OC Register: Alexander: Angels’ Keynan Middleton, and his balky elbow, are part of a trend

[AngelsWin.com]

ANAHEIM — Dodgers chairman Mark Walter put it succinctly a few years ago during a discussion about signing pitchers to long-term contracts.

“Pitchers break,” he said.

The parade of breakage continues.

Since spring training began in February, 12 pitchers have undergone Tommy John surgery. Some were prospects, others (including the Angels’ JC Ramirez, the Padres’ Dinelson Lamet, and Arizona’s Taijuan Walker) are big leaguers.

Are we about to see a 13th name on that list?

The Angels learned Monday that an MRI of reliever Keynan Middleton’s right elbow showed “damage” to his ulnar collateral ligament. Their announcement was purposely vague, noting that Middleton would get a second opinion “in the near future.”

But “damage” to the UCL is never good. The question is the severity, and whether stem cell therapy might be a viable alternative to the ligament reconstruction procedure.

Garrett Richards and Andrew Heaney both faced the same choice in May, 2016. Both opted for the therapy in which stem cells were injected into the area.

Richards’ therapy worked, and he was back on the mound by the start of spring training in 2017. Heaney’s didn’t. He underwent Tommy John surgery in July 2016 and was out until last August.

The aforementioned Ramirez tried the same tack when he was hurt last August, but he had to shut it down and have the surgery last month.

Yet it’s probably a risk worth taking, because if Middleton has the surgery he’d be out for most or all of 2019 anyway.

It is not just an Angels trend, although starters Tyler Skaggs, Nick Tropeano and Heaney have all gone through what Ramirez is enduring now and what might be in Middleton’s future. It is a baseball trend.

This is a telling statistic: From Dr. Frank Jobe’s pioneering operation on John in July 1974 through 1989, just 11 professional pitchers and two position players underwent the procedure.

There were 47 patients in the 1990s, 68 from 2000 through 2005, 61 from 2005 through 2010 … and 242 this decade, 105 since 2014.

Most have been pitchers, but not all. When the Dodgers’ Corey Seager underwent the operation this month, he was the third position player this year and eighth in the last five years.

Now balance those numbers with the reality that pitchers are treated far more gingerly today than ever before, with strict adherence to pitch counts. The night in the 1981 World Series when Fernando Valenzuela threw 150 pitches – you can look it up – in a complete-game victory? That’s nearly two starts for some pitchers today.

And that’s not a bad thing at all. Pitching is an unnatural motion, and the stress involved in throwing a baseball with any velocity – and its deleterious effect over time – is understood far better now than it was then.

“Pitching a softball is the way your arm was made to throw,” John said in a 2017 interview. “Your arm was made to go underneath and not go over the top. You’re going against the natural motion of the shoulder, throwing the baseball.”

And what of those relievers of yore who would pitch multiple innings for saves, or those starters who would make 35 or 40 starts and complete 20 to 25 of them?

“This is how they were trained,” Angels manager Mike Scioscia said Monday. “… I don’t know if any pitcher was pushed past what they were capable of, but it certainly was a different mindset to handling your starters and your bullpen 40 years ago.

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“… Before I came up in 1980, and I think all the way through probably the mid-70s, it was a four-man (rotation) and that was it.”

He paused.

“A lot of them had really short careers, too,” he added. “Some didn’t. Some kept going.”

Much of the wear and tear takes place before a player even signs a contract now, because the innings and pitches pile up for young pitchers in the summer, in travel ball and showcase events. But more often than not, Scioscia said, an organization signing a pitcher has sufficient information about his previous usage and can manage his workload accordingly.

That’s not always enough to prevent injury. But here’s the other modern baseball reality: There is pitching life, and sometimes plenty of it, after Tommy John surgery.

One example was on the mound Monday night for the Angels. Heaney, in his sixth start of 2017, was brilliant for eight innings against Houston, holding the defending champs to a run and four hits and striking out 10 on exactly 100 pitches.

Middleton might have been downcast after hearing his injury report Monday, but back stories like that should keep him going. He is, after all, only 24.

jalexander@scng.com

@Jim_Alexander on Twitter

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