Over the past couple months, I’ve felt somewhat bullish regarding the Angels’ chances of being competitive in the season ahead. They’re not a great team, and they’re maybe not even a good team, but they feel to me like an underrated team. Everyone points to a shaky pitching staff and, indeed, there’s not much in the way of depth there. The bullpen could use some assistance. But there should, at least, be solid arms in the starting rotation. Matt Shoemaker ought to make a successful return from his brain injury, as crazy as that sounds as a sentence. Tyler Skaggs is finally all recovered from his elbow surgery. And Garrett Richards is going to pitch. That’s the way things look right now, anyway.
The Richards case is going to be a big one. If he’s able to regularly take the mound and throw five or six innings, that could prove to be a game-changer, in the smaller and bigger pictures. Richards’ health won’t affect only Richards and the ballclub around him. All of baseball is going to be paying attention closely, because a successful future could spark a revolution.
A few years ago, Masahiro Tanaka was diagnosed with a partially torn UCL. You’ll remember how that went. We all associate the injury with an inevitable Tommy John procedure. There’s a reason for that — the procedure is tough to avoid. We’re skeptical whenever pitchers go the rest-and-rehab approach, because with so many cases before, that’s just put the surgery off and further delayed a return. Tanaka was advised not to have surgery. Fans, in contrast, said he should just get it out of the way. Tanaka didn’t have surgery. He had a platelet-rich plasma (PRP) injection. Maybe a few of them. Tanaka’s cleared 350 innings over the past two seasons.
Tanaka, presumably, still has evidence of a partial tear. Pitchers are commonly pitching through partial tears, and at some point, those partial tears can become complete. Adam Wainwright pitched with a partial tear for several years before his elbow finally gave out. There’s no rehabbing a total tear. That’s when surgery’s required.
PRP injections are somewhat new to the baseball landscape, but they already feel routine. No one really raises an eyebrow anymore. But PRP injections have also been only modestly successful. They come with zero guarantees, and now we get back to what Richards has done differently. Richards has had his own PRP injection. That’s not what’s unusual. When Richards was diagnosed with a UCL tear, the treatment was stem cells.
The two procedures are similar. They’re quick! And they’re hardly invasive. With PRP, an individual’s own blood is spun down, and a platelet-rich concentrate is injected into the injured area. With the stem-cell treatment, an individual’s own fat or marrow are spun down, and a stem-cell-rich concentrate is injected into the injured area. It’s all about promoting and boosting the healing process, and while PRP has some benefits on its own, using both PRP and stem-cell injections together might be far more powerful. Garrett Richards is in the middle stages of a crucial test.
For reference, here’s where things were in early May:
Sources says that given the grade of the tear, TJ is inevitable with Garrett Richards. With Andrew Heaney, he will continue to try to rehab.
— Alden Gonzalez (@Alden_Gonzalez) May 6, 2016
That second part is also important. Around the same time, Richards and Andrew Heaney were diagnosed with tears. Richards’ seemed to be more severe. Both pitchers went the stem-cell route, instead of the surgical route, and Heaney didn’t show enough healing. After several weeks of waiting and hoping, Heaney went under the knife. Richards, for some reason, has seen far greater results. His elbow showed significant progress. After three months, he was cleared to begin a throwing program. After four months, he was cleared for a bullpen session. After four and a half months, he was throwing competitively, touching 97 miles per hour. At five months, he was basically declared good to go for 2017. There were no more immediate hurdles.
This is all fairly new. There’s not a long track record of professional pitchers being treated like this, so doctors would need to figure out why Richards has had it so much better than his teammate. Maybe it comes down to luck. Maybe there was some other treatment-related or diagnostic difference. In the past, it didn’t take that long for PRP to go from weird to accepted. It didn’t take that long for microfracture to go from weird to accepted. Stem-cell injections could conceivably become an annual routine for pitchers within the foreseeable future. All they want to see are promising results.
The most famous pitcher to go through something like this is actually Bartolo Colon. At the time it was considered radical for Colon to have stem-cell treatments for his elbow and shoulder in 2010. Colon was 37, and basically toast, and his own doctor didn’t think he could get back to the majors. He’s started 175 games over the six years since, and he recently signed a new contract with the Braves. Colon’s velocity isn’t there anymore, but he’s effective at 43 years old. A number of pitchers have tried the stem-cell thing, and it doesn’t get much more encouraging than Colon.
At the same time, among those pitchers who’ve tried the stem-cell treatment, they’ve typically been desperate cases. Colon was at the end of the road. He didn’t have a whole lot to lose. He might not have been able to fully recover from major surgery. Garrett Richards is 28, and in the prime of his life. He’s maybe more relatable for other major leaguers, other pitchers who might be thinking along similar lines. It would be easy for a pitcher to convince himself someone like Colon would have to do something more radical. If Richards comes back and looks like himself, the next pitcher with a partial tear might feel emboldened that surgery won’t be necessary. The injection approach comes with greatly reduced risk, and a greatly accelerated timeline, compared to normal surgery. It’s one of those potential wave-of-the-future things you can’t so easily dismiss.
It’s not like we’re about to see the end of major operations. These treatments can’t do much of anything to help a complete tear. Those will still require surgical intervention. A snapped UCL, a big giant tear in the shoulder — surgeons aren’t going to lose all their work. And then there’s that lingering question over what went wrong with Heaney, and whether that outcome might’ve somehow been avoidable. I’m going to guess that numbers and concentrations are still being tweaked. Maybe there was an individualized adjustment Heaney would’ve needed. Maybe it was just never going to work for him. Richards might be the lucky one.
His future, though, is going to mean something for the entire baseball industry. Here’s Garrett Richards, hard-throwing staff ace. Seven months ago, it looked like Tommy John surgery would be a foregone conclusion. Richards had stem-cell and PRP injections instead, and when he’s thrown at full strength, he’s been asymptomatic. I was told at the winter meetings that, when Richards had his most recent exam, his UCL looked practically brand-new. The greatest challenge, of course, is still to come. So many questions do still remain. But Richards is being penciled into the Angels’ rotation. He’s so far avoided the worst of the Tommy John path, and his recovery time would look substantially better. For 2017, I can’t think of a pitcher who’d be more important for the sport.
Jeff made Lookout Landing a thing, but he does not still write there about the Mariners. He does write here, sometimes about the Mariners, but usually not.