MLB survey on pitching injuries points to solutions that no one likes

The most comprehensive inquiry into pitching injuries at all levels of the game still comes down to too fast, too young.

On Tuesday, Major League Baseball released the results of a year long study on pitcher injuries. The report on injuries included a survey of 200 experts in pitching and pitching mechanics from all levels of the game. The conclusions weren’t terribly surprising, and the likely solutions run counter to all the incentives in the game.

The hunt for velocity and stuff, at earlier ages and as a ongoing part of pro pitchers’ normal work, is the consensus biggest factor driving these injury levels. The data included made the scope of the problem a little more plain, but at the same time there was little to point toward solutions that can actually be implemented. All the incentives encourage players and teams to favor pushing it as hard as possible, to the breaking point and beyond. That isn’t likely to change.

The study did have a few new data points. The pitch clock doesn’t appear to have been much of a factor in pitcher injuries rising. Taking away the sticky stuff from pitchers is a little murkier, and it just stands to reason that having to exert more grip pressure isn’t going to be good for the arm. Still there was nothing conclusive there.

Another point emphasized by Jeff Passan at ESPN , is the fact that early season injuries have really soared in recent years for pitchers. That may point to poor offseason training regimens, too much work, or perhaps too little, and ineffective programs for ramping up workload in spring training. A question I don’t see answered anywhere is whether pitchers are throwing more overall, despite the declining amount of innings in games.

The amount of pitch design work, warm-up pitches, and offseason throwing sessions seems to be on the rise as pitchers work on optimizing and repeating their pitches under the watchful eye of high speed cameras and data collection technology. I can’t help wonder if pitchers are actually throwing more than they used to, or at least more full intensity pitches, despite the declining amounts of in-game action.

Another crucial data point that wasn’t discussed much in the major outlets is ever increasing success rate of UCL reconstruction surgery. As grueling a rehab process as it is, by and large Tommy John surgery is just viewed as just a cost of doing business and less like a potentially career ending injury. Surgeons and rehab therapists have gotten very, very good at the procedure and the rehabilitation process. Players and teams just assume that once or twice per decade, you’re going to blow out the UCL ligament and be out 14-16 months.

Certainly there are a lot of factors involved, and at least some of those issues may be addressed without fundamentally changing how pitchers pitch now. Still, the overriding change in the game that has accompanied the rise in UCL surgeries is the ongoing quest for more velocity and ever nastier stuff. and that absolutely isn’t going to change, at least at the major league level. Velocity remains the glaring red flag in all this, with the ever expanding work to snap off the highest spin breaking stuff possible also a factor.

From 2008 to 2024, the average major league fastball has gone from 91.3 mph up to 94.2 mph. Sliders are up 1.8 mph, while curveballs and changeups are both up about 4.0 mph apiece. Beyond the endless quest for velocity, pitchers are also working more and more to tune their pitches or develop a new one, experimenting more in the search for better “stuff” since the advent of modern pitch design programs. And of course, Tommy John surgeries are also up significantly. There is overwhelming consensus from experts that this is all related.

Dr. Glenn Flesig stated it clearly in this piece on MLB.com from David Adler.

“If we interviewed 200 people, I was concerned that we’d get 200 different answers,” Fleisig said. “The fact that there was agreement in this report — that most people think the No. 1 issue is velocity — is great. The survey does not prove what the issues are, but it shows us what people [in baseball] think the issues are. So it gives us a gameplan or roadmap for what we should try to solve.”

One issue is the fact that different stakeholders seem to have different goals. Teams and players want to be the best they can be, and if that means shorter max intensity outings, so be it. Coaches in amateur ball are under enormous pressure to compete for talent, and have to demonstrate their ability to turn young pitchers into draft quality, or at least scholarship worthy, players.

Then we have the league itself and their desire to make the game look and play a certain way at the major league level even if they have to rig the game to do it. Rob Manfred continues to muddy the issue with his desire for starting pitchers to get back to throwing six or seven innings per outing.

Are we trying to reduce injuries? Or is this mainly about Manfred and others’ desire to recapture the old days and make starting pitching matchups that went seven innings or more the marquee selling point for games again? They want less injuries and they want starting pitchers to pitch more. That’s something of a contradiction on its own, but it’s also counter to the actual goal of the people playing and coaching the game, which is winning baseball games.

Pitchers are not going to back off from trying to get better. Teams are not going to stop trying to optimize pitchers and deploy them in usage patterns most conducive to winning. Sure, there is variability from player to player. Some particularly gifted young pitchers may need less development than others. Most, will have to compete as hard as they can, and outwork the other thousands of young men trying to become MLB pitchers. That means pushing the envelope to generate the most velocity and the best stuff possible that they can still command. And so, there will continue to be a higher rate of major injuries.

Hitters have adapted as well, making it harder to promote backing off or managing workload through an outing. Hitters are now exposed to low to mid-90’s fastballs in high school and in showcases will see triple digits from some pitchers. The amount of high velocity stuff grows more and more prevalent throughout their college years. The same selection process in pitchers that weeds out the lower velocity arms in their late teens and early 20’s, ensures that hitters are exposed to better and better stuff, and likewise sifts out the hitters who can handle it from those who can’t at earlier and earlier ages. With some exceptions, backing off and sitting 91-92 mph isn’t an option for most guys, particularly right-handers. Hitters would have a field day.

At the major league level, it’s just contrary to the idea of competing at the highest level to back off in training and in-game from throwing your best stuff. It’s really hard to see how they’re going to get pitchers to throw slower and sustain success deeper into games again. The difficulty of the problem is laid bare by the inanity of some proposed solutions, like moving the mound back or trying to mandate that the starting pitcher has to pitch into a certain inning or throw a certain amount of pitches before they can be lifted without penalty. Moving the mound back is only going to force teams to emphasize velocity even more. Mandating workloads on start days is a good way to increase the number of injuries rather than diminish them.

Youth baseball

Personally, I think the main answer has to be found at the lower levels of the game. As Passan notes in his piece,

“Twenty years ago, less than 5% of drafted pitchers had reconstructive surgery on their pitching elbow’s ulnar collateral ligament, typically known as Tommy John surgery. Now, it’s more than one-third.”

Far more young pitchers arrive in college or pro ball already injured.

Even in youth baseball, the incentives are hard to overcome for the sake of long-term arm health, but pitchers throwing tons of innings in the early teen years and hunting for that 90+ mph velocity from an early age are clearly part of the problem. Guys are out-throwing their natural physical development, and that stress on the arm from an early age is no doubt a contributing factor in the amount of injuries sustained later at the professional levels.

While the amount of Tommy John surgeries has nearly doubled from a decade ago at the major league level, an ever sharper rise in major elbow and shoulder injuries in youth baseball has caused even more alarm amongst the game’s major stakeholders. Enough so that teams have reached the point of wariness with 17-18 year olds who are already throwing 100 mph at that age.

Plenty of those names will never be heard from again as they simply succumb to too many injuries in the quest to get drafted in the early rounds or earn a D-1 scholarship offer. Hunter Greene is a recent example of one who made it. But for every Hunter Greene there are many Riley Pint’s, who wowed at showcases while still in high school, but never really turned into a pitcher with any control or consistency in pro ball until after years of injuries and struggle, he finally reached the major leagues briefly as a slider heavy reliever in 2023.

Figuring out how to reduce injuries at the major league level is really difficult. The compact between player and fan insists that a pitcher is doing his best to compete on the biggest stages and for the highest stakes. It’s entirely possible that a lot of the problem, and perhaps some solutions, come straight from youth baseball, with young arms already risking wear and tear that even mature, full grown men in their early 20’s can’t avoid eventually succumbing to at the highest levels of the game. At least the pros get paid, but it’s still hyper competitive and it’s difficult to blame coaches too much for trying to do everything possible to get their kids that scholarship or that scouting interest in the draft.

Focusing more on actually developing as pitchers, and saving the explosive high velocity training for your senior season of high school, or better yet, waiting until the college years, might improve matters considerably. No one really cares how hard you throw until you’re a senior. If you weren’t on the radar as a sophomore or a junior, but now you’re pitching well, showing velocity gains, and have a projectible build and overall athleticism, sure, you may not go in the first round, but you are going to have opportunities to continue to develop in college or in pro ball.

Once again though, we’re confronted with all the incentives being on the side of pushing it as hard and as soon as one can. If you try to save your arm, you’ll never get the chance to develop further. It’s understandably hard to take the longer view and plan slowly for a long major league career, when in the moment, guys who throw harder are being handed a million dollars or more straight out of high school.

Minor leagues

One notable detail from some of the study’s released data was the huge spike in UCL reconstruction surgeries in 2021. They’ve actually declined since, though still to levels twice as high as they were a decade ago, but that huge spike may also be instructive.

The vast majority of minor league pitchers didn’t get anything close to their normal workload in during the 2020 season. Guys were largely on their own, trying to find other players to train with, or, they went all in and showed up to one of the many pitching development facilities that have popped up over the last decade, trying to add velocity and dial in a nastier breaking ball. What they absolutely didn’t do was pitch consistently in games, and all these factors presumably added to the already high rates of UCL surgeries and caused the 2021 spike.

Kyle Boddy, founder of Driveline Baseball and one of the more well respected names in the game in player development, contributed to the study and had one prescription. His feeling, backed by more research and data gathering than anywhere in the game, is that once players reach the pro level and have physically matured, they still often don’t get enough work in the minor leagues to build them up for a full season in the majors.

This issue has only been compounded by the new minor league schedule. Instead of the old series by series scheduling, since 2022 minor league teams have played a Tuesday through Sunday schedule, with six games straight against the same team. Implementing a regular five-man rotation schedule has started to fall by the wayside.

Teams like the Tigers don’t really want their starters pitching full starts twice in a week to the same team, so for instance Jackson Jobe might be scheduled to pitch on both Tuesday and Sunday one week. Then he’ll start the next Friday, and then pitch the next Wednesday. That would leave him on regular rest pitching the next Monday, but they’re always off that day, so now he’s pitching on six days rest that week on Tuesday, and then again on Sunday. That steady “every five days” grind is constantly broken up. And in an effort to help protect their pitchers, which in Boddy’s view is misguided, the Tigers often go with a short start when a starter pitches Tuesday, and then they let him go deeper in the Sunday start. Most teams are doing this sort of thing, with no observable results in terms of preventing injuries.

One might argue that they’re doing a disservice to these young pitchers by not letting them develop naturally, learning how to handle the grind of a major league schedule. In the process, they’re also conditioning them to expect to be fresh every time out and able to throw their max velocity throughout the game. They’ll be lifted at 80-90 pitches anyway, and every couple of weeks there will be an extra day of rest built into the calendar.

The lesson of Justin Verlander

So, the problems may well be rooted in youth baseball and college players trying to do too much, too often, too soon. The problem is then accentuated by the way teams are conditioning guys to throw their max stuff in shorter outings, and to train to get to the major leagues as quickly as possible, while at the same time trying to protect them by keeping their innings under strict limits.

Roster spots are limited, and cutting down the number of minor leagues in which to play in has forced an even more accelerated pace on hopeful starting pitchers. Pitchers still have to throw strikes, but much more emphasis is placed on building the nastiest set of pitches possible, as soon as possible, and reaching the major leagues quickly to justify a team’s investment in them. There’s less space than there used to be to slowly figure it out and build oneself up over years in the minor leagues while really learning how to pitch.

Even someone like Tarik Skubal, who pounds the strike zone as well as anyone in the modern era, describes himself more as a thrower than a pitcher. He recognizes the distinction. He’s going to physically train like a maniac to make his delivery as consistent and as explosive as possible, and then he’s going to attack at, or very near, max effort throughout his whole outing.

It’s always a little dangerous to point to a complete outlier as an example of a different path, but in Detroit, this discussion is always going to lead us back to that mightiest of horses, Justin Verlander. What do I mean by learning how to pitch?

Well, no starting pitcher has ever thrown harder than Verlander. Nolan Ryan, Jacob DeGrom, Spencer Strider, or whatever flame thrower you want to name, still none of them has topped out much over 102 mph. Verlander had as much velocity as any starter in the game’s history, yet year in and year out, he threw well over 200 innings and often stretched out way beyond the 100 pitch wall we see now for virtually all starting pitchers. A 115-120 pitch start for Verlander was the norm for most of his first decade in the game. Then you have to take into account the amount of postseason baseball he’s pitched, considering not just his actual competitive innings totals per year, but the shorter turnaround through the offseason. And yet, apart from the muscular issues he dealt with in 2014-2015, Verlander was absolutely unbreakable until finally going under the knife for TJ in 2020 at age 37.

Is he just a freak? Probably, but it’s worth considering the ancient art of changing speeds here as well. Few pitchers do this anymore. They may have two speeds, but Verlander had three or four different gears. While he could hit 101 whenever he wanted, his goal was to pitch deep into games, and so he often started out games in the 92-93 mph range, settling into 94-97 mph once he was really loosened up, and only breaking out the high octane gas in a jam, or in the late innings when his outing was almost over.

While a Spencer Strider might throw every fastball in a game at 96-100 mph, and average more velocity than Verlander did in his prime, the former Tigers’ ace had that velocity whenever he wanted. He just placed an emphasis on pitching deep into games. He was willing to take some chances in order to learn how to get hitters out early in the game with location, rather than just attacking them at 100 percent on every pitch all game long. As a result, in his prime it was like facing three or four pitchers in one body, each progressively tougher as the game progressed and hitters start to get their timing more and more dialed in.

Zack Greinke, another of a group led by Verlander and including Clayton Kershaw and Max Scherzer, that may be among the last to top 3000 innings in a career, is even more known for velocity control and changing speeds. In his youth, Greinke could pump high 90’s gas with the best of them, but he also developed a near freakish ability to throw all of his pitches at multiple different speeds with command.

There is a boundless supply of Greinke stories in which he called out a mph number and then hit it exactly, even far from his average velocity with each pitch. Even more than Verlander, Greinke became adept at using relative velocity to set hitters up. He’d show you 92 mph so that when he reached back for 95 mph, which wasn’t even his max velocity in his 20’s, it would play up like he fired 98-99 mph in there.

This doesn’t seem to be taught anywhere nowadays, at least not in the United States or the major hubs for talent in the Caribbean and throughout Latin America. You can’t learn to manage your own workload to throw 115 pitches in a game regularly if you’re never allowed to do it. Verlander has credited Jim Leyland again and again for allowing him to find his way without managing him with kids gloves. Even in his youth teams were already heavily limiting workload for all but the most established and durable starting pitchers. And rarely do you see anyone pitching like Greinke and changing speeds constantly with all his pitches. Instead, player development has been streamlined into a factory for producing hard-throwing pitchers with the nastiest breaking balls as quickly as possible, and getting them to the major leagues.

Would this still work? Well we seem in no danger of finding out. Obviously hitters are used to hitting high velocity stuff now, and if you’re feeding them 92 mph consistently without great movement, you’re going to get hurt. But every pitch doesn’t have to be 99 mph either, and every hitter doesn’t require that much juice to get them out with. Learning a little more artistry early in games is certainly an approach that could help starters lengthen their outings again. There’s just little evidence that teams or players are going to be patient enough to approach starts this way ever again.

In the end, the study doesn’t appear to have told us much that is new. It’s a more comprehensive look than ever at the issues, but the quest for velocity and stuff is pretty obviously the culprit. The real question is how to incentivize training methods and workload management that might help.

Backing off the gas and learning to pitch at the youth levels seems one key. At least waiting until young pitchers’ bodies are closer to maturity before they aggressively start training for pro velocity. Changing the way pitchers train and develop in the minor leagues and in college is another. Perhaps by working on those two, the game can get back to emphasizing the craft of pitching a bit more, without sacrificing max velocity and stuff, and still bring the number of major arm injuries down. Once they’re at the major league level, for big money and high stakes, you’re just not going to get many guys to ease off.

Finally, the league and the game at large doesn’t seem to know what it wants. We want maximum stuff from pitchers. We want less injuries. However teams and players have come to accept Tommy John surgery as just an unpleasant part of the deal, while the league, or at least Manfred specifically, wants the game to look a certain way in terms of starting pitching ruling the roost full time again. Injuries aren’t really the focus from that perspective, and so none of this is really compatible in the end, and no change is coming as a result.

What do you think? Is there anything the league can do here? Or does it come down to training too hard, too young, with little the league can really do to encourage a different path in the amateur levels?