The Dodgers, as you may have heard once or twice or twenty times this winter, have a whopping eight starting pitchers under contract for 2013. There’s Clayton Kershaw & Zack Greinke & Chad Billingsley & Hyun-jin Ryu & Josh Beckett & Ted Lilly & Aaron Harang & Chris Capuano & lions & bears. Oh my!
At the moment, there’s only two things we can say about the 2013 rotation with absolute certainty: first, at least one of those guys is getting traded before Opening Day, if not more than one, though I’ll admit I’m more than a little surprised it hasn’t happened already. That’s most likely going to be Capuano and/or Harang, assuming that Lilly’s cost and health make him untradable.
Second, and much more importantly: no one has any idea whatsoever what to expect from Chad Billingsley.
This isn’t the usual kind of “what kind of pitcher is Chad Billingsley” talk, which seems to be endless about a pitcher who has somehow been both underrated and underachieving simultaneously. This time, it’s “wait, he’s really going to try to pitch through a partially torn elbow ligament?” That’s the injury that ended what had been a dominant stretch for him last year, given that he’d allowed just six earned runs in 41.2 innings over six starts before leaving early against Miami on August 24. He was never seen again, had a pair of platelet-rich plasma injections in the elbow, and decided to attempt to rehab the elbow rather than submit to Tommy John surgery.
Ken Gurnick provided an update on Billingsley earlier this month:
He was shut down a month after the injections and resumed throwing to the point where he hit 94 mph in a two-inning simulated game in November. He took a month off and resumed playing catch in December.”Physically, Chad’s doing great, and he’s excited about the year,” said Stewart. “He sounds confident. I’m not in his head, but he sounds like he’s relieved that the throwing program worked out well. He’s pain-free. He said he’s right where he needs to be.”
Taken at face value, that’s incredibly promising, but it’s also an enormous risk. If Billingsley had gone under the knife in late 2012, he’d likely have missed all of the upcoming season but (probably) have been ready to go in 2014. By waiting, if the elbow goes out in spring training or during the season, not only is 2013 gone, but 2014 is as well.
Unfortunately for Billingsley, the history of pitchers attempting to rehab a partially torn (or “sprained”, since a sprain is a tear) UCL is poor at best. Back in 2010, Baseball Prospectus looked at exactly this issue:
As Dawkins wrote elsewhere, “The UCL does not completely heal on its own ever. Without surgery, the area is only stabilized by two methods. First, the elbow can be strengthened up to the point where the muscles take up the slack for the lack of ligament stability. The other method is that scar tissue is built up and the muscles are also strengthened. Regardless neither of these actually heal the tissue of the ligament, they merely control the symptom of instability.” According to BP’s injury expert, Will Carroll, doctors usually recommend surgery for a tear of any degree over 25 percent, though some will go as high as a third.
As Dawkins noted, “The ligament itself never heals itself to the point where it was before and therefore is basically a ticking time bomb.”
Now clearly I’m not a doctor, and even if I was I have no access to Billingsley’s medical records, so it’s impossible for us to know the specifics of his injury. Still, recent history is littered with the tattered elbows of those who attempted to pitch through a bad joint rather than get it repaired immediately. Going back to the BP piece…
Jesse Litsch pitched his last game of 2009 on April 13, but didn’t undergo Tommy John surgery until two months later. After the decision to operate was made, Jays manager Cito Gaston remarked, “[The elbow] just kept bothering him. He went back to Florida, he visited [Dr. James] Andrews twice … you add up the months and it looks like he won’t be back for Opening Day (2010), so that’s not good news.” As Gaston feared, Litsch didn’t make his return until the following June. Two months without Litsch is no great loss to a team ticketed for fourth place, but with another pitcher in another place, the impact of an absence of equivalent length can be measured in the millions.
Pat Neshek is another pitcher on my list who stands out for being slow to the operating table. In May, 2008, Neshek was diagnosed with a partial UCL tear, and rest and rehab were prescribed. Six months later, on the verge of completing his rehab, Neshek experienced discomfort in the same elbow, and an MRI revealed more extensive damage, which caused something of a stir in medhead circles. As a result of the delay, Neshek missed not only the rest of 2008, but all of 2009, as well.
Chris Capuano experienced elbow soreness in mid-March of ’09, received a diagnosis of a torn UCL, saw Andrews for a second opinion, and still decided to rest for a month before undergoing surgery, which he could no longer avoid by mid-May. Capuano was already a veteran of a prior TJ surgery. Perhaps his reluctance to succumb to the inevitable for a second time was an understandable byproduct of his suffering the first time around. A host of other pitchers followed similar trajectories, spiraling ever closer to a long-term DL stint while time ticked away.
There’s plenty more where that came from, as a few minutes of Googling will show. High schooler Lucas Giolito sprained his elbow in March of last year, ending his high school career and knocking him out of an nearly-certain top-ten draft selection. After attempting to rehab, he made it through just two minor-league innings with Washington before having surgery in August, likely delaying his real pro debut until 2014. Toronto’s Drew Hutchison left a June start last year with elbow pain; after weeks of attempting to rehab, he had surgery in August. San Diego’s Cory Luebke spent more than a month trying to avoid surgery last year; he got the zipper in late May and is likely to miss most of 2013.
The list goes on and on. In August of 2011, MLB.com’s Rhett Bollinger published an article that indicated Kyle Gibson would “avoid Tommy John surgery”; he had surgery on September 7. In 2006, another Twin, Francisco Liriano, attempted to fight through elbow problems of his own:
On August 1, 2006, Liriano was scratched from his scheduled August 2 start because of forearm inflammation after a bullpen session. He missed one start before resuming bullpen work without pain, but was placed on the disabled list after continued arm pain during his last start on August 7, 2006. Liriano began a rehabilitation program on August 22, and threw off a mound for the first time on August 30, throwing only his fastball and changeup, and said that he would like to pitch his breaking ball later that week. Liriano made a rehab start for the Rochester Red Wings on September 9, throwing 40 pitches for four strikeouts and one walk in three shutout, hitless innings. After the game, Liriano reported feeling no pain in his elbow and was reactivated by the Twins.
Liriano then had Tommy John surgery in November and missed all of 2007. We could go on for weeks with similar examples – J.J. Putz. Felipe Paulino. Eric Gagne, but the point is pretty clear. By all indications, it’s very rare for a pitcher to have a partial elbow tear and be able to successfully pitch through it, and the general outcome is that they simply delay their recovery time.
To be fair, there have been a few — very few — examples where this has worked. Former Dodger Takashi Saito missed the second half of 2008 with an elbow sprain and chose PRP injections & rehab over surgery, and he pitched parts of four more seasons in the bigs; Boston reliever Scott Atchison is attempting to do the same. However, even those examples are difficult comparables to Billingsley given that each were relievers who needed to be available only for an inning at a time, and since both were in their late 30s — Tommy John surgery at that point might be a career-ender, clearly influencing their choice.
The two best-case examples for Billingsley — starting pitchers who were able to pitch through a similar elbow injury — seem to be Adam Wainwright & Ervin Santana. Wainwright missed most of his age-22 season in the minors in 2004 due to an elbow sprain, but managed to pitch 874 very good big-league innings — including top-3 Cy Young finishes in 2009 & 2010 — before his elbow finally popped prior to 2011. Santana represents the other danger, because after missing months of 2009 with an elbow sprain, he managed to avoid the knife and has made 96 starts over the last three seasons. However, he hasn’t been the same pitcher; in 2007-08, he struck out 8.3 per nine, a number that dropped to 6.9 in 2010-11.
None of this is to suggest that Billingsley is clearly making a mistake here. It’s his health, his career, and his conversations with doctors — information we’re not privy to. It’s not out of the question that he can make this work, and the fact that he was able to hit 94 in November is a fantastic sign. It’s just difficult to look at the history of others have tried the same path and have a ton of optimism about it, and that’s why Ned Colletti is absolutely right to keep as much pitching depth as he can. Between Billingsley’s arm and the injury histories of Kershaw (hip), Beckett, Capuano, Lilly, & Harang, it sure seems like they’re going to need it.