In 2023 alone, a staggering 263 pitchers in the major and minor leagues required UCL surgeries in their elbow, a number that is approximately 100 more than a decade ago. The number was even higher in 2021 and has been steadily climbing over the last decade.
And while many “experts” are yelling across the internet on how to fix elbow injuries, the MLB and the MLB Players’ union are each blaming each other for the rise of injuries. And no one has the answers right now.
With all the finger pointing, it is evident that there is no simple or ready answer. If there was a solution, it would have been bottled up and sold. I am certainly not alone in that belief. Clayton Kershaw may have said it best in an interview with The Athletic:
“If someone says, ‘I have it figured out,’ I wouldn’t listen to them. I’m very wary of people that think they have it all figured out when all of this is still happening. If you had it figured out, you would’ve told somebody and made a billion dollars. You know what I mean? Nobody knows.”
One popular cause for the increase in arm injuries is the pitch clock. Beginning in 2023, professional baseball made rule changes that added a pitch clock and reduced mound visits to help games speed up. This has been great for baseball TV viewership and fan experience. But how do the players feel about it?
Many pitchers feel that the pitch clock is increasing arm fatigue and therefore increasing injury risk.
MLB Players Association chief Tony Clark even issued a statement fingering the reduced time on the pitching clock as a contributor.
Despite unanimous player opposition and significant concerns regarding health and safety, the Commissioner’s Office reduced the length of the pitch clock last December just one season removed from imposing the most significant rule change in decades.
Since then, our concerns about the health impacts of reduced recovery time have only intensified.
The league’s unwillingness thus far to acknowledge or study the effects of these profound change is an unprecedented threat to our game and its most valuable asset — the players.
Count Corbin Burnes among those who believe the clock has something to do with pro pitchers’ ligaments and arms fraying in what feels an increasingly inevitable way.
“Unless you’ve been in the sport and know what pitching does to your body, and the recovery involved, you don’t know what shortening the pitch clock does to you. MLB will tell you it’s the same, [injuries are] on pace as previous years, but if you ask them what on pace is for previous years, the line’s doing this,” Burnes said, angling his left hand skyward. “They’re expecting more guys to get hurt, so why don’t we do something to try to level that off or send it in [a lower] direction? That’s where the logic is for me.”
To counter MLBPA’s concern, MLB decided to retain Johns Hopkins University to do a study on arm injury increases and the impact of the pitch clock. Of course this was done to try and understand the issue and not to protect the increase in TV viewership and fan experience. Of course it was (sarcasm alert)…🙄.
MLB issued the following statement in response to tonight’s comments by the leadership of the @MLBPA: pic.twitter.com/Pgltw9xnZe
— MLB Communications (@MLB_PR) April 7, 2024
About that study. This report and any associated data are still unpublished, and its specific findings are unclear. Matthew Best, the director of sports medicine research at Johns Hopkins, told us that neither he nor his colleagues in orthopedic surgery were part of the study, and that it came from the School of Public Health.
“We did not see that research, and we can’t confirm it,” said Best, who is also a physician for Johns Hopkins’ athletics teams. “In addition, it’s not been published yet, so it’s not past the peer review stage, meaning other surgeons have to read it and make sure it’s valid. I’m not refuting it. It just needs to be reviewed. You really need to see more data on the injuries to tease out how much the pitch clock is associated with it or not.”
“It’s really an overuse injury,” says Dr. Matthew Best, an orthopedic surgeon and director of sports medicine research at Johns Hopkins, who frequently performs surgeries on the UCL. “People that are pitching more, they’re pitching faster, and if they’re pitching year-round, they’re just stressing the UCL more. That’s one reason for the higher rate of injuries, especially in youth athletes.
“It’s definitely been increasing over the past 10 to 20 years,” Best continues. “The repetitive kind of stress to the ligament is what leads to the ligament wearing down over time. There are ways to reduce the risk. One is keeping the muscles around the elbow strong, reducing the frequency of pitching, and ensuring that there are good pitching mechanics. It’s a multifactorial injury.”
But unpacking why there are increased injuries and pointing fingers isn’t about to fix the problem. For starters, these injuries have been piling up before the pitch clock was introduced. By the same token, the John Hopkin’s study MLB is citing hasn’t been publicly released so understanding its context needs to be better understood.
“I’m just frustrated it’s a combative issue,” Gerrit Cole said. “It’s like, ‘OK, we have divorced parents and the child’s misbehaving and we can’t get on the same page to get the child to behave.’ Not that the players are misbehaving, but we have an issue here and we need to get on the same page to at least try and fix it.”
As outlined in a piece in The Ringer, the rate of professional pitchers undergoing Tommy John surgery has been on a steady climb for years, a trend that began long before the implementation of the pitch timer. Average game time increased 14 minutes from the late ’90s to 2021 and 2022, while pitcher injuries skyrocketed from a combined 11,668 IL days in 1995-1999 to 31,558 IL days in 2023.
Some believe that off season training regimens call for less throwing while some studies lean to more throwing in the off season is beneficial for the marathon 162 game season. Who is right?
One thing we do know is that speed is the name of the game for many pitchers in today’s MLB, with the average fastball rising from 91.9 miles per hour (mph) league-wide in 2007 to 94.2 mph in 2023. Pitchers throwing harder requires more arm speed, which in turn means more stress on the elbow. Throwing a baseball is already an unnatural motion for the body, and throwing it at a speed of more than 90 mph makes it even more stressful on the body.
But the crisis confronting Major League Baseball is rooted deeper than just within its rosters. In reality, the problem goes all the way back to youth baseball.
As the focus on velocity has increased, youth coaches and scouts have fixated on the radar gun. As front offices in MLB have figured out, durability isn’t as prized as “stuff.” This change in the game is having a horrific effect on youth baseball.
Recently retired orthopedic surgeon Dr. James Andrews – considered to be the premiere expert on Tommy John surgery on UCL’s – is sounding the alarm.
“I started following the injury patterns and injury rates in the year 2000”, Andrews says. “Back in those days, I did about eight or nine Tommy Johns per year in high school aged and younger. The large majority of Tommy Johns were at the Major League level, then the Minor League level, then the college level and then just a handful or high school kids.
“In today’s situation, the whole thing is flip-flopped. The largest number is youth baseball. They’ve surpassed what’s being done in the Major Leagues. That’s a terrible situation.”
Andrews believes the obsession with velocity and spin at the youth level is the biggest culprit.
“These kids are throwing 90 mph their junior year of high school,” he says. “The ligament itself can’t withstand that kind of force. We’ve learned in our research lab that baseball is a developmental sport. The Tommy John ligament matures at about age 26. In high school, the red line where the forces go beyond the tensile properties of the ligament is about 80 mph.”
It used to be “kids” would play multiple sports within their respective seasons. “Kids” would go from football or soccer to basketball to baseball to summer vacation. You know…fun. Now youth sports is a business. BIG BUSINESS!! Year round elite baseball programs are rampant across the country. There are Under 10 years old national tournaments across the country. Some of these youth coaches are pulling down 6 figure incomes, so you know the pressure to win is paramount. Do you think the #1 pitcher is coming out in a close game. When do pitchers get to rest their arms?
It isn’t just baseball. Many colleges now look at the individual youth sports programs to recruit. Many of these programs do not allow their players to play on their High School team. If they want to play with the elitest of the elites, they have to stay on the travel team. Some high school programs have already become recreation leagues compared to the year round travel squads.
We also know that the rash of injuries is part of a multi-decade trend of pitchers throwing harder and straining their arms with more speed and spin on the ball. It did not just happen with the onslaught of the pitch clock. A pitcher who could touch nearly 100 miles per hour with a fastball was once a novelty. Now, it’s relatively common. This is what MLB is looking for in a pitcher, and amateur scouts are complying. Power pitching over pitching accuracy.
Orioles general manager Mike Elias last year said in a media session announcing John Means’ and Tyler Wells’ impending elbow surgeries to repair their UCLs.
“There are a lot of pitching injuries right now. It’s no secret,” “It’s unfortunately a big part of being a pitcher right now.”
Fellow Orioles starter, Kyle Bradish, soon followed.
Elias, in charge of the Orioles roster and the organization from top to bottom, acknowledged being “paranoid” when it comes to thinking about pitching injuries right now. He said he welcomed an ongoing discussion about the source, but also said he wasn’t sure the problems were exclusive to MLB.
“It’s concerning,” he said. “If I were to try to explain it, it would be more like a perfect storm. You go out and do amateur scouting [and see] this is happening in college and high school, basically at the same level, or the same rate to some degree. I don’t know that it’s anything we’re doing in pro ball, or not doing.”
Even with the introduction of the pitch timer in 2023, IL placements were down relative to 2022, while average fastball velocity increased, and the rise from 2022 to 2023 was greater than the increase from 2021 to 2022.
I embarked on this research as Badger was opining that Roki Sasaki should tone it down a few clicks to perhaps hold off TJ surgery. He may be correct. However, that ship may have also already sailed. He was throwing 100 MPH in High School. The process started before that. IMO it is not a question if Sasaki will have TJ surgery, but rather when.
Yes, MLB is looking for power over accuracy. With the number of year round traveling elite baseball programs, the best pitchers are throwing harder year round at an earlier age. As Dr. Best and Dr. Andrews concluded, this is a youth problem. Unfortunately, the problems are starting in Little League, not High School. The arm was never intended to throw that hard that early, and now all year.
FWIW, Corbin Burnes had a couple of suggestions. First, add time to the clock. He says pitchers are only throwing quicker in the allotted time because they don’t want to become predictable—and throw with one second left on every pitch—which allows baserunners to potentially time the pitch and steal bases easier. A longer clock would allow for more recovery.
Second, Burnes suggested MLB raise the cap of the maximum 13 pitchers permitted on the active 26-player regular season roster, which could help teams give pitchers more rest—either by allowing for six-man starting rotations or more bullpen depth, which he says is needed. And that’s saying something, considering Burnes is the most durable pitcher in the game. That recommendation has been made by many, including many on this site. How long before we see it. Another where MLBPA wants to see it increased, and MLB says…Nope!
But it isn’t always the hard thrower that has the arm injuries. A quick look at the current IL for MLB pitchers out with elbow injuries. The velo ranges from Cody Bradford and 89.8 MPH to Jonathan Loáisiga at 98.4 MPH. I tried to put them in chronological order.
Luis Garcia (HOU) – 92.7 MPH – Unable to recover from 2023 TJ surgery
Jose Scholtens (CWS) – 92.8 MPH – 03-01-24 TJ surgery
Trevor Stephen (CLE) – 94.9 MPH – 03-2024 Elbow surgery
Jackson Kowar (SEA) 96.9 – 03-15-24 TJ surgery
Eury Perez (MIA) – 97.5 MPH – 04-08-24 TJ surgery
Chris Murphy (BOS) – 93.9 MPH – 04-10-24 TJ surgery
Shane Bieber (CLE) – 92.0 MPH – 04-12-24 TJ surgery
Spencer Strider (ARI) – 96.3 MPH – 04-12-24 – TJ surgery
Sawyer Gipson-Long (DET) – 93.6 MPH – 04-22-24 TJ surgery
Jonathan Loáisiga (NYY) – 98.4 MPH – 04-2024 TJ surgery
Robert Stephenson (LAA) – 96.8 MPH – 04-30-24 TJ surgery
Matt Brash (SEA) – 98.1 MPH – 05-08-24 TJ surgery
Ken Waldichuk (A’s) – 93.3 MPH – 05-15-24 TJ surgery
Ky Bush (CWS) – 91.7 MPH – 05-15-24 TJ surgery
John Means (BAL/CLE) – 90.5 MPH 06-03-24 TJ surgery
José Urquidy (HOU/DET) – 93.1 MPH – 06-05-24 TJ surgery
Cristian Javier – 91.7 MPH – 06-06-24 TJ surgery
Tyler Wells (BAL) – 92.5 MPH – 06-17-24 TJ surgery
Kyle Bradish (BAL) – 94.5 MPH – 06-19-24 TJ surgery
Patrick Sandoval (BOS) – 93.7 MPH – 06-26-24 TJ surgery
Josiah Gray (WSN) – 92.7 MPH – 07-24-24 TJ surgery
Luis Medina (A’s) – 95.9 MPH – 08-07-24 TJ surgery
Brandon Williamson (CIN) – 92.6 MPH – 09-18-24 TJ surgery
Julian Aguiar (CIN) – 94.3 MPH – 10-11-24 TJ surgery
Joe Musgrove (SD) – 93.0 MPH – 10-11-24 TJ surgery
Braxton Garrett (MIA) – 90.7 MPH – 12-16-24 UCL Internal brace
2025 Elbow Injuries:
Jake Cousins (NYY) – 94.9 MPH – 02-25-25 Strained forearm
Grayson Rodriguez (BAL) – 96.1 MPH – 03-05-25 Elbow inflammation
Gerrit Cole (NYY) – 95.9 MPH – 3-11-25 TJ surgery
Tyler Mahle (TEX) – 91.4 MPH – 03-11-25 Forearm tightness
Cody Bradford (TEX) – 89.8 MPH – 03-12-25 Elbow tightness
Yu Darvish (SD) – 94.1 MPH – 03-13-25 Elbow inflammation
Blake Watson (ARI) – 91.5 MPH – 03-14-25 TJ surgery
Jeff Criswell (COL) – 95.4 MPH – 03-14-25 TJ surgery
Zach Pop (TOR) – 96.2 MPH – 03-17-25 Elbow discomfort
Ryan Weathers (MIA) – 95.9 MPH – 03-17-25 Forearm strain
Zach Penrod (BOS) – 94.8 MPH – 03-19-25 Elbow soreness
Drew Thorpe (CWS) – 91.0 MPH – 03-20-25 Scheduled for TJ surgery
DJ Herz (WSN) – 93.5 MPH – 03-20-25 Sprained UCL – UPDATE – Recommended for TJ
Jhonny Brito (SD) – 96.4 MPH – 03-24-25 Forearm discomfort
Jared Jones (PIT) – 97.3 MPH – 03-25-25 Elbow discomfort
Jordan Montgomery – 92.1 MPH – 03-25-25 Pending TJ surgery
Of the 42 elbow injuries identified above, 27 pitchers have a < 95 MPH 4-seamer while 15 have a > 95 MPH 4-seamer. Of the 27 pitchers with < 95MPH, 16 of those have a velo less than or equal to 93.0 MPH. So just how many clicks does Sasaki have to tone his 4-seamer down?
This exercise was not intended to draw any conclusions. However, IMHO, the problem emanates from Little League Coaches and Little League Parents. From there on to High School and College. Many of these pitchers are on their way to being damaged goods by the time they ever reach professional baseball.
For now, Mookie is in the ST finale lineup.
Knock on wood a decent spring.
So what is mlb’s argument for not adding more pitchers to the active roster?
Los Angeles Dodgers veteran infielder David Bote has exercised his upward mobility clause in his non-roster invite deal, per Fabian Ardaya of The Athletic. Bote, who had a breakout performance this spring, can now look for big league offers from another team before deciding if he wants to remain with the Dodgers in the minor leagues. The 31-year-old Bote appeared in 14 games this spring, slashing .400/.471/.700 with two home runs, three doubles, nine runs batted in, and an OPS of 1.171.
Awesome research and post Jeff D. I really appreciate the information. As you can deduce from my many posts on arm injuries, this is right up my alley.
I don’t have much to add from what you have covered here and what I have previously commented on.
I will add a couple of thoughts:
I personally don’t think the pitch clock is a contributing factor in the increased of arm injuries. I actually find it odd that many pitchers have come out opposed to speeding up the game. And I’m not sure as many pitchers as the Players Association would like us to think are opposed to it. A large % of pitchers were subject to the rule on their way through the minors so I can’t see them having any opposition to the clock. A verbal minority of verbal veteran big leaguers are not strangers to complaining about anything.
It fits right in with the contentious relationship between MLB and MLBPA. You can bet your ass that the pitch clock and ABS will be on the table for the next CBA.
So who am I going to believe more; Tony Clark and Corbin Burnes bitching about the pitch clock or Dr. James Andrews when it comes to arm injuries?
“As Dr. Best and Dr. Andrews concluded, this is a youth problem. Unfortunately, the problems are starting in Little League, not High School. The arm was never intended to throw that hard that early, and now all year.”
I have no problem with expanding rosters and 6-man rotations to help the current situation. I think there are was to train smarter with more throwing and less pitching with increased fitness and building arm strength. But until, in the Big Picture, the goal of parents, scouts and all the money makers abandon the max velocity and spin philosophy, nothing well change. That will be tough sell.
The answer my just lie with better, innovative medical procedures.
The Pirates did get some good news on Jared Jones. He does not have a UCL tear, but he will be shut down from throwing for 6 weeks. Another 3-4 weeks ramping back up???
Donne
There is an update on the above post – Washington’s DJ Herz is now recommended for TJ surgery. That will make 6 pitchers undergoing TJ surgery during ST. There were 3 last Spring. There were 22 additional TJ surgeries during or following the 2024 season. How many of the current elbow injuries will result in TJ surgery this year? How many more torn UCL’s are currently unknown but will ultimately pop up during the season?
Dodgers have decided to accept invitation to visit the White House. Betts undecided if he will go. Kike revealed he was almost DFAd last season when he was struggling. Stuart Fairchild will be DFAd by the Reds tomorrow. Austin Hays placed on the IL. Brendan Rogers, former Rockie second baseman, was informed that he has made the 26-man roster of the Astros.
I know it is way too early, but there is some potential drama to be monitored as the season unfolds. Cubs sent 3B Isaac Paredes, 3B/OF Cam Smith, and RHP Hayden Wesneski to Houston for RF Kyle Tucker. Parades is the Astros starting 3B, Smith (rookie) is the starting RF, and Wesneski is #5 in the Houston rotation.
Smith was the Cubs 1st round choice (14th overall) in 2024 out of Florida State. He has 134 total MiLB PA, with only 20 at AA. He had a marvelous spring, especially when compared to how poorly Tucker hit in ST. Houston now has 3 starters for the one they lost. It could all flip flop after the first month of the season. But could it be that the Cubs gave up way too much for one year of Kyle Tucker? Parades (3 years control), Smith (rookie), Wesneski (5 years control). This could be fun to watch how it all unfolds. Jed Hoyer could be a hero or out of a job.
While Betts said doctors couldn’t give an exact diagnosis for his lingering stomach aggravation, there is speculation the 32-year-old dealt with a case of norovirus.
Norovirus infection can cause severe vomiting and diarrhea that start suddenly. Noroviruses are highly contagious. They commonly spread through food or water that is contaminated during preparation or through contaminated surfaces. Noroviruses can also spread through close contact with a person who has norovirus infection.
Diarrhea, stomach pain and vomiting typically begin 12 to 48 hours after exposure. Norovirus infection symptoms usually last 1 to 3 days. Most people recover completely without treatment. However, for some people — especially young children, older adults and people with other medical conditions — vomiting and diarrhea can be severely dehydrating and require medical attention.
Norovirus infection occurs most frequently in closed and crowded environments. Examples include hospitals, nursing homes, child care centers, schools and cruise ships.
Some thoughts:
Well this turned out to be my longest post ever. I hope you are interested and stay with me
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After Jeff D’s excellent post about pitchers arm injuries, specifically UCL’s,
Badger and I have both offered some ideas to help curb some of the injuries within an organization. We agree on many things and differ on others. But we are both talking about management of adult pitchers.
Dr. Andrews put the blame on youth baseball which is a completely different can of worms when it comes to injury prevention.
He stated – “But the crisis confronting Major League Baseball is rooted deeper than just within its rosters. In reality, the problem goes all the way back to youth baseball. As the focus on velocity has increased, youth coaches and scouts have fixated on the radar gun.”
I’ve seen this close up and is the reason I am not optimistic in the larger picture as I have witnessed the problems w/ YOUTH SPORTS.
The explosion of “Big Business” with youth baseball was really heating up before I retired from coaching. I had a specific plan for each of my pitchers for scheduled starts and daily side-work between starts. I might mention, maybe I was lucky but I never had a pitcher blow up an arm and needing surgery. Not one. These were 18 and 19 year olds, many signing.
But on one occasion, I had a pitcher scheduled to start on a Tuesday and Monday he tells me he’s a little sore. I asked for details on the soreness and he explained that he and his dad had traveled across the state, a 500 mile round trip, to visit some pitching guru. He had thrown an extensive bullpen on Saturday and wouldn’t be available to pitch by Tuesday.
Dad, kid and I had a heart-to-heath discussion and that ended the outside intervention until our season was over. I think that would be much more difficult today. I get the impression that things have become much more like a high school golf coach who does no teaching, just management, as each kid has an individual golf pro as a teacher. Now baseball kids all have pitching and hitting instructors.
There is tons of research and information about arm injuries. But it will never change due to exactly what Dr. Andrews has concluded.
The Genie is out of the Bottle.
Allow me to offer 2 scenarios:
Little Johnny Jr. loves baseball. He’s an all-American kid who wants to be a big leaguer someday. John Sr. claims to have been a great pitcher back in his day but an injury had short circuited his promising career. But he’s dedicated to seeing Johnny Jr. get all the benefits, regardless of expense, to make him a pitcher. That includes stuff like PerfectGame Showcase Tournaments in Az. where they rate top players, by position, by state, starting at age 10. The pervasive thought is the if Johnny Jr. isn’t nationally ranked and written up by PerfectGame, his chances of a college scholarship or a pro contract will be out the window.
Also individual instruction (competency of instructors is thought to be based on how much they charge) is necessary. If John Sr. can get Johnny Jr. to Driveline or a similar pitching lab, all the better.
Clinics are mandatory.
Of course, “Daddy-Ball” / Travelball at a young age and through high school, is required to play with the best, frequently traveling out of state (as playing locally is looked down upon).
Scrapping other sports for year-around baseball is necessary to devote the attention needed to polish that craft, despite scouts encouraging participation on other high school sports).
You can always find John Sr. at the screen by the dugout during Jr’s starts verbally supporting Jr. and frequently questioning the coach.
At every level Johnny Jr. is throwing as hard as he can. That’s why they have radar guns out. All this training now is dedicated to MPH.
The next phase is exactly what we are seeing and what Dr. Andrews describes – arms blowing up at a young age.
Scenario #2 – young Juan is a skinny, poor kid growing up in the Dominican.
He loves baseball and idolizes the latin players in MLB, many come home in the off-season to support baseball. After all, the biggest export financially to his country isn’t rum or sugar or tourism, it’s baseball players. And he wants to be one. So Juan shows promise and is soon recruited by a Biscone to be part of his stable of young players. Juan moves from his poor family to live in housing provided by the Biscone, who serves as a surrogate parent/coach/agent, with other young prospects. They get good equipment and playing facilities and perhaps some questionable training enhancements not legal in the USA. Juan is 13 and needs to hone his skills to attract MLB teams who all have academies in the Dominican. Juan is long and lean and is throwing harder and harder. That’s his ticket off the island.
Juan, and his Biscone slowly starts leaning toward one MLB organization so by the time he is 16.5 he is ready to sign and with that organization. And the Bacon may get 50% of Juan’s bonus.
By 21 Juan has 5 years in pro ball. The first couple in the academy and DSL, then working his way up the chain in the states. Juan is filling out and no longer a skinny kid. Juan is 6’3” and 235 and throws a 100mph. Just what he has been groomed to do since he was 12. Juan has pitched his way off the island. And the hope is Juan’s arm won’t blow up and he ends up unskilled back on the island with other kids who didn’t make it.
At what point do you think John Sr., Johnny Jr. or Juan would have embraced the idea of NOT throwing as hard as he can to avoid arm injury?
As I concluded before, this injury epidemic is NOT going to end. While load management and training are sincere attempts at injury prevention for adult pitchers, there is no chance of changing the current culture of youth baseball.
Again, maybe improved medical procedures will prolong some careers of pitchers and some guys are just lucky to avoid injury.
But the light at the end of the tunnel is another train coming.
Spectrum Sportsnet LA and MLB are partnering to launch SNLA +. A streaming service only for fans in the LA home territory is a 24/7 digital access to all SNLA programing through the MLB app and MLB.com. This includes all games, pre- and post-game shows. Games broadcast by other networks are not included. Direct TV customers can also get the service. It is 199$ a year, or 29.99 a month. This is also a blackout free way to watch the games. The only games I do not see on my MLB package are the games with Colorado. I get those with my Spectrum TV account on the Rockies channel.
A lot of moves involving players being sent down or added to the roster still happening. Travis Jankowski will make the White Sox roster.
Jeff,
Read this trade proposal
Trade Proposal: Baltimore Orioles get RHP Bobby Miller, Los Angeles Dodgers get OF Vance Honeycutt (Orioles No. 4 prospect)
what are your thoughts?
Alex Cora announced that Devers will be the primary DH and Alex Bregman will play 3rd. Rockies signed Mickey Moniak to a major league contract.