Walker Buehler Shares His Take on the Rising Tommy John Rate

The hottest button topic in Major League Baseball right now is the recent uptick in pitcher injuries, particularly to some of the game’s brightest stars.

Over the past week, we have seen three aces go down with elbow injuries, between Shane Bieber, who will need Tommy John surgery, and Spencer Strider and Framber Valdez, who are still getting more medical opinions before deciding whether they too will need to go under the knife.

With each passing day, more and more pitchers seem to be ending up on the IL with forearm and elbow strains, which typically result in needing the infamous procedure. Right now, everyone is sharing their opinions on what has caused this rash of injuries, and what can be done to fix it.

Yesterday, we published a story from our own Kevin Henry, who spoke with Arizona Diamondbacks pitching coach Brent Strom to get this thoughts on the matter. The 75-year-old has been developing pitchers in the big leagues for nearly three decades now, and had a lot to say about what is going on in the game and how this has become a systemic problem.

Similar sentiments were echoed by Dr. Keith Meister on the Foul Territory podcast, where he gave great insight on the matter coming from the perspective of one of the most prominent surgeons who performs the Tommy John procedure for pitchers.

What everyone agrees on is the emphasis on velocity and spin forcing pitchers to go max effort more frequently than ever before. This causes great strain on the arm and is causing the breakdown of the ulnar collateral ligament.

We can debate about how much the loss of sticky stuff has contributed to the injuries, or if the pitch clock has anything to do with it. What is clear, however, is that the max effort required to be at the top of your craft on the mound has come with a real liability to put your body on the line.

Ultimately it is the pitchers themselves who understand that give and take of wanting to perform and trying to take care of their bodies more than anyone. Which is why it was so fascinating to hear Walker Buehler’s take on the matter his latest appearance on the Just Baseball Show.

Buehler has been joining the show as a weekly guest for over a year now, as he has been making his way back to the mound after needing Tommy John surgery in August of 2022. As someone who has now gone through the recovery and rehab process for Tommy John twice in his career, Buehler knows better than anyone what the pitcher perspective is as it relates to this injury.

We will break down some of his more interesting quotes here, but if you want to watch the whole conversation with Buehler, watch the video of the discussion below.

Quality Over Quantity

If you want to understand the root cause of the rise in Tommy John surgery, it is important to understand what is valued in the game today. There was once a time where innings pitched was what teams valued more than anything else.

The starting pitcher who could go seven or eight innings every time out and pitch well over 200 innings per season was the one that was held in the highest regard. And while eating innings is still a valued commodity in the sport today, where things have changed is in the emphasis in quality over quantity when it comes to innings pitched.

Teams only care about having the most effective pitchers as possible on the mound, where the strikeout reigns supreme as the most important thing.

“When quality over quantity is the overarching theme, there’s going to be a few ways to be quality, and guys are going to follow those models,” Buehler explains.

Guys see what is working in the game and they will then attempt to follow that model. So when velocity and spin get results, that is naturally what all pitchers will gravitate towards.

“When you are just trying to punch guys out, there aren’t many ways to do it,” Buehler says.

We have seen a change in the game over the last decade where teams are relying on more pitchers than ever, as they want to get the highest quality of stuff as possible to prevent runs. Max effort is almost always required, where guys are expected to throw every pitch with everything they have.

Bullpens are stockpiled with guys who are throwing 95 MPH+, with nasty sweepers and power changeups that are nearly impossible to square up.

Starting pitchers are only expected to pitch five quality innings before they turn it over to said bullpen, as teams want to have a fresh arm on the mound at all times that can throw the ball as hard as possible and with the most spin.

With max effort comes more force being placed on the arm, particularly the small ligaments in the elbow that can only take so much. The risk of Tommy John surgery has been there for pitchers for a long time, but the things that are getting valued in the game today have made pitchers even more vulnerable.

Now with all of this said, how has the pitch clock and the banning of sticky substances played into the recent spike in elbow injuries?

Buehler explains that velocity and spin makes up about 80% of the issue when it comes to the elbow injuries, but also says that the major rule changes have an impact too.

When pitchers used to have no pitch clock to worry about, and they had the use of sticky substances to help generate spin, they were better prepared to get the velocity and spin that allows them to succeed.

When you put pitchers on a clock and give them an inconsistent baseball without enough grip, they have to force the issue that much more to get the required results. This often means squeezing the baseball tighter to try to get the spin and velocity they were accustomed to. Buehler says this is the 20% that has changed, and could be the explanation for the rise in injuries.

“The sticky made it easier to spin the ball better. So when you take that away, guys are now trying to spin the ball the same as they were with it. Say that spin rate difference is 20%. To spin a ball 20% more than you are, when you’re already throwing 96, is almost impossible. The only way you can do it is by squeezing the ball harder.”

“And when you are getting a somewhat relatively inconsistent baseball, to not be able to use something to get a consistent feel, to then create consistent pressure, there’s just been a lot of alterations to a game that thrives on consistency, and I think elbows are one of those things that really need consistency.”

Buehler feels that Major League Baseball needs to be a bit more careful with the drastic changes they are making to the game, and that they need to be studying what is happening and why. He is a big proponent of having a universal substance that everyone can use, allowing pitchers to get a consistent grip on the baseball.

“I’ve joked around that a hitter should hand me their bat before they hit, and whatever they have on their bat, I should be able to use on my hand.”

The ban of sticky stuff is not the root cause for all of the elbow injuries in baseball, but it is a contributing factor that has put more strain on pitcher’s arms as they have had to compensate without the use of it.

In a day and age where information is more prevalent than ever with technology, pitchers know what they need to be successful. Buehler is currently pitching in Triple-A now as he continues to ramp himself up to return to the majors.

In his second start of the season on Saturday, Buehler pitched 4 2/3 innings and allowed just two hits with no walks and six strikeouts. While the results looked great in the box score, Buehler knows that he still is not ready to face big league hitters just yet.

“If the movement wasn’t correct and the velocity wasn’t correct, the assumption that comes into Major League Baseball players’ minds now is big leaguers can hit that. Good big leaguers will hit that. That 4 2/3 does not look the same in the big leagues. Because the bar is so much higher.”

To be able to thrive in the big leagues nowadays is so challenging that pitchers have to be pushed to be nearly perfect to succeed. What they aren’t going to do is hold back anything to protect their health, when it is the matter of performing or not and getting to stay in the show.

Pitchers will only continue to go max effort in pursuit of the quality stuff and innings that teams have come to expect. Limiting some of the mitigating factors outside of just velocity and spin is the best way to get a handle on this issue, but ultimately as long as quality is being valued over quantity, this is never going away.