Jesse Rogers, an esteemed ESPN Staff Writer, delved deep into the world of Major League Baseball pitching injuries in a comprehensive 62-page study released on December 17, 2024. This extensive research aimed to identify the contributing factors to the alarming increase in arm ailments among pitchers at both the professional and amateur levels.

Uncover the Hidden Causes of MLB Pitching Injuries

Identifying the Culprits

The study identified several key factors contributing to the rise in pitching injuries. One of the primary ones is the pursuit of higher velocity and better "stuff" by players. This often leads to maximum effort being exerted both in-game and during non-game situations. As the average fastball velocity increased, so did the incidence of injuries. An orthopedic surgeon emphasized this point, stating, "If we take the simplest thing, which is fastball velocity, you can see how the average increase in fastball velocity has completely paralleled the increased incidence of injury. If you could take one factor, it’s that."Moreover, pitchers at the professional level are "at least somewhat aware" of the injury risks but choose the more dangerous style of pitching "because they perceive that the rewards outweigh the risks, particularly in the near-term." This mindset might be filtering down to the amateur ranks as well. A pitching coach said, "We understand throwing harder increases your injury risk. That’s true at a population level. Now for the overwhelming majority of human beings on Earth who aspire to play baseball at a serious level, that trade-off is worth it."

Modern Workload Management Strategies

Contrary to expectations, modern workload management strategies meant to protect pitchers might actually be contributing to injuries. Pitchers tend to use max effort even more when they know they won’t be in the game for long. A former MLB pitcher shared his perspective, saying, "I used to pitch to chase outs. Now they chase velocity. I had to play a chess match to try to get 24 or 27 outs. Now it’s a sprint to go as hard as you can, as long as you can. Starters have a reliever’s mentality now."The study also found a "perceived" trend of minor league players being unprepared for a major league workload. Innings limits, more rest between appearances, and restrictions on pitching on back-to-back days are likely impacting pitchers negatively once they reach the majors. As one former pitcher wondered, "When do you throw your first back-to-back? It’s in the major leagues. Same with three out of four days. They’re not getting exposed to it in the minor leagues. That’s a lot of strain on your arm, if you’re not accustomed to monitoring your warm-up pitches in the bullpen and used to the recovery afterwards to prepare yourself for the next day."

Training and Its Impact

Anecdotally, experts are concerned with a de-emphasis in cardiovascular and endurance training for pitchers in favor of the "power-and strength-focused training" that is more commonly prescribed today. One athletic trainer pointed out, "There used to be starting pitchers doing endurance runs, and now we’re in the power, short-burst, sprint-type training, and that’s changed. It’s okay to train for sudden bursts of power and what I’d call anaerobic training. I always tell people that’s fine, but you need a basis of aerobic capacity to do that. … We do too much of this heavy lifting, short-burst power. That’s where I think we’re missing it."

Prior History and Its Influence

Research within the study indicates that a pitcher’s injury history can be a predictor for future injury. As pitching injuries continue to rise, especially at younger ages, more and more players become susceptible to another injury as they climb the amateur and professional ranks. An MLB athletic trainer said, "We’re getting guys now out of the draft that have been throwing year-round — our first-round guy had been throwing year-round for 3 years. The wear and tear on him isn’t going to be his first major league season, it’s going to be from those previous three years."

Rule Changes and Their Role

The study was somewhat inconclusive about the recent rule changes contributing to injuries. For instance, the pitch clock implemented before the 2023 season. The evidence suggests that it might not be a significant factor as pitching injuries have been on the rise since the 1990s while the pace of the game has slowed down (before 2023). In fact, the slower pace may have actually contributed to more injuries as pitchers took their time to throw max effort more often. However, the trend of early season or spring training injured list placements points to the pitch clock having little to do with injuries.

Surgical Advancements and Their Implications

Though medical advancements have allowed some players to return to the mound, the study found that "incorrect perceptions" of surgery may provide a false sense of security. Pitchers may be more willing to risk injury knowing they can always come back. An orthopedic surgeon explained, "They have such a faith in the Tommy John procedure, they’re willing to sacrifice their own elbow knowing if they wind up tearing it, they can get it fixed. By the way, with the new procedures going on, telling them they can get well in half the time with this internal brace phenomenon, it doesn’t help at all with the relationship that pitchers have in their own mind about getting an injury. They don’t realize that 20% of the ones who get it, don’t make it back."

Amateur Contributions

Chasing velocity and "stuff" at a younger age has been a contributing factor to the rising number of youth injuries. An orthopedic surgeon noted, "The velocity keeps going up, guys are getting bigger and stronger. As they keep getting stronger, their ligament doesn’t necessarily get stronger. I see a lot of kids. Some kids rip the bone off their elbow because their growth plate is weaker than the ligament. Instead of the ligament failing, the bone breaks off. That used to happen occasionally, but now it’s happening more and more." Additionally, the transfer portal in college has been deemed a contributing factor as schools may have kids in their programs for short periods, leading to maximizing performance instead of long-term development.

Conclusion and Potential Solutions

Though further study is needed, the league understands the importance of creating a system where pitchers are "encouraged or required to moderate their activity and throw at sub-maximum effort to go deeper into games may be better for pitcher health." Some experts suggest changes to the playing or roster rules. For example, providing an incentive for a player or team for the starting pitcher to last longer in a game might change their training habits. Smaller pitching staffs would also require starters and relievers to pitch longer, potentially influencing pitching habits all the way down to the amateur levels. A limit to the number of transactions a club can make could be another way to force pitchers to adjust their training habits. The overall goal is to "increase the value of pitcher health and durability, and decrease the value of short-duration, max-effort pitching."