MLB pitching-injury study knows the causes, but solutions may be elusive

A new report on pitching injuries released Tuesday by the commissioner's office confirms much of what we already suspected about the root causes of the sharp rise in elbow and shoulder injuries. It also makes recommendations on how to potentially reduce the scourge - including radical rule changes - and says that some contrarian thinking may be required to reverse the injury trend.

The 60-page report, commissioned after the 2023 season, documents injury rates and skill trends, along with insight from more than 200 interviews with pitchers, coaches, executives, trainers, and orthopedic surgeons explaining what they believe are the underlying causes. theScore was one of the news organizations granted early access to report on the findings.

Baseball is concerned not only for its players but what the relentless injury surge means for its on-field product. Losing star pitchers like Spencer Strider to season-ending injuries is a blow to the game. The league office is also concerned about the diminished role of the starting pitcher.

MLB found days spent on the injured list by pitchers increased from 13,666 in 2005 to 32,257 in 2024. The study asserts that the pursuit of velocity and max-effort pitching are the "primary forces driving the long-term increase in pitcher injuries." MLB also realizes pitching success has incentivized those efforts to throw harder, which makes solutions difficult to find.

Baseball's catch-22 goes something like this: to make a major-league roster, or to be drafted in the first place, pitchers must throw with increasingly more velocity and possess nastier breaking balls. Although this has been highly successful on the field, it requires more force and stress on elbows and shoulders. The pursuit of skill gains leads to more injuries.

Players believe they're behaving rationally in accepting the risk-reward trade-off and are simply following incentives.

"You are well aware of what teams are searching for," says the Cubs' Jameson Taillon, who's undergone two Tommy Johns and who I spoke with recently. "They want high velocity, swing-and-miss stuff. That's where the value is at in today's game. Guys are rightfully chasing that, knowing that is how they are going to get a job and get paid. I think everyone would do the same. That's a thing we talk about in the clubhouse: it's become more competitive than ever to make a team as a pitcher."

Ross Stripling is a decade removed from his Tommy John surgery, which he believes was tied to adding a slider during the 2013-14 offseason to improve his arsenal.

"I'm throwing my first slider to a hitter (in live batting practice in spring 2014) and my UCL goes," Stripling says. "I was kind of a classic case where a slider led to elbow problems. But I think it's probably worth the risk. If you get hurt, most guys come back from injury."

Stripling notes it's been 10 years since his surgery and the slider became an important part of his pitch repertoire.

"It's not like you're going into (training) thinking, 'If I get Tommy John, that's fine,'" Stripling said. "But at the same time, if I find a heater with 20 vert (vertical inches of movement), and a sweeper with 20 horizontal (inches of movement), getting hurt isn't the end of the road. When you come back, that pitch is there.

"I do think the risk-reward is worth it to find what we know will lead to success on the field."

A player is especially likely to pursue training risks if he believes he's on the fringe of a major-league roster, or of being drafted.

"Most pitchers now are fungible up-and-down guys who are fighting their ass off for opportunities to stay up, to get enough service to someday make some money," one unnamed executive said in the report. "So, they're trying to redline and hit these levels not even in games, to impress the pitching coaches and get more opportunities. And it's crazy because it's bad for their long-term health and durability."

One pitching-development official said in the report: "It is a dogfight to get the last couple spots in the bullpen, and guys are pushing the envelope. Going back to the third day (of the draft), a 14th-rounder, if he stays the same, he's probably got one to two years of minor-league baseball. So, for him, it's a calculated risk of: 'I know I need to get better and push it. Because I know naturally, I don't have it. So, I'm willing to push it and risk getting injured to try to achieve my dream.'"

Ron Darling, the former MLB pitcher and current Mets broadcaster, played at a time when it was unheard of to do any serious throwing during the winter. He wouldn't throw a competitive pitch until spring training and never spent any time on the injured list in 13 big-league seasons. But he also believes he'd be responding to incentives like the modern player if he played today.

"Armed with everything I know now, I would be chasing velocity as well," he told me recently. "Instead of trying to throw 90 mph for two-and-a-half hours, I would try to throw 95 mph for one hour and fifteen minutes. That's just the nature of what it is."

One data point from the research that interests MLB officials is days lost because of in-season elbow IL stints, which have decreased each year since 2021, by some 110 total instances.

However, the number of injuries sustained before the season, mostly during spring training, has nearly doubled from 2017.

That gives some reason for hope. If there's a recurring time on the calendar when injuries most often occur, perhaps that spike can be flattened.

A leading theory is that the spring surge is tied to new offseason training practices. If that's indeed the case, it presents another conundrum: How does MLB discourage athletes from wanting to get better on their own time?

"I remember my first few seasons with the Pirates," Taillon says. "The big-league throwing calendar, you didn't even pick up a ball until after Thanksgiving. You did not throw a bullpen to mid or late January, and you sure as hell did not face hitters until going to spring training."

That's all changed since Taillon was drafted in 2010.

With new training regimens and improved technological feedback entering the game over the last decade, it's never been easier to add a new pitch or velocity during offseason training. And if a pitcher isn't doing so, he's not keeping up with the Joneses.

Not that long ago, in 2008, the average MLB fastball sat at 91.3 mph. In 2024, it was a record 94.2 mph.

But those efforts create more stress even before the season begins.

"You show up to spring training now with a decent amount of mileage on you, and spring training is a big flip in lifestyle," Stripling says. "There's an intensity you cannot get to in the offseason. You get to spring training and the GM's eyes are on you, the pitching coach's eyes are on you. You ramp up to a level you haven't been to (during the offseason).

"Then you start playing spring games. The first game I am pitching in, I am trying as hard as I can. I am throwing as hard as I can."

A number of orthopedic surgeons quoted in the report say they're seeing record rates of injuries in the MRIs they examine, and they largely believe it's partially tied to new training methods.

"All the weighted-ball training is a big issue. We had a significantly higher injury rate in people that use weighted balls," one unnamed orthopedic surgeon said in the report. "Is it the ball itself that creates injury? I'm not sure. We always saw guys that would take an abrupt bump in their velocity and those guys always tore their UCL. These guys are throwing too fast for what their body can handle. They're getting paid to get guys out and their injury risk - performance trumps everything else. I don't know how you stop that, though."

The report wonders, too, if there's also a paradoxical element to this dilemma in how teams have concurrently tried to protect pitchers.

By limiting volume through pitch counts and innings limits in an effort to try and better keep pitchers healthy, the commissioner's office wonders if this approach is also playing a role in injury rates.

"Conventional wisdom holds that the best way to preserve pitcher health is to manage pitchers conservatively - i.e., fewer pitches and more rest," the report states. "There is, however, a growing consensus that conservative treatment may actually expose pitchers to greater injury risk by encouraging them to throw max effort with every pitch."

theScore studied max-effort throwing earlier this year and found the gap between pitchers' maximum and minimum throwing velocities has narrowed. MLB's report found the standard deviation of pitch speeds - for all pitches - is tightening. Max-effort throws of all types are increasing.

The increased skill, injury rates, and appetite for risk have trickled down to the amateur level.

The report cited the number of high school players to reach 95 mph at Perfect Game National Showcase events. In 2014 there were five. This past year? A record 36.

"Guys are seeing big leaguers throwing hard in short bursts. The radar gun is in their face more than it ever has been," one college coach said in the report. "I used to appreciate getting outs and having stamina. Kids today know the (velocity) and metrics of every pitch. The last thing that goes on someone's recruitment profile is ERA. It's all velocity, spin rate, vertical break. We are building guys to perform in short spurts. It's a bad formula for longevity and optimal health."

Added a youth baseball coach: "They learn how to pitch in three-inning clusters instead of throwing seven innings, 90 pitches in a district game. They spend so much time throwing in three-inning clusters, and I turn on MLB and see them throwing three to four innings. This is select baseball right here. Get us to the fifth and just get us another hard thrower, and another hard thrower. That's what the youth model is conditioning pitchers to be. Max effort. Three innings."

But as amateur pitchers chase velocity in hopes of landing a high draft spot and a major signing bonus, the report finds the share of pitchers drafted in the early rounds is in decline.

For MLB to nudge incentives to move in a different direction, it may require something as drastic as rule changes.

The report recommends exploring this avenue to encourage pitchers to work deeper into games.

"Experts recommended MLB consider changes to the playing rules and roster rules to create a better system for sustaining pitcher health - a system that would increase the value of pitcher health and durability, and decrease the value of short-duration, max-effort pitching," the report states. "For instance, playing rules could be adjusted or designed to encourage or require starting pitchers to reserve enough energy to allow them to pitch deeper into games.

"Such rule changes would be designed to increase the value of durable pitchers and incentivize players and clubs to focus on training for durability instead of short-term, max-effort performance."

Last summer, MLB floated the idea of a six-inning minimum for starting pitchers, a threshold a starter must meet unless he's injured, allows a certain number of runs, or reaches 100 pitches. Commissioner Rob Manfred threw cold water on that in an interview released Monday, calling such a change "too blunt an instrument."

MLB also experimented with the "double hook" rule with its Atlantic League partner, tying the DH to the starting pitcher. (When the starting pitcher departs, the team loses its DH slot.)

But in speaking with several pitching coaches and executives this year, there's doubt about how quickly - or if at all - the modern pitcher could adapt to something like a six-inning minimum rule.

As we reported in August, the share of starts to reach six innings has fallen off dramatically in recent years.

That's also true of the minor-league level, where the percentage of starts to reach five complete innings fell from just under 70% in 2005 to below 40% each year since 2021.

Moreover, pitchers selected in their draft years are also throwing fewer innings in college, according to the report.

MLB notes that if changes aren't made to encourage healthier development at the amateur level, the injury issue will persist. The report proposes more safeguards are put in place in youth baseball.

Darling, too, believes change must begin there.

"I would try hard to get at the grassroots level and somehow put some kind of rules and regulation in place," Darling says. "Driveline and all these places are fantastic if used the right way. Like a lot of things, there is a money-making aspect to it. For the crazed parent who thinks their son is going to be the next Nolan Ryan, these kids are being put in a difficult place. But I would begin at the grassroots level because I think, at the MLB level, the genie is out of the bottle."

The report paints a clear picture of what's ailing the modern pitcher, but answers remain elusive. Most troubling to those in the game? Maybe there are no obvious solutions.

"A lot of these (injuries) are Tommy Johns and it's a tiny ligament in your elbow," Stripling says. "Look at Paul Skenes. We are as big, powerful, and as strong as we've ever been. That tiny ligament, how can it hold up? I don't know."

Travis Sawchik is theScore's senior baseball writer.