Explaining Matt Moore and Alex Cobb’s Injuries

By Thomas Swan

How concerned should the Rays be about Matt Moore and Alex Cobb? (Credit: Kim Klement-USA TODAY Sports)

There are a catalog of famous parts of the body. Betty Grable was famous for her legs and back end, Arnold Schwarzenegger his muscles, Scarlett Johansson…well, you know. Tommy John should be given a copyright for the elbow. His name has become linked forever with the surgery and John has garnered more fame from his elbow than the fact he won 288 games and pitched in the majors from 1963-1989.

It is the most typically injury for a pitcher, and with Matt Moore set to have it, I feel it should be explained. Dr. Thomas is in. Just don’t cough on me.

Medical science has advanced Tommy John surgery and recovery time has lessened as time has went on. Dr. James Andrews has became the Grim Reaper of the medical world. If a baseball player or a quarterback is visiting Andrews, there is probably no good news to be had. He has worked wonders in the field and actually made the surgery less of the career-ender that it used to be. In medical terms, it is known as ulnar collateral ligament reconstruction in which a ligament in the medial elbow is replaced with a tendon from elsewhere in the body. The new tendon is implanted and woven in a figure eight pattern through holes drilled in the humerus and ulna bones.

At the time of John’s operation, he was given 1% chance of ever pitching again. Now, the chances of a complete recovery are 85 to 90 percent. It seems to be a popular misconception that pitchers throw harder after the surgery. The rehabilitation process is what aids in the uptick of velocity. The question is, do pitchers improve after the surgery? Like any science related study, the answers sit on opposite ends of the pole.

In a study conducted by Rush University Medical Center in Chicago, they found the surgery beneficial. In the study researchers looked at the rate of return to MLB pitching following Tommy John surgery, the level of performance of pitchers returning to the MLB, and the difference in overall performance between pitchers who underwent Tommy John and demographically similar pitchers who didn’t.

"“In the year prior to surgery, the UCLR (Tommy John surgery) pitchers were outperformed by controls (ones who didn’t have the surgery) in terms of the number of innings pitched, games played and winning percentage. However, after undergoing UCLR, pitchers allowed significantly fewer walks and hits per inning pitched (WHIP), won a higher percentage of games, and recorded lower earned run averages (ERA) than prior to their surgeries. The UCLR pitchers also recorded higher winning percentages and lower WHIP and ERA in their post-surgical career than the control group. Overall, 83 percent of UCLR patients were able to return to MLB, and their careers on average lasted an additional 3.9 years.”"

The authors of the study concluded that there is a high rate of pitchers returning to MLB following UCLR, with a significant improvement in pitching performance. Then there was another recent study saying the exact opposite. A study by the Henry Ford Hospital said that pitchers do not regain performance levels after Tommy John Surgery.

"“Researchers analyzed pitching statistics of 168 MLB pitchers before and after surgery between 1982 and 2010 and found diminishing returns in three major pitching categories: Earned runs average (ERA), walks and hits per inning pitched (WHIP) and innings pitched (IP). The findings:•ERA increased 4.15 to 4.74.•WHIP increased 1.40 to 1.48.•IP declined 59 to 50.”"

Going a bit beyond that, the study states that the Tommy John pitchers were clearly better than the pitchers who did not undergo the surgery before they went under the knife. That would make sense given what we know about Tommy John occurring more often in pitchers that throw harder and presumably have better stuff. However, the Tommy John pitchers began to fall apart the year prior to surgery, and they were never significantly better than the control group (non-Tommy John pitchers) after surgery.

There you have it. Matt Moore’s injury comes with risk, and we certainly can’t expect him to be better than before when he returns. In any event, this is happening whether we like it or not, and the Rays have to hope he turns out OK.

The other injury we must now examine is Alex Cobb’s strained oblique muscle. This is the second time he strained the one on his left side. According to reference.com, “An oblique muscle strain is caused when the muscle is forcibly stretched beyond its limits and the muscle tissue becomes torn. The Oblique muscles are located between the lower ribs and pelvis, on both the left and right side. They work together to produce twisting movements or side bending of the trunk.”

Typically, rest and ice is proscribed to treat the injury. It takes anywhere from three to four weeks to completely heal, and he could very well get a couple of rehab starts beyond that. It seems probable given Cobb’s injuries, two oblique strains and Thoracic outlet syndrome, that his delivery is putting unnecessary strain on his upper body. Some sort of adjustment must be made in his delivery or this problem is just going to continue. Hopefully Cobb can use his time on the shelf to fine-tune his mechanics and make sure this does not happen again.