Prominent MLB team doctor sounds alarm over pitching injuries

One of the game’s leading orthopedic surgeons is sounding the alarm about pitching injuries – citing the advent of the sweeper and the power change as major reasons for the spike.

Dr. Keith Meister, the chief team physician for the Texas Rangers, said teams are making the problem worse by emphasizing pitchers’ performance over their availability.

“Unfortunately, these front offices live more in the moment than with a longer, broader term vision,” says Meister. “There is a way to control this. What if a player 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 traditional ligament reconstruction with the addition of an internal brace, said surgical techniques have changed significantly over the past decade in response to the development of pitching.

As teams placed more emphasis on speed and the like, injury list placements for pitchers rose from 241 in 2010 to 552 in 2021 before declining slightly each of the past two seasons, a Major League Baseball spokesman said. The number of days pitchers spent on the IL more than doubled over a slightly longer period.

A hyperfocus on performance often starts at youth level. Many pitchers experience problems before they ever reach the majors. The number of pitchers 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 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 power changeups also get hurt, as evidenced by the increasing 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 dealing with shoulder problems. Sean Hjelle of the San Francisco Giants is out with an elbow problem and Tristan Beck had surgery to remove an aneurysm from his arm.

And that’s just a partial list.

‘We always said: if you only get one TJ, you’re good. Then it was: you get 10 years out of one. Then it was seven to eight,” Meister said. “Now guys break down into three to five, depending on who they are, the stuff they have, what they throw.”

The game therefore seems to be balancing on a dangerous edge. Pitchers are throwing more breaking balls than ever before. They’re also throwing harder than ever in the history of the sport. Speed ​​is often cited as one of the biggest causes of pitching injuries. And the sport rewards those who get after it.

“Analytics says velo is super important,” said a pitching coach granted anonymity for his candor. “Pitchers and analysts strive for velo. The pitchers who don’t do this retire. Those who stay put themselves at some risk of injury to avoid working at Costco.”

Meister, director of the Texas Metroplex Institute for Sports Medicine, recognizes the dangers that speed brings. But, he said, “spin is worse.”

The sweeper puts tremendous stress on the inner elbow, Meister said. The change in force, as Meister calls it, also puts excessive pressure on the arm. “And to throw these pitches,” he said, “you have to squeeze the crap out of the baseball.”

Years ago, Meister remembers hearing the late Johnny Sain, a former Major League pitcher and independent pitching coach, say that when a pitcher holds a ball properly, he should grip it so that he can throw a raw egg without to break. It.

Today it’s the opposite, Meister said. Pitchers apply a “death grip” to the ball, essentially preloading every muscle in their arms. When released, these muscles lengthen acutely, which is known as an ‘eccentric contraction’. The result can almost resemble a hamstring tear, affecting different pitchers in different parts of the arm.

“We’re seeing all these tears in the lat and teres, all these tears of the previously reconstructed ligament, many more flexor tendon tears,” Meister said. “I can tell you it’s mainly a result of those two pitches: the sweeping slider and these hard movement changes.”

According to Statcast, the percentage of sweepers thrown has increased from 1.3 to 3 to 4.3 percent league-wide over the past three seasons. The Rangers, the team that employs Meister, hardly throw on the field, as reported by the Dallas Morning News. Meister said the current nomenclature to classify pitches is actually insufficient. He photographs his patients’ grips and has seen four or five different grips for both sweepers and switches.

Shortly before spring training, Meister shared his concerns during a Zoom call with two Major League Baseball executives involved in injury prevention, Kevin Ma and John D’Angelo. The session was part of a study the league is conducting on throwing injuries. The league has conducted about 100 interviews, the spokesperson said, from doctors and athletic trainers to independent researchers and college coaches to club executives and former pitchers. Once the investigation is complete, the league expects to form a task force.

Not everyone in pitching research and coaching agrees with Meister’s belief that spin is more problematic than speed.

“A sweeper is just a curveball with a different grip,” one pitching coach noted, adding Research is mixed on the relationship between grip strength and spin speed. “And guys don’t mess up their changes to get this move. For both fields they use the seams to make it move differently.”

Glenn Fleisig, biomechanics research director at the American Sports Medicine Institute, also expressed doubt that sweepers are a cause for greater concern.

“We haven’t studied sweepers in the biomechanics lab per se, but we have shown in a number of studies that curveballs and sliders are not more stressful than fastballs,” Fleisig said in an email.

“Therefore, I have no reason to believe that sweepers are a greater risk factor for injury than other breaking pitches or fastballs. Science points to three major risk factors for injuries: effort (speed is an indication of this in pitchers), amount of pitching and mechanics.

At least the caveat to research by Fleisig and others that focuses on the risks of speed is that a study by Driveline Baseball showed that the elbow load per mile per hour on the field is higher for secondary fields such as switches and sliders. So a pitcher who throws his slider as hard as his fastball will actually put more pressure on his elbow.

It may not be a coincidence that Jacob deGrom, who throws his slider as hard as some pitchers throw their fastballs, has struggled to stay healthy. The higher the speed, the greater the risk, regardless of which pitch is thrown – and what speed is used in the competition has risen almost two miles per hour since baseball began publicly tracking it in 2007.

Many pitchers, who consider injuries almost an occupational hazard, hardly seem to care. Advances in “things” research, which attempts to value motion and speed separately from outcomes, show that harder breaking balls are better breaking balls, almost across the board. Furthermore, frequently injured pitchers often sign big contracts based on the quality of the equipment, not their durability. So, who’s going to tell a pitcher not to be like deGrom? Who’s going to advise someone to avoid throwing a slider like Justin Verlander’s breaking ball from the 90s?

Erik Neander, president of baseball operations for the Tampa Bay Rays, whose team lost three starting pitchers to season-ending elbow injuries in 2023, said finding the optimal intersection between performance and availability is a challenge that extends to youth baseball.

“Because of the investment in the player and the person and the care you put into it, it’s really hard to see someone get hurt and lose the opportunity to play,” Neander said. “How we can balance that with giving us the best opportunity to compete and succeed at the Major League level is a very difficult balancing act that we are obsessed with. We want nothing more than to find a better way to do this that will help them succeed.”

It’s not happening at the moment.

Meister said an analyst at one club told him that the average Major League career is now less than three years for all players and just under 2.7 years for pitchers.

“They’re like NFL running back numbers,” Meister said. “Cynically, given the ownership side of things, they will never have to pay a lot of money to any of these players. Forget about them becoming free agents. They will never even qualify for the ARB.”

Meister said for a time he believed the league was comfortable with a “next man up” mentality. That worried him; only so many weapons, he said, can pitch at the Major League level. But lately he’s been encouraged by the league’s efforts to find solutions.

“What I talked to MLB about is, look, we have all this performance data. We also have all this health data. We need to combine these two metrics,” Meister said. “I’m not going to sit here and tell you to never throw a sweeper or never do a hard changeup. But at some point you have to say, “Okay, if we see a pitcher throwing the pitch more than 15 percent of the time, the odds of him sustaining a shoulder or elbow injury increase tenfold, whatever.” ”

A return to the art of pitching could be one way to address the problem. Neander said that while teams know things are critical to getting major league hitters out, “the ability to locate can make up for an awful lot of ground for any shortcomings in things.” But for now, pitchers generally rely on throwing every pitch as hard as possible, knowing that will yield the greatest benefits.

When talking last year about the effect of kids throwing curveballs hard before a certain age, Alex Cobb of the San Francisco Giants was succinct.

“I ripped up tons of curveballs in my little league game, then I went home and threw the football after the game because I was the quarterback too,” he said last year. “I was throwing as hard as I could all the time. Maybe you shouldn’t listen to me, because I’ve undergone every surgery known to man… but I’ve also had great successes.’

(Top photo of Shohei Ohtani in August 2023: Brian Rothmuller/Icon Sportswire via Getty Images)