Finding hope in Chris Sale's injury history
It's as bizarre as it is long. And that's . . . maybe good?
I wrote a piece about Chris Sale’s unappreciatedly great 2023 season earlier this week and intentionally avoided talking about his injury history because, well, everyone else has. Everyone else. Everyone else. Everyone else. There’s been as much discourse about how much time Chris Sale spends on the IL as there has been discourse about what he does on the field.
I get it. Injuries suck. Pitcher injuries are always scary. And a guy who hasn’t put together 25 starts since 2019 - or 30 starts since 2017 - is going to set off alarm bells.
But these mostly aren’t your garden variety pitcher injuries. So let’s go through them and figure out what they might mean for 2024 Chris Sale.
The Injuries
2010-2017: A clean bill of health
This seems incredible now, but when the Boston Red Sox traded a haul for Chris Sale in December 2016, Sale had a reputation for durability. In his 5 years as a starter, he had made at least 30 appearances in 4 seasons and 26 in the other. Sale routinely flirted with the 200-inning mark and eclipsed it 3 times. Then he came to Boston and did the exact same thing in 2017.
In other words, this is not a pitcher whose mechanics were so problematic or atrocious that as soon as he started bearing a major league workload, he cracked under the weight. Sale pitched 9 complete games in Chicago (including 6 in his final year there). He was a workhorse.
2018: Left shoulder inflammation
Sale had to miss a few weeks in August because of two separate bouts of inflammation in his throwing shoulder. When he wasn’t on the IL (in those days, the DL), Sale was doing unholy stuff to hitters. He finished the year with a 2.11 ERA/2.26 xERA/1.98 FIP/2.31 xFIP in 27 starts. He struck out Manny Machado to close out the World Series. Let’s just say he was fine.
Also, while this shoulder will come up again later, this is the only time Sale was placed on the IL with shoulder inflammation. This has not been a recurring injury in his campaigns since.
Level of concern for 2024: very low
2019: Left elbow inflammation/UCL tear
Sale made 25 starts in 2019, and while the baseball card stats were ugly (6-11, 4.40 ERA), Sale was a very good pitcher, if not as earth-shatteringly great as he was in 2018 (3.51 xERA/3.39 FIP/2.93 xFIP). It was sort of like his 2023 season, actually.
Unfortunately, rest wasn’t enough to alleviate an elbow issue that curtailed the end of his year, and right at the start of the pandemic, Sale got Tommy John and missed the 2020 short season, as well as most of 2021 (though he put in 42.2 regular season innings of classic Chris Sale at the end of the year as well as 9 less great postseason innings).
Tommy John isn’t the death knell it used to be for pitchers, and since we have more than 150 innings of Chris Sale demonstrating that he can be effective post-surgery, I feel comfortable saying that his 2019 elbow injury is unlikely to affect him in 2024.
Level of concern for 2024: very low
2022: Right rib stress fracture/COVID-19/finger fracture/wrist fracture
This was the Murphy’s Law year for Sale and probably did irreparable harm to his health reputation. We’ll go through each of these one at a time.
To start, Sale fractured his rib during an offseason pitching session at his alma mater. Sale described the fracture as a “freak accident”. The NIH has a paper on rib fractures in pitchers and I won’t claim any expertise, but it seems like the key points are that rib fractures happen more often to pitchers than we think, that they generally heal uneventfully with rest without affecting future competitive ability, and that they can be prevented by “correct[ing] any improper throwing techniques” since there’s biomechanical risk from poor throwing form. We’ve basically heard nothing about Sale’s ribs since he recovered from this injury and it seems fair to assume that Sale’s pitching coach, who’s as invested in his success as anyone, would have advised any mechanical changes if he deemed them appropriate to reduce the odds that Sale would hit the IL with another rib fracture. I think given the biomechanical aspect and NIH’s note that “prior stress fractures are the strongest predictor of future stress injury,” the level of 2024 concern here is a touch higher than with the previous injuries.
Level of concern for 2024: low
Then, Sale contracted COVID-19. Sale is unvaccinated, which means the odds of him getting it again are higher than that of the general public. But the odds of Sale getting COVID and then undergoing a meaningful IL stint or drop in performance seem slim.
Level of concern for 2024: very low
Then, Sale took a comebacker and fractured his pinky finger. This is about as freak as freak injuries get; other than ‘drink more milk’, I’m not sure what advice you give him here.
Level of concern for 2024: none
Then, Sale fractured his wrist riding a bike. I don’t know, man.
Level of concern for 2024: please do not let Chris Sale ride any sort of bike
2023: Left shoulder scapular stress reaction
Sale missed about two months this summer with a scapular stress reaction in his left shoulder. Beyond the Box Score wrote about the scapular stress injury back when Michael Wacha suffered it in 2014, noting that other than Wacha, there were only three pitchers to ever suffer such a documented injury. On the surface, the numbers look dire for those three: Brandon McCarthy missed extensive time with multiple scapular fractures over the years, Kurt Ainsworth pitched nine more (very bad) major league outings post-injury, and Edwin Correa never pitched in the majors again. But McCarthy wasn’t particularly durable to start with, Kurt Ainsworth wasn’t particularly good to start with, and Edwin Correa was a marginal pitcher being treated to the best of 1980s sports medicine.
Wacha is the happiest outcome here. Like Sale’s, Wacha’s injury has most often been described as a ‘reaction’ rather than as a full-on fracture. After the injury, he has gone on to make at least 25 starts in 5 seasons.
The NIH tells us that the best cure for a scapular stress injury is - surprise - rest. Sale rested for a month and a half, rehabbed, and came back for 9 starts to end the year in which he had a virtually identical xwOBA to his pre-injury starts. Now, he did so with decreased fastball velocity and effectiveness, but the fact that he could still generate elite inputs by modifying his pitch mix is a good sign.
Sale says he intends to work on strengthening his shoulder this offseason - the first offseason since 2018 that he is entering healthy. Hopefully, he can avoid the recurrent fractures that Brandon McCarthy dealt with. It’s a good sign that he was effective and healthy for the last few months of the season, but this one isn’t quite in the rearview mirror yet.
Level of concern for 2024: moderate
The Takeaway
Since 2018, Sale has had six different ailments land him on the IL, affecting five parts of his body (in order: shoulder, elbow, ribs, immune system, wrist, finger, shoulder). This is bad. And it consoles no one who watched their team spend $27M annually on him in that time period that these injuries were weird and largely unpredictable.
But how about the team that’s got Sale under control for the next two years? It seems to me that with the exception of the shoulder injury from last year and perhaps the rib injury from 2022 - neither of which was season-ending - these injuries are more odd and tragicomic than they are actually concerning about Sale’s availability in 2024. I’m not convinced that Sale’s wrists or fingers are any weaker than anyone else’s; I’m not convinced that Sale’s Tommy John surgery four years ago was any less effective than anyone else’s; and I’m not convinced that Sale’s shoulder soreness five years ago will be any more persistent than anyone else’s.
Pitchers break easily. Even if Sale had an immaculate injury history, there would be a real chance that a rail-thin, six-foot-six man who throws a baseball like it’s a weaponized frisbee would get hurt while doing so, especially if he’s done that thousands of times over the last twenty years. But as long as Chris Sale’s injury history is, in my book, his slate is actually mostly clean.