UTK Special 1/13/25

The State of the State: UCL

This is the first of several articles I have coming looking at some very basic, but very important concepts around pitching. They may be recap for longtime readers, but my hope is that this is something I can regularly update, year over year, as a resource. We start with looking at the biggest challenge facing pitching - keeping the UCL intact. Let’s look at the state of the state when it comes to pitching:

Baseball has always been a game of fascination and tradition, with the pitcher perched on the mound like a conductor, orchestrating every pitch. But for all the beauty in that motion, the reality is that the pitcher’s elbow, specifically the ulnar collateral ligament (UCL), is under enormous stress. At the youth level, where bodies are still developing and mechanics often remain unrefined, that stress can become too much. We’ve seen professional pitchers recovering from Tommy John surgery grab headlines for years, yet the real battleground is at the youth level, where overuse and improper mechanics can set the stage for major injuries. As someone who has spent countless hours investigating injuries, talking to trainers, and studying the evolution of baseball sports medicine, I can’t emphasize enough how critical it is to address UCL injury prevention while these pitchers are still in their formative years.

One of the major culprits behind UCL injuries is the simple fact that many kids are throwing too often, almost completely without the benefit of proper scientific workload management. Competitive leagues, showcases, travel teams—everyone wants a piece of the next phenom, which leads to pitch counts that keep climbing. Even with rule changes aimed at limiting how many pitches a kid can throw per outing or per week, the combination of multiple teams and year-round baseball can be deadly on a developing arm. The UCL is not made of steel or even kevlar, despite modern techniques; it’s more like a rope that frays when it’s overloaded over time. Parents and coaches must understand that resting doesn’t merely mean having a day off from one game. It means a complete break from throwing so the ligament can recover and even then, there are workload implications. As Dr. James Andrews once observed in a 2015 interview with The New York Times, “We’ve known for years that overuse is the leading factor in the injuries we are seeing with these young pitchers.”. Sure, a kid might bounce back quickly when he’s 12, but cumulative damage doesn’t wait until adulthood to appear. It slowly chips away at the ligament’s integrity.

Proper mechanics are just as crucial as controlling workload. The kinetic chain starts from the ground up, and if a young pitcher isn’t engaging his lower body and core, that force has to go somewhere else—usually the elbow and shoulder. We see red flags in the form of an overly rotated torso or an arm lagging behind, which can create significant valgus torque on the elbow. Valgus torque is the boogeyman here. If you apply a consistent high level of torque to the elbow, eventually something gives. Making sure youth pitchers learn how to use their hips, keep their trunk aligned, and release the ball with efficient timing can go a long way in reducing that stress. The problem is that too many young pitchers are emulating big-leaguers they see on TV without understanding that those major-league guys have spent years refining their deliveries and building up the strength needed to handle high-velocity throws. A 13-year-old kid trying to throw like Gerrit Cole might end up having a date with a surgeon sooner than he’d ever imagined.

Beyond mechanics and pitch counts, there’s another line of defense in the form of strength and conditioning programs. The forearm flexor-pronator group, for instance, can be trained to help stabilize the elbow, which is enormously beneficial for UCL health. It’s easy to write off forearm exercises as something only bodybuilders worry about, but in reality, they’re as important to a pitcher’s elbow as the rotator cuff is to his shoulder. The same goes for scapular and rotator cuff strengthening. A stable scapular platform gives the arm a solid base to work from, which means less stress at the elbow. It’s almost like having a sturdy foundation for a house; if that foundation is weak, the rest of the structure is going to wobble under stress.

In recent years, technology has opened new frontiers in injury prevention. We see wearable sensors that measure elbow torque in real time, giving coaches immediate feedback about whether a pitcher is nearing a danger zone. Just a few years ago, the best we could do was rely on a coach’s watchful eye, hoping he could see subtle changes in release points or arm angles. Now, a small sensor on the sleeve or elbow can provide accurate metrics, allowing adjustments before something pops. The same goes for high-speed video analysis, which used to be reserved for the big leagues or top-tier collegiate programs. Today, affordable cameras and software can break down a pitcher’s motion frame by frame. Even if you don’t have a professional biomechanist on hand, a coach with some training in video analysis can spot mechanical flaws and correct them before they become major issues. This sentiment is echoed by Dr. Neal ElAttrache, who told ESPN’s Stephania Bell in 2018, “The biggest issue is the mechanical stress placed on the elbow from poor form and repetitive throwing.”

There’s also the world of ball-tracking technology—radar systems that can tell you not just velocity but also spin rate and spin axis. This can help identify if a youth pitcher is over-relying on a particular breaking pitch that’s generating excessive torque. It might be tempting for a 14-year-old to show off a devastating curveball, but long-term health is too high a price to pay for short-term dominance.

Of course, none of these technologies or biomechanical fixes matter if there isn’t a concerted effort to educate everyone involved. Parents, coaches, and even the young athletes themselves need to recognize the seriousness of an overworked and overstressed elbow. Kids are resilient, but you can’t cheat biology. When parents start to notice their child losing velocity or complaining about elbow soreness, the solution isn’t to pitch through it or ramp up bullpen sessions. It’s to rest, get an evaluation from a qualified medical professional, and reset. As Dr. Tim Kremchek stressed in a conversation with Bleacher Report, “We have to start at the youth level with pitch counts, rest, and teaching mechanics if we want to curb the Tommy John epidemic.” This might mean missing a tournament or two, and that can be a tough pill to swallow in a competitive environment. But that short-term sacrifice can spare a young athlete from long-term damage.

I’ve always believed that solutions need to be multi-pronged. You can’t just say “throw fewer pitches” or “use a sensor” and call it a day. A holistic approach includes education, mechanical efficiency, proper strength and conditioning, and smart use of technology. It also means rethinking the way we approach youth sports culture, which so often demands year-round specialization and relentless competition. If we’re serious about reducing UCL injuries, we have to remind kids—and sometimes their parents—that baseball is a marathon, not a sprint. Having that perspective can be the difference between a kid who burns out at 15 and one who grows into a healthy, high-performing pitcher at 25.

Ultimately, the goal is to keep young arms healthy and able to do what they love for the long haul. By combining the best in modern sports science with common-sense guidelines, we can mitigate the risks, lower the incidence of UCL injuries, and give these kids a chance to develop into the next generation of stars. It’s never going to be perfect. There will always be injuries and unfortunate circumstances. But by focusing on reducing stress through proper mechanics, controlling workloads, emphasizing rest, and harnessing technology, we’re giving ourselves the best possible shot at protecting the future arms of the game. That’s what youth baseball should be about—nurturing talent, building a passion for the sport, and making sure the next wave of pitchers stays on the field instead of in the operating room.