This past Major League Baseball (MLB) season cast a shadow over the careers of several of the league’s most preeminent pitchers.
Sandy Alcantara, the 2022 Cy Young recipient — an award given annually to the league’s most dominant pitcher — underwent UCL surgery in October. This procedure is commonly referred to as the “Tommy John surgery,” where the doctor repairs a torn ulnar collateral ligament inside the elbow. He will miss the entire 2024 season. Tampa Bay Rays All-Star, Shane McClanahan, fell victim to a torn UCL in July and will also miss the entire 2024 season. McClanahan was the eighth Ray to undergo Tommy John surgery since 2020. Jacob deGrom, a former two-time Cy Young winner, endured his second career Tommy John surgery in June and is also expected to miss the entire 2024 season. Additionally, in what many might describe as the biggest story of the 2023 season, Shohei Ohtani, former MVP and the most sought-after free agent this offseason, underwent his second UCL repair in September. Ohtani, whose average fastball speed is 96.8 mph, is rendered ineligible to pitch in 2024.
According to USA Today Sports, during the 2023 season, approximately half of the top 64 hardest-throwing pitchers, based on their average fastball velocity, had undergone, or are expected to undergo, Tommy John surgery at some point in their careers. In fact, a total of 12 MLB pitchers underwent Tommy John surgery in May alone. “Frankly, the number of Tommy John injuries in minor league and major league baseball continues to rise,” said Dr. Glenn Fleisig, director of the American Sports Medicine Institute in Birmingham, Alabama.
Beyond the disappointment that the injured player faces, fans are deprived of the chance to witness the sport’s most dominant pitchers in action. Moreover, teams are financially committed to multi-million-dollar contracts, which the recipients are increasingly unable to fulfill. For example, deGrom is slated to receive $40 million for the 2024 season — a season during which he will not pitch a single inning.
The question that the league, teams, the medical community, performance specialists and rehabilitation providers must now ask themselves is: why is there an uptick in severe throwing injuries among the sport’s most prominent and well-conditioned pitchers? As one might suspect with complex topics, especially those concerning functions of the human body, there is inevitably a diverse amount of opinions and suggested solutions.
Highly-renowned Los Angeles orthopedic surgeon Dr. Neal ElAttrache told the Wall Street Journal in late September that the recently installed pitch clock — allowing pitchers only 15 seconds in between each pitch — might be a culprit. “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. As soon as that starts to break down, then their mechanics break down,” ElAttrache explained.
Dr. David Altchek, the current medical director for the New York Mets, has raised concerns about the use of weighted balls during training — specifically, those exceeding the standard 5-ounce baseball. He told USA Today Sports in June, “Throwing those [weighted balls] does increase velocity, but at what cost? If it’s not done effectively, it can lead to higher injury rates to the UCL.”
Dr. Keith Meister, the team physician for the 2023 World Series Champion Texas Rangers, has warned that he believes the recent surge in Tommy John surgeries is a result of pitchers pushing their throwing speeds to unprecedented levels, particularly starting at younger ages. “Stresses and loads have exceeded what the body can handle, and they’re doing that at much younger ages, when the body hasn’t developed,” Meister remarked.
Altchek shares Meister’s concern, believing the desire to increase velocity is contributing to the rapid uptick in UCL injuries. He noted, “There have been a lot of studies that have looked at variables about ulnar ligament injuries, but the only issue that clearly stands out is velocity. Guys throwing harder will have a higher incidence of injuries to that ligament.” Fleisig agrees, highlighting, “If you chart the rates of Tommy John injuries compared to the average fastball velocity, it’s scary how the graphs look the same.” In 2008, the average MLB fastball velocity was 90.5 mph. Today, it has increased to 93.9 mph. Moreover, pitches exceeding 100 mph increased by a staggering 72%, from 1,948 in 2008 to 3,356 in 2022. This past season, Minnesota Twins relief pitcher, Jhoan Duran, set a new MLB pitch speed record by throwing a pitch at 104.6 mph.
In the modern era, pitchers are indeed being trained to throw harder. This development is made increasingly possible by advances in strength training, technology, personalized nutrition and supplement programs, as well as cutting-edge recovery techniques. Furthermore, the incentive to throw harder has never been stronger. Aside from the potential increased chances of success that an arm capable of touching triple digits brings on the mound, organizations have proven that they are willing to pay lucrative sums of money for pitchers able to light up the radar gun. This past July, the Pittsburgh Pirates selected Paul Skenes from Louisiana State University with the first pick in the amateur draft. Skenes has a fastball that regularly reaches 100 mph and has even reached 102 mph on various occasions. Upon signing with the Pirates, Skenes received a $9.2 million signing bonus, the highest recorded bonus ever.
The most crucial position on the baseball field has evolved significantly in recent times. Pitchers are not only pushing their throwing arms to the limit, but also raising questions about the surge in Tommy John surgeries. Amidst this ongoing debate, a prominent statistical correlation emerges: as pitch speeds increase, injury rates also increase, signaling a concerning trend in the sport’s development. MLB faces a pressing challenge that demands swift and thoughtful action from its leadership. Time is of the essence, and we can only hope for a timely response.
Barrett Snyder is a WCUPA graduate student pursuing a master’s degree in Exercise Science with a specialization in Sports Psychology. JS1030435@wcupa.edu