fact” that Pineda needed to develop a change-up, because… well, you know. You just need to have one of those to be succeessful, and Pineda’s change-up sucked. You gotta have one of those to get lefties out.
Except… that’s not true. Pineda’s L/R splits were not completely out of line with the league average, and in fact may have been better than most RHP. (source: Fangraphs)
There is no law that states that starting pitchers must have three pitches to succeed. The number of pitchers out there that can reliably command and control three above-average pitches are all superstars. Most are lucky to command two pitches that are above-average with regards to “stuff,” and I don’t think anyone would argue that Pineda’s fastball and slider were below-average.
So what’s the big deal? How could Pineda’s shoulder injuries be related to developing a change-up? Well, as I’ve stated before, forcing someone to develop a better change-up often kills a pitcher’s fastball velocity. I said it on the Pro Ball NW podcast about training, and I said it in a previous article about teaching youth pitchers how to throw a change-up.
Paul Nyman made this observation many years ago, and I agree with him wholeheartedly. Youth pitchers who rely on a changeup and throw it often in their bullpen sessions will often change their throwing mechanics to get better sink and velocity separation off their fastball. As a result, their pitching mechanics become highly linear and their arm speed decreases due to poor use of rotational force, and this loss of velocity creeps into all of their pitches, including their fastball.
Repeatable mechanics play a role when it comes to reducing shoulder/elbow injuries, so it could very well have been the constant forcing of the change-up that helped Pineda along the path to shoulder surgery – to say nothing of the fact that sinkerballers tend to have shoulder issues in the first place!
Much of this could have been detected if only the Yankees and/or Mariners had an on-field system that analyzed the biomechanics of a pitcher in real-time to see if pitchers appreciably changed how they threw their pitches after making tweaks to their deliveries. Even multiple high-speed cameras installed with constant video review would have been helpful. This type of system would be inexpensive to develop (we have one in our Seattle facility) and could produce a huge edge for any MLB team willing to deploy it. (I’ve been beating this drum for some time now, and while I’ve had some interest from pro teams, there’s a general lack of motivation on this particular subject – why this is, I can’t figure out.)
Damaged Goods? Previous Shoulder Issues?
Pineda’s effectiveness went down as 2011 wore on, and while his velocity ticked down a bit, no one was really worried about his health except for the somewhat-large workload he accumulated as a rookie. (For the record, I don’t think it was unreasonably large at all.) Many are wondering if Pineda was “damaged goods” when he was sent over to the Yankees, but if this had been true, shouldn’t the Yankees have seen something on the initial MRI they did?
The problem is that people view an MRI as a diagnostic panacea, when it’s barely a baseline tool for analysis. When you consider the torque about the shoulder that’s required to throw a baseball 90+ MPH and how often it’s done, there’s no way you wouldn’t expect massive structural changes in the connective tissue in the glenohumeral and acromioclavicular joints – and this is exactly what you see. Consider that MRIs of the shoulder in asymptomatic (completely healthy) pitchers are really screwed up (source 1, source 2), and you’ll begin to understand that the initial MRI is more of a formality than anything else. Unless the Yankees had seen a complete tearing of the labrum off the bone, they wouldn’t fail Pineda based on a wonky MRI.
The Lowdown on the Situation
As with most things injury-related, this is a highly complex and multivariate problem. You can’t just force a pitcher to learn a pitch that was previously pretty bad without expecting a lot of secondary and tertiary changes. It’s not as simple as developing a change-up (one of the hardest pitches to master) and leaving everything else the same. Athletes who struggle with throwing a particular type of pitch will change their pitching mechanics to accommodate the new pitch, and these changes will creep into their other pitches. Occasionally, this leads to great results – especially if you’re re-learning how to throw a fastball harder – but usually it leads to velocity-killing issues and/or and increased risk of injuries in the pitching arm.
MRIs aren’t perfect; they’re diagnostic tools. As I said above on my Twitter feed (@drivelinebases), you get a basic diagnostic with the MRI, pain levels, and crappy velocities – you can only confirm the extent of the damage if you insert an arthroscope.
The Yankees didn’t act negligently when it came to acquiring Michael Pineda. They may have acted negligently when it came to developing him.
I can’t stand doctors, or the medical profession in general. Good physical therapists that understand the need for strength training as a vital part of rehabilitation (and prehab) are exempted, but pretty much everyone else in the industry bothers me to no end.
Recently while training the Olympic lifts, I caught a power snatch poorly and hurt my non-throwing wrist. The next day, there was significant pain while doing anything with it – including typing. I taped it and it relieved some of the pain, but not all. There wasn’t inflammation in the area, and it didn’t seem to be discolored, so I figured it was a bone bruise or possibly a hairline fracture.
As days went by, the pain subsided – I could pitch but couldn’t swing a bat (which was a bummer, since I love to hit) for my fall league baseball team. It was easy to see what specific area the pain was radiating from and what movements irritated it, and it seemed to be coming from the distal part of the ulna.
My wife was pretty adamant that I should see a doctor, but it would involve shelling out for a co-pay and dinging our insurance plan to simply be told: “Don’t do anything that makes it hurt too much.” They might even prescribe complete rest, which is a great way to cause atrophy in the area and make it more susceptible to damage in the future!
If it were as simple as going in to an office and getting a X-ray, I might have done it. But the hoops that you have to jump through in our medical system (and most in the world, I might add) is simply not worth my time. It would probably take 10-12 hours of my life (including transportation) over several days to even see a specialist, much less get an X-ray of my wrist/forearm.
Someone I know is having shoulder pain while bench pressing, and asked for advice. I told him that he should schedule an MRI and gave him some general training tips that typically work for most people (lots of pulling / rowing / shoulder rehab stuff). When he saw the general practitioner, this is what she said:
Went to the PT today so wanted to give an update on what she said. Basically she “diagnosed” the issue as a rotator cuff strain, with probable tendonitis and/or bursitis. She states an underlying etiology contributing to this is weak lower trap muscles. She says this is a postural stabilizer muscle and it gets lengthened and weakened when people spend a large amount of time with shoulders hunched forward, like slouching in front of a computer (guilty).
Unfortunately, she said you cannot really strengthen this muscle directly by working out, but rather through good posture, with your shoulders back and scapulas in. It seems to me some of the Cressey scapula workout stuff would be a good idea, so I will focus on this in addition to chinups and upright rows in my accessory work moving forward.
She says once the inflammation/possible bursitis goes down bench pressing should not be a problem, so hopefully I can get back on the bench train soon, don’t want what little pecs I have to turn into moobs.
This is all stuff you could easily find out from Mike Robertson’s, Eric Cressey’s, Mike Reinold’s, or my site without shipping a co-pay and notifying your insurance company – meaning it’s completely worthless. Unless, of course, you think that advice from a general practitioner with no experience in exercise science / kinesiology is worth something. Look at the second paragraph: You can’t strengthen “this muscle” directly by working out? My response:
Ask her why you cannot increase the contractile properties of a muscle in your body through progressively overloading it.
Maybe she meant that strengthening it wouldn’t fix the underlying issue of poor posture; that’s true. But everyone slouches and almost no one sits straight up at the desk for their whole life. You need to make recommendations that people can live with. It’s simple to say: “Eat 1.2g/lb protein per day, eat 9.5 kcal/lb body weight, lift heavy 3x/week, do some cardio to tolerance, focus on mobility, and you’ll have a great body” but a whole lot tougher to find out what works for individuals.
Here’s the next steps for this guy to even see a specialist:
Still, I am going to have to go to 3-4 “therapy” appointments, dish out a couple hundred more bucks, then go back to the family doctor, then get a referral to a orthopedic specialist who would have to schedule an MRI, so it will be a couple more months at least before this happens.
Hopefully, it will get better in the meantime and I will not have to follow through. I 100% feel the HMO system is designed so patients become discouraged and give up before doing anything expensive, like going to a specialist or getting an MRI.
Emphasis is mine, because I completely agree. However, it’s more than that: It’s not just the discouragement – they do it to increase the # of co-pays and times they can bill the insurance company to make money.
This is why I can’t stand how medical care is doled out. They pander to the lowest common denominator and don’t give anyone with training experience or self-taught knowledge any respect.