The Pitching Injury Epidemic:
A New Perspective on an Old Problem
Just in case you have been vacationing somewhere far away that doesn’t allow you access to American sports media… recently there have been dozens of articles and podcast conversations regarding the current epidemic of injuries, especially ulnar collateral ligament injuries in professional baseball.
Whenever MLB stars such as Spencer Strider, Gerrit Cole, Shane Bieber, Framber Valdez, and Lucas Giolito have injuries, the “big hitters” in the industry weigh in.
Although I have not read or listened to every article or comment, I am going to focus my energies on the comments made by Justin Verlander, Tom Verducci, Dr. James Andrews, Dr. Keith Meister, and Dr. Glenn Fleisig. I picked these men because I not only highly respect and admire their work, but I also know each of them personally.
These men strongly believe that the recent rash of UCL injuries is brought on primarily by an overemphasis on velocity, as well as the current efforts to “design” pitches that are sharper and more difficult to hit. Others still point to overuse, the new pitch clock constraints, and the slicker, more lively ball coupled with the elimination of using substances for grip enhancement as the culprits. I believe they all would concur that the issue is multifactorial, but the two big factors for the aforementioned men are an overemphasis on velocity and the pitch design piece.
Do I agree with their evidence and synopsis? My short answer is—yes and no.
So, how can one possibly agree with the facts stated by these brilliant and talented men, yet reach a different conclusion?
I’m going to do my best to explain. You see, I have been on this very case for some time now and have seen this coming.
Young men come to the Texas Baseball Ranch® for multiple reasons. Most often, they come to gain velocity to make a specific team (whether a summer travel team or their high school team), obtain a college scholarship, or possibly be considered for the MLB draft. We are very aware of the challenging road they are starting down, and we always begin with a frank conversation.
Here is part of my very scripted introduction:
“Your time here with us at the Ranch can’t just be about gaining velocity. This is not about one night at the county fair and hitting a radar number on one thrown ball so you can win a huge teddy bear for your best girl. That certainly would be a far different and easier process. I don’t believe that’s really your goal. You want to become a prolific throwing athlete. And to become a successful pitcher, it's about so much more than just hitting a number on a radar gun.
First and foremost, it is about maintaining health and durability, as well as developing repeatable levels of recovery. Consistency in performance absolutely can’t be created without them. One can’t build velocity, let alone maintain it, without health, durability, and consistent recovery.
It’s about throwing it over the white thing. You can throw it 105mph… and while certainly exciting… if you walk the ballpark, your time on the bump in any meaningful game will vary from limited to nonexistent.
It’s about avoiding 100% on-time barrel matches and creating swing-and-misses. That will involve movement, deception, tunneling, sequencing, shape, and challenging the hitter’s perception of the strike zone's height and width.
Therefore, the real question is not, “How can I increase my fastball by five mph?” but “What does my process look like to achieve all of the above?”
Unfortunately, there is no single universal recipe for answering that question. Individual athletes are far too unique. In fact, not only will one size not fit everyone, but one size won’t fit one person forever. This complex answer will take due diligence, assessment, and incredible dedication, purpose, and intention. Are you really ready for that, or do you just want me to recommend a weighted ball website and let you go on your way?”
I will share my personal perspective by taking things out of the baseball realm for a moment.
Imagine we inherited a car that had been used in actual NASCAR races. It hadn’t been driven in years. Its tires were very old and worn. The engine was out of tune, and the oil hadn’t been changed for quite some time. The front wheels were out of alignment, and the brake pads were nearly worn out. However, it does run, and one could drive it around town without it stalling or breaking down.
My question is, how hard or how long could we push this car before any of those previous issues showed up as substantial problems?
You see, if I drive the car from my house to the auto repair shop that is one mile away, using side streets and maxing out at 35mph, I will probably be able to make it without incident.
However, the more I push the limits of performance in terms of horsepower, maneuverability, or distance, the more likely those issues are going to interfere with my trip (and probably end via a breakdown). In other words, the higher the standards of the car’s performance become, from a simple drive to the repair shop to actually competing in a NASCAR race, the more those issues need to be addressed and solved.
If my ultimate goal is to return the car to its former NASCAR glory and race it routinely in competition, most of us would agree that a tremendous amount of work would need to be done in all those areas I pointed out to even give it a chance to compete. (Plus multiple other items I haven’t even listed.) You see, as performance standards increase, the room for error or slack gets smaller and smaller. Keep this obvious factoid in mind as we continue in this discussion.
The exact same thing can be said for a pitcher. The greater the standards… the higher the velocity, the higher the spin rate/vertical break/horizontal break, the higher the pitch count, the longer the season, etc. … the smaller the room for error before something breaks down.
The complexities and difficulties in training pitchers are even more significant than in my NASCAR example. With pitchers, we are not dealing with stock machines but with completely unique human beings who are always changing.
One of my favorite authors is renowned cancer surgeon, Dr. Bernie Siegel. Dr. Siegel is fond of asking, “In what way does your ailment or condition fit your life?” In other words, “What about your philosophies, lifestyles, circumstances, or situations may be contributing to your condition?”
For example, arm pain, discomfort, or injury for a pitcher:
If an athlete has considerable limitations or constraints in his physical structure, alignment, or strength balance, it can directly contribute to extra stress being placed on his UCL.
If an athlete has considerable limitations or constraints on his ankle, hip, thoracic spine, or shoulder mobility, it can directly contribute to extra stress being placed on his UCL.
If an athlete has considerable limitations or constraints in the flexibility of prime movers or stabilizers, it can directly contribute to extra stress being placed on his UCL.
If an athlete has considerable limitations or constraints in creating stability at the end ranges of his movements, controlling his center of gravity, or effectively generating force, it can directly contribute to extra stress being placed on his UCL.
If an athlete has considerable mechanical inefficiencies in his movement pattern, it can directly contribute to extra stress being placed on his UCL.
If an athlete is fatigued, it can directly contribute to an inability to effectively dissipate force and place additional stress on his UCL.
If an athlete is not fully recovered, it can directly contribute to an inability to effectively dissipate force and place additional stress on his UCL.
If an athlete is sick, dehydrated, insufficiently fueled, or performing on inadequate amounts of sleep, it can directly contribute to an inability to effectively dissipate force and place additional stress on his UCL.
If an athlete has an inadequate ramp-up period and the soft tissue is not given enough time or the appropriate stimulus to adapt to the demands that will be placed upon the athlete at game intensity, it can directly contribute to stress being placed on his UCL and/or an inability to effectively dissipate force, which can place additional stress on his UCL.
If an athlete has inadequate, improper, or mismanaged training regimens, these can directly contribute to stress on his UCL and/or an inability to effectively dissipate force, which can further stress the UCL.
And these are just the top-tier contributors! I could go on for another page, but I hope you get the idea. I do not list these to scare or overwhelm you. In fact, it is just the opposite. I list these to point out that while I believe the increases and obsession with velocity, spin, and performance are certainly true… they really are, in fact, what Dr. Siegel would refer to as the “philosophies, lifestyles, circumstances, and/or situations that may be contributing to your condition.”
I promise you we are not without options, alternatives, or choices. As an old friend of mine, physical therapist Randy Sullivan loves to say… “Soft tissue has no free will of its own. It will respond to the stimuli we place upon it.” Our challenges then lie in figuring out the amount, frequency, and duration of the dosages of those stimuli for each individual athlete to keep them healthy, durable, and performing at the highest levels.
In my opinion, we must not panic or attempt to legislate our way through these rough waters. Instead, we must roll up our sleeves, look at the problem holistically and practically, and then address those possible contributors with each individual athlete. There is so much more that can be done that is not often addressed or considered because it’s far more complex and difficult. That must not deter us. Too much is at stake.
Final Thoughts: I believe much of what is being forwarded as contributing to the rash of injuries is actually correct and valid. The real question is: What exactly are we going to do about it?
The increase in injuries can indeed be correlated to the gradual but steady increase in velocity over the last 15 years at every level of baseball. I personally believe we are going to find it very difficult, if not impossible, to convince young athletes (12-26 years of age) to throw the baseball slower when they are currently trying to ascend in levels. The fact remains that higher velocity often creates more opportunities for players. However, as pitchers approach their personal "red line" of maximum effort, the risk of injury inevitably increases. This is the reality we must confront.
If we are not careful, our pitch design may overly emphasize specific manipulations of the ball and hand to maximize pitch movement. Such manipulations can be inefficient and harmful to arm health, durability, and recovery. It is crucial to use common sense and educate coaches, trainers, and players about optimal deceleration patterns to enhance health and durability. These topics must be openly discussed and debated.
I believe slicker, livelier baseballs and the elimination of grip-enhancing substances CAN indeed place some extra stress on many individual pitchers. This to me, a pitching guy, is a very easy fix. Have MLB veteran pitchers such as Verlander, Scherzer, Kershaw, Cole, Snell, Bauer, deGrom, and Burnes give MLB some ideas on ball tackiness as a compromise on the seemingly endless shift toward more offense. The current “super ball” that feels like a pool cue ball is absurd, in my opinion.
I believe that for some pitchers, whose soft tissue is not adequately prepared for the demands of high-intensity throwing every 12 seconds, the pitch clock may increase the risk of injury. I think pitchers and their training will eventually adapt to the faster pace of play, including the recovery and adaptation of their soft tissue. However, this piece appears to be the straw that broke the camel's back for many. It is important to consider this issue in a broader context. I encourage people to adopt a more holistic perspective avoiding recency bias.
In my opinion, if we are going to solve this issue, we must look past our reactive instincts and recency biases and instead consider the challenge from a broad, comprehensive, and integrated perspective.
Coach Ron Wolforth is the founder of the Texas Baseball Ranch® and has written six books on pitching including the Amazon Best Seller, Pitching with Confidence. Since 2003, The Texas Baseball Ranch® has had over 579 pitchers break the 90 mph barrier, 208 have toped 94mph or better, and 135 of his students have been drafted in the MLB’s June Amateur Draft. Coach Wolforth has consulted with 13 MLB teams, dozens of NCAA programs and has been referred to as “ America’s Go-to-Guy on Pitching” and “The Pitching Coaches Pitching Coach.” Coach Wolforth lives in Montgomery, TX with his wife, Jill. They are intimately familiar with youth select, travel baseball and PG events as their son Garrett (now a professional catcher) went through the process. Garrett still holds the PG Underclass All-American Games record for catcher velocity at 89 mph which he set in 2014 at the age of 16.
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