Inside baseball’s arms crisis: What can be done to curb the game’s outbreak of pitching injuries?

Every day, it’s someone else.

“I heard two more guys today went down,” Aaron Nola said, shaking his head before pitching for the Phillies this week in St. Louis. “It [stinks], man. I don’t like seeing it. I don’t know. I don’t really have an answer.”

There aren’t answers — not uncomplicated ones, at least — for the most worrisome problem in baseball. Pitcher injuries, notably shredded elbow ligaments, skyrocketed more than a decade ago and have remained constant. By now, they’re less epidemic to the sport than a full-blown pandemic. This isn’t a new issue.

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But it is leading the conversation again after a wave of pitchers landed on the injured list — or worse, the operating table — during the season’s first two weeks. A partial list: Miami’s Eury Pérez, Cleveland’s Shane Bieber, Atlanta’s Spencer Strider, Washington’s Josiah Gray, Boston’s Nick Pivetta, the Yankees’ Jonathan Loáisiga, the Mets’ Tylor Megill, and Houston’s Framber Valdez.

Add those who got injured in spring training — the Yankees’ Gerrit Cole, the Mets’ Kodai Senga, Baltimore’s Kyle Bradish, Boston’s Lucas Giolito, Taijuan Walker of the Phillies — or were already recovering from elbow surgery or other arm trouble — Houston’s Justin Verlander and Luis Garcia, Texas’ Jacob deGrom, Miami’s Sandy Alcantara, San Francisco’s Robbie Ray, Baltimore’s Félix Bautista, Tampa Bay’s Shane McClanahan, Colorado’s Germán Márquez, Phillies top prospect Andrew Painter, the Dodgers’ Walker Buehler and Shohei Ohtani — and you have an All-Star pitching staff that’s unable to pitch.

It’s a crisis that baseball hasn’t confronted. Instead, MLB and the players used the injury boom to bicker further over the pitch clock. Union chief Tony Clark issued a statement in which he blamed pitcher health on the league for shaving two seconds off the clock with runners on base; MLB cited an unpublished study that found no correlation between the clock and an injury spike.

Meanwhile, fastball velocities keep rising, spin rates continue to increase, and organizations invest more bucks in the arms that generate the most swings and misses.

And when elbows explode and shoulders snap, well, teams unearth new ones. Want to play in October? It’s about enduring pitching attrition.

“We’ve been talking about it a lot,” Phillies ace Zack Wheeler said. “I feel like [injuries] might be happening a little quicker now. I don’t know the reason why. I think a lot has to do with how guys are brought up. Maybe it’s not being totally ready in the sense of the amount of innings and pitches being thrown.

“But I know guys are throwing harder. When guys throw super, super hard, [with] more effort, you put more stress than you already do. And on top of that, you’re spinning stuff at a high effort. That doesn’t help, also. I think all of that combined, there’s a lot of stress on guys’ arms.”

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Indeed, the causes of the problem are multifaceted, which only adds to the complexity of finding solutions.

MLB is conducting a study of pitching at all levels of development and seeking input from players, coaches, and medical experts. The idea is to make recommendations for how to keep pitchers healthier.

In separate conversations this week, Wheeler, Nola, Phillies pitching coach Caleb Cotham, and surgeon Brandon Erickson of the Rothman Orthopaedic Institute shared their thoughts on the recent spate of injuries and what might be done to curb them.

When they’re old and gray, pitchers of this generation will be identifiable by the crescent-shaped scar on the inside of their elbows.

Of the roughly 800 pitchers who appeared in a major-league game last season, more than one-third — 274, according to researcher Jon Roegele — survived Tommy John surgery, a procedure in which the torn ulnar collateral ligament in the elbow is reconstructed with a tendon taken from elsewhere in the body.

Why are so many UCLs snapping?

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“The biggest risk factor is pitch velocity,” Erickson said. “The harder guys throw, the higher their risk for injury. There’s a linear relationship with that. If you’re throwing mid-80s, your risk of a UCL injury is not tremendous; if you’re throwing in the high-90s, your risk of a UCL injury is pretty significant.”

And more pitchers than ever are throwing in the high 90s.

In 2008, the average four-seam fastball was 91.9 mph, with a total of 21,820 pitches clocked at 96 mph or harder, based on Baseball Savant data. Last year, four-seamers averaged 94.2 mph, with 53,549 pitches reaching at least 96 mph.

Velocity is in like your Spotify playlist, finesse pitchers are out like your old CD collection.

Imagine, then, being a minor-league pitcher who is trying to win a spot on a major-league roster. Or a high-school pitcher looking to make an impression on pro scouts. How far would you go to chase velocity? How hard would you push that elbow ligament?

“It is the question,” Cotham said, “and I don’t know that I have a great answer. If you ask a lot of players, I think they don’t want to get hurt. But is it worth a X-percent higher chance of getting hurt to make it to the big leagues and provide for your family? I think a lot of guys would say the juice is worth the squeeze.”

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As a coach, Cotham said, he spends “the majority of the day that’s not part of the game” thinking about his pitchers’ health. As a former pitcher, he relates to anyone who pushes the envelope to optimize talent.

After shoulder surgery and struggling in triple A, Cotham found Driveline Baseball, a data-driven think tank near Seattle and a leader in new, innovative training programs. He added velocity to his fastball and reached the majors in 2015 with the Yankees.

“You understand that throwing harder helps you get more outs,” said Cotham, who retired in 2017 after knee and shoulder injuries. “Throwing harder helps you throw off-speed pitches better and nastier. It’s been that way forever. There’s a lot at stake. There’s a lot of incentives.”

Or, as Wheeler put it, “What are you going to do? Tell guys to stop throwing hard? Everybody wants to throw hard.”

Here’s an exercise: Google “pitchers pulldowns.” You will find videos, many from Driveline’s website, of young pitchers pushing their arms by getting a running start and making maximum-effort throws, sometimes with a weighted ball, often into a net.

It’s like nothing Wheeler ever did growing up in suburban Atlanta.

“Just looking in, I’m like, you’re wasting bullets throwing into a freakin’ net as hard as you can,” Wheeler said. “I get what you’re trying to do, but there’s probably better ways to do it. Throw to a person. Long-toss. Why not get out on a football field and let it loose a little bit, so you can actually throw to somebody?”

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Welcome to youth pitching instruction in the social media age.

Erickson, who treats amateur pitchers in addition to pros, is familiar with “pulldowns” and other max-effort training exercises. Young pitchers like to show off their arm strength and post videos on Instagram and elsewhere to attract followers, notably coaches and scouts.

From a medical perspective, Erickson isn’t in favor of such methods.

“That’s not what pitchers need to do,” he said. “That’s not how you get guys out. That is how you show yourself off. But that’s not how you’re going to be a successful pitcher in Major League Baseball.”

Wheeler was coached by his father, who didn’t let him spin curveballs in a game until he was physically mature. He pitched for East Cobb Baseball, a nationally recognized travel program in Georgia. It wasn’t until he trained with his high school’s football team and put on 15 pounds of muscle before his senior year that his velocity climbed into the 90s.

“I don’t think I got clocked until I was a junior in high school,” said Wheeler, the sixth overall pick in 2009 and a top prospect. “Now, guys are getting clocked when they’re playing 12-year-old baseball, which I think is wild.”

But Wheeler still broke down in 2015. He blew out his UCL, underwent Tommy John surgery, and missed two seasons with the Mets.

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“Any time you pitch there’s always a risk of shoulder, elbow. It’s not a natural motion,” Wheeler said. “If you throw above 90 and you throw for so long, you’re probably going to have TJ. It is what it is. I don’t think there’s any right answer right now.”

Is it possible that elbow surgeries are unavoidable for pitchers?

Not if baseball gives them a reason to change their habits, according to Erickson.

“Especially the younger guys, they almost assume it’s going to happen to them, which is kind of a scary thing,” Erickson said. “It’s an inherent risk with the sport at this point. We can optimize everything we want, but the reality is, if guys are going to keep throwing really hard, we’re going to keep seeing this problem. There’s a change that has to happen with teams and scouts and how we view guys as prospects.”

Since 2018, Nola has made more starts (178) and worked more innings (1,081⅓) than any pitcher in baseball. He also hasn’t ranked higher than the 35th percentile in average fastball velocity since 2020.

Coincidence?

“The emphasis needs to be on innings,” Nola said. “How many innings are you able to go? How many innings do you want to go? It shouldn’t be five. As starters, we need to throw longer than that. To throw a lot of innings, you can’t just constantly try to throw as hard as you can all the time because you’re not going to withstand it.

“You don’t want to get hurt. Because you could be struggling, but if you’re healthy, you’ve got another opportunity to get out there and have a really good game.”

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Nola wonders if young pitchers are babied. Some organizations have their minor-league starters pitch only once a week rather than a standard five-day schedule to monitor their workload.

If there’s a secret to Nola’s durability, it’s his work between starts. He adheres to a strict routine. Each throwing session has a purpose.

But Nola also appreciates the art of pitching. He never threw as hard as, say, Strider and Pérez, who live in the upper-90s, or even Wheeler, who pitches with less velocity now but can still run it up to 95-96.

“Pitching to a lineup three, four times, it’s not just overpowering stuff,” Nola said. “It teaches you that, yeah, I might not have everything that day, and I’m facing this guy four times. I’ve got to figure out another way to get him out. Those are the fun games where you’re grinding through, working with the catcher on, ‘OK, how are we going to get ‘em out?’”

It’s the difference between pitching and throwing.

Nola paused. He smiled.

“Man,” he said, “I could talk for hours about this.”

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A day later, Nola struggled with his footing on a wet mound in the rain in St. Louis. He shortened his stride to avoid injury, dialed back his velocity (his fastball averaged 89.5 mph), and allowed only a pair of solo homers in six innings.

Maybe the best way to solve the injury crisis is to mandate that every young pitcher watch video of Nola’s start against the Cardinals. It’s definitive proof that velocity isn’t everything.

“I think their counterpoint would be, ‘I’ve got to get there [to the majors] first,’” Erickson said. “And that’s the impossible part. If a guy thinks if he throws 95 mph consistently that he’s going to make a team, you can’t tell him not to do that. Because that’s going to be his livelihood.”