“Designer” Pitches, Horizontal Movement, and the Pitching Injury Epidemic

About the Author: Eric Cressey

Just a few weeks ago, Texas Rangers team doctor and renowned orthopedic surgeon Dr. Keith Meister gave a fantastic interview about the current state of arm injuries in baseball. He made a lot of good points, but one that particularly intrigued me was his commentary on how “designer pitches” were to blame for some of the challenges we’re facing in today’s game. In case you missed the interview, tune in starting around the 2:00 mark to get his take.

Sure enough, if you examine Major League Baseball injured lists right now, you’ll see a lot of players who recently added a lot of horizontal movement on injured lists. In particular, the sweeper (a newer designation for a slider with considerable horizontal movement) seems to at least have a loose association with increased injured risk to the naked eye. In Dr. Meister’s words, “to create horizontal ball movement, you’ve got to grip the crap out of the baseball, and then you have to cut it. Either pronate it hard, or supinate it hard with a very, very firm grip. And it’s causing this eccentric load on the muscles on the inner side of the elbow and then everywhere up the kinetic chain.”

To reframe this, new movement patterns are stressors. Go do five sets of ten reps on stiff-leg deadlifts, and let me know how your hamstrings feel 36 hours later. Try to do it again – or sprint at full velocity – in the days that follow, and it’s probably not going to work out well for you. Eccentric stress involves a lot of muscle damage, and that stress is magnified when you layer novelty and the stress of competition in the single fastest motion in all of sports (pitching) on top of it.

In a real-world example that might resonate a bit more, check out this NY Times article about Lance Armstrong’s first marathon in 2006: In Under Three Hours, Armstrong Learns Anew About Pain and Racing. Here’s a key excerpt:

Exhausted and nearly walking, Armstrong crossed the finish line in 2 hours 59 minutes 36 seconds. He was 869th, with a pace of 6:51 a mile.

“I can tell you, 20 years of pro sports, endurance sports, from triathlons to cycling, all of the Tours — even the worst days on the Tours — nothing was as hard as that, and nothing left me feeling the way I feel now, in terms of just sheer fatigue and soreness,” he said, looking spent, at a news conference.

The marathon was Armstrong’s first major athletic endeavor since retiring from cycling in 2005, and he said he had not prepared for the race as he should have.

In less than a year, arguably the most accomplished cyclist of all time had become an absolute injury risk in a different athletic endeavor: running. He was able to gut his way through it with mental fortitude and (likely) the fact that his aerobic base stuck around really well. However, localized muscular endurance and tissue resilience was what faltered first.

Do you think an 18-year-old college freshman learning a sweeper on Twitter and then throwing it in a competitive game at a 40% usage clip the next day is any different? I do – because it’s actually far worse.

High velocity pitching with dozens of safeguards – pitch counts, meticulous arm care programs, manual therapy, close technological scrutinization of mechanics – is still very high risk. But the risk profile becomes astronomically higher when you can learn a new pitch/approach quickly and roll it out in games at the highest levels of competition before you’ve had a chance to build up sufficient tissue strength and extensibility – and skill-specific work capacity.

I’ve had a number of conversations with Max Scherzer over the years about how he developed his curveball. It was a year of conversations with teammates about their grips; experimenting with grips; and playing catch with it before it appeared in bullpens and, in turn, games. He adjusted his training to incorporate a bit more direct eccentric biceps work to account for the slightly different movement pattern. His usage over the years:

2012: 3%
2013: 6%
2014: 10%
2015: 8%
2016: 8%
2017: 8%
2018: 8%
2019: 9%
2020: 9%
2021: 10%
2022: 9%
2023: 13%

It was a gradual, calculated process to determine not only how his body responded, but how its inclusion impacted the rest of his pitching arsenal. To this day, he’s never thrown more than 23 curveballs in a game. The process had to be gradual, in part, because there wasn’t technology available to accelerated the learning curve.

In contrast, thanks to advanced modern technology (namely ball tracking devices like Trackman and Rapsodo; high-speed cameras; and increased access to biomechanical analysis), pitchers can now pick up new pitches extremely quickly.

And, teams can better evaluate just how nasty these pitches are in their pitch grading models. As a result, when a team identifies an outlier pitch, they’re going to want players to roll them out much more frequently. This creates a perfect storm: pitchers throwing brand new pitches at high usage rates at the highest level of competition.

Sometimes, however, these are not big adjustments. If the mentality of the pitch is the same context as an existing pitch, but with a subtle seam adjustment, I have less concern:

“Just think of getting to the front of the baseball exactly like you have with your long-time curveball.”

“Just offset the grip here and throw it exactly like your fastball.”

However, if you’re giving someone a brand new grip and encouraging them to “grip it and rip it” in a way that’s foreign to them, that’s a recipe for injury. These dramatic changes require longer timelines and more calculated approaches to preparing the affected tissues. Additionally, players may need a gradual onboarding from a usage standpoint, and increased recovery between “pitch design” bouts.

I don’t think “designer pitches” involving increased horizontal movement are the devil – but I do think the way that pitch design is taking place industry-wide is flawed. As I’ve written before,

[bctt tweet=”You can’t truly evaluate a method or device without considering its application.”]

The problem is exacerbated by a number of issues (and this is not an exhaustive list, by any means):

1. Early sports specialization and high velocity pitching in adolescents is leading to a generation of broken arms entering pro ball

2. Higher velocity (which is, to me, the single biggest contributing factor)

3. An increasingly specialized game (shorter outings with higher velocity and outlier pitches taking place at high usages)

4. Grip concerns (“tack” on a slippery baseball)

5. Reduced recovery time (pitch clock concerns)

6. Shorter, more specialized offseasons (more pitchers continuing to throw when the season ends – and initiating bullpens/live BPs earlier)

It goes without saying that the modern era of pitching injuries is out of control, and we can’t overlook Dr. Meister’s observations that this is a serious component of the challenges we face. If you’re looking to dig in a little deeper on the topic, here’s a podcast – How Pitching Injuries Occur – that I recorded on the topic:

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