By Alex Earl, DC DACRB DNSP
Is This Year an Anomaly for Major League Pitching Injuries?
As of today, there have been 10 professional baseball pitching injuries of the ulnar collateral ligament (UCL) of the elbow requiring surgery. This procedure is better known as “Tommy John” surgery.
Looking back over pitching injuries over the past two decades, you would find that the current amount of injuries is not unusual during the first 100 days of the season.
Back in 2005, only one pitching injury required Tommy John surgery, which was the lowest amount recorded since 2000. This year’s 10 pitching injuries is the most since 2021 (11).
While the overall pitching injuries percentages are not an anomaly, here are the overall percentages of Major League Baseball pitching injuries from 2016 onward who had Tommy John Surgery at some point in their careers:
- 2016: 27.4%
- 2017: 25.9%
- 2018: 28.5%
- 2019: 30.8%
- 2020: 32.0%
- 2021: 32.0%
- 2022: 34.4&
- 2023: 35.6%
It’s actually remarkable to think that more than 1 in 3 Major League Baseball players has now had Tommy John surgery.
But why is it that pitching injuries continue to happen?
What Causes Ulnar Collateral Ligament Injuries?
There are two main reasons why pitching injuries, such as the ulnar collateral ligament can occur. It is important to recognize patterns of pitching injuries before trying to solve the issue.
The first pattern to note is the observational fact that there is no team that has mastered the “injury prevention” model of Tommy John injuries. Even when teams have spent thousands, if not millions, on expert consultations and training programs to prevent this brutal injury, the data does not suggest any one team has an edge over any one else in the league.
When it comes to pitching injuries, it all comes down to load and capacity.
In my experience, most sport injuries, including pitching injuries, comes down to load exceeding a given tissue’s capacity.
Let me explain a little further so I don’t lose you…
Load takes in account intensity, volume, and frequency.
Capacity takes into account strength, endurance, fatigue threshold, and tissue quality.
Let’s break down each variable in depth.
Reason 1: Load
The first variable is intensity.
Intensity relates to torque. And there is a strong correlation between a pitcher’s velocity and the torque they put on their elbow, shoulder, neck and wrist.
It’s a well known fact that pitchers are throwing harder than ever before right now, so it should be no surprise that there is a greater risk for pitching injuries.
The next variable is volume.
Volume relates to the total number of pitches (or throws) in an inning, game/outing, or day.
Volume is needed in order to gradually build up tissue tolerance and increase capacity. But large spikes in volume risk exceeding what the throwing arm can usually handle.
Tim Gabbett’s research and data into workload management is our go-to resource for managing training and rehab volume. I highly recommend reading this article for more information on the volume issue when it comes to mitigation risk factors for injury.
The next variable is frequency.
Frequency relates to how often a pitcher is throwing, either in a game or in a training session. Long toss also counts towards frequency.
There’s a significant difference between a pitcher being on the 5 day rotation compared to the 7 day rotation. It affects the frequency, which affects the correlation between increasing throwing load and potential injury.
Now, it is worth noting that correlation does not equal causation. An example of this is the fact that both ice cream sales and crime increase in the summer months. This does not mean that ice cream sales caused an increase in crime. The two factors have a common denominator, warmer weather!
Simply because a pitcher has increased his overall throwing frequency, it does not mean that he will be destined for one of the major pitching injuries.
We can’t play God when it comes to injury prevention.
Reason 2: Capacity
According to Cook, a soft tissue is at full capacity when the individual is able to perform functional movements at the volume and frequency required without exacerbating symptoms or causing tissue injury.
The capacity of a tissue clearly varies between individuals and the load they place on their tissues.
Elite athletes require greater tissue capacity than recreational players. The tissue of young people has greater capacity than that of older people (all other things being equal) and normal tissue has greater capacity than injured tissue.
How can you increase tissue capacity?
Well, it’s a great question and it is important to note that no treatment will increase tissue capacity.
Let me explain a little bit further…
Nothing a doctor or therapist can do to you will increase your tissue capacity.
The only thing that will increase your tissue capacity is your active loading of the tissue.
Since, by definition, treatment is passive, then it is easy to see how passive care will NOT increase tissue capacity. It will make the tissue feel good, but it will not make it more durable.
Real Life Case Study: “Thought I would never play baseball again.”
A few years ago, I had the privilege of taking on the post-surgical rehabilitation of a collegiate baseball player who had a torn Ulnar Collateral Ligament (UCL) which required Tommy John Surgery.
Most chiropractic and physical therapy offices do a great job of treating the initial swelling and stiffness after surgery. In fact, most providers do a better job at that phase of care than I do!
One of the areas of expertise I’ve really enjoyed has been the 2nd and 3rd stages of rehabilitation. For our collegiate athlete, it was in these two stages of care that we really started to build some momentum on his load and capacity.
After the injury, he was pretty certain he would never play baseball again.
It took a while for him to belief that he was capable of returning to baseball AND that he could actually return stronger than before the injury.
After going through months of rehab and programming his strength training progressions, I am proud to say that not only did he return, but he returned with a vengeance. He was incredible on the field when he returned. It was one of the best moments of my clinical career when he came back and was absolutely crushing all aspects of his game.
He led his team so well and the younger players looked up to him with admiration. It was a blessing to partner with him on his health journey and it was truly an honor to get a front row view of his hard work and determination to redefine his limits.
If you’re an athlete or an active individual who is also experiencing pitching injuries, then don’t wait any longer. Give us a call or text us at (630) 765-0575 to get started on your own complete recovery today!
Do this next!
- Share this Article with a Friend or Family member who knows a youth pitcher who need to know this information. We help pitchers increase load safely and build exceptional tissue tolerance so that they can continue to play the sport they love WITHOUT fear of pitching injuries.
- Call our office TODAY at (630) 765-0575 to book your BFR Taster Session today OR click here to book online.
- Keep an eye out for next week’s article!
Alex Earl
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