What can be done to curb the outbreak of pitching injuries?
Every day, it’s someone else.
“I heard two more guys today went down,” Aaron Nola said, shaking his head before pitching for the Phillies this week in St. Louis. “It [stinks], man. I don’t like seeing it. I don’t know. I don’t really have an answer.”
There aren’t answers — not uncomplicated ones, at least — for the most worrisome problem in baseball. Pitcher injuries, notably shredded elbow ligaments, skyrocketed more than a decade ago and have remained constant. By now, they’re less epidemic to the sport than a full-blown pandemic. This isn’t a new issue.
But it is leading the conversation again after a wave of pitchers landed on the injured list — or worse, the operating table — during the season’s first two weeks. A partial list: Miami’s Eury Pérez, Cleveland’s Shane Bieber, Atlanta’s Spencer Strider, Washington’s Josiah Gray, Boston’s Nick Pivetta, the Yankees’ Jonathan Loáisiga, the Mets’ Tylor Megill, and Houston’s Framber Valdez.
Add those who got injured in spring training — the Yankees’ Gerrit Cole, the Mets’ Kodai Senga, Baltimore’s Kyle Bradish, Boston’s Lucas Giolito, Taijuan Walker of the Phillies — or were already recovering from elbow surgery or other arm trouble — Houston’s Justin Verlander and Luis Garcia, Texas’ Jacob deGrom, Miami’s Sandy Alcántara, San Francisco’s Robbie Ray, Baltimore’s Félix Bautista, Tampa Bay’s Shane McClanahan, Colorado’s Germán Márquez, Phillies top prospect Andrew Painter, the Dodgers’ Walker Buehler and Shohei Ohtani — and you have an All-Star pitching staff that’s unable to pitch.
It’s a crisis that baseball hasn’t confronted. Instead, MLB and the players used the injury boom to bicker further over the pitch clock. Union chief Tony Clark issued a statement in which he blamed pitcher health on the league for shaving two seconds off the clock with runners on base; MLB cited an unpublished study that found no correlation between the clock and an injury spike.
Meanwhile, fastball velocities keep rising, spin rates continue to increase, and organizations invest more bucks in the arms that generate the most swings and misses.
And when elbows explode and shoulders snap, well, teams unearth new ones. Want to play in October? It’s about enduring pitching attrition.
“We’ve been talking about it a lot,” Phillies ace Zack Wheeler said. “I feel like [injuries] might be happening a little quicker now. I don’t know the reason why. I think a lot has to do with how guys are brought up. Maybe it’s not being totally ready in the sense of the amount of innings and pitches being thrown.
“But I know guys are throwing harder. When guys throw super, super hard, [with] more effort, you put more stress than you already do. And on top of that, you’re spinning stuff at a high effort. That doesn’t help, also. I think all of that combined, there’s a lot of stress on guys’ arms.”
Indeed, the causes of the problem are multifaceted, which only adds to the complexity of finding solutions.
MLB is conducting a study of pitching at all levels of development and seeking input from players, coaches, and medical experts. The idea is to make recommendations for how to keep pitchers healthier.
In separate conversations this week, Wheeler, Nola, Phillies pitching coach Caleb Cotham, and surgeon Brandon Erickson of the Rothman Orthopaedic Institute shared their thoughts on the recent spate of injuries and what might be done to curb them.
‘Juice is worth the squeeze’
When they’re old and gray, pitchers of this generation will be identifiable by the crescent-shaped scar on the inside of their elbows.
Of the roughly 800 pitchers who appeared in a major-league game last season, more than one-third — 274, according to researcher Jon Roegele — survived Tommy John surgery, a procedure in which the torn ulnar collateral ligament in the elbow is reconstructed with a tendon taken from elsewhere in the body.
Why are so many UCLs snapping?
“The biggest risk factor is pitch velocity,” Erickson said. “The harder guys throw, the higher their risk for injury. There’s a linear relationship with that. If you’re throwing mid-80s, your risk of a UCL injury is not tremendous; if you’re throwing in the high-90s, your risk of a UCL injury is pretty significant.”
And more pitchers than ever are throwing in the high 90s.
In 2008, the average four-seam fastball was 91.9 mph, with a total of 21,820 pitches clocked at 96 mph or harder, based on Baseball Savant data. Last year, four-seamers averaged 94.2 mph, with 53,549 pitches reaching at least 96 mph.
Velocity is in like your Spotify playlist, finesse pitchers out like your old CD collection.
Imagine, then, being a minor-league pitcher who is trying to win a spot on a major-league roster. Or a high-school pitcher looking to make an impression on pro scouts. How far would you go to chase velocity? How hard would you push that elbow ligament?
As a coach, Cotham said, he spends “the majority of the day that’s not part of the game” thinking about his pitchers’ health. As a former pitcher, he relates to anyone who pushes the envelope to optimize talent.
After shoulder surgery and struggling in triple A, Cotham found Driveline Baseball, a data-driven think tank near Seattle and a leader in new, innovative training programs. He added velocity to his fastball and reached the majors in 2015 with the Yankees.
“You understand that throwing harder helps you get more outs,” said Cotham, who retired in 2017 after knee and shoulder injuries. “Throwing harder helps you throw off-speed pitches better and nastier. It’s been that way forever. There’s a lot at stake. There’s a lot of incentives.”
A root in the grass roots
Here’s an exercise: Google “pitchers pulldowns.” You will find videos, many from Driveline’s website, of young pitchers pushing their arms by getting a running start and making maximum-effort throws, sometimes with a weighted ball, often into a net.
It’s like nothing Wheeler ever did growing up in suburban Atlanta.
“Just looking in, I’m like, you’re wasting bullets throwing into a freakin’ net as hard as you can,” Wheeler said.
Erickson, who treats amateur pitchers in addition to pros, is familiar with “pulldowns” and other max-effort training exercises. Young pitchers like to show off their arm strength and post videos on Instagram and elsewhere to attract followers, notably coaches and scouts.
From a medical perspective, Erickson isn’t in favor of such methods.
“That’s not what pitchers need to do,” he said. “That’s not how you get guys out. That is how you show yourself off. But that’s not how you’re going to be a successful pitcher in Major League Baseball.”
Wheeler was coached by his father, who didn’t let him spin curveballs in a game until he was physically mature. He pitched for East Cobb Baseball, a nationally recognized travel program in Georgia. It wasn’t until he trained with his high school’s football team and put on 15 pounds of muscle before his senior year that his velocity climbed into the 90s.
“I don’t think I got clocked until I was a junior in high school,” said Wheeler, the sixth overall pick in 2009 and a top prospect. “Now, guys are getting clocked when they’re playing 12-year-old baseball, which I think is wild.”
But Wheeler still broke down in 2015. He blew out his UCL, underwent Tommy John surgery, and missed two seasons with the Mets.
“Any time you pitch there’s always a risk of shoulder, elbow. It’s not a natural motion,” Wheeler said. “If you throw above 90 and you throw for so long, you’re probably going to have TJ.” Is it possible that elbow surgeries are unavoidable for pitchers?
Not if baseball gives them a reason to change their habits, according to Erickson.
“Especially the younger guys, they almost assume it’s going to happen to them, which is kind of a scary thing,” Erickson said. “It’s an inherent risk with the sport at this point. We can optimize everything we want, but the reality is, if guys are going to keep throwing really hard, we’re going to keep seeing this problem. There’s a change that has to happen with teams and scouts and how we view guys as prospects.”