In Major League Baseball’s much-anticipated pitching injury report, the league spends most of the 62 pages breaking little new ground. This is by design. To address the game’s rash of arm injuries with a sense of urgency, MLB couldn’t undertake the years of research necessary to better explain where the sport has failed and where it must go. More than a solution, this is, quite literally, a call to arms.
Over the past year, MLB officials talked with more than 200 people: pitching coaches, athletic trainers, former big leaguers — really anyone who might offer a nugget of insight or wisdom. Alongside bringing some clarity to the issue, MLB endeavored to answer lingering questions. Did the pitch clock cause arm injuries to soar? (There is no evidence to suggest as much.) What about the lack of sticky stuff to give pitchers a better handle on the ball? (Still unclear, though with the amount of ink devoted to the importance of grip, logic suggests it could be a factor for some.)
The larger issue is that arm injuries are a problem bigger than MLB. They exist in every crevice of the baseball universe, from college to youth baseball to the international game. This means fully dissecting the issue takes nuance and space better provided by a book, which I undertook a dozen years ago. Like the league, I came to no “aha” conclusion, beyond the brokenness inherent in a game fruitlessly trying to breed pitchers to do the very thing that gets arms hurt and the accompanying trajectory that portended trouble. In nearly a decade since “The Arm” was published, almost nothing has changed. In fact, arm injuries have gotten worse.
This report is an adequate, if banal, first step. Sound the alarms from the top, and hope to pull the right levers so a decade from now the game, at all levels, looks different. At the very least, it’s an acknowledgement that this is a matter worthy of the league’s time and energy. And while MLB isn’t explicit in its plans going forward, the main takeaways from the report are clear.
Early-season injuries have become especially worrisome to teams
In a memo sent to executives and team medical staff with the report Tuesday, MLB outlined the next phase of its research: “a detailed examination of offseason training regimens and early-season workloads.”
Injured-list placements between spring training and Opening Day have spiked precipitously in the past two years: nearly 100 in 2023 and more than 110 last year after never exceeding 80 over the previous five full seasons. And with spring training report dates less than two months away, how pitchers work in the offseason is at the forefront of clubs’ minds.
Professional pitchers now strive to show up at camps in Arizona and Florida looking near-ready to pitch in the big leagues. Over what should be their offseason, they use available technology to perfect current pitches and learn new ones, and, after a long season, rest insufficiently. Early in camp, they try to impress their team with the quality of their stuff — valuing spring measurables over staying healthy for a full season. Spring training workloads, in the meantime, have dipped, even as pitchers bypass using camp to build arm strength.
“Although well-intentioned,” the report says, “this trend of reduced spring training workloads has coincided with an increase in early-season and spring training injuries, which contributes to the conclusion of some experts that pitchers are exposed to a higher risk of injury because they are not prepared for the dramatic increase in workload and intensity when the season begins.”
Undertaking this sort of a study necessitates buy-in from players, trainers and teams. Years of data will be needed before any sort of conclusion — and that is often the issue with the arm: Even data alone won’t necessarily lead to a satisfying explanation. What makes the arm such a puzzle is that any number of things can ruin it.
MLB is now on the record saying the most significant causes of arm injuries are velocity, spin-chasing and maximum-effort pitching
Anyone familiar with how the arm works understands that the modern style of pitching is incompatible with arm health. Teams prize velocity and spin in the players they draft, promote and eventually keep on their rosters. If going deep into games led to better career outcomes, pitchers would adjust their behavior. It hasn’t. So they don’t.
Everything starts with velocity.
“Despite a direct correlation with injury risk,” the report says, “average fastball velocity in MLB jumped from 91.3 mph in 2008 to 94.2 mph this year. Velocity has been pursued by pitchers because it is advantageous in achieving positive performance outcomes, can be quantified and acquired, and is valued by major league clubs. Private facilities that specialize in velocity-focused methods of training have grown in popularity.”
Further, the report says, the culprits of injury proliferation include “the emphasis on optimizing ‘stuff’ (a term referencing the composite movement characteristics of pitches, including horizontal and vertical break and spin rate) and the modern pitcher’s focus on exerting maximum effort while pitching in both game and non-game situations.”
Partially at fault, the report posits, is that MLB teams’ response to this has not been to change the behaviors antithetical to health but rather work around them. More teams have resigned themselves to arm injuries and instead sought roster depth, taking advantage of rules that allow them to churn their pitching staff. In each of the past four years, teams have averaged more than 32 pitchers used per season. In 2010 that number was 22.8, in 2000 22.5, in 1990 20 and in 1980 15.1.
Technology runs the game
Never does the report explicitly ask what could join velocity, spin and max-effort pitching on the Mount Rushmore of Blown-Out Elbows, but it alludes implicitly and, at times, explicitly to technology’s part. This is not to suggest tech in baseball is inherently bad; on the contrary, it has done wonders for the game. But one quote in particular, from an athletic trainer, accurately reflects the environments in which pitchers are being taught.
“They’ll turn around and look at the Edgertronic and TrackMan, and they’re married to it,” the athletic trainer said. “And they’ll ask, ‘Where was that? Am I tunneling?’ I think it’s deadly. You’re challenging them on the mound to grip it, rip it. They come in and are asking, ‘What’s my carry?'”
First, a few definitions. An Edgertronic camera takes super-slow-motion video and allows pitchers to see how their pitch grip relates to the spin they seek on a certain pitch. TrackMan is a radar system that tracks ball flight and measures velocity and spin. Tunneling is trying to create difficult swing decisions for hitters by releasing different types of pitches from the same point. And carry is a pure-backspin fastball that isn’t pulled down by gravity as much as one even slightly off-axis, giving it the illusion of rising.
To be a pitcher at almost any competitive level today means fluency in this language. This is what pitchers are taught. And because the technology provides accurate and objective numbers with which growth can be tracked, it is fully embraced by the next generation of pitchers.
The consequences of this can damage pitchers who see performance-tracking data not as a tool but as their hammer. And who can blame them? When teams are interested in pitchers, the first thing they want to see is his data. With that being the case, of course pitchers are going to focus on juicing those numbers any way possible. It’s just another case of misplaced incentives running amok.
The minor leagues do not prepare pitchers for the demands of the major leagues
Twenty years ago, about 55% of major league starts and just over 50% of minor league starts came on five or fewer days’ rest. In 2024, that dropped to about one-third of starts in the big leagues and barely 10% in the minor leagues. The same trend applies to relief pitchers: Big league relievers pitch on back-to-back days around 16% of the time; in the minor leagues, it’s closer to 2%. Want to know why the number of major league starts going at least five innings has dropped from 85% to 70% in the past two decades? Maybe it’s because over the same period, minor league starts of that length have gone from around 70% to less than 40%.
By and large, young players are no longer training — or, better put, being trained — to do what major league teams ask of them. One can’t reasonably expect a pitcher to throw deep into games when they’ve trained to air it out for five innings. Going back-to-back is a physical test that far too many relievers fail because nobody bothered telling them it’s an imperative skill for a big league bullpen arm.
And at the same time, the starting pitcher has been deprioritized. With the emergence of a seemingly endless supply of high-velocity relief pitchers, starters’ inability to go deep into games and the fear of the third-time-through-the-order penalty, the slow death of the starting pitcher has accelerated, much to the league’s discontent.
“Starting pitchers are no longer incentivized to establish their durability in games over the course of the championship season because clubs are more willing to rely on relief pitchers than ever before,” the report says. “Instead, they now pursue max-effort performance over much more limited periods of time — putting them at more substantial risk of future injury. These trends similarly raise questions about whether rule changes can be considered to make it more appealing for pitchers to prioritize durability over max-effort performance, in order to improve pitcher health.”
Perhaps the easiest rules changes the league can make are limiting moves back and forth between Triple-A and the big leagues and limiting the number of pitchers a team can roster, forcing starters to chase innings over stuff and strikeouts. The blowback would be strong — from teams and players — but when the league says the outcomes of modern pitching theory have “a noticeable and detrimental impact on the quality of the game on the field,” it’s the sort of damning statement that tends to prompt change.
The danger of amateur trickle down
Perhaps the most damning graphic in the report comes on page 33. It covers 11 years of pitchers at the Perfect Game National Showcase, at which the largest company in youth baseball invites the best high school juniors in the country to play in front of an endless supply of talent evaluators. In 2014, five pitchers threw at least 95 mph. Same in 2015. Over the next three years, it was seven, six, three and eight. In 2020, it doubled to 16. Since then, the report says, it has more than doubled again, to 36.
High school players are simply doing what will get them recruited to college, where they’ll simply do what gets them drafted, where they’ll simply do what gets them promoted. Everything filters down from the big leagues. Kids aren’t using TrackMan and Rapsodo if big leaguers don’t. Compound that with the encouragement by travel-ball operators to participate in year-round play via showcases, the adoption of misguided weighted-ball programs from people ill-suited to properly monitor such training tools and the straight-up ignoring of PitchSmart guidelines recommended by a panel of medical experts, and far too often, players are coming into MLB systems already broken. 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.
“The risks of arm injury due to overuse largely have been ignored in favor of year-round travel baseball and showcases (a longstanding concern with amateur baseball that experts view as only worsening in recent years),” the report says. “Indeed, high-level amateur players perform year-round with intense pitching schedules that put them at greater risk of future injury. Although some suggest that current youth and amateur development models may be primarily responsible for an increase in pitcher injuries across all levels, we conclude that improving pitcher health requires both adjusting professional incentives and implementing changes to amateur baseball so that appropriate training and performance practices trickle down to the amateur level.”
The report, which generally skimps on recommendations in favor of additional research, does no such thing with youth baseball. It recommends closing loopholes in PitchSmart guidelines, enforcing standards on participating tournaments and leagues, and increasing education. Even more, it suggests blackout periods that prevent professional scouts from evaluating players and allowing them proper rest and recovery during the offseason.
This is where the baseball universe must converge. All the stakeholders. For the sake of the kids. For the sake of the game. Solving arm injuries won’t ever come in one fell swoop. With so many pathologies, answers are built, not found. And though it will take years to see progress, it’s vital for MLB’s report to be just the beginning, not a standalone effort that stops where it started.
