The Twins' Injury Issues Aren't Just a Twins Problem. Does MLB Have a Broader Concern to Address?

[Nate Palmer]

Injuries are on the rise in Major League Baseball, and the Twins are one unhappy face of the problem. What is happening, and what can be done? 

Image courtesy of © Bruce Kluckhohn-Imagn Images

The Minnesota Twins front office has taken a lot of heat for the lack of moves made at the trade deadline. It's fair to levy that criticism, because since they opted not to deepen their depth, they've been systematically depleted by injuries. On the other hand, we shouldn't overlook the talent they have accumulated: The front office initially put together a promising roster for the current season. The roster has simply been one of the most injured in baseball. 

Byron Buxton and Carlos Correa grab the headlines when it comes to injured Twins, but there have been a lot of other important players who have spent or are spending time on the injured list. As much as Buxton's and Correa's absences were felt over the last month and change, having Joe Ryan and Brock Stewart around would have been even bigger difference-makers. According to Baseball Prospectus, the Twins currently rank near the top of the league in WARP lost to injuries, only trailing the Dodgers, Braves, Red Sox, Astros, Giants, and Rangers. 

But this isn't just a local story--not by a long shot. There is a disturbing league-wide trend of rising elbow, shoulder, hip, and back injury rates; all of those areas have resulted in more IL stints throughout MLB this season than in any of the previous four full campaigns. The baseball world has been watching this trend (especially pitcher arm injuries) for many years now, but seeing that it has hit another peak shows that many answers still need to be found. 

Here is a quick rundown of currently injured Twins, and their maladies: Alex Kirilloff (back discomfort), Max Kepler (patellar tendinitis), Joe Ryan (strained shoulder), Daniel Duarte (elbow-UCL), Brock Stewart (shoulder), and Justin Topa (patellar tendinitis). Each of those players fits into one of the categories above. Only Chris Paddack (strained forearm) and Anthony DeSclafani (flexor tendon) don't fit into any of those rising categories, and really, both of those are elbow injuries by other names. 

Coming off of a stretch (and a season, for that matter) of bad losses due to the bullpen struggles, it is easy to wonder: What if Stewart had been healthy, and had any semblance of the 2023 success that made him so integral to their relief corps last fall? Stewart helping lock down the back end of the Twins playoff bullpen? Duarte, who briefly looked brilliant before requiring season-ending surgery in the early going, as a surprising complementary setup option?

Topa hasn’t been able to grace the mound for the Twins after being acquired from the Mariners. His 2023 2.61 ERA would be a breath of fresh air, as the Twins have tried shuffling arms in and out of the bullpen for any sense of competency. DeSclafani (early) and Ryan (late) going down thinned the rotation and put more pressure on the young arms we now see fighting for the finish line.

While there was a path for the Twins to do something to help midseason, a bigger problem looms for Major League Baseball—a problem that has greatly affected the Twins this season. Can baseball continue to let players max out at this velocity, foot speed, and bat speed? Is it time to introduce some more parameters or rule changes that will help force players to play at a different exertion level? Maybe that's too extreme, but then, does the league as a whole need to reconsider its best practices for injury prevention and management? Do teams need to prescribe different training methods?

Major League Baseball has reportedly considered a rule that would push starters to pitch six innings, barring a few exceptions. This rule change could cause starters to strike a different balance between stamina and high effort than they currently do. Potentially, that could be part of the answer to the injury problem among starting pitchers. The problem is that the league's injury issues seem to have broken free of the pitching sphere.  

We see plenty of instances of injuries among relievers, who already have their own version of this rule. So what about them? And what about hitters dealing with more hip, knee, and back trouble? That is a question facing the Twins, but it can't all be laid at their feet; the problem is league-wide. The Twins especially can’t afford to see this many key players hit the IL without investigating if there is a way to prevent them. 

The Twins put together a strong roster. Now, it is time to find a way to keep that talent in the field. They have to do that better, but so does the league as a whole.

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[NYCTK]

Honestly, this feels like the new Moneyball angle. Some injuries are completely freaky and random, but a lot of injuries are not. The Twins injuries fall more in the latter category. 

Brock, Paddack, Buxton, Lewis, and the guy that had two contracts ripped up due to health concerns getting injured seems entirely unsympathetic at an organizational level. I am absolutely sympathic towards the players and their individual plight, but no one is actually surprised. 

But to your point, some teams hyperfocus on velocity and RPM in pitchers doesn't seem to be all that beneficial towards the players. But if you're an organization, do you care? If every pitcher is just an asset, it makes sense to treat them like a VC. What does it matter to them if 9 nothing pitchers have severe injury if one can become an ace? 

The Dodgers are on that list towards the top and I've heard folks saying basically exactly this about them specifically. 

[FlyingFinn]

I don't ever see a rule requiring 6 innings from a starter.  That would create more injuries. Everyone is so pitch count conscious now. Can you imagine suddenly forcing a starter to throw 250 pitches when he's having a bad day?

[Doctor Gast]

Overall IMO the Twins have addressed the problem although they can do better with their pitchers. Many of the Twins' injury problems have been soft tissue coming back from prior injuries. Buxton's problem is due to scar tissue from a previous injury. Correa's is due to poor footwear (as reported) as also with series of Lewis & Kiriloff's injuries as the result from larger ALC & wrist problems. Some injuries like getting HBP or fouling one off your body parts which is hard to avoid. But others IMO injuries problem will be getting better thanks to Paparesta.

[Karbo]

I wonder if the players were playing thru more injuries in the previous century. I know they are getting bigger and stronger today, but that may be part of the problem. Pushing the human body past it's limitations leading to more injuries?

[TwinsDr2021]

24 minutes ago, FlyingFinn said:

I don't ever see a rule requiring 6 innings from a starter.  That would create more injuries. Everyone is so pitch count conscious now. Can you imagine suddenly forcing a starter to throw 250 pitches when he's having a bad day?

not sure if I should like or disagree with your post. I completely agree I don't ever seeing that be the rule. I don't agree they would ever force anybody to throw that many pitches or causing more injuries. They have talked about this on the foul territory show and there would be exceptions for runs, pitch count, rookie debuts, and guys coming off injury and probably others. Also different criteria  for different parts of the season. What they are trying to get away from is a guy throwing max effort for 4 inning and being at 80 pitches because they are so worried about strikeouts type of starts and being gassed. AJ Pierzynski as a very opinionated take on this (imagine that right) about how teams are doing what they are doing to pitchers to keep costs down, take young guys and turn them into max effort, max spin rate guys throwers, don't teach them to actually be pitchers and churn and burn though them.

I mean Brock Stewart has basically said that is the only reason he is in the majors (max effort 100% of the time) and he believes that has contributed to his injuries but he is basically fine with it because it got him to the majors.

[Trov]

I think part of the injury issue is also teams having guys go on injury list more.  I think back in the day guys would play hurt much more than they do now.  I think teams would rather have a guy go on injury list for a week or two, one because how options work now, than before.  The idea is if a guy is playing hurt, which reports were last year Ryan did, and AK has a few times not told team they were in pain.  

In years past a guys numbers would be down for the year, then we hear oh they were playing hurt for a long time.  Now, guys maybe try for a game or two, Kepler, but then go on IL because their production is down.  I do not know if injuries to position players are up from years past, or teams are just putting guys on the IL more. 

In the past, if you called a guy up from minors, I think even if it was to fill in for injury, they used up and option.  Players only had so many options.  Now, they have options years, and can go up and down as many times as you want in a single year.  So less risk of calling up guys due to minor injuries or being in pain. 

In terms of pitchers, their numbers are up, but that is in part because I think they are doing things their bodies should not be doing for most guys and it leads to injuries. 

[jmlease1]

It's a complicated issue. Is it max effort stressors as players continue to push the tolerances of the human body, or repetitive stress issues from year round training? Both? Are we seeing the results of playing so many more games at younger ages and getting into travel teams and so forth at younger ages? What's the impact of kids specializing in one sport at younger and younger ages? I don't have kids and I'm not involved in youth sports any longer and even I hear about coaches pushing kids to pick one sport over another as they're hitting middle school FFS. May have been real benefits to kids playing different sports or just having an actual off-season where they weren't constantly playing and/or training.

i think it's going to be hard to regulate at the MLB level via rule changes. Maybe the real solutions start much earlier?

[Cagycat]

What ever happened to the Ironman days when players would play through minor injuries? a sore pinky finger or an ingrown toenail wouldn’t put you on the disabled list. Planter facetious or pulled muscles are a different thing, but a sore wrist or a twinge in the shoulder shouldn’t land a player on the disabled list.orrrr being in a slump and an imaginary injury to sit back for 10 days is unacceptable period. We pay these players bigg money to watch them perform and we fans pick up a large part of their money. Fans deserve performance for their money 

[DJL44]

12 minutes ago, Cagycat said:

What ever happened to the Ironman days when players would play through minor injuries? a sore pinky finger or an ingrown toenail wouldn’t put you on the disabled list. Planter facetious or pulled muscles are a different thing, but a sore wrist or a twinge in the shoulder shouldn’t land a player on the disabled list.orrrr being in a slump and an imaginary injury to sit back for 10 days is unacceptable period. We pay these players bigg money to watch them perform and we fans pick up a large part of their money. Fans deserve performance for their money 

Players don't do that anymore because the worst players are better now than they were 40 years ago. That means the dropoff in performance is nearly zero when comparing an injured starter to a healthy AAA backup.

If you're comparing to 30 years ago, those players were able to recover faster and stay on the field more because most of them were taking PEDs.

[RpR]

Using drugs to over come injuries is some thing that most likely was common in the past; I do not mean performance increasing drugs, I mean the kind that reduces the pain/s so one can push harder than without the drugs.

[saviking]

1 hour ago, Karbo said:

I wonder if the players were playing thru more injuries in the previous century. I know they are getting bigger and stronger today, but that may be part of the problem. Pushing the human body past it's limitations leading to more injuries?

Exactly, Karbo! Too much weight training. Muscles are stronger, but soft tissue is precisely the same. Do players really need to be that jacked up? 

[RpR]

4 minutes ago, saviking said:

Exactly, Karbo! Too much weight training. Muscles are stronger, but soft tissue is precisely the same. Do players really need to be that jacked up? 

Each human body has X number of repititions on a part till is goes Pffft, the harder you push when  younger the early it will go Pfft.

[LambchoP]

I think it's the more preventable injuries that are frustrating like pulled hamstrings, tight groins. Medical staff needs to teach these guys better preventative measures to stay healthy. Also, durability should be a skill that teams look at when drafting, developing or signing free agents. Some guys like Buxton and Lewis are just injury prone and always will be. Guys like Santana or Bobby Witt are everyday players who take care of themselves well enough to not get injured. Those are the guys you want. Otherwise with a team of injury prone stars, the only option is to build solid depth and lots of it ...

[Vanimal46]

Pitcher arm injuries is a problem across every level of the sport down to 10 and 11 year olds. All everyone focuses on now is how hard you can throw the ball. Pitchers like Greg Maddux and Dan Haren would have been passed over in AA today because they threw 88 MPH. 

[Parfigliano]

32 minutes ago, saviking said:

Exactly, Karbo! Too much weight training. Muscles are stronger, but soft tissue is precisely the same. Do players really need to be that jacked up? 

They seem to think so.

[chpettit19]

2 hours ago, Trov said:

I think part of the injury issue is also teams having guys go on injury list more.  I think back in the day guys would play hurt much more than they do now.  I think teams would rather have a guy go on injury list for a week or two, one because how options work now, than before.  The idea is if a guy is playing hurt, which reports were last year Ryan did, and AK has a few times not told team they were in pain.  

In years past a guys numbers would be down for the year, then we hear oh they were playing hurt for a long time.  Now, guys maybe try for a game or two, Kepler, but then go on IL because their production is down.  I do not know if injuries to position players are up from years past, or teams are just putting guys on the IL more. 

In the past, if you called a guy up from minors, I think even if it was to fill in for injury, they used up and option.  Players only had so many options.  Now, they have options years, and can go up and down as many times as you want in a single year.  So less risk of calling up guys due to minor injuries or being in pain. 

In terms of pitchers, their numbers are up, but that is in part because I think they are doing things their bodies should not be doing for most guys and it leads to injuries. 

FYI, you can only option a guy 5 times in a season now. After that you have to put them on waivers. It's likely why Varland is still on the team right now. He's out of options this year.

[NYCTK]

9 minutes ago, chpettit19 said:

FYI, you cab only option a guy 5 times in a season now. After that you have to put them on waivers. It's likely why Varland is still on the team right now. He's out of options this year.

This is a good rule. It limits the manipulation a team can do with their roster. If you don't have depth, making up for it by just having a constant merry-go-round for your bullpen to get fresh arms in there is a strategy, but with limitations. 

[umterp23]

High $$$ guaranteed contracts for x amount and the rise of baseline contracts heavily influences injuries (minor) more than really bad major injuries.  The investments made in the top line guys from each team with really large $$'s tied to the team bankroll come into play.  Owners need performance for their investment and then protecting that asset tied to money spent.

One way is tie $'s to category of player for salary minimum and then back end the money tied to performance bonuses from that year.  We have a crap ton of measurable statistics to choose from, so are useless in my opinion, but there can be a way to balance year over year money vs the 2-3 year guy who has been awesome takes a team for 10 year deal and $300MM and then plays less than 50% of the time during the contract.  Then reset the following year and earn your bag of money as the kids say these days.

Now this will never happen, but the model would have guys fighting to stay on the field to earn money based on performance.  If it did, talk about leveling the small market big market conversation by base pay for a player being the base pay no matter what team he is on.  You perform you get a bonus, kind of like us non professional athletes live, work and provide.

Interesting take but MLBPA won't like, Owners would 

[chpettit19]

24 minutes ago, NYCTK said:

This is a good rule. It limits the manipulation a team can do with their roster. If you don't have depth, making up for it by just having a constant merry-go-round for your bullpen to get fresh arms in there is a strategy, but with limitations. 

Yeah, I believe they started it as part of their strategy to "bring back starting pitching." Making teams keep demoted pitchers down for at least 15 days and limiting the number of times they can be optioned in a season means you have to stick closer to the 13 pitcher maximum. Teams still use to to bounce out long relievers after they throw 3 or 4 innings in an emergency, but it's helping some.

[jmlease1]

55 minutes ago, Bigfork Twins Guy said:

I have 2 potential solutions...

1. Cut the schedule down to like 140 games and give the players more off days to recover.  The owners will never agree to this but IMO it would help.

2. Increase the roster size from 25 to 35.  Look at the NFL. As their players have become more physical specimens, the roster size has given players more time off DURING the game and have become more specialized.  Maybe even tweak the ability for a player to return to the game for one additional time after coming out.

Just need to be creative.  Maybe something similar would work for MLB.

The first one would probably help. Owners might go for it, but players would have to give something back in the CBA.

The second is one I want no part of. The pace of play has drastically improved and if you give managers more options for platooning and longer bullpens, they WILL use them. I have zero interest in seeing game after game with 12-15 pitchers being used and sub after sub coming in.

[bean5302]

3 hours ago, FlyingFinn said:

I don't ever see a rule requiring 6 innings from a starter.  That would create more injuries. Everyone is so pitch count conscious now. Can you imagine suddenly forcing a starter to throw 250 pitches when he's having a bad day?

I'm not sure we'll get a rule, but I also don't think it's going to increase injury. MLB has clearly singled in on a desire to see starters be a bigger factor in baseball, and if we get a rule (pretty good chance) I do think it'll be a rule with a lot of exceptions.
6 innings minimum
Exception at 100 pitches
Exception for pitchers allowing more than 3ER.
Exception for injuries.
Exception for first or second start after return from IL.

Something like that is probably what's going to happen. In the end, most pitchers aren't going to see any real change.

[RpR]

The season was 154 games for a long time; 140 is WAY too short.

But then, the hockey season is starting NOW and will run till May-June?

Baseball need more exposure, not less.

[TwinsDr2021]

23 minutes ago, Bigfork Twins Guy said:

More exposure, hence the same number or close to the same number of games, does not address the injury issue presented in this article.

Only 67 players as of today has played 140 games, and they aren't the ones getting hurt, so I don't see how that addresses the injury issue.

I think one of the issues is that young kids are required to stress their bodies at a young age (6th, 7th and 8th grade), doesn't matter the sport unless you play at a small high school you really don't have much of a chance of playing varsity high school sports unless you are adding a bunch of weight from muscle. My son plays football at a 5A school and if you can't bench 200 plus pounds and much more if you play linebacker or linemen you have no shot of playing. It is very similar for the baseball players if you aren't in the gym getting stronger you get left behind.

Watch any MN state tournament and see how big and strong these kids are.

[DJL44]

When computing WARP lost to injuries they should subtract Buxton from the Twins estimate. He's played MORE games than expected this season.

[RpR]

1 hour ago, Bigfork Twins Guy said:

More exposure, hence the same number or close to the same number of games, does not address the injury issue presented in this article.

They are big boys well paid,  cannot handle it , find a different job.

[Coach Wheels]

I'm not sure of the point of the essay. Guys have always gotten hurt; I remember being frustrated by Hrbek missing games every year. He was blamed for not being in shape, now we blame them for being too good of shape? 

I would love to see this team have their best players play 140 games together. I think they're talented enough to win this division by 8-10 games

[Fire Dan Gladden]

Baseball has become a game of torque.  Max effort on everything shoulders and elbows for pitchers, max effort on core and joints for batters.  Like football in the sense that everyone knows the concussion risk now and weighs the risk/reward on their bodies, so do mlb players.

How do you regulate individual effort and physical stress?  You can't.  No matter what rules they try to implement regarding usage, it will not matter.

I think we are near the top of the velocity range for pitchers.  Batters will ultimately adjust and better learn how to hit these pitches.  Then what? Location and deception will need to  come back into vogue.  Pitchers will need to pitch again instead of throw.

[USAFChief]

18 minutes ago, Coach Wheels said:

I'm not sure of the point of the essay. Guys have always gotten hurt; I remember being frustrated by Hrbek missing games every year. He was blamed for not being in shape, now we blame them for being too good of shape? 

I would love to see this team have their best players play 140 games together. I think they're talented enough to win this division by 8-10 games

In the specific case of Hrbek, he played fewer than 140 games once in his first 9 full seasons.

He was pretty durable.  

[ashbury]

This whole health topic is one that I would love to have a discussion with the Twins analytics department.  I suspect that each team has their own closely-guarded angle on forecasting player availability. 

For instance how much of a role does body type play in forecasting pitcher durability?  Jose Berrios had some detractors as a prospect due to his physical makeup - but in regard to being there to take the ball every 5 days, he's been rock solid.  By contrast the big strong guys who look like farmboys that nothing could harm, break down right and left - or at least that is my subjective recollection.  But the teams have access to injury records that I would find difficult to acquire, and maybe I'm wrong, and there are tons of Berrios physiques who spend time on the IL and there are plenty of Tyler Mahle clones (to pick a name) who turn out to be bulletproof.  Teams probably each have some kind of special sauce in this area that they rely on.

Bottom line, this area is way above my pay grade to try to play armchair GM, so all I can do is grumble and believe I could do better than our FO, without any actual reason to think so.  They might already be using all of my little ideas, and then some.