The Dizzy Dean Injury Cascade

It is spring training, and that means some pitchers will miss a few starts to minor aliments. Before you breathe a sigh of relief after that pitcher is back, it pays to be cautious.

Stephen Strasburg: During his first big league starts, he was having trouble getting comfortable on some pitching mounds. In his start in Cleveland, he had the ground crew out to mess with the mound. Later, he had shoulder fatigue. Once could explain the fatigue as his body getting use a major league starting pitching schedule. Going forward, he needed Tommy John surgery. To me, the landing issue and the shoulder fatigue were huge indicators that something was amiss. Why? Because of The Dizzy Dean Injury Cascade.

In 1937, Dean was pitching for the National League in the All-Star game. Earl Averill from the Indians, was batting for the American League. Averill hit a comebacker that hit Dean’s foot, fracturing his toe.*

* “Fractured. Hell, the damn thing’s broken!” Dizzy responded. I love that quote. Almost as good as Gomer Hodges, after going 4-for-4 to start his big league career, stating, “Gollee, fellas, I’m hitting 4.000”.

It was this toe injury that led to Dean’s injury-shortened career. While still nursing a sore foot, Dean resumed pitching. The soreness caused him to change his pitching mechanics, leading to the shoulder and arm problems that Dean was never able to fully overcome, leading to his retirement in 1941.*

* Apparently Dizzy learned from his mistake. In his one-game comeback in 1948, he pitched four shutout innings before hurting his hamstring running out a single. He took himself out and stated he was done.

And you might ask, Who cares about Dizzy Dean’s toe? Because Dean’s broken toe cascaded to his shoulder and arm troubles. I call it The Dizzy Dean Injury Cascade.

Why Dizzy Dean?

First, Dean is just a fun player and baseball person to research. So while many pitchers from the 1920s or 1930s could be used as examples, Dizzy’s toe quote wins out. His case was also one of the most dramatic and universally accepted.

Most importantly, it shows the cascade potential of any injury to a pitcher. He broke his toe, leading to shoulder and arm issues and quieting a great career. For pitchers, any injury can lead to other injuries. Altered mechanics or additional stress can cause issues up the pitching motion’s kinetic chain. Fixing one link in the chain could cause the next weakest link to break. Sometimes a weak link can cause another weak link to break. It can be a vicious cycle.

When you see a pitcher having issues in one area, it is best to monitor the pitcher to stop any cascading injures. This applies to any pitchers, from the young ones to 47 year old lefties.

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  1. Jim C said...

    Very perceptive and totally accurate. Pitcher A has some shoulder stiffness, starts throwing 3/4 or sidearm to relieve the stress on his shoulder, and boom, there goes the elbow. The way most pitchers fall off the mound to one side or the other also creates problems, and not just with ground balls that should be outs going back through the middle for cheap hits. The pitcher lands hard on his off foot, not balanced over both feet, a la Greg Maddux, leading to left-knee injuries for righthanders, and right knee injuries for lefthanders.

  2. DrBGiantsfan said...

    I dunno.  A lot of people had questions about Strasburg’s mechanics and the potential for injury long before he started fussing with pitching mounds.  As for Dizzy Dean’s injury, it is purely speculation that his toe injury led directly to his arm injuries,speculation that has now become part of baseball folklore.  To take that speculation and then reason by analogy to something like Strasburg’s injury is pretty sloppy, IMO.

  3. Mat Kovach said...

    No, it is not purely speculation about Dizzy Dean. Everybody, including Dean, has stated SPECIFICALLY that he changed his mechanics because of his toe injury and that hurt his arm. The specific reason, as noted, I named it after him was because it was accepted that was the reason.

    As I said:

    “First, Dean is just a fun player and baseball person to research. So while many pitchers from the 1920s or 1930s could be used as examples, Dizzy’s toe quote wins out. His case was also one of the most dramatic and universally accepted.”

    The cascading of injuries is talked about by Dr. Jobe, Dr. Andrews, and Dr. Fleising among others. Rick Peterson and Tom House are two people that have done research regarding cascading injuries.

    Based on my research, I stand by my observation that there was some huge indicators that something was wrong with Strasburg.

  4. DrBGiantsfan said...

    I am not disputing that Dizzy Dean changed his mechanics after he injured his toe.  It was Dizzy’s OPINION that the altered mechanics caused his injury, not a FACT.  Just because an OPINION is universally accepted does not turn it into a FACT.

    If you have links to the research by the people you refer to, I would be interested in reading it.  Anecdotal observations by experts are important pieces of information to be aware of, but do not necessarily prove cause and effect.

    You reason by analogy that since Dizzy Dean’s injury was caused by altered mechanics, and since Strasburg MIGHT have changed his mechanics too, then his injury must have been due to the altered mechanics. 

    You take an unproven opinion, speculation really, and then speculute that it may be similar to anther speculative situation.  I don’t know what you call that, but I call it speculation.

    It may be valid to say that since multiple experts believe there may be a connection between one injury, altered mechanics and further injuries, it may be prudent for pitchers to not try to pitch through even minor non-arm injuries, then I can buy that.  To say that Strasburg’s injury was caused by the same process is unproven and speculative.

  5. DrBGiantsfan said...

    I would add that medical history is rife with examples of beliefs regarding the etiology of disease and medical interventions that were universally accepted based on anecdotes and expert opinion later proven to be untrue or non-efficaceous when subjectd to rigorous analysis.

    One statistical way of looking at this, though still flawed, would be to take a large sample of pitching injuries separated by recent preceding injury to anther part of the body vs no recent preceding injury and see if there is a statistically significant difference.

  6. Mat Kovach said...

    Some links of notes regarding cascading of pitching injuries and the cumulative nature of pitching injuries. Athlete.html Injuries in the Throwing Athlete.pdf+cascading+pitching+injuries&hl=en&gl=us&pid=bl&srcid=ADGEESgcowHm0H2yq6Ds6hvTi1q3Mef2qR9nrd6GIfILBGms8EMFfGokYyvsn7I3rjmHbCW41B7Of5Zp8p-8uS308NjemRXkoPcjyA6lO5FU7c2TIf5NxzkXKLvmdljgawkS8SZTTBMp&sig=AHIEtbRdTWoiS5XZUeT9mWU_aZ1NKMbMYA also has/had a DVD describing pitching injuries. There they describe how injuries to one part of the body can causes issue with other parts of the body. (For a typical person, foot issues can lead to back problems.)

    Discovery the link and cascade of issues through the kinetic change is pretty easy. Ask a doctor or an athletic trainer. That or take the time to read through a few medical books. I have just found that most doctors and athletic trainers are better to learn from then medical books. The books tend to be really boring.

    In terms of pitchers getting injured more?

    As they state, it may be that we are able to diagnose problems more often, but if you research or talk to Dr. Jobe, Dr. Andrews, Dr. Yokum and many that work in pitchers, injuries are most certainly up. Pitchers make up 1/2 the roster but account for 7 of 10 injuries ( and about 1 in 10 pitches on a 40 man roster has had Tommy John Procedure.

    If you say that pitching injuries are NOT increasing, you’ll need to provide evidence that is the case. Simply because you haven’t heard of the research, doesn’t make it not true.

  7. Jim C said...

    I know this is a problem for a lot of people, but there are some important aspects of baseball that do not readily lend themselves to statistical analysis. From years of pitching in adult baseball leagues, years of coaching, and the privilege of going to a fantasy camp for three years and getting to talk about pitching and arm injuries with people like Gary Bell, Dick Radatz, Bill Lee, Bill Monboquette, Bert Blyleven, Mike Caldwell, Jim McAndrew and others, I have seen and learned the truth of cascading injuries.

  8. DrBGiantsfan said...


    Thank you for the links.  I will take a look at them.  I believe the burden of proof is on those who would claim that injury rates are increasing as the null hypothesis would be that they aren’t.

    Again, while you have to respect expert opinion, medical history is rife with examples of beliefs that were based on expert opinion that later proved to be false. I would think writers on a website that values sabermetric analysis would understand that fairly simple concept.

  9. DrBGiantsfan said...


    If you actually go through Dr. Andrews’ presentation, he is simply reporting the number of cases he sees in his clinic which he says may well be related to greater awareness of injury and increased referrals rather than a true increase in injury.

    He goes on to list and discuss PRESUMED risk factors.  Get it?  PRESUMED risk factors.  A PRESUMPTION is not a FACT!

    It is important to have a clear understanding of language and listen carefully to how experts phrase their opinions, as well as a clear understanding of basic logic and the difference between FACT and OPINION.

    Again, show me one study which gives statistical support to these PRESUMED risk factors.

  10. DrBGiantsfan said...

    Jim C,

    The problem is, pitching injuries are quite common.  For every “cascading” injury you can point to, there are likely 1, 2 or even 3 someone else could point to that were not preceded by another injury. 

    There is, in fact, a way to get at this question statistically.  You take a large sample of pitchers with serious arm injuries and you divide them based on whether there was an identifiable “cascade” injury or not and see if there is a significant difference. There are variations of that study which could add validity to the findings.  Until studies like this are done and published, (and maybe they have been) this is all based on anecdote and expert opinion, a rather weak way of analyzing it and very likely wrong.

  11. Jim C said...

    I coached some players who were as hardheaded as you Doc, and I could not teach them anything, because they knew it all already. Cascade injuries are hardly unique to baseball. They are common in many sports, from baseball to tennis, from basketball to track and field. Since you’re a doctor, I have a question for you. Why is it that, over the last 25 years or so, pitchers throw less and less, and get hurt more and more?

  12. DrBGiantsfan said...

    Jim C,

    Before I answer that question, you need to show some evidence that the premise is correct, that in fact, pitchers are getting hurt more.  I’d be willing to bet that’s not true!

  13. DrBGiantsfan said...

    Fact:  Dizzy Dean suffered a broken toe.

    Fact:  Dizzy Dean changed his pitching mechanics as a result of his broken toe

    Fact: Dizzy Dean suffered a serious arm injury subsequent to the broken toe and altered mechanics.

    Opinion:  Dizzy Dean’s arm injury was caused by the toe injury and altered mechanics.

    Fact:  Stephen Strasburg was unhappy with the pitching mound in a couple of starts.

    Fact:  Stephen Strasburg suffered a serious arm injury subsequent to having a problem with the pitching mound.

    Invalid Analogy:  Dizzy Dean’s arm injury was caused by his toe injury and altered pitching mechanics therefore Stephen Strasburg’s arm injury was caused by altered pitching mechanics due to variations in the pitching mounds.

    Anyone who has taken a class in basic logic can see the fallacy in this line of reasoning.

  14. DrBGiantsfan said...

    ….but assuming it is true, one could speculate on the reasons,  maybe because they throw harder on average(I’m not even sure if that is true, but I think it is), throw breaking balls at an earlier age, get abused in college,  lot of possible reasons.  The thing is, it would be all speculation because I am not aware of any studies that have looked at it sysematically, if in fact, the premise is true which I have my doubts about.

  15. Mat Kovach said...

    “Opinion:  Dizzy Dean’s arm injury was caused by the toe injury and altered mechanics.” .. Yes, that was the opinion of the doctor’s that examined Dizzy Dean and told him about his injury.

    Since you would like to bring up language:

    I said, “Most importantly, it shows the cascade potential of any injury to a pitcher.”

    Note the word potential.

    “… it pays to be cautious. “

    Note the word, cautious.

    “To me, the landing issue and the shoulder fatigue were huge indicators that something was amiss.” …

    Note the words, to me …

    Lastly: “Altered mechanics or additional stress can cause issues up the pitching motion’s kinetic chain. Fixing one link in the chain could cause the next weakest link to break. Sometimes a weak link can cause another weak link to break. It can be a vicious cycle. “

    Note the usage of terms, “can cause”, “could cause”, “sometimes”.

    It should be obvious to anybody that claims interesting is sabremtrics to understand that NOTHING is going to be completely predictive. No predictive approach that I have seen handled what happens to a pitcher if he develops a drinking problem or addiction to crack. Despite efforts I have never seen a model to demonstrate who used steroids and who did not.

    Sabrmetric analysis is used to provide an explanation based on the available data, using current models and accepted knowledge to either a) predict the past or b) predict the future. In reality, most sabrmetric models presumptions. Somebody that gets on base often is presumed to be value. But then, Nick Johnson can never stay healthy. In fact, Sabrmetric is quite a bit of opinion.

    So, I continue to stand by what I said. When Strasburg had shoulder problems, in addition to problems with the mound, the Nationals should have done more to monitor and determine the medical issues he had. This actions, based the medical and historical evidence currently available, where indications that something might be wrong. Ignoring them just might lead additional injury and him for a year NOT to pitch.

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