MLB pitching injuries continue to spike upwards

Nov 29, 2023

Ballclubs have better and more knowledgeable doctors, trainers and physical therapists than ever before. They’re equipped with the nation's top medical researchers. They have the latest in technology.

And yet. ….

Baseball continues to be stricken with their nightmare epidemic: Elbow injuries.

Day after day, team after team, someone is undergoing Tommy John surgery.

There have been 31 pitchers who have undergone Tommy John surgery this year – 12 in May alone – involving everyone from Cy Young winners Jacob deGrom and Robbie Ray to first-round prized prospect Kumar Rocker to young star Luis Garcia to Colorado Rockies veteran German Marquez.

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Elbow and shoulder injuries have increased 44% from just a year ago, according to Baseball Prospectus research.

Look around, the Milwaukee Brewers already are without four starters from their opening-day rotation: Brandon Woodruff (shoulder inflammation), Aaron Ashby (shoulder surgery), Wade Miley (shoulder strain) and Eric Lauer (shoulder impingement).

The Tampa Bay Rays lost starters Jeffrey Springs (Tommy John surgery) and Drew Rasmussen (flexor strain), will be without Shane Baz until 2024 (Tommy John surgery), and now have placed Josh Fleming (elbow) on the injured list.

High-priced free agents deGrom, Justin Verlander and Carlos Rodon, who signed for $433.6 million this winter, have combined for 12 starts and just 66⅓ innings.

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What in the name of Tommy John is going on?

"There have been a lot of studies done and looked at variables about the ulnar ligament injuries,’’ renowned orthopedist Dr. David Altchek, the New York Mets medical director, told USA TODAY Sports, "but the only issue that clearly stands out is velocity. Guys throwing harder will have higher incidents of injuries to that ligament. Throwing harder really seems to make a big difference.

"The second thing is there's a lot of debate over using weighted balls [in workouts]. Throwing those does increase velocity, but at what cost? If it's not done effectively, it does increase incidents and injuries to the UCL.’’

Miami Marlins starter Jesus Luzardo remembers picking up a weighted ball and practicing with it during his senior year in high school. He underwent Tommy John surgery a month later in March 2016.

He was 18 years old.

"I think it's just these guys throwing harder, guys throwing at such a young age, and these kids that get put in these showcases,’’ Luzardo says, "and they’re being told that throwing hard is all that matters. That plays such a huge part.

"I wish when I was younger I didn't throw as much. But I never put it on my dad, he didn't know any better. My high school coach didn't know any better. At the time, I was competitive at the point that I always wanted to pitch.

"But now, looking back, do I probably regret all of those throws early.’’

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It's a shame when the pitchers are more dominant than ever, but their frailty has never been worse, with complete games now becoming as commonplace as $3 per gallon gas.

"Pitchers are pushing the envelope because of all their training to increase velocity, which leads to more injuries,’’ former Cy Young winner David Cone said. "The allure of throwing harder is too great not to take that risk. If I was pitching today, I would be doing same thing, pushing the envelope.’’

Maybe it's time for baseball to reduce the 162-game schedule simply to protect the health of pitchers, Dodgers pitching great Orel Hershiser says.

"This is the best the baseball has ever been thrown,’’ Hershiser says, "but you can't strengthen connective tissue. I think every pitch today is more stressful than it's ever been thrown. When you make your body perform at its highest level every pitch, I don't think that wear and tear is possible to maintain. Look there are no back-to-back games in hockey. The NBA has days off between games. Football has a week off between games.

"But in baseball, we’re keeping the same schedule, but we’re increasing the intensity of the events. There's just not enough rest.’’

Teams are trying to compensate by utilizing six-man pitching rotations, but still, it hasn't reduced the amount of injuries.

"I know everybody wants to jump on the velocity thing because they throw harder,’’ Arizona Diamondbacks veteran pitching coach Brent Strom says. "but Tommy John had Tommy John, and he didn't throw that hard. There's been a lot of guys who had it who didn't throw hard, like myself.

"A lot of it is the workload at a young age. The two-headed monster in this is to become an accomplished major league pitcher in this thing, you’ve got to have repetitions, and it depends on the physical strength and time you get. I know myself, I threw way too much in high school. I threw way too much in college.

"So, I don't know if it's a physical thing, or accumulated stress in the joint, I think it's just a weakness that takes place. It's unfortunate but I think there definitely some mechanical movements that people make that put undue stress on the arm. But it's hard when you’re trying to make it. If you’re looking at performance and health, the players going to opt towards performance, whatever is going to help get him where he's going to go.’’

Luzardo, 25, who has never thrown more than 100⅓ innings or made more than 18 starts in a season, suddenly is back feeling healthy. He is 4-4 with a 4.05 ERA, and leads the league with 12 starts, pitching 66⅔ innings.

"I feel like I finally got my feet under me and know what works for me,’’ Luzardo says, "and what makes my body tick.’’

Luzardo uses Proteus Motion system as part of his routine, saying it has had a positive impact, providing explosiveness in his pitches. It measures physical strength and power from all movements.

"It's a lot of preventive measures, trying to find things before they break down,’’ Proteus CEO and founder Sam Miller says.

Nearly half of all MLB teams now are using Uplift Labs to help curb their injury rate. It provides movement tracking and analysis in reports to help identify potential risk factors.

"We know pitchers are throwing harder and faster than they ever have,’’ says Matt Kowalski, Uplift's director, "and there will always be a lot of stress on the joints and body segments. It's just not a natural human movement. So we’re providing data using our analysis and trying to help identify what coaches should look for that puts stress on the ligament.

"We’re really looking forward to be on the forefront looking at not just potential risk factors, but to help athletes perform better and longer. We’d love have pitchers healthy and still working at the age of 46.’’

Oh, for the days of Nolan Ryan, who won the National League ERA title and led his league in strikeouts four times after turning 40, before retiring at the age of 46.

"It would be so nice, wouldn't it,’’ Dr. Altchek says, "just to have the best pitchers being healthy in our game.’’