Young baseball players are throwing harder than ever. But at what cost?

At first, it just felt like a forearm cramp.

Sam Rosand shook it off. The high school junior figured serious pitching injuries involve a pop of the elbow, so he toed the rubber and threw again. Besides, it was Landon’s final game of the 2024 season. So when the inning ended, his spring was over regardless.

He went through some postgame tests with the training staff just in case, but nothing felt out of the ordinary. Some tightness is normal, particularly for a teenager whose fastball tops 90 mph.

After a few weeks off, the right-hander started throwing again, and everything felt good. But when he stepped back onto the mound, something wasn’t right. His first pitch, which he expected to land somewhere in the high 80s, was clocked at 73 mph. He couldn’t even finish the bullpen session.

“My elbow was just screaming at me,” Rosand said. “I knew something was wrong.”

He consulted with doctors and got an MRI exam, which revealed multiple tears in his ulnar collateral ligament (UCL). He traveled to New York for a second opinion, where it was recommended he undergo a full reconstruction of his UCL — a procedure better known as Tommy John surgery.

More young baseball players than ever before are receiving similar diagnoses. As average pitching velocities have gone up, so have the frequency of arm injuries at all levels of the game.

In December, a report by Major League Baseball found a significant rise in injuries to professionals and a connection to similar shifts at the amateur level. More kids are suffering injuries that leave them sidelined for a year or longer, forcing them to start from scratch as they grapple with what went wrong.

“You’ve built sort of a name — this is who you are, this is what is expected from you, then you get hurt and now you lose traction and momentum. You have to come back without any tailwind, without sort of any track record,” said Rosand, who recently graduated after missing his senior season. “I really just hope the baseball industry in general finds a way to move past this elbow injury epidemic.”

The chase

When Billy Wagner started playing baseball, there was no such thing as “velocity training.” A native of Marion, Virginia, he learned to throw by long-tossing, throwing a football or even working in a hayfield. He didn’t need a tailored regimen to develop an untouchable arsenal.

Wagner pitched 16 seasons in the major leagues and was a seven-time all-star. One of the most prolific relievers in history, he will be inducted into the Baseball Hall of Fame this summer.

In his 13 seasons as the coach at Miller School in Albemarle, he has watched the chase for velocity became ingrained in high school baseball. Players throw every pitch at maximum effort, striving to make every out a strikeout.

“They love playing baseball. I mean these kids love it,” Wagner said. “But they feel like they’re behind and they need to do this or that. I mean, it’s never good enough … There’s got to be an understanding that there’s a better way to do this.”

Their social media feeds are littered with videos of the hardest throwers maxing out their arms as onlookers gawk at velocities that creep toward triple digits. Many training facilities promise similar results, dangling a ticket to the college game. For players trying to show scouts they have what it takes, the number that pops up on a radar gun is as much a measure of success as ERA.

“Kids that I’ve been around and trained are like, ‘I need to be throwing 90,’ and you’ve got parents who think that their kid is the next big-time pitcher,” Wagner said. “I think they’ve lost the value of what this game is really about.”

When combined with command, velocity works. In MLB, average pitch velocity has risen steadily over the past two decades, coinciding with a continual dip in batting average. Hitting a professional-grade fastball as a seasoned veteran is hard enough, but even high-schoolers are seeing it more often.

According to the 2024 study by MLB, five pitchers at Perfect Game’s national showcase — an event for the top prep players — threw at least 95 mph in 2014. That number reached double digits in 2020.

At last year’s event, it was 36.

“If you threw 90 miles per hour and were a left-handed pitcher, you were a first- or second-round draft pick 20 years ago,” said Eric Cressey, who runs sports performance centers in Massachusetts and Florida while serving as the New York Yankees’ director of player health and performance. “Nowadays, those pitchers — I wouldn’t call them a dime a dozen — but they’re far more prevalent.”

As professionals throw harder, hopefuls need to match those numbers to have a chance of making it. As college teams fill their rosters with such players, spots become reserved primarily for those that fit the profile.

“College coaches got to the point where, you know, they weren’t even going to look at a guy unless he threw 85,” Paul VI Coach Billy Emerson said. “That became, ‘We’re not even going to look at a guy unless he throws 90.’ So there’s this rush and this anxiety for players and parents to get their kid there.”

It’s an inevitability that some players will throw harder than others. But it’s the chase for velocity, the determination to max out one’s arm before they are grown, that presents the danger. As players are taught to throw with maximum effort on every pitch, some coaches feel as though the “art” of pitching — the ability to locate and throw strikes, to change speeds, to mix in off-speed pitches — has fallen by the wayside.

“I’ve got guys that are throwing hard. We all want it, everybody wants it,” said Mark Gjormand, the coach at Madison High in Vienna and the owner of a popular training facility called MVP Baseball School. “Let’s just do it in a way that we’re not misleading kids. I go back to the sign that hangs in the Nationals’ bullpen at spring training: ‘Nobody cares how hard you throw ball four.’”

The chase happens primarily outside of school. Players outsource their training to private facilities, where they engage in weighted ball exercises, pulldowns (when players throw at maximum effort with a running start) and tailored weight routines that strengthen them to launch that 5-ounce sphere with maximum muster. They throw off rubber mounds into netting, with velocity and spin-rate readings nearby.

“You can do a search online and find a lot of places that say they’ll increase your velo by ‘X’ miles per hour,” said Seth Blee, now a physical therapist in Chantilly after being the Nationals’ head physical therapist 2016-2023. “A lot of youth athletes, they like to go to the weight room, to the gym, and they like to get stronger and throw harder. But they don’t always put it all together and use their bodies as efficiently as they can.”

Players are being taught to optimize their bodies to put more force behind the ball, but not all are learning the proper mechanics. They’re learning how to throw before they learn how to pitch, coaches say.

“Right now, these kids are taking a very advanced solution to what, to me, is a very simple problem,” Cressey said. “They’re not training the foundational things to build the base of the pyramid. Instead, they’re taking a car with no engine and throwing some fancy wheels on it.”

If the primary culprit for arm injuries is the hunt for velocity, the second biggest issue is volume.

After a busy spring, summer and fall, the winter is generally a dead period for game action, when pitchers can get a break and rest their arms. Some play other sports, which keeps them in shape while scratching their competitive itch. But others keep at it, lured by a chance to increase their velocity in time for the spring. Those that push themselves have been going full bore for an entire year before the high school season resets the cycle. No matter whether one has perfect mechanics, no matter hard or what pitches they throw, their injury risk has been multiplied.

“Every time you throw a baseball, it's wear and tear on the body,” Blee said. “You need time off to be able to repair your tissues and to build strength and resiliency so that they can handle the demand. If kids aren’t taking any time off at all, they're not going to be able to last.”

Fewer kids than ever before are playing multiple sports, spending the entire calendar working the same parts of their body. Data from the Sports & Fitness Industry Association showed that children ages 6-17 were playing an average of 1.63 sports in 2023 after averaging more than two sports over the previous decade. Causes range from funneling into demanding travel programs at young ages and a belief that to become elite, one needs to dedicate as much time as possible to a singular craft. But research shows that specialization, particularly before late adolescence, significantly heightens the risk of overuse injuries.

“When I was playing, you weren’t constantly doing one thing. It wasn’t baseball, baseball, baseball,” said Wagner, who also needed elbow surgery — but not until he turned 37 and had amassed 818 innings in MLB. “I can appreciate the love of the game for these kids. But we have to say, we can’t do it to the point where there’s going to be injuries. When you’re velocity training all year long, you’re going to break down.”

‘Broken to some degree’

The equation is simple: throwing a ball harder requires exerting more force upon it. More force requires more exertion — more strain on muscles, ligaments, bones and tendons. To throw with maximum effort is to push them to their limits.

“When you throw, let’s say 90 mph, the amount of force that’s on the inside of your elbow is like putting six or eight bowling balls in your hand while you lie with your elbow across the kitchen table,” said Christopher Ahmad, chief of sports medicine at New York-Presbyterian/Columbia University Medical Center and the Yankees’ team physician. He performed Rosand’s surgery last June.

The UCL absorbs much of that strain, and it is not designed to be pushed to the edge again and again. Its thickness is comparable to a stack of three credit cards, with a width like a shoelace. In a demonstration on a cadaver, Ahmad could tear a UCL with just his hands.

“It's like breaking a piece of celery, or a popsicle stick,” he said.

More than third of major-league pitchers have undergone Tommy John surgery at some point in their career, but younger players are particularly at risk. An analysis of a national medical claims database showed that 15 to 19 year olds accounted for more than half of all recorded UCL injuries in the United States between 2010 and 2019.

The 2024 MLB report showed that youth and high school players made up more than 40 percent of all UCL surgeries at Andrews Sports Medicine & Orthopaedic Center in Alabama every year since 2015, and 35 players drafted in the first 10 rounds of the 2024 MLB draft had previously undergone UCL surgery.

Doctors believe the UCL doesn’t fully mature until around age 25. Having smaller hands at a younger age requires a pitcher to grip the ball tighter, further flexing the forearm and leaving the elbow exposed. It takes time to adapt to throwing harder, and the push to rapidly increase velocity rushes that process.

When Ahmad began performing UCL reconstructions nearly 25 years ago, he saw the occasional professional athlete, and sometimes a high-workload, high-velocity college player. Now, those in high school or younger are flooding his office.

For the first five years after Cressey’s facilities opened in 2007, even with baseball players making up what he estimated was 90% of clients, he didn’t have one recovering from Tommy John surgery. They started arriving with more frequency around 2012.

Now, “100% of pitchers are broken to some degree. It’s not even negotiable,” Cressey said.

Doctors are seeing patients as young as 10 years old with throwing-related ligament or bone injuries, with some as young as 14 needing Tommy John surgeries. Even those without UCL tears have signs of wear and tear, including calcifications in their ligaments, damaged flexor tendons and bone spurs in their elbows.

“The [arm of a] 16- or 17-year-old today looks like a 35-year-old from 20 years ago,” Ahmad said. “UCL injuries in kids are a crisis, and if the culture of baseball doesn’t have a dramatic change in how we value arm health, we’re not doing our job. We’re losing the fight for elbow health in baseball.”

Searching for a solution

Some injuries are an inevitability — the result of bad luck. But never before has baseball dealt with such a widespread incidence of similar ailments, leaving those in charge searching for answers.

Just about every youth league in the country has some form of a pitch count limit. In Maryland public schools, any pitcher who throws 76 or more pitches in a game must have at least four days of rest before their next game appearance, with a limit of 105 pitches. The Virginia High School League has a 110-pitch limit, with 101 or more pitches mandating four days of rest.

Informing players and parents of the risks can help them manage their workload and its intensity. Gjormand and Wagner helped found the Global Baseball Coaches Network, which hosts a weekly live show in which the issue of player safety and chasing velocity is a frequent discussion. Emerson ran a symposium in Vienna, where former major leaguers, coaches and doctors spoke of the dangers facing pitchers in the modern baseball landscape. In circles of coaches and former players, Wagner said, the state of arm health is one of the most frequent topics of discussion.

On the medical front, doctors and researchers are working to better understand the issues and provide more effective treatments. The newest mainstream version of the Tommy John procedure is called the Triple Tommy John, or TJ3. While the original procedure pioneered by Frank Jobe takes a ligament from the forearm or leg and places it in the elbow, TJ3 also repairs the native ligament and places an artificial internal brace to cover the ligament, acting like a seat belt to better protect it from future injury.

Rosand received an internal brace and recently finished his year-long recover program, now throwing without restrictions. After a precautionary summer away from competitive pitching, he will play college baseball at Virginia. Even without the setback, it took time getting used to being back on a mound — he compared it to learning to run after a year without walking.

“It’s definitely made me more aware when I have a teammate or a friend with any sort of elbow or arm pain, don’t take the chance,” Rosand said. “I wholeheartedly believe that if you want to throw hard, you have to trust that it’s going to come naturally. Sometimes it does, sometimes it doesn’t, but when you chase velocity is when you run into problems.”