Shohei Ohtani Is and Always Was an Extreme Health Risk

On Wednesday evening, Yahoo’s Jeff Passan revealed the results of a physical conducted by the Angels on new signing Shohei Ohtani. Most notable among the findings in that document: a strain of the ulnar collateral ligament in Ohtani’s pitching arm. Sports Illustrated had previously reported on the receipt by Ohtani of a platelet-rich plasma shot in October.

From Passan’s piece:

“Although partial damage of UCL in deep layer of his right UCL exists,” the report said, “ … he is able to continue full baseball participation with sufficient elbow care program.”

[…]

When reached late Tuesday, Angels general manager Billy Eppler told Yahoo Sports: “Shohei underwent a thorough physical with MRI scans to both his elbow and his shoulder. Those are scans we conduct whenever we sign a pitcher. Based on the readings of those MRIs, there are not signs of acute trauma in the elbow. It looks consistent with players his age. We are pleased with the results of the physical and we are very happy to have the player.”

While it is a Grade 1 strain, the mildest of tears, it’s still a weakness in the finicky ligament that so many pitchers have torn and required Tommy John surgery to repair. While some pitchers with mild strains have been able to pitch through the issue — like Masahiro Tanaka, for example — others have not.

The teams that bid on Ohtani were aware of the elbow issue. I assume that every team besides the Marlins and Orioles would have gladly paid the posting fee and bonus even if Ohtani required a UCL reconstruction. Structurally sound ligament or not, Ohtani is still fascinating, still the top free agent of the offseason.

But this revelation does curb our enthusiasm. In an age where some of the most talented, hardest-throwing young pitchers have had careers put on hold (Stephen Strasburg and the late Jose Fernandez) or derailed (Matt Harvey, Francisco Liriano) due to Tommy John, Ohtani is obviously not immune himself to the prospect of injury or the perils of surgery and rehab.

Baseball cannot protect its top assets — starting pitchers — the same way the NFL can attempt to safeguard quarterbacks. A defensive player can be penalized for an illegal tackle. Elbow ligaments, however, are immune to censure.

Baseball cannot have nice things — or, at least, struggles to keep them healthy.

Perhaps it’s because velocity is pushing the limits of the body, or that sports specialization and year-round throwing is fraying ligaments like a rope, and/or that modern lineups do not allow for less stressful periods through a batting order. Whatever the reason, I’m sure you’re aware of the Tommy John epidemic.

Before Tuesday evening we were aware that Ohtani had missed most of last season ostensibly due to an ankle injury, but now we know the elbow likely played a role. After all, an ankle injury wouldn’t explain why his splitter usage fell off so dramatically in 2017 in his small sample of work. (SF% and SFv denote split-finger percentage and velocity, respectively.)

Ohtani’s Pitch Types and Velocity
Year Age FA% FAv SL% SLv CB% CBv SF% SFv
2014 19 56.3 94.6 21.0 80.5 6.4 72.5 16.2 86.1
2015 20 56.5 94.7 17.0 80.3 4.9 71.5 21.6 86.5
2016 21 54.1 96.1 23.1 82.7 4.5 71.7 18.3 87.1
2017 22 59.6 96.6 32.3 81.5 0.7 72.7 7.4 88.8
SOURCE: DeltaGraphs

While his velocity remained stable, the decline of splitter usage suggests something might not have felt right.

Then consider opponents’ plate discipline against Ohtani. Without the split, he was unable to create the same amount of chase in his small sample of 2017 work:

NPB Opponent Plate Discipline vs. Ohtani
Year O-Swing% Z-Swing% O-Contact% Z-Contact% F-Strike% SwStr%
2014 35.0 64.8 53.4 84.9 46.1 13.5
2015 37.5 64.9 53.0 84.2 43.2 14.5
2016 35.5 69.5 47.5 83.0 44.4 15.8
2017 29.2 68.9 39.1 82.6 39.0 15.0
SOURCE: DeltaGraphs

His results were still good in that sample, which included an elite 15% swinging-strike rate. Eno found that plate-discipline and batted-ball trends in the NPB and MLB are remarkably similar.

But the concern with Ohtani is the same as with Noah Syndergaard, who entered last spring throwing even harder: can the body withstand the stress? Ohtani’s average fastball last year was 97 mph. There are not many comps for that in the majors. Only Luis Castillo, Nathan Eovaldi, James Paxton, Luis Severino, Strasburg, and Syndergaard have averaged 96.5 mph or better with their fastballs as starting pitchers in a single season in the PITCHf/x era.

Among them, only Strasburg has reached 200 innings in a professional season, and he’s reached that threshold just once. Moreover, a Henry Ford Hospital study found that fastball usage has a correlation to Tommy John surgery.

Researchers suggest that throwing fastballs nearly half of the time puts pitchers at risk of injury to their elbow. MLB pitchers who have undergone Tommy John surgery threw on average 7 percent more fastballs than pitchers who had no surgery.

Last season, MLB pitchers threw fastballs at a 55.2% rate. Ohtani threw a fastball at a 59.6% in Japan, a fastball that averaged as much velocity as any starting pitcher in the world.

Ohtani is a fascinating player. He’s the best player in the world who hasn’t yet played in the majors. But like any other pitcher, he’s a health risk. And probably — given his stuff, fastball usage, and ligament tear — he should be regarded as an extreme health risk.

Pedro Moura reported for the L.A. Times that the Angels are considering using a six-man rotation to mitigate risk and keep Ohtani fresher.

Indications are the Angels will use something resembling a six-man rotation to begin next season, a marked departure from orthodoxy and something that general manager Billy Eppler framed Tuesday as a sort of moral imperative.

Eppler has entertained the idea for years now, and nearly attempted it in September 2016. Friday’s surprise signing of Japanese two-way sensation Shohei Ohtani injected some urgency, as the 23-year-old Ohtani never pitched more than once a week in Nippon Professional Baseball.

Of course, even a six-man rotation might not prevent a full ligament tear. What baseball knows for sure about injury prevention is there is still much to learn.

Baseball knows it’s tough for the sport to have nice things like once-in-a-generation, age-23 arms. Ohtani is the nicest of things, but he’s a good bet to eventual miss significant time to injury. That said, every team would love to have him. Let’s hope he can beat the odds and stay healthy.





A Cleveland native, FanGraphs writer Travis Sawchik is the author of the New York Times bestselling book, Big Data Baseball. He also contributes to The Athletic Cleveland, and has written for the Pittsburgh Tribune-Review, among other outlets. Follow him on Twitter @Travis_Sawchik.

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Maxamuz
Member
Maxamuz

Ohtani has a slightly torn UCL. Given the velocity at which he throws, the stress on that weakened ligament isn’t likely to decrease.

I think saying he has a “slightly torn UCL” is a tad misleading.

There is 3 levels of sprains for the UCL.

A grade 1 sprain means that the ligament is stretched but no tear is felt. A grade 2 sprain indicates the ligament is stretched and a partial tear could be present. A grade 3 sprain indicates there is a complete tear of the ligament.

Everything I’ve read indicates that it’s a grade 1 and he’s already received PRP injections to aide in the healing process of the stretching of the ligament.

Is it still concerning? Yes. I’d venture to say most MLB pitchers will have this sprain at some point and with proper elbow care, won’t lead to TJS. I’m curious on the report from @MLBPlayerAnalys on PRP injections and what grade sprains a majority of them had at the time.

Paul22
Member
Paul22

MRI’s don’t catch every small tear and a Grade 1 strain or sprain is by definition tearing of under 10% tissue fibers as the ligament stretches out and becomes lax. Grade 2 tears are larger but incomplete. The lax UCL results in bone spur formation and command issues.

The UCL is compromised. At his age and velocity I would put the chance of TJS at greater than 70% over the next 6 years although limiting his starts and IP with a 6 man rotation could possibly allow them to dodge a bullet.

A larger concern is does the injury get in his head and force a change to his pitch selection as we saw last year with the reduced use of the split. Tanaka increased his split use almost 100% in MLB before going down with a similar issue. All is well so far after PRP but you can hear the clock ticking and last year was his worst year and he did not opt out, probably fearing teams concerns when they saw his latest MRI

channelclemente
Member

PRP has proven to be more of a placebo than a real medical treatment in scientific studies, if not the sports medicine literature. I think the article placed the chance at ~30% of TJS. Given expectations, this makes his future success more of a crap shoot than it was perhaps thought to be.