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MLB Injury Report: AL East Tommy John Rehabs

Nic Civale is a Doctor of Physical Therapy and former NCAA Division I Baseball player. He combines his knowledge of anatomy and physiology with that of baseball mechanics to provide expectations for players who will be rehabbing this offseason. Utilize The MLB Injury Report to start your planning for 2021 drafts and keeper decisions.

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MLB Injury Report – AL East

Tommy John Surgeries

Recipients of the well-known and frequently-performed Tommy John surgery from the AL East this past year include Luis Severino and Chris Sale. Tommy John surgery is utilized to repair a damaged or ruptured Ulnar Collateral Ligament (UCL). This can be found near the “funny bone” region of the elbow, which is medically referred to as the cubital tunnel. Severino went under the knife to repair his UCL on February 27th while the Sale had his done on March 30th. Sale would have gotten in about a week sooner had the coronavirus pandemic not slowed proceedings in scheduling the operation.

Both pitchers remain extremely valuable assets to their team, financially and as leaders of the clubhouse. Severino and Sale combined for a grand total of 995 strikeouts in their 2017 and 2018 seasons combined, finishing 3rd and 2nd in 2017 Cy Young voting, respectively.

There is no doubt that the ceiling for these two arms is immense. With two separate fanbases that can be equally impatient with their stars, it will be interesting to see how these two pitchers come back from their injuries later in 2021.


There is no specific timetable for these two pitchers, although it is optimistically expected that each will return around mid-June to mid-July. Despite the 1-month head start on Sale, Severino will likely be progressed back to game action more conservatively according to manager, Aaron Boone. Amongst the countless variables that impact rehab and recovery, some of the more notable factors include Luis Severino’s size and Chris Sale’s pitch mix.

Luis Severino

Luis Severino has a solid build, around 6’2″, 218 pounds, but has a knack for delivering his average fastball 96.0 mph or faster in each of his MLB seasons. In order to maintain this type of velocity, impeccable mechanics are required to avoid over-exertion of the upper body and throwing arm. There is, however, one aspect of his mechanics that seems, at times, downright erratic. Although his windup and arm-slot appear reasonably repeatable, Severino tends to occasionally follow through with a notable momentum shift towards first base. This causes a hurried whip-around action from the right leg and often times a hard landing with the right foot to slow his momentum as it drives him towards first base. There isn’t anything inherently wrong with this in isolation, but it only seems to happen on some of his pitches.

In Severino’s most recent MLB game against the NYY in the 2019 playoffs, he demonstrates this disparity in mechanics quite evidently. In the 4th inning, Severino strikes Carlos Correa out with a fiery 96mph inside fastball, right leg swinging around aggressively as his body progresses towards first base. Just a few batters later, he nestles a nicely executed glove side slider inside to Martin Maldonado, landing in a controlled fashion, weight progressing towards home plate. The inconsistencies exist within pitch-types as well. Some fastballs his momentum takes him towards home, some towards first, and other times he is moving so aggressively towards home, he ends up in a near squatting position.

This could not be considered evidence-based research by any means, but no matter what you know about pitching mechanics or kinesiology, there must be inevitable disparities in the delivery to make the body move so differently. All this information becomes relevant because there is a possibility the inconsistencies in delivery and the follow-through may have caused increased stress to the forearm, and ultimately the UCL. We have no way of knowing this without a motion analysis lab, subjective accounts from Severino, and stress tests. But as a Physical Therapist, the first thing you want to identify is outlying factors; the most obvious of which is where on the mound Severino ends up after his pitch.

Going forward, it will be very interesting to see if Severino has a more mechanically sound follow-through amongst his entire repertoire. There’s a chance he doesn’t change a thing, and he remains healthy the rest of his career, but the 2021 season will require a healthy amount of close analysis of the Yankees still-young SP.

Chris Sale

Chris Sale is less of a mystery. We know him well. We know he throws in a Randy Johnson-esque sidearm delivery that may never be replicated with such efficiency ever again. It’s impossible to say if the unorthodox arm slot is what caused the UCL injury; it’s never that simple. It could have been the 1,535.1 innings pitched from 2012-2019, or the fact that he is 4 inches taller than Severino, but 35 pounds lighter! Whatever the case with Sale’s mechanism of injury, it’s hard to tell with the naked eye. But the ongoing experiment with the super-sidearm delivery will continue in mid-late 2021 when Sale returns to the mound.

One of the most notable aspects of Chris Sale’s past 5 (full) seasons has been the pitch mix. Sale’s slider has become a more frequently used pitch in a big way.

Year Slider Usage %
2019 38.4
2018 34.5
2017 32.9
2016 25.2
2015 19.7

From 2015 to 2019, Sale’s slider usage nearly doubled. This is likely due to the success he was seeing with the use of this pitch, as his xBA never was higher than .197! Similar to the analysis of Severino’s mechanics, there is no way to determine a direct relationship between the pitch mix and the UCL injury. With the advancements in motion analysis and electromyography (the study of electrical activity in muscle groups), more and more studies are being done to determine the strain the elbow and the UCL takes with certain pitches. The important thing to remember with these studies is that every pitcher’s anatomy and arm slot are very different and results will likely be relevant on a case-by-case basis. Regardless, it will be exciting to see what the future holds and if there will be any post-procedural insight on the cause for Sale’s need for Tommy John.

The hot stove is just starting to heat up, but FantraxHQ has been cooking all offseason! If you enjoyed Nic’s MLB Injury Report make sure to check out all our 2020-21 MLB Offseason Analysis.

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