The Tony Cingrani "Problem" and Shoulder Impingements

Tony Cingrani has been a personal favorite (I've rated him as high as 2nd on my Reds prospect rankings) since the day he was drafted. He is such a favorite that I advocated signing him to a long-term extension, pegging him as the right player to lock-up in order to take advantage of annual player salary inflation. All of which made Cingrani's 2014 season rather disconcerting for me.

It's no secret that shoulder injuries are much scarier for pitchers than elbow injuries. Repairing elbow injuries is almost routine these days, shoulder injuries less so. Perhaps that's not surprising because the shoulder is simply a more complicated joint than the elbow (So complicated that it's worth pointing out again that I'm not a medical professional, so this is just a layman's overview). In actuality, there are four different joints that make up the shoulder complex: glenohumeral, scapulothoracic, acromioclavicular, and sternoclavicular. Pitching is an unnatural motion, it's a motion that can create a problem in the interplay between those fours joints, resulting in a shoulder impingement.

The good news is that a shoulder impingement is not a traumatic injury. It's not a blown out tendon or ligament, it's not a torn rotator cuff or labrum. The bad news is that isn't always the easiest ailment to identify and resolve. The worse news is that, if unresolved, it could lead to one of the aforementioned serious injuries.

Over the years I've come around to the idea that most of these traumatic arm injuries are actually more like "symptoms" than "diseases." While you may be able to effectively treat the symptoms, that's not the same thing as curing the underlying disease. Put another way, traumatic arm injuries are frequently the "downstream effects" of an "upstream cause."

The "upstream cause" might be flawed mechanics, overwork, poor physical conditioning, or any number of other factors. Here's something worth considering, what's the value in treating the downstream effect if you don't also remedy the upstream cause? We have the ability to patch up pitchers faster and more effectively, but are we curing the disease? Or, are we just sending pitchers back out to the mound until the upstream cause once again sends carnage floating down the river?

Why do I bring all of this up? Because Tony Cingrani's shoulder impingement might ultimately be an upstream cause, which, if left unresolved, leads to a serious downstream injury.

Tony Cingrani is a unique pitcher, one who leans heavily on his fastball for success. The effectiveness of that pitch is due to some combination of velocity, deception, and movement, all of which are tied directly to his pitching mechanics.

In the best case scenario, which is still a reasonable possibility, Cingrani's shoulder impingement can be resolved without changing his mechanics. That may, in fact, be, by far, the most common resolution, but it's tough to say just how common because those impingements are resolved so quickly and quietly that we never really know they existed. Hopefully, that's what happens with Cingrani, as that would allow him to continue to build on his success, rather than trying to recreate it with a different arm action. It's hard enough to invent the wheel the first time, recreating it may be impossible.

If the impingement can't be resolved easily, then the Reds may be left to choose between effectiveness and health. That's a helluva choice. Two equally bad options.

If Cingrani needs to change his mechanics to eliminate the impingement, then he may lose all effectiveness. On the other hand, if he keeps his mechanics to maintain effectiveness, then he may lose all durability.

The fact that Cingrani missed the majority of the 2014 season is one reason to think that the impingement might not be easily resolved. Unfortunately, there may also be something identifiable in his mechanics that points to continuing problems.

Here's one part of Cingrani's mechanics that I've always loved, the differential between the hip and shoulder rotation:

Tony Cingrani demonstrating impressive differential between hip rotation and shoulder rotation.

That differential really allows the kinetic chain to work, as the force generated by the body is transferred to the ball in a way that minimizes the stress on his arm. His mechanics are built on a very efficient kinetic chain and have a real fluidity. That's a real and substantial positive to his mechanics.

The problem with Cingrani's mechanics, which, in light of the above, I've been willing to downplay and deemphasize, is that his arm is later than normal in the delivery. Typically, you want the pitching arm up in throwing position at foot-strike. As you can see below, when his stride foot touches, his pitching arm is down, parallel to the ground. It's late.

Late arm, increases whip and deception, but at what cost?

Late arm, parallel to ground.

The combination of the differential and the late arm might actually be what makes his fastball so effective. It creates a real looseness and whipiness in his arm action, a crack-the-whip type motion. Furthermore, the late arm action serves to increase the deception, as the above photos show he hides the ball behind his pitching shoulder. So, the combination of these two components of his delivery might be central to his success, creating both a whip-like arm-action and real deception.

While the late arm action may be a significant key to his performance, there is a possible downside to that lateness. The arm dragging behind the body when it first starts to accelerate can lead to an "internal impingement" (just one type of impingement). The late cocking and early acceleration of the arm can create problematic contact between the rotator cuff muscles and the postsuperior lip of the labrum. This repetitive contact between the structures can lead to partial rotator cuff tears, fraying or tears of the labrum, or cystic changes in the humeral head.

Pitchers with internal impingements generally suffer pain while throwing and often have stiffness or trouble getting loose. These pitchers often suffer decreased velocity and command.

The Reds were fairly tight lipped about Cingrani's injury, but, in many respects, it sounds like he could have been dealing with an internal impingement. If so, is the "cure" to get the arm up into proper position earlier? If so, will that reduce the effectiveness of his most important pitch, the fastball?

In light of the Reds efforts to rebuild while contending, the team needs Cingrani more than ever. The departures of Alfredo Simon and Mat Latos and the likely impending departure of Johnny Cueto mean that they need young, cost-controlled options for the rotation this year and into the future.

Next season will provide a very important data point on the question of whether Cingrani can dependably hold down a rotation spot. The shoulder impingement has me worried (maybe far more than it should) about the answer to that question. Fortunately, the early reports about his health are good and the Reds have named him a front runner for a rotation spot, so we should have our answer one way or the other.