Pitching injuries problem at all levels of baseball

GOODYEAR, Ariz. — Figuring out a cause for the skyrocketing number of arm injuries among pitchers is easy.

Finding a solution could prove much more challenging.

Major League Baseball issued a 62-page report in December that showed how the focus on throwing with increased velocity and using maximum effort on every pitch was a likely reason for the increase in injuries. The study provided numerical data backing a thesis already supported by conventional wisdom.

“It makes sense,” Cleveland Guardians right-hander Tanner Bibee said. “You do anything at a max capacity, you’re going to be at more risk for injury. If you try to squat your absolute max, you’re going to get hurt more often than if you’re squatting a plate and a bar. It’s just kind of the nature of anything you do in life.”

The study showed that major league pitcher injured list placements increased from 212 in 2005 to 485 in 2024. Days on the IL rose from 13,666 to 32,257.

Tommy John surgeries for major and minor league players increased from 104 in 2010 to a peak of 314 in 2020, though they slipped to 281 last year.

The study recommended “ considering rule changes at the professional level that shift the incentives for clubs and pitchers to prioritize health and longevity.” Instituting those types of rule changes could prove challenging when pitchers of all ages understand how much MLB organizations are emphasizing velocity.

“I don’t know if rules are the right way to go about it,” said Chicago Cubs left-hander Matthew Boyd, who underwent Tommy John surgery in 2023. “You can’t tell someone to throw softer. But I was a guy in college that threw high 80s. I would randomly throw a hard number, but I didn’t know how to do it consistently right. But I got outs. But I knew that some wise people ahead of me told me outs are going to get you to the big leagues, velocity’s going to get you drafted. So therein lies the problem.”

Perhaps most concerning were the statistics involving younger pitchers.

Prospects who threw 95 mph or higher at the Perfect Game National Showcase for top high school players increased from three in 2018 to 36 in 2024. Thirty-five players selected in the top 10 rounds of last year’s amateur draft had Tommy John surgery, up from four in 2005.

The evidence of increasing injuries isn’t limited to this study. An Orthopaedic Journal of Sports Medicine study showed there were five times as many injuries among Pac-12 baseball players in 2021 as in 2016, though that applied to all players and not just pitchers.

Problems are starting early in the pipeline

Those numbers help explain why one school of thought suggests any changes need to start at the youth level. That idea has the support of Eric Cressey, who trains more than 100 pro baseball players though his Cressey Sports Performance facilities in Florida and Massachusetts.

Cressey also is the New York Yankees’ director of player health and performance, but he was speaking only on his own behalf and wasn’t representing the Yankees on this issue.

“I’ve long maintained that everything begins with fixing what’s happening at the younger levels, and there will eventually be a trickle-up to the big leagues,” Cressey said.

Cressey noted the problems at the youth level by citing the videos he sees of young pitchers with “arms and legs flying everywhere” as they enter throwing programs when their bodies aren’t prepared to handle it. He believes that young pitchers throwing max-effort showcases in the offseason and disregarding basic warmup guidance has contributed to significant injuries.

“Thirteen-year-olds should never be blowing out ligaments,” Cressey said. “That should just not be happening. And every time it happens, it’s because someone made a terrible, terrible decision on that child’s behalf, whether it’s a coach or a parent. Just like you or I wouldn’t let our kids have candy for dinner or run with scissors or something like that, some of the things that I see in the youth space are nothing short of embarrassing.”

Cressey recommends imposing a scouting dead period for the months of October, November and December.

“It’s absurd for us to ask a still immature 17-year-old to go out and throw 95 miles an hour in November when major league players are resting during that time period,” he said.

Of course, not all MLB pitchers rest during that time.

Pro pitchers don’t rest like they used to

San Francisco Giants pitching coach J.P. Martinez says he doesn’t have a problem with major leaguers throwing throughout the year, though he acknowledges high-effort throwing year-round could make them more susceptible to injury.

“There’s quite a lot of guys that don’t shut down throwing at all nowadays,” Martinez said. “I think that gets vilified a little bit when a lot of the time they’re just keeping the arm moving and keeping the range of motion and workload at a certain level, so when they do ramp up, it’s less of a transition. You’re not going from zero to 60. You might be going from 30 to 60.”

The level of workload pitchers attempt in the offseason is notable because data shows that more injuries happen at the start of the season or in the preseason than at any other time of the year. The MLB study released in December showed that over 40% of the injured list placements due to elbow injuries from 2010-24 came in either March or April.

“That is generally because I don’t think guys are ramping up correctly,” Martinez said.

The challenge with going old school

Guardians pitching coach Carl Willis said he’d like to see an industry-wide emphasis on “turning the clock a little bit to a more old-school and traditional type of way” that relies on locating pitches and changing speeds and shapes. Willis believes that approach could allow pitchers to realize they don’t have to go full-throttle every time they release the ball.

“To prevent some of these injuries, that’s kind of the direction we have to go,” Willis said. “You can’t take away the power and the profiles that these guys can create, but you can take a little bit of the pressure off.”

That pressure can start at the youth levels, which explains why MLB has established Pitch Smart initiatives that set recommended workload limits for pitchers. The idea is to limit the likelihood they would pitch with fatigue since that increases injury risk.

The trick is making sure those recommendations get followed, particularly at a time when pitching prospects across the world believe velocity is what’s going to make an impression on scouts.

“What’s challenging right now is it’s hard to close Pandora’s box,” Cressey said. “A lot of these kids who are 25 and blowing out in the big leagues, they were kids who were doing a lot of things incorrectly in their teenage years, and now they’re just bigger, stronger and are in higher-pressure situations.”