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Bud Norris' injury probabilities: The importance of context

The offseason is over.  Hallelujah.  With pitchers and catchers beginning their first workouts under Astros manager Brad Mills, there are few questions left for us to ponder because answers are on their way.  However, the two most lingering questions of the offseason (will Bud Norris stay healthy and can Tommy Manzella play defense) still have me nervous.  

Thankfully, the Verducci Effect has been hot lately.  So hot that there have been three statistical inquiries into its merits and a whole host of discussion surrounding all of it.  With Bud Norris listed as the second candidate on Verducci's annual list, this meme has become fascinating.  There have been interesting takes and findings on what the actual effect the Verducci effect (an increase of 30 innings or more over the career high of a pitcher under 26) might wrought for his future.  Since Norris is a leading candidate, let's delve into what those takes and findings might imply for Bud's 2010 campaign.

Star-divide

To quickly sum up the Verducci Effect for those not in the know, Rick Peterson, at the time that he was the A's pitching coach, determined that the most reliable indicator for injury was too many innings too soon.  Since baseball writer Tom Verducci caught wind of this, he has tracked pitchers with the aforementioned qualifications and people have paid attention. The name itself, however, was coined by Dr. Will Carroll of Baseball Prospectus, who also saw the pattern and correctly named it after its biggest proponent.  Until the injury database was released a few days ago, there hadn't been an all encompassing, easily utilized data set to test the Verducci Effect.  

Problem solved.

The first study that I stumbled upon was by Baseball Analysts' Jeremy Greenhouse.  Using Pitch/fx data, combined with the injury data, Greenhouse tested the correlation between performance indicators, usage patterns and injuries. His results are far more nuanced than the summary I'm about to provide, but this succinctly wraps it up:

The Verducci Effect, like most everything else I tested, is not significant in predicting future injuries. Injuries are hard enough to predict as is, and there's certainly no straightforward rule of thumb. A high workload does coincide with a trip to the DL the following year, though the causative effect may be that pitchers who throw a lot of pitches have more opportunities to get injured, rather than the pitches placing more stress on their arms.

Essentially, Greenhouse found no real indication that the Verducci Effect is useful for predicting injuries. And, even if it would have been, it wouldn't have been the reasons for which the Verducci Effect has become famous.

JC Bradbury has dedicated two efforts to the Verducci Effect as well.  In his first effort, Bradbury tested the literal claims of the Verducci Effect (that a pitcher will become less effectived/injured), and found this:

If you increased your workload by more than 30 innings in the preceding season and are under the age of 26, then we should expect to see a decline in innings pitched and ERA. However, it turns out that this is not the case. In terms of workload, Verducci Effect pitchers actually increased their innings pitched between 19 to 22 innings. In terms of performance quality, pitcher ERAs declined by an average of 0.1 runs; however, the effect was not statistically significant, which means it’s probably best to say there is no effect.

His second effort utilized the injury database and simply looked at the predictive value of the Verducci Effect on trips to/days on the DL.  He, again, found no statistical support for the Verducci Effect's hypothesis.

As I mentioned at the outset, the value of this discussion is that Bud Norris is a Verducci candidate.  So what does any of this tell us about Norris' Verducci-osity? Not a lot. The statistical inquiries into the the Verducci Effect's validity say that it tells us very little.  We know that we shouldn't necessarily condemn Norris to a season full of ineffective pitching, or one spent on the DL.  But what else?

I think that what the Verducci Effect can't tell us is much more than we could hope for from the hypothesis itself.  If the various statistical inquiries cannot find a reliable correlate in the injury database from seemingly obvious variables that should predict injury (thresholds of usage, fastball velocity, etc.), then there is no correlate for the sample (either that, or we just don't have a way to measure whatever it is just yet...I'll table that thought).

Obvious, I know. To me, that was a refreshing of the intuition.  To quote Greenhouse again, "there is no rule of thumb."  When I wrote about Bud Norris' yellow flag from Will Carroll's Health Matrix, I referenced Norris' PAP and the inverted-W to Carroll when asking for a comment.  In his response, he chided me for pitching those "facts" to him as though they constituted legitimate herrings for Norris' health.  Although some of his response was off the record, essentially he spoke about the very individual nature of injury.

With this week's focus on the failings of the Verducci Effect from a statistical standpoint, hopefully more emphasis will be put on determining how to go about understanding injury on a micro-level, and macro-level attempts to predict injury gain less credence.  Until pitch/fx modeling, combined with bio-mechanics, and lord-knowns what else allow for this to be easily done, we're still left in the dark.

What do we make of Norris' 78.2 IP increase in 2009?

We know that it was a substantial increase, in a year following an elbow injury, but that Norris' MLB inninngs weren't high on the stress scale.  Referring back to Greenhouse's conclusion, we know that the increase alone provides a greater sample space for Norris to have inflicted damage upon himself.  Thus, we can conclude that 2/3 of the known facts about Norris' 2009 campaign are negative.  We know that the information Will Carroll pays attention to has flagged Bud Norris a strong candidate to wind up on the DL, too.

What we don't know is just what kind of adjustments Norris might have made after his 2008 elbow injury.  We also don't know how scrutinized Norris' every pitch has been by the organization.  All we can really do is trust that they knew about the increased chance of Norris injuring himself through his increased sample space because we also know that the Astros, as an organization, have been remarkably good at keeping players healthy.  If they kept all the critical pieces of context in play, perhaps we should trust that they made an informed decision.

Then again...there is that whole thing about Norris' arm being too fatigued to finish out September that can be worrisome.

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It’s difficult to distinguish the Verducci Effect from expected regression to mean. Verducci points out that 25 of 30 young pitchers on his annual lists over the past 4 years incurred an injury or had a lower ERA the following year. However, by its nature, his listing is likely to include breakout seasons, and those pitchers are expected, as a matter of statistical probability, to decline the following year.

The Verducci Effect makes intuitive sense, as does Rick Peterson’s principle that young pitchers’ annual work load should increase in a stair step fashion. Having said that, the selection of 30 innings as the dividing line seems arbitrary, and may be lower than it needs to be. If the principle could be re-stated in terms of “batters faced,” rather than innings, it might be a more accurate measure.

I think statistical testing of pitcher injury causes will always be difficult, because it may require more granular data. For instance, “injury” or “DL time” alone may not mean much; it might require grading the seriousness of arm injuries.

by clack on Feb 20, 2010 8:28 AM CST reply actions  

That photo of Bud Norris looks too much like the Brad Lidge Squat, by the way.

by clack on Feb 20, 2010 9:48 AM CST reply actions  

Dave Bush does that too as baseballs enter orbit.

by ol Pete on Feb 20, 2010 10:51 AM CST up reply actions  

That's why I selected it...

Sadism. Masochism, too.

The Crawfishboxes
A good friend of mine used to say, "This is a very simple game. You throw the ball, you catch the ball, you hit the ball. Sometimes you win, sometimes you lose, sometimes it rains." Think about that for a while.

by Stephen Higdon on Feb 20, 2010 4:34 PM CST via mobile up reply actions  

I don’t think Will Carroll has any medical qualifications so outside of sarcasm calling him doctor is wrong.

A high workload does coincide with a trip to the DL the following year, though the causative effect may be that pitchers who throw a lot of pitches have more opportunities to get injured, rather than the pitches placing more stress on their arms.

This seems confused to me (or me be confused), but aren’t pitching injuries from a single motion pretty rare? Isn’t the whole subject of discussion whether or not wear on arms leads to injuries? Does Gallardo colliding at first base count in the Verducci effect?

by ol Pete on Feb 20, 2010 10:58 AM CST reply actions  

This blasts a hole in much of our assumptions last season

We fretted that Cecil Cooper overworked Bud Norris and couple of other callups after he wore out his original staff; and that he risked young pichers futures in an attempt to save his job.

The concern I believe was that increasing a young picthers innings hurt something – muscles or tendons or bones, presumably because their bodies are not fully developed; and it takes more than one season to recover from the over work.

For sure, the 30 innings is rule of thumb and must be adjusted for the individual – age, body style , mechanics, type of pitches thrown,etc. The theory, however, made sense.

Now folks are debunking that theory, Don’t know what to think now.

Astros fan for life

by Joe in Birmingham on Feb 20, 2010 11:31 AM CST reply actions  

Well, just because statistical significance isn’t achieved in a study, doesn’t mean that the principle or idea is wrong. Practically every baseball team in the major leagues buys into the principle behind the Verducci Effect to some extent—-or else they wouldn’t pay attention to a young pitcher’s innings increase (even the Astros said they were aware of the issue and were “watching” it—presumably leading to the shut down of Norris in September).

I also agree with Pete that the notion of “more innings gives more opportunities to get injured” is an odd rationale which may obscure the question more than illuminate it. For purposes of examining young pitchers, the studies should focus on shoulder or arm injuries—not all types of injuries. And, event then (as I tried to say—perhaps not very well—above), there could be a need to differentiate the severity of arm and shoulder injuries. So, for that reason, I hesitate to put a lot of weight on the statistical studies.

by clack on Feb 20, 2010 1:33 PM CST up reply actions  

I always thought “more stress during the period immediately prior to the injury” felt more intuitively plausible than “more stress in the past” as a cause for injury.

When I injure a muscle, it’s typically because I’ve overworked or done something stupid at one specific time and I’m feeling it for days or weeks afterward. For instance, sprinting all-out without stretching and warming up first is a good way to hurt myself. Alternatively, a hard workout when my muscles are not fully recovered.

Granted, there are parts of our joints which can wear down over time. I’m not an M.D. Yet it doesn’t feel right to me that the past season’s workload jump specifically would be the cause of future problems, as long as the player in question has had time to fully rest and let his muscles recover.

by OremLK on Feb 20, 2010 11:35 AM CST reply actions  

For pitchers, I think the main issues are connective tissue, ligaments, joints, rather than the muscles themselves. These structures can become weakened, stretched, frayed, etc. from overuse over a period of time. After that period of time, the effects are not easily reversed. Based on ligament type injuries (not arm injuries though), I’ve had, the general idea makes some sense to me. Many months ago (maybe a year or more ago), someone linked a lengthy NY Times article on young pitcher injuries (high school and college was the focus, if I recall) which had some quotes from Dr. Andrews (the Birmingham specialist on pitcher arm injuries) which provided a good description of how overworking young pitchers affects the elbow ligaments. Dr. Andrews told how young pitchers would continue to pitch in big games, ignoring soreness, because they could pitch through it, but that the impact moves from damage which the body can repair to irreversible damage. Rick Peterson worked with Dr. Andrews’ sports injury institute after he left the Mets, by the way.

by clack on Feb 20, 2010 1:53 PM CST up reply actions  

I agree the the stats aren't definitive

And definitely that it’s the wear and tear on connective tissue, just based on my own history of athletic injuries (extensive to the point of absurdity).

The stats probably aren’t granular enough, and I don’t think the lack of validation of the Verducci effect means we ignore IP increase, etc. I think the fact that these studies can’t validate it, though is important. As you said, batters faced and other measures of usage are probably more beneficial. However, I think the studies suggest that there isn’t a clear cut threshold of any measure that will be replace the Verducci Effect. Rather, I hope that more tailored measures and testing for players on a case by case basis are sought. I know that there are teams that are measuring the stress on joints, etc. and not just looking at IP increases.

I think we might also reevaluate the Astros handling of Norris because the Astros have been an intelligent enough team at keep arms healthy over the years (with the exception of converted position players). So maybe we do trust them when we know they were aware of the IP, but that Norris could handle it. Not to say we should or should not, but that the lack of validation has inclined me to reconsider.

The Crawfishboxes
A good friend of mine used to say, "This is a very simple game. You throw the ball, you catch the ball, you hit the ball. Sometimes you win, sometimes you lose, sometimes it rains." Think about that for a while.

by Stephen Higdon on Feb 20, 2010 2:39 PM CST via mobile up reply actions  

To me, the most concerning point is that Norris later admitted that he had tried to pitch through some pain and soreness last season. This admission came after that period of four poor starts three or four weeks into in his major league career. During those bad starts, he continued to say his arm was fine—and didn’t talk about his soreness. He was taken out of the rotation for awhile, and seemed to pitch better when he came back. He was shutdown near the end of the season when the Astros became worried about some continued soreness. This isn’t unusual. Probably most, if not all, young pitchers would react the same way in their first trip to the majors. My concern is the combination of pitching more innings than previous season, and pitching through some arm soreness. Since you know that young pitchers will try to pitch even if they shouldn’t, this is one of the risks in extending the number of innings.

by clack on Feb 20, 2010 4:25 PM CST up reply actions  

I didn't recall the soreness at 3-4 weeks

I’m back to near certainty his all falls off, then.

The Crawfishboxes
A good friend of mine used to say, "This is a very simple game. You throw the ball, you catch the ball, you hit the ball. Sometimes you win, sometimes you lose, sometimes it rains." Think about that for a while.

by Stephen Higdon on Feb 20, 2010 4:33 PM CST via mobile up reply actions  

The last game of his slump was the D-Backs game, where he didn’t last long, which was at the end of August. A tell-tale sign that something was wrong is the brief reference in an article shortly after that D-Backs game that Norris would pitch a bullpen session to “see how his arm responds” before deciding whether to skip a turn. Even though Norris said the bullpen session went fine, the Astros decided to skip his rotation spot. Although I couldn’t find an immediate link, Norris’ admission that he was battling soreness may have been after he was shut down in late September.

by clack on Feb 20, 2010 5:13 PM CST up reply actions  

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