Part of the problem with deconstructing the whole “pitchers are getting hurt a lot, huh?” situation is that we have to first acknowledge the almost impossible number of variables that come into play. The human body. Mechanics. Effort and intensity. Fatigue and recovery. Nutrition. Analytics. Training as a youth. Injuries as a youth. Weather. Spin rate. Grip strength. Pitch design. Lower body strength. Recovery time (annual). Recovery time (in-week). Recovery time (in-game). Recovery time (between pitches). On and on and on. There is no one thing.
If the source of pitcher injuries were easy or obvious, they would probably happen a whole lot less. I say “probably” because there is yet another variable embedded in there: it very well could be that a lot of the things that lead to injury also lead to better performance, so there may be CONSCIOUS TRADE-OFFS happening every day around baseball. We cannot treat this issue like it’s a simple, “uh oh, the pitch clock broke guys!” There are factors here that range from clear to obscure, significant to minor. And it all gets jumbled up inside of a human body that comes, intrinsically, with its own unique sets of limitations.
For now, all we can do is pay attention, study the issues available for study, consider expertise, and try to figure out ways to shave off some risk at the margins.
I want to share some of what’s going around out there following a spate of pitcher arm injuries, and then a public spat between the MLB Players Association and MLB about the pitch clock (which COULD be a contributing factor *in a max-effort environment*, but is pretty plainly not the source of an injury epidemic that started swelling years and years ago). First, though, I do want to point out two things are happening that are making the recent rash of injuries seem more dramatic than it probably is: (1) some of the guys getting hurt are among the biggest names in the sport, so the injury issue really stands out; and (2) March/April is always a little more heavily weighted toward significant arm injuries for a variety of reasons. So, as much as I’m happy to share what follows and ponder where things stand going forward on pitcher arm injuries, I don’t want to contribute to the idea that somehow things are now TOTALLY DIFFERENT this year. I’m not sure that’s the case.
Items to consider …
Tom Verducci wrote about the big picture issue, and zeroed in on the ligament at the heart of one of the most common significant arm injuries: the ulnar collateral ligament. That’d be the one in the elbow that frequently tears in pitchers and then requires Tommy John surgery. Not all of the concerning pitcher arm injuries are in the elbow, much less with the UCL specifically, but a disproportionate amount are. And that’s where Verducci would start:
I wanted to include that chart there because it is just so stark. Even two of the “none” guys on there actually have had significant injuries, including two Tommy John surgeries for Ragans. You can basically say that every single one of the hardest-throwing starting pitchers over the last four years has had a major arm injury, and the vast majority come with the UCL. As Verducci’s article notes, citing experts who’ve studied the issue, current training is pushing the body to be able to throw harder and harder, but (1) you can’t train up the UCL, and (2) more velocity means more torque on the UCL.
Even if all of that is correct – let’s say the simplest version is something like “more velocity means more elbow injury risk” – that doesn’t mean there’s an easy fix. All else equal, we know that higher velocity pitches perform better than lower velocity pitches. So we’ve got a serious incentive misalignment if players and teams want more velocity for performance, but less velocity for health. It’s a tricky issue, and again, that’s only if you’re focusing on JUST ONE SPECIFIC aspect of the bigger picture.
Eno Sarris took an analytical approach to evaluating many of the possible factors (and ultimately agreeing that velocity is the biggest contributing factor):
Among the things Sarris notes in there, although you could make a pretty easy theoretical argument that the pitch clock would increase injuries if everyone stays all max effort-like (less time to recover = more fatigue = more injuries), that hasn’t yet actually happened. There is no evidence yet that the arrival of the pitch clock has impacted the rate of pitcher arm injuries.
A note from Casey Mulholland, who runs Kinetic Pro, a private player development lab, to Sarris on how these injuries happen from the physiological standpoint: ““Our brain passes messages to our muscles, forearm flexors in this case, via the central nervous system to contract at just the right moment to offload the stress applied to the UCL. When we become fatigued our brain doesn’t pass this message as well, the muscles don’t contract at the ‘optimal time’ or the ‘optimal amount’ and we end up not being able to offload this stress. The UCL then wears more of a direct stress. Over time, under fatigue, the load of throwing eventually overcomes the tissue tolerance and boom, UCL tear. This is why workload management is the only logical answer to slow the injury rate. Workload management predicts the possible time at which an athlete might experience too much load.”
So, yeah. If he’s right about that – and it tracks with things we believe we’ve known about pitcher health for decades – then two of the biggest injury issues for the elbow are going to be velocity and pitching-while-fatigued.
Jeff Passan, who wrote the literal book on “The Arm” nearly a decade ago, worries that baseball is facing an existential problem:
Just to confirm that this year is not an outlier in terms of elbow surgeries, Travis Sawchik looked at the first 100 calendar days of each year going back to 2010:
That isn’t to say this isn’t a crisis-level issue overall – I’m inclined to agree with Passan that it is – it’s just to note that we aren’t currently in the middle of a one-year spike. (In fact, the broader trend in the MINOR leagues, as Passan mentioned in his article and as Sarris specified in his, is what is most alarming: the rate of UCL injuries has seemingly doubled in the last decade.)
Justin Verlander, himself a Tommy John recipient, spoke at length about the complex web of factors impacting the current era of pitching injuries, and about how hard it is going to be to unwind:
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