It's pitch counts: We live in an age when pitch counts appear on a corner of our TV screens, updated after every pitch. So clearly, they must be a big deal. But are they as big a deal as we make them out to be? "I've never been able to find a study, or do a study, that shows the relationship between pitch counts and injuries," Conte said. Now once upon a time, back in 2001, there was a study on this -- by Keith Woolner and Rany Jazayerli in Baseball Prospectus -- that did establish a link. But it was based on the much higher pitch counts of that era, which could range to 130-140 pitches, or even higher. Since then, Jazayerli told ESPN.com, "No one that I'm aware of has studied the issue in as much detail in the 12 years since, which might seem strange except that pitch counts dropped so dramatically from 1998 to 2005 -- give or take -- that the issue essentially evaporated in the analytical community." So, now that 120 pitches or so has become pretty much the absolute max, does it still make sense to blame high pitch counts for an uptick in Tommy John surgery? "Who would say it's OK for a pitcher to throw 140 pitches?" Conte said. "I wouldn't say that. And if I wouldn't, that would suggest I think pitch counts have something to do with injuries. But where's the science that says that?" Aside from Fleisig's studies of younger pitchers, the fact is, that data doesn't exist.
It's the love affair with Tommy John surgery: Finally, one odd trend Conte has discovered in his research is an increase in time spent on the disabled list by pitchers with elbow issues but a decrease in the time logged because of shoulder trouble. The percentage of pitchers who land on the disabled list hasn't changed. And the percentage of time on the DL because of arm problems hasn't changed. What has changed over the past five years, Conte says, is that shoulder injuries used to be the No. 1 reason for lost time -- and accounted for more than twice as many DL days per year (about 9,000) as elbow issues (about 4,000). Now, strangely, elbow time has zoomed up to No. 1 and shoulder time is down. And one possible reason, Conte theorizes, is that pitchers are opting for Tommy John surgery at any sign of ligament trouble -- but gravitating away from shoulder surgery "because the rate of return is so dismal." When a pitcher with a partial ligament tear has Tommy John, he knows, with reasonable assurance, that he'll be back in a year or so. If he opts for rest and rehab, on the other hand, his future is shrouded in mystery. So, think of the pressure that weighs on everyone -- pitchers, doctors and everyone around them -- to choose surgery, not the old-fashioned route. "It's really hard sometimes," Ciccotti said, "to get athletes and their advocates -- if they're younger, their parents, and if they're older, their agents -- to accept non-operative treatment." So, is it way too fashionable to have Tommy John surgery these days? It just might be.
So those are the big theories. But do any of them -- valid as they all are -- fully explain what we're seeing? It doesn't seem like it.
"The truth is, it's not pitch counts," Conte said. "It's not fatigue. It's not velocity. It's not youth baseball. It's all of those. The question is which has the most impact on the result. And that takes more scientific study."