One of the most significant shifts in baseball over the past decade has been the emphasis on throwing velocity. Pitchers are chasing 100 mph fastballs, and with that comes a tremendous increase in stress on the elbow and shoulder.
Higher velocity means higher force, and the ulnar collateral ligament (UCL) — the one repaired in Tommy John surgery — is bearing the brunt. In 2024 alone, there were over 280 Tommy John surgeries in professional baseball. What used to be a rare, career-altering injury is now a common part of a pitcher’s timeline.
Baseball has become a year-round sport. Young athletes are playing spring ball, summer travel leagues, fall ball, and then heading straight into offseason velocity camps. There is little to no true recovery period.
In sports medicine, we understand that the body needs cycles of stress and rest to develop resilience. Without recovery, athletes accumulate microtrauma — which eventually becomes a macro-injury.
More kids are specializing in baseball at younger ages. While this may seem like a way to develop elite talent, early specialization is associated with higher rates of overuse injuries. The same motion, repeated over and over — like pitching or swinging a bat — places stress on a limited set of muscles, tendons, and joints.
Cross-training and multi-sport participation help develop more balanced musculature and reduce burnout. Unfortunately, many young players (and parents) feel pressure to focus exclusively on baseball — often to the detriment of long-term health.
The 2020 season was disrupted at every level of the sport, and many athletes lost access to coaches, training programs, and structured conditioning. When play resumed, many tried to pick up where they left off — but the body wasn’t ready.
This abrupt return to full-speed play likely contributed to a spike in injuries in 2021 and 2022, as athletes ramped up too quickly and lacked proper preparation.
As physicians, coaches, and trainers, we need to shift the culture:
Promote smart training: Velocity is valuable, but mechanics, strength, and recovery are just as important.
Emphasize recovery: Build in true rest periods during the year — especially for pitchers.
Encourage multi-sport play: Broader athletic development in youth leads to healthier, more adaptable athletes.
Educate early: Help young athletes understand how their body works — and what it needs to stay healthy.
Baseball isn't inherently more dangerous than it was 20 years ago, but the way it's played has evolved — and our approach to athlete care must evolve with it. If we continue to chase performance without prioritizing health, injuries will remain part of the game’s landscape. But with smarter training, better education, and a long-term perspective, we can help athletes stay on the field and out of the operating room.
Call or click to book a session with our professionals at Fuse Sports Performance, associates of Princeton Sports and Family Medicine, P.C. In addition to problem-focused visits, we offer sports performance evaluations to stop problems before they start. Plan your visit today!
At Fuse Sports Performance and Princeton Sports and Family Medicine, P.C., our professionals specialize in sports medicine services, including baseball evaluations to assess your risk for injury and assist in your performance goals.
