From a Wall Street Journal story by Lindsey Adler and Jared Diamond headlined “The ‘Mini-Bombs’ Blowing Up the Elbows of Baseball’s Top Pitchers”:
Max Scherzer made a dark prediction at the beginning of the baseball season. Pitcher injuries, already at high levels, would intensify. His concern, Scherzer repeatedly warned to anybody who would listen, was the introduction of the pitch clock.
He was right about at least one thing: It has been another painful year for pitchers. Jacob deGrom, Shohei Ohtani, Shane McClanahan and Tony Gonsolin are among the key starters who have undergone elbow surgeries that will likely keep them off the mound until 2025. Scherzer himself strained a muscle in his throwing shoulder last week, leaving the Texas Rangers without their ace for the final stretch of a fierce postseason race.
Now everyone—players, teams, league officials and the top doctors responsible for treating these injuries—is searching for answers.
In some ways, what has happened over the past few months is simply a continuation of a devastating trend. The dramatic rise of star pitchers succumbing to elbow ligament surgery has been one of the defining story lines of the last decade.
But the top orthopedic surgeons who routinely work with major leaguers are sounding alarm bells about what they consider to be a concerning development. It isn’t just the number of significant injuries that has them worried—but the severity of them.
Dr. Keith Meister, the Rangers’ team physician, said the MRIs of some of his recent patients “look like a friggin’ mini-bomb going off on the medial side of the elbow.” And he’s not the only expert to take notice.
“I’m seeing injuries now that I haven’t seen to this degree,” said Dr. Neal ElAttrache, a prominent orthopedic surgeon in Los Angeles who has operated on many major-league players. “There’s definitely something different happening now to the shoulder and elbow, and before any other changes are made to try to fix something, people in baseball need to better understand exactly what we’re seeing right now.”
The ramifications of an injured ace extend far beyond the emotional agony, for the player and fans, of a pitcher not working every five days. It’s an overwhelming financial burden. Teams pay elite starters enormous amounts of money. Losing them for a year or more destroys their investment, and teams are desperate to solve the mystery that is keeping the human elbow intact. (The Rangers, for instance, awarded deGrom a $185 million contract before this season. He made six starts and now probably won’t pitch again until 2025.)
Experts are trying to understand what is causing all these injuries, despite the strict pitch counts and innings limits teams now impose in the name of health. The explanations being mooted include rising velocities, the pitch clock, the pitching mechanics needed to throw today’s mind-bending breaking balls and even the league’s crackdown on “sticky stuff” used to enhance grip and spin—or some combination of them all.
For Scherzer and others, the pitch clock has emerged as a potential boogeyman. With less time to recover between throws, the thinking goes, pitchers are more likely to be fatigued, which leaves them more susceptible to injury.
“You put a pitch clock in play now, and you get guys who are now really working hard to meet the clock and the time and you pile on a bunch of pitches, and their endurance is not going to be the same,” said ElAttrache, who performed elbow surgery on Ohtani this week. “As soon as that starts to break down, then their mechanics break down.”
Meister said he has spoken with veteran pitchers who told him they believe the clock has “increased their fatigue level pitch to pitch, which could have potential consequences.” He said that in general, younger pitchers haven’t expressed that sentiment.
Glenn Fleisig, the director of biomechanics research for the American Sports Medicine Institute, is part of a MLB-created research committee that is studying this issue. He said the committee will compile all the injury data after the season and present their findings this winter.
At this point, there appears to be limited concrete evidence directly linking the pitch clock to additional injuries. There have been fewer injury list placements among pitchers than this time last year, though injuries soared to record highs in the wake of the pandemic-related shutdown in 2020. IL placements among pitchers are up from 2019.
As of now, MLB says its in-season research has found no correlation between the pitch clock and pitcher fatigue and injury, pointing out that pitcher injuries have been on an upward trajectory for many years. There have been few violations of the clock at all this season, with the league noting that pitchers are leaving time on the clock.
“We don’t live in a world where only one thing changed from last year to this year,” Fleisig said. “Unfortunately, we don’t live in a laboratory where any change we see we can definitely say it’s because of the pitch timer or not.”
Consider the other changes that have taken place across the sport in both the last decade and in very recent seasons. Pitchers are throwing harder than ever, with the average fastball velocity now sitting at 94 mph, compared with 92 mph in 2013. Today’s pitchers are taught to throw every pitch with maximum effort, rather than conserve energy for later innings like in the past, putting even more stress on the arm.
“Pitch speeds are going up and up, and injuries are going up and up,” Fleisig said. “This is one statistical factor that correlates.”
Pitchers are throwing physically strenuous pitches like sliders at a higher rate, too. The centurylong convention in pitching has been to build an arsenal around the fastball. Now, in an era when pitchers can maximize the velocity and movement on their secondary pitches, teams are urging pitchers to use their statistically best pitch more frequently.
The inciting incident for this change in pitching philosophy comes from the fairly new ability to quantify the spin rate on a pitch using technology.
Pitchers have always sought to optimize the spin on their pitches—a true backspin can create the illusion of a “rising” fastball, while the frontspin sends a curveball tumbling toward a batter’s knees. But the ability to measure spin has led to a hyperfocus on the value of spin and research into how to increase it.
ElAttrache said the arm actions required to generate that kind of spin are “the worst set of forces and mechanics for the ligament.”
Knowing the value of spin, many pitchers started using extremely sticky substances to help generate more friction and spin on their pitches. When MLB cracked down on the use of sticky stuff, some pitchers struggled to adjust.
In 2021, Tampa Bay Rays starter Tyler Glasnow blamed his elbow ligament tear on the crackdown. He said, quite colorfully, that he had intensified his grip on the baseball as a result, which led to the flexor strain that so often precedes a UCL tear.
“I’m choking the s—out of all my pitches,” Glasnow said.
Meister believes Glasnow isn’t alone. He said in order to generate spin without the assistance of sunscreen or pine tar, pitchers are gripping the ball harder than they should, which is “biomechanically a very dangerous problem.”
Scherzer found himself mired in the continued fallout of the sticky stuff crackdown this year when an umpire ejected him for having hands that were deemed as too sticky, leading to a 10-game suspension. Scherzer has denied any improper use of the league-provided rosin for grip, but he additionally helped foment another wave of caution amongst pitchers.
Scherzer can proceed with the knowledge that to some extent, his concerns about pitcher injuries this season were proven correct. Unfortunately for him, the foresight and caution around the topic didn’t spare him from suffering the same miserable situation he worried would befall many others.
He is finishing the regular season on the injured list, one of many of the game’s aces who will not be able to participate in their team’s championship effort in October.
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