There is an epidemic in baseball. Everyone involved in the game knows it exists. Each club is working on a cure. Yet in some ways there is still an inability to fully gauge the extent of the problem.

There were 166 players on the injured list Thursday for the domestic Opening Day, and I asked 10 baseball officials to guess how many were pitchers. No one got within 20 of the correct answer. Most went through a logic similar to Mets pitching coach Jeremy Hefner, who reasoned half the roster is pitchers, but pitching is a more hazardous occupation so he reasoned, “Half would be 83, so I am going to bump it up to 105.”

When told the correct answer was 132, Hefner gasped, “Oh, my God.”

Yep, 79.5 percent of the IL stints were for pitchers. And the trend line is not good. The number of pitchers on the IL to open the previous four 162-game seasons was 122, 96, 88 and 85. In 2019, pitching injuries accounted for just 66.9 percent of the season-opening IL.

There is a big-picture issue here that teams and their sports scientists are attacking to try to better preserve pitching health. But no organization is willing to surrender an in-the-moment competitive advantage by attacking the main issue, or as Adam Ottavino said, “It [pitching injury] is a runaway train because of velocity.”

Yep, every year the average fastball ticks upward, but also now an acknowledgment that hitters have seen enough of it that they are adjusting to hit even high-end fastballs better. Thus, pitchers are spinning the ball with greater force and frequency.

And, as Hefner said, “More injuries are going to happen when you are doing an unnatural thing [throwing a ball with force overhand] and trying to do it as hard as you can and then trying to make each pitch as nasty as possible and then it is what the industry is paying for. This is how teams have won the World Series and we are a copycat league and everyone is trying to do the same thing. So the consequences are the injuries.”

Another consequence of teams hunting stuff (velocity, movement) above, for example, finesse is that MLB might have to step in as the adult in the room. The league, which already mandates no more than 13 pitchers on a staff, often thinks about going to 12 or 11. The hope would be having fewer pitchers available would force, in particular, starters to not go max effort on every pitch as a way to physically endure to cover more innings.

But that is the big picture — perhaps too is wondering whether having to throw more often within a pitch clock is detrimental to pitcher health. In the small picture there is a 2024 season to play and having “only” 13 pitchers allowed on a staff unnerves teams. Because having so many injuries to pitchers to begin the season only means there are a lot more to come.

When asked what comes to mind when considering how to cover the roughly 1,450 innings to complete a 162-game season, Brewers GM Matt Arnold offered, “It is a terrifying way to think about it.”

Said an AL executive: “It keeps me up at night. I think even good teams would be willing to admit that beyond just having good pitching, they’re also counting innings [in staff construction]. You need 1,400-1,450 innings and you look at your staff and say, ‘How is that going to happen?’ … Who the hell can find 1,450 innings of value? At a point you’re stockpiling innings that you hope won’t suck.”

Executives now spend as much time in spring training trying to conjure their next 13 pitchers as the 13 they will take to open the season. There were 801 pitchers used last season plus another 62 position players who took the mound. The Astros and Giants used the fewest pitchers at 24 and the A’s the most at 41. So you are lucky if you have to roughly double the 13 to open the year.

Thus, executives are trying to determine how to keep depth options. For example, Dennis Santana pitched well enough to make the Yankees out of spring. He is on a minor league contract, but is out of options. If put on the roster to begin the season, he could not be demoted to the minors, for example when Tommy Kahnle is due back in a few weeks, without being exposed (and likely lost) to waivers. Since Santana does not have an opt-out until July 1, the Yankees can keep him in the minors for a while for an emergency. Every team is doing a version of this.

As the Kahnle timeline also exhibits, not all injuries are created the same. Among the 132 pitchers on the season-opening IL, some like Kahnle were slow-played in spring training with the big picture in mind. Others such as aces Sandy Alcantara (Miami) and Shane McClanahan (Tampa Bay) are already known out for the year due to the timing of their Tommy John procedures.

But when currently injured pitchers can return matters. As one NL executive said, “You have to fill in for one start, fine. But even five starts is a month of starts, a lot of starts, especially if it is someone you don’t believe in.” Thus, quality Plan Bs matter. The Mets, for example, are going to be down ace Kodai Senga for probably two months minimum. So Hefner’s belief that the Mets have more trustworthy pitching depth at the ready in the minors than any time in his five seasons as pitching coach will be tested. The same for the Yankees, down their ace, Gerrit Cole.

So much of the season has a March Madness feel — can you survive and advance until top pitchers return? For example, the Astros tied the Rays for the most players on the season–opening IL with nine, but all nine were pitchers. They believe Justin Verlander will be back in a few weeks. The wait for Luis Garcia and Lance McCullers Jr. will be longer.

Conversely, both the Tigers and Braves had a MLB-low one player on the IL; both were pitchers, but far from main figures in Sawyer Gipson-Long (Detroit) and Angel Perdomo (Atlanta). Of course, this is an epidemic. Thus, the healthy teams today can quickly reverse.

So when asked if he thinks about pitching depth more than anything else in his job, David Stearns, who had four Mets pitchers on the IL, responded, “Yes.” Then added, “We’re constantly thinking about it because you have injuries and you also have fluctuations in pitching performance. It’s just what happens over six months.”

It just happens more than ever.

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