THE BASEBALL ELBOW INJURY EPIDEMIC

Elbow injuries in baseball are no longer a rare or “freak” occurrence—they’re becoming the norm. What’s most alarming isn’t just how common Tommy John surgery has become at the professional level, but how rapidly it’s rising among youth and high-school athletes.

Baseball has been a lifelong passion of mine, and over the past decade, I’ve watched an injury trend accelerate in a way that should concern every parent, coach, and athlete involved in the game.

The good news? Many of the biggest risk factors for elbow injury are controllable.

The Current Landscape: Why Baseball Elbow Injuries Are Exploding

Tommy John surgery—technically a reconstruction of the ulnar collateral ligament (UCL)—has been around for more than 50 years.

Surgical techniques have improved dramatically, yet the incidence of the surgery continues to rise by roughly 9% per year.

At the professional level, nearly half of pitchers entering the 2025 season in Major League Baseball had already undergone UCL reconstruction.

More concerning: Athletes aged 15–19 now account for nearly 60% of all UCL surgeries in the United States.

This is not a genetics problem. It’s a development problem.

Velocity First: A Dangerous Development Model

Modern pitching culture places enormous emphasis on velocity—especially hitting the mythical 90-mph threshold in high school.

Research consistently shows that the earlier an athlete reaches and surpasses 90 mph, the higher their risk of UCL rupture.

Velocity itself isn’t the enemy.

The problem is when and how it’s pursued—often before athletes have the physical maturity, strength base, or mechanical efficiency to tolerate the stress.

Mechanical Changes That Shift Stress to the Elbow

One major shift I see clinically and on the field is the coaching of a late hand break.

Traditionally:

• The hands separate as the lead knee begins to drop

• The arm is up and ready at front-foot contact

What we now see:

• The arm is still down at front-foot contact

• The body rotates ahead of the arm

• The elbow absorbs stress meant for the shoulder

  
  

The elbow is not a “big engine.”The shoulder and trunk are.

When the timing of this mechanic breaks down, elbow stress skyrockets.

Pitch Design and Grip Pressure: More Isn’t Better

Another modern contributor is aggressive pitch design—specifically, teaching young pitchers to create more movement through increased grip pressure.

Here's what happens when chasing higher spin rates:

• More thumb and finger force

• Increased tension through the flexor mass

• Greater strain on the medial elbow during high-speed rotation

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When velocity, spin, and immature tissue all collide, injury risk climbs fast.

The Strength Deficit Nobody Wants to Talk About

Many youth pitchers are skilled—but weak.

Year-round baseball often replaces:

• Off-season strength development

• Athletic variability

• The natural increase in tissue resilience through variable times of high and low stress.

  
  

Professional sports medicine groups consistently recommend that youth pitchers benefit from a true off-season away from throwing, focused on building strength and general athleticism.

For the highest risk group of pitchers, aged 15 to 19, that means 4 months off competitive pitching, and 2-3 months off of overhead throwing-at a minimum.

This is low-hanging fruit—and it’s commonly missed.

Over-Competition and Showcase Culture

High-level amateur players often participate in 10+ showcases during high school.

The data is clear:

• More than 10 showcases = significantly higher UCL injury risk

• Fewer than 10 = 50% lower injury risk

  
  

Early maturity, year-round competition, and constant exposure may increase visibility—but they also increase the risk of breakdown.

What Actually Reduces Risk (and Improves Recruitment)

Here’s what consistently matters at the next level:

• Pitch command over raw velocity

• Multi-sport athletic backgrounds

• Time spent developing strength

College recruiters routinely favor a healthy, strong athlete with command over a sore-elbow thrower chasing radar numbers.

Smarter Development Starts with Better Questions

Key red flags parents and coaches should not ignore:

• Elbow soreness lasting 2–3 days after competition

• High-volume throwing early or late in the season (don't chase velocity or play in tournaments or showcases in March or October)

• Pressure to “push through” pain after long tournament stretches

  
  

The goal is not less ambition. It’s longer careers.

A Better Path Forward for Young Pitchers

Elbow injuries are not a rite of passage in baseball—and they are not the price athletes must pay for playing at a high level. What we’re seeing now is the predictable outcome of asking developing bodies to perform at professional intensities without the physical foundation to support it.

High school athletes don’t need to throw harder year-round.

They need to get stronger, move better, and build resilient tissue that can tolerate the demands of pitching over time.

A well-designed strength program does more than add muscle. It improves force transfer from the ground up, reduces unnecessary stress at the elbow, and gives pitchers the capacity to train, compete, and recover without constantly living on the edge of injury.

Just as important, it creates better athletes—stronger, faster, and more durable across every position on the field.

If you’re a parent, coach, or athlete who wants to play the long game—college, beyond, or simply pain-free—now is the time to shift the focus. Strength training is not a distraction from baseball development. It is the foundation that makes baseball development sustainable.

If you want help getting your high school athlete on the right track with strength training that builds athleticism, resilience, and longevity—while reducing injury risk—we’re here to guide that process.

Reach out, start the conversation, and let’s build arms and athletes that last.