Why Johan Santana’s Arm is at Risk

One week ago today, Johan Santana accomplished what no other Mets pitcher ever did before. But was it damaging to his health?

After tossing 134 pitches in the first no-hitter in Mets history, Johan Santana was given an extra day of rest. There is the perception among some that the additional 24 hours will somehow be a cure-all for anything that may be ailing Johan as a result of the outing. Additionally, others don’t believe a “few extra pitches” can hurt a MLB pitcher such as Santana. And still others think that if a pitcher is going to get hurt, it can happen at any time, on any pitch — it’s just plain old dumb luck and/or inevitable.

To those people, let me introduce you to something new and fascinating called “science.” It’s a fairly recent concept, with its roots developing in 3500 BC (nascent, I know, considering that Earth has been around for between 100 million and 4 billion years). Also, there is something called causality — a.k.a., “cause and effect.” Causality is the relationship between an event (the cause) and a second event (the effect), where the second event is understood as a consequence of the first. This philosophy and the concept of science enjoy widespread acceptance — except in the societal subset known as “baseball.” For some reason, people in and around baseball deny science and causality, preferring instead to blame pitching injuries on mysterious forces such as lady luck or the “baseball gods.” If you are among the population that has either a belief or passing interest in science and causality, please read on; otherwise, click away to some other post or another website.

Here are the facts:

(btw, “facts” is a scientific term)

1. Johan Santana expended 134 pitches one week ago.
2. Prior to last Friday, Johan Santana was conditioned to throw about 92-95 pitches every five days.
3. Injuries result from subjecting it to, or being subjected by, a force for which the body is unprepared.

I don’t expect anyone to argue with fact #1; it’s public knowledge that Johan threw 134 pitches.

Fact #2 is explained thusly: over a period of about two months and through the ten starts preceding his no-hitter, Santana’s pitch counts were as follows: 84,99,55,105,90,108,82,107,96,96. If you add up all of those pitches and divide by 10, the average is 92 pitches per outing. To get a more accurate read on Santana’s conditioned workload, I’m going to remove his lowest count (55) and his highest count (108) and do the math again with the remaining eight games; the new result is just under 95 pitches per start.

Now, either you trust that I know what I’m talking about, or you know enough about general athletic conditioning to agree that based on his most recent two months of activity, Santana was conditioned to throw about 95 pitches. That doesn’t mean it was necessarily risky to throw 100 or 105, but it does set a baseline.

If you’re still with me, let’s do a bit more math. Subtract 95 from 134 and you get 39. So, in his no-hitter, Johan threw 39 pitches over what he’s been conditioned to throw. Is that a significant amount? Well, divide 39 by 95 and you get .41 — in other words, 41 percent.

Again: Johan Santana threw 41 percent more pitches than he was conditioned to throw.

(To be clear: 95 is not a “magic” number. If Santana’s throwing program conditioned him to throw 125 – 140 pitches every five days, then his 134-pitch effort would not be of concern to me.)

So again, is that significant? Does it correlate to fact #3 (subjecting the body to a force for which it is unprepared)? It’s up for debate, but scientific research suggests yes, it is significant — particularly when the activity is pitching, where it’s vital to coordinate several large and small body parts to prevent injury, and where some of the most overworked parts of the motion are the smallest muscles.

But we need to take this significance one step further, and look at the individual in question. The research is quantitative and therefore generalized; it’s based on many pitchers of varying ages and pitching motions. We must apply quantitative research to a qualitative analysis of the individual to get an idea of risk. According to experts in qualitative pitching analysis, Santana’s mechanics are dangerous and risky — in fact, those risky mechanics are exactly why he injured his shoulder in 2010. Combining both the qualitative and quantitative analysis and applying it to Santana’s no-hitter, my fear is that Santana likely injured himself in some way during his no-hitter.

But you don’t have to take it from me; consider checking out this interview with Dr. Glenn Fleisig that occurred earlier this week. There wasn’t too much specific to Santana, but Fleisig’s main point was this:

“Pitchers get hurt because they pitch with poor mechanics, and then they throw too many pitches; it’s a combination of that.”

Dr. Fleisig is the Research Director of the American Sports Medicine Institute — not some hack know-it-all blogger.

As for the hack know-it-all blogger, I believe there is a good chance that Johan hurt something at some point between pitches 95 and 134 last Friday. This fear comes from my belief in the research and my faith in causality — not to mention the uncertain strength of his surgically repaired shoulder. Is it possible that Johan didn’t hurt himself? Of course — anything is possible. If he did injure something, an extra day of rest isn’t likely to cure it. It may help with the overall recovery of his body, but it won’t necessarily reverse small tears and fraying in his shoulder and/or elbow that may have occurred. That’s why Terry Collins was still terrified that he may have done the wrong thing, even a few days after the no-no.

Now, what if Johan throws a three-hit shutout tonight against the Yankees? Does that mean he’s OK? Not necessarily — it IS possible to pitch with pain and/or injury, as we saw from Santana in the second half of 2010 (based on his mechanics, my guess is he was hurt as of late July, if not earlier).

What does it all mean? Should we be concerned that Johan’s no-no was a “no-no” in terms of what’s good and bad for one’s health? If we care about the team, then yes — because the Mets’ success or failure depends heavily on whether or not Santana can take the mound. Further, if that no-hitter turns out to be the beginning of the end of Santana’s career … well, that would be sad.

As it stands now, Johan Santana will take the mound tonight in the Bronx. Let’s collectively hope that he looks great, and continues to look great going forward.

In the meantime, I encourage all young pitchers, parents of pitchers, and baseball coaches to watch the interview with Dr. Glenn Fleisig below, as it will give you wonderful insight on the risks of pitching at all levels.

Joe Janish began MetsToday in 2005 to provide the unique perspective of a high-level player and coach -- he earned NCAA D-1 All-American honors as a catcher and coached several players who went on to play pro ball. As a result his posts often include mechanical evaluations, scout-like analysis, and opinions that go beyond the numbers. Follow Joe's baseball tips on Twitter at @onbaseball and at the On Baseball Google Plus page.
  1. SiddFinch June 8, 2012 at 12:23 pm
    You raise some good points Joe. But, nobody was going to remove Santana from that game. As you know a no-no is like the holy grail for a pitcher. It was a fait accompli from the 7th inning on that as long as the no-hitter was intact, he would finish the game. That was the correct decision. You simply cannot take away the opportunity for a pitcher to accomplish a feat that is unarguably the most special for a hurler to achieve in a game. After everything Johann has gone through to get back on a MLB mound why can’t you celebrate his achievement instead of focusing on the negatives? Sure, his arm could be at risk but let’s rewind a week and you go out there to the mound and tell a pitcher in the midst of an historic moment that, ‘hey, great job but you know you’re over your pitch limit so I’m afraid your no-hitter will have to come on another day,’ I don’t care if you were Joe Torre, Santana would’ve decked you and kept on pitching. And he would’ve been right to do so.
    • HobieLandrith June 8, 2012 at 1:39 pm
      That’s the problem with American sports today – individual achievement is valued over team.
      • SiddFinch June 8, 2012 at 1:58 pm
        Seriously? We live in an era when a SP, at most, goes 7 innings. In your American sports yesterday, pitchers would go the distance. Is that because they wanted to bask in the glory of “individual achievement”? Find me one pitcher at any level from LL up to MLB who would want to be removed from a game where they are pitching a no-hitter 3/4 into the game. In fact, find me a pitcher from your idyllic yesterday who would be ok with being removed. Spahn? Koufax? Seaver? Ryan? Johnson? Mathewson? Young? Were they “individual achievement” glory boys? There is not one pitcher in the history of the game who would’ve wanted to or been pulled from last weeks game. Think about it-134 pitches thrown was nothing to a Carlton, a Gibson, or even a Koosman. Despite the medical advances, as well as scientific ones, there are far more arm injuries to pitchers in these pitch count centric days then in the days when a pitcher took the mound and finished what they started. Speaking of, doesn’t that make CG games “individual achievement” oriented too? Also our bullpen sucks, who knows if could’ve held the lead if Collins pulled Santana after the 7th, for example. Last Friday Santana took the hill and put the team on his back, just like an Ace should, just like “yesterday’s” pitching heroes you grew up with did. Or maybe not, perhaps Whitey Ford or Luis Tiant was all about individual achievement over team too.
        • HobieLandrith June 8, 2012 at 2:07 pm
          I’m not talking about the pitcher. I’m talking about the response of the Mets fans are celebrating this no-hitter as if it’s as big as a World Series win. It’s ridiculous.
        • SiddFinch June 8, 2012 at 2:40 pm
          It is ridiculous but it isn’t. In many ways this was a way for fans to put ’06 to rest, and ’85, ’87. The Cards almost always best us and this time they didn’t. Add to this the fact that in past few years there really hasn’t been much to celebrate about. On top of all this is the amazing comeback by Johan, topped off with it being the first no-hitter in team history. All of those factors put together make a perfect storm that does make last Friday, in some ways, especially since both Carlos and Molina played such prominent roles, a way to put so many ghosts to rest for Mets fans-Carlos does homer off Wainwright, the Mets win the NL East from ’85’-’89. It’s not the WS but in many ways it’s the most fulfilling thing to happen to this franchise, without an ultimately negative outcome, this century.
    • Joe Janish June 8, 2012 at 1:59 pm
      Sidd, I recognize that Santana wasn’t coming out of the game, and not arguing that point. Nowhere in this post do I suggest that Santana should have been removed.

      Rather, my point is to examine the after-effects and analyze what might happen in the future. What’s done is done, there’s no point in rehashing it — but, we do need to look back at what happened that night in order to understand what may happen going forward.

      I wrote this mainly because I saw and heard a ton of misinformation after the no-no, both in response to my “Fallout” post and via watching/reading/listening various media outlets. There is this ill-conceived notion that pitching injuries are determined by fate, and/or that pitchers have a predetermined number of “bullets” before their arm gives, and/or many other unscientific reasons. This post, hopefully, sheds some light on the truth, knocks down some of the myths, and most importantly, educates parents and coaches of young players — as well as pitchers of all ages.

      That’s really the purpose of this blog; MetsToday is more about teaching baseball through the lens of Mets games than it is about celebrating Mets wins / lamenting losses.

      As far as celebrating Johan’s achievement, we covered that here the night it happened — along with a few hundred other Mets blogs. Now I’ve taken the liberty of going beyond the emotion of the event, and analyzing the process and clinical results.

      • SiddFinch June 8, 2012 at 2:54 pm
        As I stated, you raise some very good points about science and pitching but to me the gist of your article is that Mets placed too much emphasis on the no-hitter game to the detriment of an entire season or a pitcher’s future. My point, as you recognized, is that it’s a moot point as far as Santana goes.

        It would be absolutely sad and tragic if that game led to the end of Santana’s career.. But also unavoidable. That was my point.

        Do you think Santana should’ve pitched the whole game?

        • Joe Janish June 8, 2012 at 4:29 pm
          “…the gist of your article is that Mets placed too much emphasis on the no-hitter game to the detriment of an entire season or a pitcher’s future.”

          If that’s how you read it then I’ve failed in communicating my message, which is that one extra day of rest is not going to undo the damage of an effort that was 41% above conditioned norm.

          “Do you think Santana should’ve pitched the whole game?”

          Depends. If I believe that the Mets are going nowhere this year, and a no-hitter is the highlight of the season, and I’m fairly sure that the 134-pitch effort won’t have a long-term, negative impact on Santana’s health, then sure, he should’ve pitched the whole game.

          On the other hand, if I believe that there is at least a decent chance that the effort could harm Santana, then no, he should not have pitched the entire game. But, I also don’t put as much value into the Mets finally getting a no-hitter thrown as 90% of Mets fans. To me it’s just a freak event that may or may not be related to a pitcher’s skill and likely would have been executed by a Mets pitcher eventually. If inferior pitchers such as Bo Belinsky, Andy Hawkins, Charlie Lea, Phil Humber, Bud Smith, and Jonathan Sanchez didn’t pitch no-hitters, I might feel differently. To me it’s similar to hitting for the cycle, though much cooler and more exciting to watch. Once the game’s over, though, it’s over — it’s just another game, another win that counts the same as any other win.

          Now, when someone like Nolan Ryan, Sandy Koufax, or Roy Halladay throws multiple no-hitters in their career, to me that’s indicative of something. Still, though, nothing to gush over to the extent Mets fans are doing this week.

          But that’s just me and that’s my perspective; everyone else is free to interpret and enjoy the event as they deem appropriate.

  2. Steven June 8, 2012 at 2:35 pm
    Joe. Thanks for the analysis. One thing that I would also be interested in that I dont think I have seen yet is your analysis of what/when caused the Pelfrey injury? Did I miss your analysis of that question.
    • Joe Janish June 8, 2012 at 4:30 pm
      No, you didn’t miss anything. I was supposed to discuss it on Joe Castellano’s show a few days after Pelfrey went down, but technical issues prevented me from being part of the broadcast. Eventually I’ll post something. Thanks for asking!
  3. Crozier June 8, 2012 at 5:37 pm
    Joe, I appreciate the analysis, as always. You didn’t need to convince me; I did the math as well. I recall a game in, I think, April or May of 1989, when Gooden was allowed to throw in the neighborhood of 140 pitches — well above his norm. Compounding this was cool, rainy weather. Gooden ended up with a shoulder injury that year.

    I know you’ve received many dismissive comments regarding your Santana risk assessment, but I doubt being sarcastic and condescending helps your cause. But hey — it’s your blog. Fire away. But could you please reconsider using the now-ubiquitous “no-no” for no-hitter? That’s got to be the single most annoying (not to mention emasculating) sports slang in memory.

    • Joe Janish June 8, 2012 at 11:49 pm
      Crozier, you’re right – I definitely get too condescending and can sometimes be a … well, let’s just say it’s similar to R.A.’s last name, only without the “-ey” at the end. Often I have no filter, and it’s gotten me into trouble before. Thanks for calling me out; I need that sometimes.

      Also thanks for the support of my argument, it’s appreciated. Good comparison to Doc; I remember him going into the 140-pitch range at least twice in 1989, when he first started suffering arm woes. I believe his norm was around 110 at that time.

  4. NormE June 8, 2012 at 5:59 pm
    Joe, stick with us. We are all fans, and that usually means that our hearts overrule our heads. Many of us are willing to learn and you do try to educate us.
    I truly believe that Terry Collins would have been relieved (though disappointed) if a Cardinal had broken up the no-hitter in the latter part of the game. His face gave away his anxiety.
    But, as you and SiddFinch pointed out, Johan was not coming out as long as the no-hitter was in place.
    Forgive an old man’s failing memory, but I vaguely recall at least one instance that a manager did pull a pitcher in the midst of a no-hit attempt. I don’t remember the details, but the manager may have been Preston Gomez. Forgive me if I am wrong.
    • SiddFinch June 8, 2012 at 7:30 pm
      Yep, it was Preston Gomez who pulled Clay Kirby in the 8th inning of a no-hitter.
  5. Gary S. June 8, 2012 at 11:34 pm
    Excellent article Joe.Considering the strict pitch count going into the game I was surprised that Santana came out for the eighth inning.Once he was clean thru 8,Collins boxed himself in and had to put him out for the ninth.If he took him out after 7 and explained it was to preserve Santana for the whole year I would have had no problem with it.
  6. Izzy June 9, 2012 at 9:16 am
    Ah, the love of statistics. Its a wonderful thing. You can use the stats for as long or short a period of time to mkae things come out any way you want. The numbers, your numbers are presented as if they were the totality of Johan’s work, thereby proving he threw 40% more pitches. Uh oh. not true. You omit pitches. You omit every pitch he threw before each inning, every pitch he threw in pre game warming up every pitch he threw in all his side sessions between starts. Well, not every pitch in those sessions were full force folks will say. OK. But they had the same delivery, the risky delivery every pitch. so maybe they were worth 75% of a pitch. And in the game, did Johan take some pitches off early in the game? Lots of factors ignored. I’m not knocking your study. I’m knocking all the work done with statistics because we can use them with proper thought they can be twisted and turned to whatever end is desired.
    Did Johan risk injury?? Sure. Even Collins gives you that. So what? The game sometimes demands a little risk taking. That’s baseball. The love of the team and the game. To hobie. Its shame you are totally clueless about baseball. For your arrogant and snobby info since you decree all Met fans loving the no hitter to be imbeciles or something, baseball is a team game that glorifies individual accomplish. We grow up glorifying the 714 of the Babe, or the day Hank Aaron broke his record, the day Pete Rose surpassed Ty Cobb on the hit list. We talk of the last triple crown winner and so on. Nobody but you will talk about the Seattle 6 pitcher no hitter. It was your game. A team effort. But it was a joke.
    • Joe Janish June 9, 2012 at 5:32 pm
      Izzy, in response to:
      “The numbers, your numbers are presented as if they were the totality of Johan’s work, thereby proving he threw 40% more pitches. Uh oh. not true. You omit pitches. You omit every pitch he threw before each inning, every pitch he threw in pre game warming up every pitch he threw in all his side sessions between starts. ”

      Yes, you are correct that I omitted those pitches. Why? because I have no idea how many pitches he throws during his pregame. From what I’ve heard from people close to him, he generally throws anywhere from 40 to 65+ — it varies depending on how he feels (by the way, most MLB pitchers throw about 25-35 in their pregame).

      I’m glad you brought up the “extra” pitches, because that is an issue for me as well. When I was a college pitching coach, we counted every single time the ball left a pitcher’s hand — the warm ups, the drills, the pickoff throws, EVERYTHING. That’s why people thought I was insane when I said I had starters on a progressive plan of reaching 185 – 250 “pitches.” The 8 pitches between innings is 72 pitches right there, for example.

      I use the game pitch counts as a guide. What concerned me more was that at around pitch #105, I started seeing a breakdown in his mechanics — and that signifies fatigue.

      As for your “so what?” comment regarding the injury risk, I have no answer to that. The way I see it, the Mets have zero chance to make the postseason w/o Johan, and if he’s injured, well, that means he ain’t pitching, and in my mind, it makes sense to try to avoid his getting injured if possible.

    • Crozier June 9, 2012 at 7:08 pm
      Izzy, I agree you have to take risks, but for a no hitter? Can much glory really be attached to a feat so ordinary that Phillip Humber, Dallas Braden, and Bud Smith (!) have done it? This will be a noteworthy achievement in Mets’ history, but that just shows the limits of the team’s individual achievements. The rest of the baseball universe will forget about it quickly enough — unless Santana is hurt. Then it will definitely be remembered.
  7. DaveSchneck June 9, 2012 at 2:51 pm
    Joe,
    I agree with your “scientific” basis, but I take exception to one point – Johan threw 41% more than he was conditioned. Having played ball at a high level, you may kn ow better, but by my count Johan threw over 230 pitches. The bullpen and between innings pitches may not be “mas effort”, but I take it they are close and thus tasing. Secondly, Johan’s arm strength has been improving based on all available information, and his “95” was being pushed to “105-115”. Otherwise, how would any pitcher ever increase pitch limit? Overall, I think the risk of injury was increased based on 134, no doubt, but it sound to me that the risk was overrated and that from what we know now it has not resulted in any injury directly attrributable to that game.
    • Joe Janish June 9, 2012 at 5:38 pm
      Dave, where do you get the 105-115 figure? I would agree with you if I saw a progressive-load program. In other words, if he started out throwing 80-90 in his first start, and progressively worked up to 95, then 100, then 105, then 110, then 115 in each successive start. But that’s not the case; the pitch counts I listed were in order from his first through last start, and in his last two starts he threw 96 pitches each. In other words, there’s no intention of progression, and if the goal is to “push him to 105-115” then they’re going about it in an unusual way. I would think differently if Johan went into the bullpen to throw an extra 10-15 pitches after he was removed from games, but he doesn’t do that.

      Was the risk overrated? Maybe. If he doesn’t get hurt, then perhaps you’re right. If he does, what then?

      • DaveSchneck June 10, 2012 at 6:49 pm
        Joe,
        I got the 105-115 amount baed on statements mae by the Mets – it was either Collins or Santana. Neither of us are there and know for sure his prep – pregaem, bullpens, etc., so I take it right or not that they were going to allow him to throw more pitches regardless of the no-no. I agree with you that if Johan goes down so does any hope of postseason. The rislk-reward thing is a tricky balance.