One of the game’s top orthopedic surgeons is sounding the alarm about pitching injuries and citing the advent of the sweeper and the change in power as major reasons for the increase.
Dr. Keith Meister, head team physician for the Texas Rangers, said teams are exacerbating the problem by emphasizing pitchers’ performance over their availability.
“Unfortunately, these headquarters are living more in the moment than taking a longer-term view,” Meister said. “There is a way to manage this. What if a guy doesn’t have a WHIP (walks and hits per inning pitched) of 0.8? What if he has a WHIP of 1.1 but he can play 162?”
Meister, who pioneered the hybrid elbow procedure that combines a traditional ligament reconstruction with the addition of an internal brace, said surgical techniques have changed markedly over the past decade in response to the evolution of pitching.
As teams increased their emphasis on speed and stuff, pitchers’ DL placements rose from 241 in 2010 to 552 in 2021 before declining slightly in each of the last two seasons, according to a spokesperson. of the Major Leagues. The days pitchers spent on the disabled list doubled in a slightly longer span.
A hyperfocus on performance often begins at the youth level. Many pitchers experience problems before reaching the majors. The number of pitchers selected in the top 10 rounds with a history of elbow reconstruction increased from six between 2011 and 2013 to 24 between 2021 and 2023, the league spokesman said.
Meister, 62, said he repaired about 230 elbow ligaments last year and is “way ahead of that pace” this year. Shohei Ohtani he threw more sweepers than anyone in baseball from 2021 to 2023 before undergoing his second major elbow procedure. Of course, pitchers who don’t throw sweepers or changeups are getting hurt, too, as evidenced by the mounting injuries this spring.
Lucas Giolito of the Boston Red Sox may need a second elbow reconstruction. Justin Verlander of the Houston Astros, Kodai Senga of the New York Mets and Kevin Gausman and Alek Manoah of the Toronto Blue Jays are among those facing shoulder problems. Sean Hjelle of the San Francisco Giants is out with an elbow problem and Tristan Beck underwent surgery to remove an aneurysm in his arm.
And that’s just a partial list.
“We used to say, if you get your one TJ, you’re fine. So it was that they give you 10 years. Then it was seven to eight,” Meister said. “Now the guys are divided into three or five, depending on who they are, the things they have, what they throw.”
The game, then, appears to be teetering toward a dangerous edge. Pitchers are throwing more breaking balls than ever. They are also throwing harder than at any other time in the history of the sport. Velocity is commonly cited as one of the biggest injury factors in pitchers. And sport rewards those who pursue it.
“The analysis says the headscarf is very important,” said one pitching coach who was granted anonymity because of his candor. “Pitchers and analysts pursue veil. Pitchers who don’t do this retire. Those who stay put some risk of injury to avoid working at Costco.”
Meister, director of the Metroplex Institute of Sports Medicine in Texas, recognizes the dangers of speed postures. But, he said, “the effect is worse.”
The sweeper puts enormous pressure on the inside of the elbow, Meister said. The change in power “motion,” as Meister calls it, also puts excessive strain on the arm. “And to make these pitches,” he said, “you have to squeeze the ball deep.”
Years ago, Meister remembers hearing the late Johnny Sain, a former major league pitcher and independent-minded pitching coach, say that when a pitcher holds a ball correctly, he should grip it so that he can throw a raw egg without breaking it. he.
Today it’s just the opposite, Meister said. Pitchers apply a “death grip” to the ball, essentially preloading every muscle in their arms. Upon release, those muscles lengthen sharply in what is known as an “eccentric contraction.” The result can be almost like a hamstring tear, affecting different pitchers in different parts of the arm.
“We’re seeing all these tears in the latissimus dorsi and teres muscles, all these tears of the previously reconstructed ligament, many more tears of the flexor tendon,” Meister said. “I can tell you it’s predominantly a consequence of those two pitches: the wide slider and these tough changeups.”
Over the past three seasons, the percentage of liberos thrown has increased from 1.3 to 3 to 4.3 percent leaguewide, according to Statcast. The Rangers, the team that employs Meister, barely hit the field, as reported by the Dallas Morning News. Meister stated that the current nomenclature for classifying pitches is actually insufficient. He photographs his patients’ grips and has seen four or five different grips for both sweepers and changeups.
Shortly before spring training, Meister shared his concerns on a Zoom call with two MLB executives involved in injury prevention, Kevin Ma and John D’Angelo. The session was part of a study the league is conducting on pitcher injuries. The league has conducted about 100 interviews, its spokesman said, ranging from doctors and athletic trainers to independent researchers and college coaches, club executives and former pitchers. Once the study is complete, the league hopes to form a working group.
Not everyone in pitching research and training agrees with Meister’s belief that spin is more problematic than velocity.
“A libero is simply a curveball with a different grip,” noted one pitching coach, adding that Research is divided on the link between grip strength and turning speed.. “And guys aren’t screwing up their swings to make this move. On both pitches, they are taking advantage of the seams to make them move differently.”
Glenn Fleisig, director of biomechanics research at the American Institute of Sports Medicine, also expressed doubt that sweepers are of greater concern.
“We haven’t studied sweepers, per se, in the biomechanics lab, but we have shown in several studies that curveballs and sliders are no more stressful than fastballs,” Fleisig said in an email.
“Therefore, I have no reason to believe that liberos are any more of an injury risk factor than other breaking balls or fastballs. Science points to three main injury risk factors: effort (velocity is an indication of this within pitchers), number of pitches, and mechanics.”
The caveat to research by Fleisig and others who focus on the risks of speed is that at least a Driveline Baseball study demonstrated that elbow stress per mile per hour in the field is greater for secondary pitches such as changeups and sliders. Therefore, a pitcher who throws his slider as hard as his fastball will actually put more stress on his elbow.
Perhaps it’s no coincidence that Jacob deGrom, who throws his slider as hard as some pitchers throw their fastballs, has struggled to stay healthy. The higher the velocity, the greater the risk, no matter what pitch is thrown, and the slider velocity across the league. has gone up almost two miles per hour since baseball began publicly tracking him in 2007.
Many pitchers, who view injuries almost as an occupational hazard, hardly seem to care. Advances in “stuff” research, which attempts to value movement and speed separately from results, show that harder breaking balls are better, almost across the board. Additionally, frequently injured pitchers are often signed to big contracts based on the quality of the material, not its durability. So who’s going to tell a pitcher that he’s not like deGrom? Who’s going to advise anyone to avoid throwing a slider like Justin Verlander’s?
Tampa Bay Rays president of baseball operations Erik Neander, whose team lost three starting pitchers to elbow injuries during the 2023 season, said finding the optimal intersection between performance and availability is a challenge that extends to the youth baseball.
“Because of the investment in the player and the person and the care you put into them, it’s really difficult to see someone get injured and lose the opportunity to play,” Neander said. “How to balance that with giving them the best opportunity to compete and be successful in the Major Leagues is a very difficult balancing act, one that we obsess over. We would love nothing more than to find a better way to do it that also allows them to be successful.”
Right now, that’s not happening.
Meister said a club analyst told him that the average major league career is now less than three years for all players and just under 2.7 for pitchers.
“It’s like NFL running back numbers,” Meister said. “Cynically from the owners’ point of view, they will never have to pay any of these players a lot of money. Forget about them becoming free agents. “They won’t even be eligible for arbitration.”
Meister said for a time that he believed the league was comfortable with a “next man up” mentality. That bothered him; There are only a limited number of arms, he said, who are capable of pitching at the major league level. But lately he is encouraged by the league’s effort to find solutions.
“What I’ve talked about with MLB is that we have all this performance data. We also have all this health data. We have to bring these two metrics together,” Meister said. “I’m not going to sit here and tell you to never throw a sweeper or never throw a hard changeup. But at some point, you have to say, ‘Okay, when we see a pitcher throwing that pitch more than 15 percent of the time, the chance that he has a shoulder or elbow injury increases, whatever, tenfold.’ . “
A return to the art of pitching could be one way to attack the problem. Neander said that while teams know stuff is critical to getting hits in the major leagues, “the ability to locate can make up a lot of ground for any shortcomings in stuff.” But for now, pitchers generally rely on throwing each pitch as hard as possible, knowing it will produce the greatest benefits.
When discussed last year about the effect of kids throwing hard curveballs before a certain age, Alex Cobb of the San Francisco Giants was succinct.
“I used to throw tons of curveballs in my little league game, then I’d go home and throw the ball after the game because I was the quarterback, too,” he said last year. “I threw as hard as I could the whole time. Maybe you shouldn’t listen to me because I’ve had every surgery known… but I also made it to the big leagues.”
(Top photo of Shohei Ohtani in August 2023: Brian Rothmuller/Icon Sportswire via Getty Images)
