MLB taking first step in attempt to better understand elbow injuries

Early in the 2014 season, when barely a day went by without a pitcher blowing out his elbow and needing Tommy John surgery, Bud Selig told his staff in the commissioner’s office to start pouring money and resources into a solution. The first step in a process expected to take well over a decade begins Wednesday, and instead of major league pitchers with bum elbows it focuses on the kids who hope to avoid injuries going forward.

Dave Stewart, current GM of the Diamondbacks, is part of the group unveiling MLB's Pitch Smart initiative. (AP)
Dave Stewart, current GM of the Diamondbacks, is part of the group unveiling MLB's Pitch Smart initiative. (AP)

Major League Baseball will announce a new initiative called Pitch Smart, in which it will aim to educate young players and their parents and coaches about risk factors in arm injuries and preventative measures to minimize them. A new website,, includes guidelines and risk factors for youth participants, along with an attempt to dispel a number of myths about the surgery that has affected hundreds of pitchers, including the still-rehabbing Matt Harvey and Jose Fernandez.

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A news conference during Wednesday’s general managers’ meetings in Phoenix will see a group of current executives – Yankees GM Brian Cashman, Diamondbacks president Tony La Russa and two former big league pitchers, Angels GM Jerry Dipoto and Diamondbacks GM Dave Stewart – join MLB’s Joe Torre and Chris Marinak at the unveiling of Pitch Smart.

“It’s just Step 1,” said Marinak, a senior vice president at MLB in charge of the project. “The next step is to work with the youth organizations and get their buy-in.”

The trouble in doing so is more difficult than recognized. Fractures exist everywhere among youth baseball. Different leagues, different rules and different motivations lead to inconsistent application of the most simple guidelines handed down by MLB. Down the road, one of MLB’s goals is to help USA Baseball grow into a stronger governing body that could eventually oversee youth leagues with hard-and-fast pitch-count rules.

A group of industry-leading doctors, including surgeons James Andrews and Neal ElAttrache and researcher Glenn Fleisig, joined MLB to sketch guidelines amenable to all. The recommendations cover four age groups: 8 and under, 9-12, 13-14 and 15-18. Not only are the youngest kids told to limit themselves to 50 pitches a day, the site suggests they don’t throw anything but fastballs and changeups. The same pitch restrictions apply to kids up to 12.


After years of intimating that youth baseball could have something to do with the rash of surgeries that replace torn ulnar collateral ligaments in the elbow, this is MLB’s strongest statement yet on the danger of the current youth-baseball system. It’s pervasive from the lowest levels to the highest competition, in which the desire to win and impress big league scouts often takes precedent over the future health of a pitcher.

MLB hopes to better understand how young stars such as Jose Fernandez can possibly avoid arm injuries. (AP)
MLB hopes to better understand how young stars such as Jose Fernandez can possibly avoid arm injuries. (AP)

While limiting pitches far from guarantees a good-to-go arm, doctors believe in its effect, especially with the specialization of sports leading to more innings being thrown by top amateur pitchers than ever before. The current group of pitchers coming up from the minor leagues represents the first generation that spent a significant amount of time playing so-called showcase baseball, in which elite players travel to weekend tournaments and play loaded schedules.

The concern, of course, is that the Tommy John epidemic isn’t abating anytime soon, and that baseball is working at least a decade behind on an initiative that will necessitate a fundamental overhaul in baseball culture to have a demonstrative effect. Currently, MLB is considering a research project to better understand the progression of elbow injuries in which researchers follow a player from the time he is drafted for five years and catalog biomechanical factors to try and glean a deeper sense of why elbows might be blowing out.


“The problem with all these studies,” Marinak said, “is it takes a long time to see the results.”

So he figured baseball would start small for now. Tell parents that Tommy John surgery does not make a pitcher throw harder or give him some sort of superhuman arm strength. Give leagues incentive to adopt the guidelines, perhaps in the form of a stipend for those that do. Make it such that the rules are so widely accepted they become standard practice.

It’s a start. And considering baseball treats medical information as a potential advantage, thus preventing teams from cooperating to pool their brainpower and resources, it’s long overdue.

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