No one knows more about the pitcher injury crisis sweeping through professional baseball than Keith Meister.
He’s never thrown a baseball in the majors, and he never played anything above Little League. But as the physician for the Texas Rangers and one of the top elbow surgeons in America, Meister has seen more ravaged pitching arms than he can count. His office is lined with framed jerseys belonging to hundreds of millions of dollars’ worth of baseball talent. His phone is full of Cy Young winners.
What Meister can say for certain is that he’s never seen anything like the slew of injuries felling pitchers right now. And to major-league elbow experts, it’s no coincidence that these are rising right as hurlers reach for more velocity and increasingly dramatic breaking pitches such as the sweeper every time they take the mound.
“We’re getting very recognizable tear patterns as a consequence of this,” Meister says. “You can look at a scan now and say, ‘Oh, this guy throws a sweeper.’”
On Monday afternoon, Meister examined the sore elbow of his latest high-profile patient: 25-year-old Atlanta Braves ace Spencer Strider.
Strider is the model of a modern pitcher. He throws a 96 mile per hour fastball, along with a sweeping slider that he throws roughly a third of the time. He struck out 281 batters last season, by far the most of any MLB pitcher. Now, in what should be the prime of his career, he could be headed for his second elbow reconstruction surgery in just five years.
The conventional wisdom among surgeons was once that one elbow repair surgery would last a player for the rest of his career. Then, it was expected to last them 10 years—a lifetime in pitcher years.
“Now five is a very solid number,” Meister says. “And really, three years is the number at which you see guys start to tear and break down.”
All-Stars and Cy Young winners filter in and out of Meister’s office at an alarming clip. In recent years, he’s operated on Jacob deGrom, Sandy Alcantara, and Robbie Ray. Meanwhile, baseball’s other busiest elbow surgeon, Neal ElAttrache, handled Shohei Ohtani, who will spend the first year of his $700 million contract in Los Angeles playing as a designated hitter while recovering from his second elbow ligament surgery.
Those heading to the operating table or nursing more recent elbow injuries, meanwhile, could make up their own all-star ballot.
Strider is the pitching centerpiece of the World Series favored Braves and, if he undergoes elbow surgery again, he will be out for all of this year and part of 2025. Shane Bieber, the 28-year-old former Cy Young winner in Cleveland, will undergo elbow surgery as well in the coming days. In Miami, 20-year-old Eury Pérez was set to be the rare bright spot on a miserable Marlins team. He’s already had his surgical procedure.
Astros ace Framber Valdez became the latest pitcher to miss an early season start due to elbow pain. And in New York, Yankees ace Gerrit Cole is out until at least late May as he attempts to recover from elbow nerve inflammation—and hopefully stave off a full ligament tear.
The growing consensus throughout baseball is that the velocity gold rush and obsession around “pitch design” has pushed players to a point where they must be willing to sacrifice their bodies to keep a major-league job. The dilemma has become obvious: Choose your elbow ligament, or choose strikeouts.
Major League Baseball and the MLB Players Association are arguing over what’s making it worse, rather than working on ways to stop it. In response to the latest wave of pitcher injuries, Tony Clark, the head of the MLBPA, issued a statement criticizing baseball’s pitch clock, which gives pitchers 15 seconds to throw the ball when the bases are empty and 18 with someone on base. The league responded to Clark’s statement by blaming players’ obsession with velocity and spin rate.
“It’s like we have divorced parents,” Cole said Monday in an emotional plea that lasted 20 minutes inside the Yankees’ clubhouse.
In reality, there’s no longer much doubt over why pitchers are breaking down at an alarming pace. They are motivated to throw each pitch at maximum effort, over and over until their bodies give out.
Chris Langin, the director of pitching for Driveline Baseball, says that players are prepared to blow out their bodies in the pursuit of a few more ticks on their fastball or spin on their breaking ball.
“The ways that you would lower the injury risk are also the ways you’d be lowering the players value,” Langin said. “At the end of the day, that’s not the business we’re in.”
A pitcher who finds himself making $30,000 per year in Double A knows that he can accelerate his path to MLB (and to the minimum $700,000 per year payday) by throwing every ball as hard as he can. And where they used to hone their craft in the minor leagues, pitchers now aim to burn brighter and sooner, hacking their own bodies to make it to the majors.
As a result, everyone on a pitching staff feels the need to throw their hardest at all times instead of carefully picking their way through a batting order.
“In 2013, you could pitch to like 85% of the lineup with fastball away and have no threat of it leaving the park,” Cole said. “But in the modern game, power hitters can slug to the opposite field and, “it changes everything.”
Once a core principle for a viable major-league starter, long-term reliability has become an afterthought in a game that has allowed efficiency to overtake physical capabilities. Even the best pitchers in baseball can be replaced in the aggregate by a pool of willing hurlers who know that they, too, might blow out their elbows soon.
“We want higher performance,” Cole says, “but we also want durability.”