Herm Schneider and the Immense Value of Health

Last week, Ben Lindbergh authored an excellent piece regarding baseball’s “ever expiring ideas” for The Ringer. FanGraphs editor Dave Cameron described the trend as a “devaluation of new ideas.” But I think many can agree on one area of the game that features considerable room for growth, one many clubs are pursuing: injury prevention.

Even as teams employ modern treatments, the total of days missed due to injury continues to increase. MLB players spent 36,893 days on the disabled list last year, according Jeff Zimmerman’s excellent research, which broke the previous high of the 15-year study by 21%. There are many culprits cited to explain this trend, from the rise from youth sports specialization to the toll of increased velocity on the elbows and shoulders of pitchers. Will Carroll, one of the few who have tried to measure injury loss and cost, estimated the sport spent $1.1 billion alone on disabled pitchers from 2008 to -12. Despite advances in wearable technology, despite more focus on injury prevention and strength and training programs, injuries keep increasing.

To better understand how the industry might improve its ability in keeping players healthy and on the field, I spoke to the athletic trainer who’s had more success than anyone in keeping players off the disabled list in the 21st century.

Last week, I talked with Herm Schneider as he made his way to O’Hare airport in Chicago to catch a flight to Arizona to begin his 38th season as the head athletic trainer of the White Sox. The 64-year-old is the sport’s longest tenured head athletic trainer. And for good reason: according to Zimmerman’s data, he’s been the most effective.

Over the last 15 years, the White Sox have lost the fewest days to the disabled list of any major-league team – and it’s not close. While DL data is hardly a perfect measure of time lost to injuries, as the disabled list is also employed by clubs as a roster-manipulation tool, the White Sox have averaged just over 500 DL days per season since 2001, according to Zimmerman’s research. Only three other teams have averaged fewer than 775 days lost to injury. The White Sox’ domination is illustrated clearly by this chart from Zimmerman’s piece:

The White Sox continue to remain one of the healthier teams in recent years, as well. Over the last five seasons, the White Sox have recorded the second fewest DL days, and fourth fewest over the last three seasons.

Carroll has dubbed Schneider and his staff “miracle workers” and has generally regarded the White Sox’ training and medical staff as the top one in the majors. People in and around the industry understand the White Sox’ track record of success, particularly with a pitcher like Chris Sale, who many thought had an elevated risk of injury due to his unorthodox delivery and frame. But few understand the hows or whys behind the success. Said former White Sox manager Robin Ventura to Yahoo!: “I don’t know exactly how he (Schneider) does it… I’m not sure exactly why we’ve had success.”

What are the secrets?

They are generally not high tech. Schneider has been considered an “old school trainer.” While Schneider says he is interested in “anything that can help” and while the White Sox have experimented with the Motus sleeve and other wearables that measure stress, Schneider says many of the new technology products are not quite ready to be widely adopted as effective tools.

“The problem is [the Motus sleeve] is always sliding down and not staying where it should,” Schneider said. “The theory is good, it just really hasn’t gotten out there yet. Now if you’re going to a lab and you’re in a good environment and it’s not hot, you’re not sweating, then you can get some better information. But if you’re talking about the real world, and being out there in spring training, it’s still a little bit up in the air.”

What are the secrets of Schneider, his staff, and the club’s doctors?

“We just stay on top of things and don’t let things get away from us,” Schneider says. “We try to head things off at the pass before they become unmanageable. I keep using the word ‘unmanageable,’ but that’s what it is… Everything is manageable as long as we get it before it becomes unmanageable.”

“Staying on top of things,” is a phrase and practice he repeats often. To accomplish it, Schneider says trust between players and training staff is “huge.” Perhaps it is the trust built through relationships, results and his history of success, that’s behind the White Sox’ competitive health edge. Some of those skills are perhaps innate, others are learned during a career that began in 1969 with the Orioles’ instructional-league team. Schneider advanced to become an assistant trainer with the Yankees in 1978-79 under under Gene Monahan, whom he considers an important influence. Monahan was the game’s longest-tenured trainer until his retirement after the 2011 season.

“I learned a lot from Gene. He encouraged how to stay on top of things,” Schneider said.

Schneider and his staff are vigilant in making sure players complete their individualized maintenance programs. Schneider doesn’t require or ask players to fill out surveys, like some clubs do, to get a gauge on how players assess their health and readiness. What Schneider does do is stay in constant dialogue with players about how they’re feeling, making sure they complete their maintenance programs.

Researcher, writer and surgeon Atul Gawande articulated in an New Yorker article titled “Heroism of the Incremental Care” an idea that is perhaps applicable to the success of Schneider.

Gawande noted surgeons and specialists in the medical field are treated as heroes, celebrated and compensated as such, and often perform life-saving procedures. Health in baseball is no exception: Dr. James Andrews is perhaps the most well known medical person in the field. It’s Andrews and others like him that perform career-saving surgery. But Gawande explores, learns and argues that it is actually primary-care physicians, clinicians, who are perhaps the medical personnel are most undervalued (and underpaid) and who produce more overall value than specialists. It’s the clinicians who can help a patient avoid a surgery through regular contract and familiarity. And in MLB, it’s trainers like Schneider who are on the front line of prevention.

Wrote Gawnde of his conversation with clinicians:

“`It’s the relationship,’ they’d say. I began to understand only after I noticed that the doctors, the nurses, and the front-desk staff knew by name almost every patient who came through the door. Often, they had known the patient for years and would know him for years to come. In a single, isolated moment of care for, say, a man who came in with abdominal pain, (the relationship) looked like nothing special. But once I took in the fact that patient and doctor really knew each other—that the man had visited three months earlier, for back pain, and six months before that, for (the) flu—I started to realize the significance of their familiarity.

For one thing, it made the man willing to seek medical attention for potentially serious symptoms far sooner, instead of putting it off until it was too late. There is solid evidence behind this. Studies have established that having a regular source of medical care, from a doctor who knows you, has a powerful effect on your willingness to seek care for severe symptoms. This alone appears to be a significant contributor to lower death rates.”

Now, this isn’t a perfect comparison. Baseball does not often feature life-and-death situations. Training-staff personnel are always present in clubhouses, while a trip to the doctor requires time, travel and an appointment for the rest of us.

But what does carry over, perhaps, is familiarity and trust. What’s the difference between a player willing to be open about how he is feeling versus being unwilling?

“I really, truly believe that no one cares about them more than we do,” Schneider said. “You can go to other places and share your concerns, but no one is going to care more about you than our medical staff and our team of people. You are part of our family.

“I think they realize once it’s starting to become a bit unmanageable, I think they would certainly share… They know that if they are a bullpen guy I will go to bat for them every time. If we need to give them a day off from pitching in the bullpen because they pitched four or five days in a row, I am very willing to go to bat for them and they know that.”

How else do you develop trust? It can be little things, Schneider says, like giving a new player his personal cell phone number and telling him to call him without any hesitation. Schneider says “reputation precedes you.”

“People know I am there to help them,” Schneider said. “I am certainly not to hurt them in any shape or form. We are givers. We don’t want anything back other than them being healthy and doing their vocations.”

And perhaps that reputation, that familiarity, is the difference between a pitcher willing to disclose some elbow soreness and avoiding a major issue, or not disclosing it. For instance, Sale ended up on the disabled list for the first time in his career in 2014 after a 127-pitch outing, but he avoided a worse fate by communicating discomfort after his start. What if he had not been open about discomfort?

Adam Eaton told Joshua Nelson of SouthSideSox that Schneider played a role in his decision to sign an extension with the White Sox.

“I got to know Herm very well starting my career [in Chicago]. I had two stints on the disabled list, one with a hamstring injury and the other with an oblique injury. Both injuries really nagged me all season so I was in Herm’s office quite a bit,” said Eaton. “Before signing a long-term deal, you want to know who are the people around you and who is going to take care of you. I really enjoy working with him on a day-to-day basis and I wouldn’t sign a five-year deal if I wasn’t comfortable.”

Schneider said there is also a top-to-bottom understanding of the importance of “pre-hab” in the organization, coaches and front office personnel are pulling the same direction.

“[Pre-hab] is a huge focus for us and within our organization everyone realizes that and appreciates it to the utmost,” Scheider said. “I kind of put it like Listerine: you hate it but you love it. Sometimes [the players] don’t like you bugging them because we kind of keep them accountable. When it’s all said and done, and they’ve been healthy and had a decent year and they are up for a contract – and they are blessed where they sign a good contract and take care of their family – all of the sudden it gets appreciated. ‘I’m glad they kept me accountable.”

Programs are tied to positions and needs of individual players. Schneider took Nelson through the between-start process with starting pitchers.

Day one after a start: The pitcher will participate in 10-15 drills focused on the shoulder. The next set of drills focus on getting fresh blood flowing to heal micro-tears in the shoulder that work concentrically and eccentrically on recovery. Finally, pitchers will work with trainers on their general endurance as well as leg and back work.

Day two after a start: The pitcher will throw a bullpen session with pitching coach, Don Cooper, to focus on their sport-specific issues.

Day three after a start: Repeat of the first day, but pitchers only conduct half of the drills. This is aimed to get the body to temper down.

Day four after a start: A rest day, in which Schneider doesn’t prefer to see the pitcher unless absolutely necessary.

I asked Schneider for some player-specific success stories. For example: why does Sale have no operating scar inside his left elbow? While there were recent years when no White Sox pitcher appeared in the top 30 of Baseball Prospectus’ “pitcher abuse points” leaderboards, Sale led the last two seasons. But Schneider was hesitant to praise any one player and notes HIPAA privacy rules limit him in discussing specifics.

“[Sale] followed the program to the T. You never had to look for him or track him down, encourage him, irritate him to do his conditioning and pre-hab work for his shoulder and elbow,” Schneider said. “Taking the ball every five days is a very difficult thing to do. He felt a sense of obligation to himself, his family, to the organization, and to the game, to do what he had to to stay healthy.”

And Sale was helped by a training staff, that in the 21st century, has done a better job than any of its contemporaries at keeping its players on the field.

Schneider believes the industry can learn to better prevent injuries in an era when they keep growing in number. To Schneider, the process doesn’t have to be rocket science, but it does require diligence and organization-wide agreement on practices and principles. And perhaps the greatest lesson to be learned from the White Sox is this: for as much promise as science and technology hold, preventing more injuries begins with open, honest dialogue.