Why the Epidemic of Elbow Injuries
in Pitchers and Others?
This Spring has been a particularly bad one for
elbows; a relatively large number of pitchers have had their
Ulnar Collateral Ligaments fail and now have to get Tommy John
Surgery as a result.
I have been concerned about this happening
and I think what we are seeing is just the first wave of
what could be (at least) 10 to 15 years of problems.
Let me explain why I say that.
Learn More About The Epidemic
piece is an early version of my thoughts on the pitcher
injury epidemic. I have since expanded it into an entire webbook
“Proper pitching mechanics” used to be defined as
anything that helped you throw hard while staying
In the current definition of proper pitching
mechanics, that second proviso
has been dropped. Now, in large part due to Tommy John
Surgery removing the fear of injury, “proper pitching
mechanics” is pretty much
anything that lets you throw hard.
As a result, pitchers (and throwers) are being taught
any number of shortcuts and tricks that
are helping them throw
harder -- which is why those shortcuts and tricks are used and why pitching
velocities are up -- but that have significant, negative injury
Fixation on Velocity
Above all else, the problem that we are facing results from a nearly exclusive fixation on velocity.
Velocity sells to
both coaches and scouts. As a result, pitching coaches are doing
everything they can to increase their pitchers' velocity, pretty
much regardless of the consequences.
That is a problem because, as a pitcher's velocity goes up, so too
does the load on their elbow and shoulder. The harder that pitchers throw, the greater the risk they face.
However, the larger problem is that many of the
pitching velocity increases that we are seeing of late are the
result of the use of a number of cues, tricks, and shortcuts.
And you know what your coach said about shortcuts.
While these cues, tricks, and shortcuts are increasingly
being labelled as proper pitching and throwing mechanics -- in
large part because they will
help pitchers achieve velocity increases -- they are not what the best pitchers
Or, more accurately, used to do.
The Inverted W
Of course, part of the problems that we are seeing are due to my old
nemesis the Inverted W and his cousins the
Inverted L and the
The simple fact is that the Inverted W does work -- the Inverted
W is a pretty much guaranteed way of giving a pitcher a
velocity boost, which is why so many people (still) teach it -- but it
does so at a cost.
In most cases, the Inverted W creates a timing problem that significantly increases the
load on -- and usually overloads -- the pitcher's elbow and
In terms of new developments with respect to the Inverted W,
as I discuss in my piece on
The Science Behind the Inverted W, a recent study of the
Inverted W confirmed that there is in fact a relationship
between the timing problem that the Inverted W (is designed to)
create and a pitcher's risk of injury.
What's Being sold and taught
as Good is Actually Bad
In my opinion, the bigger, and to date largely unaddressed, part of the story is that there are a number of
other cues that baseball coaches and
pitching coaches are using, and that are increasingly widely
regarded as proper
throwing and/or pitching mechanics, that are actually problematic.
While I believe these cues
will help ballplayers throw
harder, I also believe they are contributing to the current
plague of elbow injuries because, like the Inverted W, these
cues create a timing problem that increases the load on the
elbow and the shoulder.
As I explain in my piece on
Matt Harvey's pitching mechanics, I first came into contact
with Matt Harvey when his father contacted me back in 2007 to have me take a look at
Matt's pitching mechanics and make sure that he didn't have the
Inverted W or any other obvious problems.
I pronounced Matt clean
at the time.
However, at some point after I looked at him -- I believe it
happened later on in college or in the minor leagues -- someone
taught Matt Harvey a trick. They taught him to keep his fingers
on top of the ball and to make his arm swing as long as
The result was a timing problem that gave Matt Harvey a
velocity boost but that in my opinion also increased the load on his elbow
(and most likely also his shoulder).
Throw It Right Trainer
What's worse, products are now being created to reinforce the
cue that I believe damaged Matt Harvey's elbow. Yes, this
product may help ballplayers throw the ball harder in the short
term. However, I believe that products like this may also
increase the risk of elbow problems in the long term.
Another emerging trend I am seeing
is pitchers who pronate too early and too long. They experience
significant timing problems and, in my opinion, are at a
significant risk for both elbow and shoulder problems as a
When I look at
pitching mechanics, I see a pitcher who is a perfect example
of this problem and who is at a high risk of elbow and/or
shoulder problems as a result. You can also see some of the same
thing in the arm actions of
Pineda and Ivan Nova.
In terms of other pitchers who I think could fall victim to the
elbow injury epidemic, the picture below of Jose Fernandez was
recently brought to my attention by a reader.
Unfortunately for Jose Fernandez and Marlins fans, this
picture shows both premature pronation and a resulting timing
problem. While this arm action may improve both Jose Fernandez's
velocity and his stuff, it will most likely also lead to elbow
and shoulder problems.
Overuse is Bad, But...
There is no doubt that overuse is part of the problem with
injuries to young pitchers.
In terms of kids, the simple fact is that kids aren't
just shorter, skinnier adults. Instead, kids are fundamentally
different; they have immature skeletal systems and have to be
handled differently as a result.
That is why the best possible advice for adult ballplayers --
throw as much as possible -- is not good advice for kids.
However, I do not believe that abuse is the sole
explanation for the problems that we are seeing in both youth
and adult pitchers, especially since we know that pitching and
throwing instruction has changed over the past 20 years.
Instead, I believe that, for both kids and adults, the real
problem with abuse comes when you combine poor pitching
mechanics and the use of any number of problematic cues, tricks,
and shortcuts with abuse.
Think Mark Prior (and Dusty Baker).
That said, it seems to be just as true that proper pitching mechanics
seem to enable adult pitchers to tolerate some level of abuse. One of the things that turned me off about PAP and PAP3 was
that Randy Johnson -- a pitcher who never had a serious arm
problem -- consistently appeared at the top of the abuse lists.
Of course, if you compare Mark Prior and Randy Johnson, you
see two pitchers who looked superficially similar but who moved
Shoulders are Next
The problem with many of the cues that I discuss above is that, as
in the case of
Garcia, the thing that first gets the elbow then gets the
shoulder. As a result, I believe that the current wave of elbow
problems will turn into a epidemic of shoulder problems
in three to five years as these pitchers get over their elbow
problems and their shoulders then begin to wear out.
Where to go From Here
a result of the tremendous interest in and positive response to
the topic and this piece, I am in the process of expanding it
into a webbook called
The Epidemic that goes into more detail about what I think
is happening, why, and what can be done about it.
If you are a coach or parent want to know how you should be teaching your kids
and/or players how to throw, then my piece on
Throwing Mechanics is a good place to start.
101 combines a streaming DVD and a webbook and lays out my
view of proper pitching mechanics, based on my study of dominant
and durable pitchers like
1. To his credit, Dr. Mike Marshall was one
of the first, if not the first, people to understand the negative
implications of what is currently being taught in terms of
throwing and pitching mechanics. Unfortunately, Marshall is an
absolutely miserable communicator; he refuses to use the common
vernacular of pitching and uses non-standard
physiological terminology, among other things. As a result, pretty much nobody, myself
included, understood exactly what he was talking about. There's
also the issues that Marshall is a fairly disagreeable person
and the fact that it's debatable whether Marshall's proposed
solutions will actually fix the problem without introducing a
whole new set of problems.