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Carson Smith/Risk of TJ Surgery
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Post by dirtywater43 on Mar 23, 2016 4:10:17 GMT -5
It really is kind of discouraging to see that some people on here were waiting for the "I told you so moment" when it came to the fall out of the Smith injury too.
For whatever reasons they had, like "you never trade a starter for a reliever" or "here's my stats proving this guy is going under the knife at some point."
Sometimes stuff happens. Andrew Miller and Homer Bailey had the same injuries, and I'm sure they weren't criticized for the way they throw a baseball. Throwing a baseball in any motion isn't natural when repeated over and over again, so any pitcher is liable for any kind of arm problem. What happened to Smith is unfortunate but this by no means he's going to be guaranteed Tommy John at some point. This was just a unfortunate scare.
I really saw the writing on the wall that if the ucl was torn 2 days ago, that it wasn't a major tear and I really thought it wasn't a tear at all. It sounded like a strain from the beginning. You don't wake up with a torn UCL the next morning and "feel better" like with what Carson was being quoted with. Torn UCL's don't get better, they get repaired.
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Post by fenwaythehardway on Mar 23, 2016 7:58:50 GMT -5
It really is kind of discouraging to see that some people on here were waiting for the "I told you so moment" when it came to the fall out of the Smith injury too. For whatever reasons they had, like "you never trade a starter for a reliever" or "here's my stats proving this guy is going under the knife at some point." Sometimes stuff happens. Andrew Miller and Homer Bailey had the same injuries, and I'm sure they weren't criticized for the way they throw a baseball. Throwing a baseball in any motion isn't natural when repeated over and over again, so any pitcher is liable for any kind of arm problem. What happened to Smith is unfortunate but this by no means he's going to be guaranteed Tommy John at some point. This was just a unfortunate scare. It happens more to guys who throw sliders 40% of the time, and his velo loss last season was a red flag as well. Yes, all pitchers carry risk. Some carry more than others, and it's hard to argue that Carson isn't on those. (by the way, just to make it clear for everyone, my "never trade for a reliever" thing is not entirely serious. Yeah, I'd be pretty happy to trade Bryce Brentz for Kenley Jansen. And I actually liked the Carson Smith deal because of the inclusion of Elias. But even though "never trade for a reliever" rule isn't exactly true, in practice, relievers do seem to be responsible for a disproportionate number of highly regrettable trades.)
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Post by jmei on Mar 23, 2016 8:02:25 GMT -5
It really is kind of discouraging to see that some people on here were waiting for the "I told you so moment" when it came to the fall out of the Smith injury too. For whatever reasons they had, like "you never trade a starter for a reliever" or "here's my stats proving this guy is going under the knife at some point." Sometimes stuff happens. Andrew Miller and Homer Bailey had the same injuries, and I'm sure they weren't criticized for the way they throw a baseball. Throwing a baseball in any motion isn't natural when repeated over and over again, so any pitcher is liable for any kind of arm problem. What happened to Smith is unfortunate but this by no means he's going to be guaranteed Tommy John at some point. This was just a unfortunate scare. That's a pretty big straw man. I never said that he's guaranteed to have Tommy John, and, as far as I know, no one else did, either. But because of his unorthodox delivery, high velocity, velocity decline last year, and heavy use of a slider (roughly half his pitches thrown last year), the research does suggest that Smith has higher odds of undergoing Tommy John surgery than the average pitcher. You're also projecting-- I did not see a single real "I-told-you-so" post. We're all Red Sox fans here, and none of us are happy that they'll be missing one of their better relievers of the season for at least the first month of the season.
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Post by Oregon Norm on Mar 23, 2016 8:39:32 GMT -5
Jmei is right, you're reacting to ghosts. All he did was mention the red flags, which are there. As for fenway, he's restating something he's been saying since he joined the board. I don't think you want to take this stuff so personally. It isn't directed at you.
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Post by telson13 on Mar 23, 2016 17:44:15 GMT -5
It really is kind of discouraging to see that some people on here were waiting for the "I told you so moment" when it came to the fall out of the Smith injury too. For whatever reasons they had, like "you never trade a starter for a reliever" or "here's my stats proving this guy is going under the knife at some point." Sometimes stuff happens. Andrew Miller and Homer Bailey had the same injuries, and I'm sure they weren't criticized for the way they throw a baseball. Throwing a baseball in any motion isn't natural when repeated over and over again, so any pitcher is liable for any kind of arm problem. What happened to Smith is unfortunate but this by no means he's going to be guaranteed Tommy John at some point. This was just a unfortunate scare. I really saw the writing on the wall that if the ucl was torn 2 days ago, that it wasn't a major tear and I really thought it wasn't a tear at all. It sounded like a strain from the beginning. You don't wake up with a torn UCL the next morning and "feel better" like with what Carson was being quoted with. Torn UCL's don't get better, they get repaired. There's a distinct (i.e., complete anatomical) difference between the flexor carpi ulnaris muscle/tendon of the forearm and the ulnar collateral ligament. The origin of the flexor carpi ulnaris is a two-bellied attachment to two separate bones: ulna (forearm bone) and the medial epicondyle of the humerus ("upper" arm). The UCL sits beneath the origins of the muscle bellies and connects ulna to humerus, and the ulnar nerve runs between the muscle bellies down the forearm into the hand. Brian Johnson had irritation of this nerve, probably due to compression by the muscle bellies. Smith's issue is not his UCL, and we don't even know if it's his flexor carpi ulnaris. When they refer to "flexor mass," it's probably a distinction between muscle belly vs. tendon (tendon being the coalescence of the muscle covering, the fascia, which then inserts into bone). But there's no "flexor mass" muscle. It doesn't exist. So he could actually have issues with his digital flexors (muscles arising from the bones of the forearms near the elbow and extending into the hand as long tendons), or the flexor carpi radialis. The focus on the F.C.U. in this thread was just because of his pitching style. UCL tears do not unilaterally require surgery. Smaller tears, like with most ligaments, can be successfully managed conservatively. Platelet-rich plasma injections have little more than anecdotal evidence to support them, but they probably don't hurt. The idea is that platelets release things like transforming growth factor-beta or fibroblast growth factors that facilitate ligament reconstruction and remodeling. For an MLB pitcher, UCL tears that are conservatively managed can hold up for some time (Tanaka had something like a 30% tear), but yeah, almost invariably require surgery at some point due to the recurrent, repetitive stress. Velocity at a young age (and overall) is really the only correlate with UCL susceptibility that's currently defined. But arm motions are very difficult to quantify, making any study problematic. Smith's motion, and heavy reliance on his slider, is certainly considered an injury risk by scouts, although medical analysis can't (yet) back that up.
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Post by dirtywater43 on Mar 24, 2016 2:59:17 GMT -5
It really is kind of discouraging to see that some people on here were waiting for the "I told you so moment" when it came to the fall out of the Smith injury too. For whatever reasons they had, like "you never trade a starter for a reliever" or "here's my stats proving this guy is going under the knife at some point." Sometimes stuff happens. Andrew Miller and Homer Bailey had the same injuries, and I'm sure they weren't criticized for the way they throw a baseball. Throwing a baseball in any motion isn't natural when repeated over and over again, so any pitcher is liable for any kind of arm problem. What happened to Smith is unfortunate but this by no means he's going to be guaranteed Tommy John at some point. This was just a unfortunate scare. That's a pretty big straw man. I never said that he's guaranteed to have Tommy John, and, as far as I know, no one else did, either. But because of his unorthodox delivery, high velocity, velocity decline last year, and heavy use of a slider (roughly half his pitches thrown last year), the research does suggest that Smith has higher odds of undergoing Tommy John surgery than the average pitcher. You're also projecting-- I did not see a single real "I-told-you-so" post. We're all Red Sox fans here, and none of us are happy that they'll be missing one of their better relievers of the season for at least the first month of the season. I wasn't referring to anyone poster here. There are a lot of people here who have the same thing repeatedly. Go back to the original thread of the trade of Carson Smith for Miley, and you'll see what I mean. I just believe in Karma. The only thing that struck me was the bad Karma that was around here when the trade went down and to see him injured now is just disappointing.
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Post by dirtywater43 on Mar 24, 2016 3:04:50 GMT -5
Jmei is right, you're reacting to ghosts. All he did was mention the red flags, which are there. As for fenway, he's restating something he's been saying since he joined the board. I don't think you want to take this stuff so personally. It isn't directed at you. None of what anyone says around here I take personally. Fenway isn't the only one saying what he's saying either. There are a ton of people who feel the Miley trade wasn't worth it. Carson Smith is probably a major dl guy waiting to happen. Etc. I just don't agree, I'm not chasing ghosts. I know it isn't directed at me. I just posted about it because that's the way I felt at the time. Everyone else seems to be taken what I've said more personally than what I came off and wrote, to be honest and frank.
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Post by dirtywater43 on Mar 24, 2016 3:09:34 GMT -5
There are a lot of relievers who threw a ton of sliders/cuters in baseball who stayed healthy for a really long time. Billy Wagner, Dennis Eckersly, Mariano Rivera. The data doesn't tell me anything, he got unlucky.
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Post by jmei on Mar 24, 2016 8:23:35 GMT -5
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Post by fenwaythehardway on Mar 24, 2016 8:31:38 GMT -5
There are a lot of relievers who threw a ton of sliders/cuters in baseball who stayed healthy for a really long time. Billy Wagner, Dennis Eckersly, Mariano Rivera. The data doesn't tell me anything, he got unlucky. How would you know? You're not looking at it.
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Post by mandelbro on Mar 24, 2016 9:06:56 GMT -5
In case anyone didn't notice, that NIH article describing the increased risk associated with slider use has a very credible name on it. "JR Andrews" in the author list is the famous Dr. James Andrews.
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Post by Oregon Norm on Mar 24, 2016 11:07:27 GMT -5
What was interesting about that study, which is from 2002, is that the anecdotal notion that kids shouldn't be throwing a bunch of breaking pitches at a young age, had its statistical ticket punched. What some parents and coaches had long thought to be true, was easy enough to verify with a controlled study.
An interesting follow up would be to find out if that information has had any effect on the rate at which young players are throwing those pitches. That would be a bit more work, of course.
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Post by telson13 on Mar 24, 2016 13:23:27 GMT -5
In case anyone didn't notice, that NIH article describing the increased risk associated with slider use has a very credible name on it. "JR Andrews" in the author list is the famous Dr. James Andrews. FWIW, name recognition has very little to do with quality scientific work. For example, the chair of Anesthesia at Brigham and Women's hospital (arguably the most presitgious anesthesia training program in the world, and certainly one of the best hospitals) has a reputation as one of the world's foremost tissue engineers (along with his brother, who's a vascular surgeon). His lab/funding was responsible for the "human ear grown on the mouse." He also had major research recently, roundly discredited (and considered by many falsified), and went on sabbatical. That's not to say anything negative about Andrews, or this study (which should be noted, is in very young children). It's just a caveat that, because a recognizable name is on an article (he's also the third author...least important of the four, with #1 being the person who actually did the work and the last author usually being the "sponsor" of the project), doesn't make it good scientifically. That said, there is growing retrospective analysis suggesting that frequent use of breaking balls, and especially sliders, are associated with arm injury. Most isn't in peer-reviewed territory, but that's probably impossible to do anyway. The fangraphs articles are pretty instructive in light of the cohort study.
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Post by telson13 on Mar 24, 2016 15:41:29 GMT -5
There are a lot of relievers who threw a ton of sliders/cuters in baseball who stayed healthy for a really long time. Billy Wagner, Dennis Eckersly, Mariano Rivera. The data doesn't tell me anything, he got unlucky. How would you know? You're not looking at it. Yeah, and a cut fastball isn't thrown the way a slider is, either. The arm action is quite different.
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Post by telson13 on Mar 24, 2016 19:53:18 GMT -5
What was interesting about that study, which is from 2002, is that the anecdotal notion that kids shouldn't be throwing a bunch of breaking pitches at a young age, had its statistical ticket punched. What some parents and coaches had long thought to be true, was easy enough to verify with a controlled study. An interesting follow up would be to find out if that information has had any effect on the rate at which young players are throwing those pitches. That would be a bit more work, of course. Well, it's a cohort study, which isn't the gold standard that an RCT is. On the other hand, it's a big study, so the statistical power is pretty good. Edit: wonder if it gets any play in terms of coaching...maybe coaches should be teaching circle changes instead?
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Post by dirtywater43 on Mar 25, 2016 3:58:06 GMT -5
There are a lot of relievers who threw a ton of sliders/cuters in baseball who stayed healthy for a really long time. Billy Wagner, Dennis Eckersly, Mariano Rivera. The data doesn't tell me anything, he got unlucky. How would you know? You're not looking at it. The day someone/anyone predicts injuries, tell them to buy me a powerball ticket.
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Post by dirtywater43 on Mar 25, 2016 4:16:05 GMT -5
Tyler Skaggs and Tim Collins also had Tommy John surgery. Neither throw hard or even threw sliders. The thing about Tommy John is that it's unpredictable. I'll give Carson Smith the same amount of a chance to have Tommy John as Henry Owens this year. I'll base this off of completely nothing and I'll have just as much of a chance of being right as any one of those articles. A soft tossing Henry Owens who throws very few sliders shouldn't be that much of a risk for Tommy John, right? Not the case. Predicting injuries is like predicting pre season playoff teams in 2016, no one has a clue. You can't base trades off of future injuries that hasn't even happened yet. That's a terrible way to devalue trades or to not like a trade. Go with the talent and take the gamble, and every pitcher is a gamble. Eckersly and Randy Johnson all threw a ton of sliders and didn't throw from a traditional arm slot. They were fine. Smith got unlucky. Hopefully he comes back strong and doesn't need Tommy John for the next 4+ years while he's under Sox control.
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Post by telson13 on Mar 25, 2016 14:13:30 GMT -5
How would you know? You're not looking at it. The day someone/anyone predicts injuries, tell them to buy me a powerball ticket. Multiple people on this site voiced concern about Smith after the trade, myself included. I still liked the trade, but Smith had multiple warnings predictive of arm injury. Honestly, you seem to have absolutely zero concept of probability. Your whole "nobody can predict...", at least in the terms you seem to be presenting it, is what's known as a fallacy of reason (specifically, a reduction to absurdity). What's really laughable is that you make predictions about players based on all sorts of variables (FB velocity, past performance, command issues, whatever), and treat it like those predictions are written in stone. But here, in the face of actual confirmation of the predictive value of variables re:UCL tear, you make the absurd statement "nobody can predict..." With 100% certainty, no. But with relative likelihood, yes. Seriously, you're wasting everyone's time with this line of thinking. You're directly detracting from the intellectual value of this thread. Please, please stop.
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Post by telson13 on Mar 25, 2016 14:28:57 GMT -5
Tyler Skaggs and Tim Collins also had Tommy John surgery. Neither throw hard or even threw sliders. The thing about Tommy John is that it's unpredictable. I'll give Carson Smith the same amount of a chance to have Tommy John as Henry Owens this year. I'll base this off of completely nothing and I'll have just as much of a chance of being right as any one of those articles. A soft tossing Henry Owens who throws very few sliders shouldn't be that much of a risk for Tommy John, right? Not the case. Predicting injuries is like predicting pre season playoff teams in 2016, no one has a clue. You can't base trades off of future injuries that hasn't even happened yet. That's a terrible way to devalue trades or to not like a trade. Go with the talent and take the gamble, and every pitcher is a gamble. Eckersly and Randy Johnson all threw a ton of sliders and didn't throw from a traditional arm slot. They were fine. Smith got unlucky. Hopefully he comes back strong and doesn't need Tommy John for the next 4+ years while he's under Sox control. This post suggests that you operate on a fixed belief system. You've shown that before with the circular arguments about Kelly's ability to break out (and the giant list of late bloomers I gave) and the Owens FB thing. If something predicts a 10% (absolute) greater likelihood of injury, and the base rate is 10%, there is still 80% of the population that remains injury-free. Focusing on that 80%, which is what you're doing, is both willfully ignorant and totally uninformative. I say this only in the interest of your enjoyment of this site: if you continue to engage people in these sorts of belief-based arguments where you deny any value of analysis, many people are just going to start ignoring you. I come here for insight and thoughtful analysis. I think a lot of people do. What you're doing borders on trolling. It's just arguing for the sake of argument.
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Post by Oregon Norm on Mar 25, 2016 15:03:20 GMT -5
...Tyler Skaggs and Tim Collins also had Tommy John surgery. Neither throw hard or even threw sliders. I'm not sure where you got your information. For a guy who's all of 5'7", Tim Collins threw quite hard when he arrived in the major leagues. This is from FanGraphs:
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Post by fenwaythehardway on Mar 25, 2016 15:34:54 GMT -5
Tyler Skaggs and Tim Collins also had Tommy John surgery. Neither throw hard or even threw sliders. The thing about Tommy John is that it's unpredictable. "I can recall several days when the forecast called for sun but it was cloudy. The thing about the weather is that it's unpredictable. Therefor I'm headed to Mt. Washington tomorrow even though they're forecasting a blizzard". I mean, come on. This isn't even an argument worth having.
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Post by telson13 on Mar 25, 2016 16:10:15 GMT -5
...Tyler Skaggs and Tim Collins also had Tommy John surgery. Neither throw hard or even threw sliders. I'm not sure where you got your information. For a guy who's all of 5'7", Tim Collins threw quite hard when he arrived in the major leagues. This is from FanGraphs: I've come to the conclusion that facts and information are useless with him. It seems like he's going to believe what he believes, and that's the end of it. Kind of like anti-vaccination thinking. Evidence is useless. Resistance is futile.
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Post by dirtywater43 on Mar 26, 2016 1:22:19 GMT -5
The day someone/anyone predicts injuries, tell them to buy me a powerball ticket. Multiple people on this site voiced concern about Smith after the trade, myself included. I still liked the trade, but Smith had multiple warnings predictive of arm injury. Honestly, you seem to have absolutely zero concept of probability. Your whole "nobody can predict...", at least in the terms you seem to be presenting it, is what's known as a fallacy of reason (specifically, a reduction to absurdity). What's really laughable is that you make predictions about players based on all sorts of variables (FB velocity, past performance, command issues, whatever), and treat it like those predictions are written in stone. But here, in the face of actual confirmation of the predictive value of variables re:UCL tear, you make the absurd statement "nobody can predict..." With 100% certainty, no. But with relative likelihood, yes. Seriously, you're wasting everyone's time with this line of thinking. You're directly detracting from the intellectual value of this thread. Please, please stop. So you admit I'm right in saying that it's completely unpredictable and then you say it can be predicted? I'm the troll? I'm pointing out the truth. Please explain to me why Tyler Skaggs had Tommy John surgery. He fit none of the criteria of having Tommy John.
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Post by dirtywater43 on Mar 26, 2016 1:24:23 GMT -5
I'm not sure where you got your information. For a guy who's all of 5'7", Tim Collins threw quite hard when he arrived in the major leagues. This is from FanGraphs: I've come to the conclusion that facts and information are useless with him. It seems like he's going to believe what he believes, and that's the end of it. Kind of like anti-vaccination thinking. Evidence is useless. Resistance is futile. There is no useful information on Tommy John. That's the point. The fact that's there's thousand of articles trying to predict it is a complete waste of anyone's time. No one has a clue. Also notice how Henry Owens struggled bad when he couldn't find the plate with his 90+ mph fastball this spring? It's a direct correlation of him having to be perfect to have even a shot at the big leagues. Joe Kelly still hasn't proven anything outside of this spring training either. When you find a point that I have a bad understanding at, I want you to really point it out because anything I have said isn't totally wrong at least so far. Not everyone comes here to learn and be informed either. Some people like to come here to express their opinions and see what gels and how other Sox fans feel about a similar subject. I come in with a strong statement usually, but most times I'm looking for the good argument to take me a step back and realize that I could be mislead. Other times I'm seeing if other Sox fans see if I feel as strongly as I do on a important subject. I feel as though I brought a couple of subjects at hand that are worth the argument. We will see how it plays out in the next year or so.
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Post by jimed14 on Mar 26, 2016 10:50:38 GMT -5
Not everyone comes here to learn and be informed either. That's pretty obvious. Thanks for the effort.
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