The doctor who performed elbow surgery on Stephen Strasburg said he did not tell the Washington Nationals to shut down their ace pitcher.
“I wasn’t asked,” Dr. Lewis Yocum told the Los Angeles Times.
Yocum said he had not talked with Nationals General Manager Mike Rizzo since last year and had not talked with Strasburg since spring training….
Yocum said that, had he been asked, he would not have been able to provide conclusive information about whether Strasburg’s long-term health would be best served by shutting him down.
“There’s no statistic as far as studies,” Yocum said.
Yocum noted that Rizzo set his own standard with Nationals pitcher Jordan Zimmermann….
Yocum said that process — and not any medical directive — essentially determined how Rizzo would proceed with Strasburg.
“It’s based on Mike’s experience,” Yocum said. “Mike is extremely confident. His track record speaks for itself. Zimmermann did extremely well.”
Yocum said the results with Zimmermann and Strasburg might well influence how other teams handle the progress of young pitchers coming back from Tommy John surgery, in which a damaged ligament in the forearm is replaced.
“If there was a guarantee, everybody would be doing it right now,” Yocum said. “You just don’t know. This may be the beginning of a trend.”
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But this is like Christmas for me in the meantime. Meanwhile, many of the pro-shutdown Nats fans are all like "lalalalla can't hear can't hear. Rizzo is awesome! Count Da Winzzzz!!!"
I'd have to go back and look, but weren't you saying in the other threads that Yocum was specifically involved, and that the much ballyhooed 50-page study was produced by doctors?
But we do know that Yocum wasn't consulted recently. And that Dr. Andrews hasn't consulted at all on Strasburg.
So either Rizzo lied, or he said he consulted with Dwight Yocum and Stark misreported it.
Despite the fact that Rizzo claimed he did consult Yocum what Yocum said here still backs up a lot of what was said in the past articles. Which was that the doctors weren't the ones saying Strasburg had to be or should be shut down or that there was medical evidence/data that it was a good idea.
As Yocum said, this is Rizzo's idea (or we could say the Nationals' idea) and not an idea put together by a team of doctors who studied the issue and came up with a plan of usage for Strasburg. That was and still is utterly false.
The most charitable interpretation for Rizzo is that he spoke with Yocum last year and got general feedback from Yocum -- but not related to a "shutdown" -- and Rizzo used that in making his decision.
Because unless Yocum is lying or mistaken, Rizzo never asked him about shutting Strasburg down. And Yocum said that had he been asked, he wouldn't have been able to provide anything conclusive.
Right. KT snarked that Rizzo never said specifically that he "only" consulted Yocum, but according to Yocum he was never consulted *at all* about any shutdown.
And we were told from people here that medical evidence from doctors - such as MRIs - were driving this decision, so doctors had to be involved, but now we learn that the surgeon himself wasn't involved in the decision. To say nothing of the point I raised earlier, which is that in order to compare MRIs you need MRIs and the Nats couldn't have had them for most of the pitchers in this much-trumpeted 50-page study.
How can an MRI tell you that he's ok to go 160 IP but not 200?
Rizzo has altered the course of the Nats' franchise based on 200>160, which is ludicrous. It's one thing to lose an ace pitcher to injury, but to lose him to bizarre decisions is inexcusable. If the Nats fall short they will never be able to go back and replay the 2012 postseason this time with Strasburg, and they have absolutely no guarantee that they will ever be back in the postseason again with him, much less so with a team this good.
And no real reason to believe that 200>160 is going to keep Strasburg healthy for coming years, and they only have him under control for so long - it's not like he's signed for another 10 years - and despite their carefulness so far he already got hurt so what are we really doing here, anyway?
Because he's smart. There is no conclusive evidence.
A highly esteemed Dr. has nothing to gain by offering speculative opinions outside his immediate field.
(*) I know Rany's system didn't prove to be all that useful, but neither is IP..
Is there good evidence?
I kind of doubt it, but they've said they weren't using IP.
Not that I know of.
The John Grisham masterpiece?
George R. R. Martin's next book.
You're right Ray. Fire Rizzo! What a bum! No clue what he's doing!
Washington Nationals WSN 89 54 .622 --
Atlanta Braves ATL 81 63 .563 8.5
Philadelphia Phillies PHI 72 71 .503 17.0
New York Mets NYM 65 78 .455 24.0
Miami Marlins MIA 63 81 .438 26.5
On the other hand, there is no way to say that the plan is inherently flawed. This Yocum interview is weak circumstantial evidence about the plan development process. Again, we don't know what it is, or what went into adopting/developing it, so we cannot really say it is doomed.
Because it wasn't "the plan".
I'm not complaining, I just think it's weird. It's no skin off my nose if the Nats don't pitch him.
I understand why they didn't start it in mid-May - they weren't necessarily expecting to be in this position and they wanted to make sure that Strasburg reached his presecribed limit.
What I'll never understand is why they didn't modify the plan once it became apparent (which it did early on) that they were going to be serious contenders this year. It's one thing to have a theory, with little supporting evidence, on how a limited workload is best following TJ surgery. It's something entirely different to believe that there's absolutely only one way to execute that theory. It's that unflinching devotion to The Plan, in the face of very different circumstances than you anticipated, that I can't get behind.
You can always send him to Puerto Rico or the Dominican League for 3 or 4 starts.
And while we're at it let's take out all the garbage at once and shitcan that geriatric turd of a manager they've got in Davey Johnson. WTF has that guy ever accomplished?
Isn't the fact that they had excess starters an argument for keeping him in extended ST?
Rizzo has been pretty clear that stopping and starting him was something they believe would have a negative effect.
I don't agree with this decision but I'll say this for Rizzo; he has been pretty good about addressing the concerns. I think he is reaching the wrong conclusion but at every step in the process he has had a reason for what he is doing.
So what if he had tweaked a hammy on April 30, and needed to go on the DL? Shut him down?
So your post completely misses the mark. I await an acknowledgement and apology.
Yup.
Not "worked." Has worked. So far.
But in relation to what? They chose Plan A with Zimmerman; we don't know what would have happened if Plan B had been chosen, any more than I know that when I take Route 16 to my grandmother's house and arrive safely, I would have crashed had I taken the Mass Pike.
And again, they weren't in contention when they did it with Zimmerman. I don't think anybody would be complaining if they did this and the Nats were 10 out.
But how does starting him in mid-May risk him not reaching his prescribed limit?
Yes. There is absolutely no evidence that this "plan" is more reasonable than any number of other similar plans that could have been implemented.
Where "devastatingly on target" means "not at all on target"? Where did I submit a wholesale rejection of Rizzo's career and body of work?
I said that he is making an irrational decision here and should be overruled or fired because of it.
EDIT: Sorry, I guess I missed the sarcasm.
You need to get out more often. I know a few unhappy Nats fans.
They are simply concluding that. With no evidence to back it up.
Since when is "a reason" ample justification for doing something? I'm sure every man who cheats on his wife has "a reason."
How about a good reason?
Exactly. No organization, ever, anywhere, has approached pitchers this way.
If a young pitcher tweaked his hammy on September 1st and a team was out of contention they might shut him down; if they were in contention they'd try to bring him back.
No apology needed. Saying that he is making an irrational decision and should be overruled or fired because of it is not a wholesale rejection of Rizzo's career and body of work.
Still ranting about a decision that you don't even have a rooting interest in, I see. Do you want me to say something socialistic so you can at least have a nice change of pace?
But you'll have to excuse me, as I have to get ready to record about seven hours worth of Mack Sennett shorts so I can watch them at least twice each at some later date.
He is their number 1 starter.
I'm a Nats fan, and I'm pretty ticked off that one of the most dominating pitchers in the game won't be available to us in the playoffs because the team somehow didn't have enough foresight to handle this situation better. There is no guarantee whatsoever that the Nats are going to be in as good a position to win it all any time again in the near future as they are this season.
Starting and stopping isn't the only way to achieve that goal. You could skip every third start. You could limit the innings he throws in individual starts more than you're doing now. You could move him to a bullpen role (though one that mimics starting condidions - regular rest between outings, ample warm-up before takign the mound).
There were creative ways Rizzo could have employed to achieve his goal (limiting Strasburg's innings) while also having him avaialble for postseason work. There's not a lot of evidence this was genuinely considered.
No, he is their number one in terms of seasonal performance. He has a similar ERA and better peripherals (including a league-leading K rate). Perhaps the others have better durability (I assume so but haven't checked), but (a) his durability is more a management decision than him not being capable of going deeper into games, and (b) durability matters more on a seasonal basis than a per-game (playoff) basis.
And since when is "best pitcher on the team" limited to one season?
As for your Mr. Empirical Evidence quip, I'm on record here that I basically ignore in-season splits. This came up recently in connection with David Wright. Check the thread.
As to "fire Rizzo" being an overreaction, I flat disagree. EVEN IF he just had to do this, there was a better way.
Rasmussen says a plurality support Rizzo right now, although I'm not sure how they sample registered Nats fans or "likely" Nats fans. Nate Silver likely thinks otherwise but he's a @!$#$%@ Cubs fan so he's almost certainly biased about pitcher abuse.
I think in fairness to Rizzo it should be noted that just as he cannot conclusively demonstrate that his idea is a good one, neither can we conclusively demonstrate that it is a bad one.
And once more with feeling, I think this is a terrible idea.
How is it creative if he did the exact same thing last year with Zimmermann?
Teams have limited innings before. When you have a reasonable expectation of playing meaningful September/October baseball, the creative way would be to limit his innings, but still keep him available for the most important games late in the season.
The uncreative thing would be to do the exact same thing you did last year, when you were coming off a last place finish and considered yourself lucky to win 80 games.
When Rizzo (after much angst) talked about the 50-page binder, my first lame joke was to Boras' "Ollie Perez is Sandy Koufax" binder. But after today, I started wondering if there's a bit more to that. How much input did Boras provide? How many of the statistical comps did Boras point out? He was certainly well spoken and knowledgeable about the comps the team was supposedly using. And after today, we know that neither Yocum nor James Andrews were involved involved in the regular rehab process, other than Yocum having provided some general guidelines early on. Did Boras have a medical team give the team advice?
I mean, you've got an agent who's established a great relationship with the owners. And Boras and Rizzo are practically BFFs, to the point where Boras is openly talking about how he helped shape the direction of the franchise. And when you look at the type and quality of the Boras agents on the team, Rizzo's certainly a bit beholden to him.
Was Boras' team helping to shape this decision despite the inherent conflict between Boras' long-term interests and the Nationals' long- and short-term interests? How much did he push and influence Rizzo? How much behind-the-scenes cozying did he do to the ownership to ensure they were on Rizzo's side when the tough questions came? How much of the Boras media tour over the last month or so was to help deflect some of the toughest questions that Rizzo was getting once the heat finally was turned up?
Where did Boras' influence with this end, and where did Rizzo's resolve begin? I guess that's what troubles me about this.
If you excuse me, I'll be fashioning a tin foil Curly W.
Rizzo should light Strasburg on fire and jump over him with his truck!
You don't know if Harper blows out a knee next year. You don't know if Zimmerman hurts himself again.
You do - not - know if Strasburg gets hurt despite this. You don't even know if this really reduces his chances of getting hurt in future years.
"It includes the view of the surgeon, Lewis Yocum, who’s performed all the operations on Nats pitchers in recent years. It is Yocum’s belief that pitchers who break down from premature returns from elbow surgery — sometimes ruining their shoulders, and their whole careers, rather then their new elbows — don’t usually do so during the first big stress year but rather the following season."
Jordan Zimmermann, the Nats big prospect pre-Stras, was shut down at 161 1/3 innings on 28th August his first full year back - and lived to pitch about 200 healthy and productive innings this season.
And the Nats have another Yocum client as of 31st August - Lucas Giolito, 16th pick in the draft because of concerns over a strained elbow ligament that later ruptured Aug. 14 during pitching in the Gulf Coast League, underwent Tommy John surgery in Los Angeles.
"It includes the view of the surgeon, Lewis Yocum, who’s performed all the operations on Nats pitchers in recent years. It is Yocum’s belief that pitchers who break down from premature returns from elbow surgery — sometimes ruining their shoulders, and their whole careers, rather then their new elbows — don’t usually do so during the first big stress year but rather the following season."
Jordan Zimmermann, the Nats big prospect pre-Stras, was shut down at 161 1/3 innings on 28th August his first full year back - and lived to pitch about 200 healthy and productive innings this season.
But doesn't that suggest that this year was the danger year for Zimmerman, and next year will be for Strasburg? i.e. you need to baby them for two years?
By limiting Zimmermann in year one they believe they have not overtaxed the ligaments and enabled almost complete healing (and possibly also avoided damaging his shoulder by altering the motion due to inflammation) and that he is healthy enough post-this surgery to pitch from this point on.
If they had not put in limits on stress in the first season (especially since the recovery time has been cut from 18 months to 12 months, it may have been a different 2012 for Zimmermann. That's how I interpret Yocum's statement.
Money.
If you blow up Stasburg due to overuse you loose the #1 draw in DC....not just this year but maybe for 10 to 15 years to come.
If your strategy is to do the very best you can to show him, his parents, his agent and other young pitchers that you have a caring strategy with a primary purpose being the long term health and care for your pitching assets it will go a long way to help resigning Stasburg and attracting free agent pitching talent.
This is a shrewd move, well thought out with 100% ownership buy-in.
This team will be contending for world series titles for years to come; this is the Phillies redux.
Money.
If you blow up Stasburg due to overuse you loose the #1 draw in DC....not just this year but maybe for 10 to 15 years to come.
If your strategy is to do the very best you can to show him, his parents, his agent and other young pitchers that you have a caring strategy with a primary purpose being the long term health and care for your pitching assets it will go a long way to help resigning Stasburg and attracting free agent pitching talent.
This is a shrewd move, well thought out with 100% ownership buy-in.
This team will be contending for world series titles for years to come; this is the Phillies redux.
Fans come to see winners, and FA sign for the most money.
A World Series win this year is worth more to the Nationals' bottom line than 4 years of Strasburg.
Yes.
Ron J has looked specifically into the issue of whether there is a bump in attendance for certain star pitchers. From what I can recall - and perhaps I am recalling it incorrectly - he found a bump for Nolan Ryan but it may have been the result of people who would otherwise have gone on a different day simply waiting to go on a day that Ryan started instead. So there was no real attendance increase, or maybe was a small one.
In either case any real attendance boost in Strasburg's starts is pretty much swamped by a WS win - which shows up not only in playoff revenue but also in increased attendance the following year.
The problem with Strasburg getting hurt is not so much losing him as "a draw" but simply that the team will be worse without him, and worse teams draw worse. And yes, I know that the point is that losing him = a loss in revenue no matter how specifically that happens, but again, offsetting that is the fact that playoff runs are huge revenue sources, both during the run and in the next season.
The last comment, which is most on point, is from this thread, for those interested.
This Nationals team was built to have sustained success due to the benefits (higher draft picks/Strasburg/Harper) of their recent poor performing seasons. Because this is their first year of which the rebuild is paying off, the fan mentality becomes more panicked with the idea that "this may be our only chance!" That would be the case if they have over purchased all their players at older ages on the free agent market, however they have a young core of players that are built for success over the long term, and Rizzo knows that he is entering a window of success and that Strasburg is an important cog in that machine. The Nationals will still make the playoffs this year, but by looking out for the long-term health of Strasburg, he is making the more calculated risk, and conservative risk that the next 4-5 years are more important that going "all-in" for one year.
As a GM, you do not have success by having one good year out of five (one championship in one playoff appearance), but by having 6 good years out of 7 (making the playoffs as many years as possible). As a fan, I would rather be the 1990s Atlanta Braves than the 1990s Florida Marlins.
NU 41 is spot on. To build brand equity and fan loyalty, you need three years of success (in the playoffs or close enough in late September) - not just one. That will change the image of the fracnhise and enhance non-attendance related revenue streams.
As the former MLB pitcher notes, this is the biomechanical expectation with respect to post-TJ condition -- no single pitch is expected to cause massive damage, but each pitch should lead to accumulation of small amounts of damage that may not heal fast enough to prevent increased risk (as a function of time/pitches/usage) of crossing a critical threshold.
If the Nats follow this particular strategy for 15-20 years, we might be able to answer whether or not this particular procedure seems to be effective.
Now, nothing says *this* (160 IP) is the correct procedure, but a slight limitation from a "normal" workload wouldn't really provide any information here --- if you knock off 10 or 15 IP per year, I expect you would be well within normal year-to-year variation so you'd have no idea how the load change affects long term health. By chopping off a sizeable chunk of IP, you improve your chance to assess whether a reduction is a good thing. If 160 IP is actually found to reduce subsequent injury rates, maybe you bump it up to 190 IP and see what happens. If that still works, you either stop there or return to "normal" workloads (and if THAT works, you are essentially able to rule out workload as being the issue underlying re-injury following "modern" surgery). If 160 IP is NOT found to reduce the injury rates, you either try something drastic (like 80 IP out of the bullpen) or else you punt on workload being a determining factor in re-injury and start examining how you might change pitching mechanics (potentially dangerous) or training regimens.
Workload *should* matter (if one were to throw 1 IP per year, its pretty likely you'd be too old to be effective before you got injured; if one were to try to throw 1000 IP per year, its pretty likely you'd be injured along the way), but its contribution remains unclear. So, from a scientific/engineering research perspective, Rizzo's chosen as good an initial "alternate hypothesis" as any. I'd rather see someone try SOMETHING different that is at least not irrational (i.e., "I think re-injury comes from wearing the color white, let's change all of our uniforms to avoid having any white on them!"), than continue to do what everyone else has always been doing.
That said, Rizzo's arguments about having spoken with Yocum and Andrews look a bit fuzzy...but we (my research group, that is) often see players refer to having spoken to doctors in the context of concussions, only to find that they DID speak with the doctor about the topic ("Wow, these concussions seem pretty bad. Oh well..."), but not when they actually were experiencing symptoms or side-effects of said injury. If he asked questions right after surgery, he may well see that as being "close enough" to having consulted with Yocum.
That depends on the outcome of the lawsuit that is almost certainly coming in the near future. We'll see.
OK, what if it turns out the Nats win the WS this year, and Struesel leads them to not only the playoffs for the next 10 years but three or four WS titles over that span? Would Rizzo be a genius then, or a blind squirrel who found a nut? To have any credibility, you must opt unequivocably, right now, for squirrel.
This whole thing is a little like arguing over a trade. What's the point in What Iffing the future? It's going to unfold, and then we can use hindsight instead.
The doctor who performed elbow surgery on Stephen Strasburg said Thursday he has worked with the Washington Nationals on the rehabilitation strategy that led the team to shut down the pitcher last week.
Dr. Lewis Yocum had told the Los Angeles Times that he "wasn't asked" by the Nationals about whether to shut down Strasburg and had not discussed the subject with General Manager Mike Rizzo since last year.
On Thursday, Yocum clarified his comments by saying he and the Nationals -- as well as Strasburg and his agent, Scott Boras -- had agreed last year that the team would limit Strasburg's innings this season. Over the course of this year, Yocum said, he has spoken with Rizzo and the Nationals' medical staff but has left to the team the decisions about how and when to shut down Strasburg.
Yocum and Rizzo spoke on Aug. 13, as Strasburg approached his innings limit. The Nationals ended Strasburg's season after his Sept. 7 start.
Yocum said he stands behind the Nationals' decision to shut down Strasburg.
Rizzo declined to comment.
Yocum also issued the following statement:
"I would like to correct the misimpression generated from today’s L.A. Times article, that I have not been a participant in discussions with the Washington Nationals regarding the recovery strategy for pitcher Stephen Strasburg. In fact, I have been contacted repeatedly and have had numerous discussions with the Nationals GM Mike Rizzo and the team’s medical personnel, as recently as mid-August. While the final decision was up to the team, as is standard practice, I was supportive of their decision and am comfortable that my medical advice was responsibly considered."
If Strasburg gets hurt they lose Harper?
I don't like switching from the interesting topic of why the Nats shut Strasburg down, and whether they should have, to the uninteresting question of whether Rizzo should be fired (obviously he built this club, he shouldn't be fired even if he's handling Strasburg wrong), but you're not the one who changed the subject.
Was that a 180-degree switch? Wow, I didn't know that the Boras empire owned and operated re-education camps too!
EDIT: But, the more I think about it, not impossible. The original LAT article may have simply made a butchery (intentional or otherwise) about Yocum's position. He might have spoken with Nats medical personnel as recently as August but not Rizzo or Strasburg.
BORAS: Doctor... Yocum, is it? Nice little ligament replacement practice you got here; be a shame if anything happened to it. Now, you do remember that series of conversations you and Mike Rizzo had regarding Strasburg's rehabilitation plan, don't you, doctor?
YOCUM: ::Gets on the phone to the LAT::
As I mentioned before, considering that on 31st August Dr. Yocum did the surgery for Nats 2012 1st round selection Lucas Giolito, I'd say that there HAD to be conversations with medical personnel in DC throughout August.
Rizzo looks more and more clown shoes as the days pass. I don't care about the Nats but when this all blows up in his face it will pretty satisfying to those of us who like to see poor decision making punished. It's been a little dry since the Schilling bankruptcy. Speaking of baseball only of course, the Romney campaign is the gift that keeps on giving in this regard.
Strasburg has the lowest xFIP on the team this year by .50 points. ZIPS projects a 2.6 FIP going forward or Stras, 3.5 for Gio and 3.82 for Zimmermann. That's some straight up ######## going by single season ERA to try to show that Strasburg is not the best starter on the team.
How many pitches does a starter typically throw during his bullpen session? At what level of exertion, overall, is he throwing them?
How many pitches are used when a guy loosens up each inning - is eight the max? Do most pitchers use them all? At what level of exertion is he throwing them?
How much has the conventional wisdom on the above shifted through the years? Do guys throw more or fewer warmups now as opposed to, say, 1960?
Could you, theoretically, safely lessen the bullpen session and the warmups each inning by some amount and thus "save more bullets" for the actual game?
I assume things are the way they are for good reason, but I've never really heard this aspect of pitcher usage discussed. People say "Oh, he threw 110 pitches" or whatnot, but he also threw X number in the bullpen and X number of warmups through the game, even if they were less stressful. I would guess that anything thrown from the mound anywhere near full velocity puts at least a little something on the day's odometer.
Well, what the hell else do a bunch of miserable Red Sox fans have to talk about these days? Li'l Petunia's newborn? Bobby Valentine's mustache collection?
Try being a Cubs fan where the lone excitement is Soriano's march to 100 RBI's.
Thanks, but I saw enough of Soriano in the 2003 World Series to last me a very long lifetime, although I do admire the fact that he speaks Japanese.
I bet someday, if they try really, really hard, Joey and Chris can become just as big a Nats fan as you are Andy.
A specific question or anything at all? The article doesn't say.
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