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The Baseball Pitcher Injury Epidemic


It seems like 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.

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 actually do.

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 Inverted V. 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 shoulder.

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.[1]

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.

Matt Harvey

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 possible.

Matt Harvey

Matt Harvey

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

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 will also increase the risk of elbow problems in the long term.

Shelby Miller

Another emerging trend that 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 result.

Shelby Miller 2013

Shelby Miller

When I look at Shelby Miller's 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 Michael Pineda and Ivan Nova.

Jose Fernandez

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.

Jose Fernandez

Jose Fernandez

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 will see two pitchers who looked superficially similar but who moved totally differently.

Shoulders are Next

The problem with many of the cues that I discuss above is that, as in the case of Jaime 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

If you want to know how you should be teaching your kids and/or players how to throw, then my piece on Proper Throwing Mechanics is a good place to start.


1. To his credit, Dr. Mike Marshall was one of, 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 issue that it's debatable whether Marshall's proposed solutions will actually fix the problem without introducing a whole new set of problems.

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