Keith Meister is worried. The 63-year-old orthopedic surgeon feels as if he’s screaming into a void, his expert opinion falling on deaf ears.
Meister, whose slight Southern twang sweeps into conversation through his 20-plus-year career in the Lone Star State as the Texas Rangers’ team physician, is a leading voice in baseball’s pitching-injury epidemic. Meister wants the sport to err on the side of caution and create change to save pitchers’ arms. The trend, Meister says, stems from the industry-wide push to increase speed, spin and break at all costs.
While MLB and the Major League Baseball Players Assn. bicker about what’s causing the problem and how to solve it, the doctor provides his perspective. He just wants the 17-year-old high schooler, the 23-year-old college pitcher, and the 32-year-old MLB veteran to stop showing up at his office.
“It’s not going to change at the lower levels until it changes at the highest level,” Meister said in a phone interview. “I don't see a motivation within Major League Baseball to change anything that would enhance the level of safety.”
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MLB asked Meister to sit on a committee examining the growth in pitcher injuries about 18 months ago, he said. Meister says the committee never met. (MLB did not respond to a request for comment about the committee.)
Injury is among the biggest risks for youth pitchers looking for the all-too-sought-after faster fastball. Their quest to emulate their heroes, such as hard-throwing veteran starters and stars Justin Verlander and Jacob deGrom, has caused them to need the same surgeries as the pros.
Trickling down, it's the teenager, the budding pitching prospect desperate to land his Division I scholarship, who is hurt the most. MLB teams wave around multimillion-dollar signing bonuses for the MLB Draft. Those same pitchers hurt their elbows after pushing their abilities to the extreme, calling into action surgeons such as Meister.
“It’s an even bigger problem than it appears,” said David Vaught, a baseball historian, author and history professor at Texas A&M. “This goes back into high school or before that, this notion that you throw as hard as possible. … It's so embedded, embedded in the baseball society.”
Tommy John surgery saves careers. But as pitchers across baseball push for higher velocity, more hurlers are going under the knife — for a first time, a second time and in some instances, a third or fourth procedure.
MLB pitching velocity steadily rose from 2008 to 2023, with average fastball velocity going from 91.9 mph to 94.2. According to Meister, the total number of elbow ligament surgeries in professional baseball in 2023 was greater than in the 1990s altogether. A 2015 study revealed 56.8% of Tommy John surgeries are for athletes in the 15- to 19-year-old age range.
“It's like the soldiers on the front lines — they come into the tent with bullet wounds,” Meister said. “You take the bullets out, you patch them back up and you send them back out there to get shot up again.”
MLB released a report on pitcher injuries in December 2024. The much-anticipated study concluded that increased pitching velocity, “optimizing stuff” — which MLB defines as movement characteristics of pitches (spin, vertical movement and horizontal movement) — and pitchers using maximum effort were the “most significant” causes of the increase in arm injuries.
Meister was interviewed for the report. He knew all that years ago. He was yelling from the proverbial rooftop as MLB took more than a year (the league commissioned the study in 2023) to conclude what the doctor considered basic knowledge.
“Nothing there that hadn't been talked about before, and no suggestion for what needs to be changed,” Meister said to The Times Wednesday.
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Although pitching development labs such as Driveline Baseball and Tread Athletics provide fresh ideas, Meister said he does not entirely blame them for the epidemic.
It’s basic economics. There’s a demand for throwing harder and the industry is filling the void.
However, Meister sees the dramatic increase in velocity for youth pitchers, such as a 10-mph boost in velocity within six months, as dangerous.
“That's called child abuse,” Meister said. “The body can't accommodate. It just can't. It's like taking a Corolla and dropping a Ferrari engine in it and saying, ‘Go ahead and drive that car, take it on the track, put the gas pedal to the metal and ask for that car to hold itself together.’ It's impossible.”
On the other end of the arm-injury epidemic is the player lying on his back, humming along to Kendrick Lamar’s “Not Like Us” as an air-cast-like device engulfs his arm, pressurizing the forearm and elbow.
The noise of the giant arm sleeve fills the room of Beimel Elite Athletics, a baseball training lab based in Torrance — owned by former MLB pitcher Joe Beimel. It generates Darth Vader-like noises, compressing up and down with a Krissshhhh Hhhwoooo… Krissshhhh Hhhwoooo.
Greg Dukeman, a Beimel Elite Athletics pitching coach whose 6-foot-8 frame towers over everyone in the facility, quipped that the elbow of the pitcher undergoing treatment was “barking.”
For professional and youth players alike, this technology, along with red-light therapy — a non-intrusive light treatment that increases cellular processes to heal tissue — and periodic ice baths, is just one example of how Beimel attempts to treat athletes as they tax their bodies, hoping to heal micro-tears in the arm without surgical intervention.
With little to no research publicly available on how high-velocity-and-movement training methods are hurting or — albeit highly unlikely — helping pitchers’ elbows and shoulders, Meister said, it’s often free rein with little — if any — guardrails.
Josh Mitchell, director of player development at Beimel’s Torrance lab, said that’s not exactly the case in their baseball performance program. Beimel will only work with youth athletes who are ready to take the next step, he said.
“You got the 9- and 10-year-olds, they're not ready yet,” Mitchell said. “The 13- and 14-year-olds, before they graduate out of the youth and into our elite program, we'll introduce the [velocity] training because they're going to get it way more in that next phase.”
Beimel uses motion capture to provide pitching feedback, and uses health technology that coincides with its athletes having to self-report daily to track overexertion and determine how best to use their bodies.
Their goal is to provide as much support to their athletes as possible, using their facilities as a gym, baseball lab and pseudo health clinic.
Mitchell knows the pleasure and pain of modern-day pitching development. The Ridgway, Pa., native’s professional career was waning at the Single-A level before the Minnesota Twins acquired him in the minor league portion of the Rule 5 Draft.
The Twins, Mitchell said, embraced the cutting-edge technique of pitching velocity, seeing improvements across the board as he reached the Double-A level for the first time in his career in 2021. But Mitchell, whose bushy beard and joking personality complement a perpetually smiling visage, turned serious when explaining the end of his career.
“I'm gonna do what I know is gonna help me get bigger, stronger, faster,” said Mitchell, who jumped from throwing around 90 miles per hour to reaching as high as 98 mph on the radar gun. “And I did — to my arm's expense, though.”
Mitchell underwent two Tommy John surgeries in less than a year and a half.
Mitchell became the wounded soldier that Meister so passionately recounted. Now, partially because of advanced training methods, youth athletes are more likely to visit that proverbial medic's tent.
“There's a saying around [young] baseball players that if you're not throwing like, over 80 miles per hour and you're not risking Tommy John, you're not throwing hard enough,” said Daniel Acevedo, an orthopedic surgeon based in Thousand Oaks, Calif., who mostly sees youth-level athletes.
In MLB’s report, an independent pitching development coach, who was unnamed, blamed “baseball society” for creating a velocity obsession. That velocity obsession has become a career route, an industry, a success story for baseball development companies across the country.
Driveline focuses on the never-ending “how” of baseball development. How can the pitcher throw harder, with more break, or spin? And it’s not just the pitchers. How can the hitter change his swing pattern to hit the ball farther and faster? Since then, baseball players from across levels have flocked to Driveline’s facilities and those like it to learn how to improve and level up.
“Maybe five or six years ago, if you throw 90-plus, you have a shot to play beyond college,” said Dylan Gargas, Arizona pitching coordinator for Driveline Baseball. “Now that barrier to entry just keeps getting higher and higher because guys throw harder.”
MLB players have even ditched their clubs midseason in hopes to unlock something to improve their pitching repertoire. Boston Red Sox right-handed pitcher Walker Buehler left the Dodgers last season to test himself at the Cressey Sports Performance training center near Palm Beach Gardens, Fla., before returning to eventually pitch the final out of the 2024 World Series.
Driveline is not alone.
Ben Brewster, co-founder of Tread Athletics, another baseball development company based in North Carolina, said high-school-aged players have been attracted to his performance facility because they see the results that MLB players and teammates achieve after continued training sessions.
Tread Athletics claims to have a role in more than 250 combined MLB draft picks or free agent signings, and says it has helped more than 1,000 high school players earn college opportunities.
Kansas City Royals left-hander Cole Ragans achieved a 4.4-mph increase from 2022 to 2023, the largest in MLB that year. With the velocity increase after his work at Tread Athletics, Ragans went from a league-average relief pitcher to a postseason ace in less than a year.
So what makes Ragans’ development different from that of a teenage prospect reaching out to Tread Athletics?
“Ragans still could go from 92-94 miles per hour to 96 to 101,” Brewster said. “He still has room, but relatively speaking, he was a lot closer to his potential than, like, a random 15-year-old kid throwing 73 miles per hour.”
Meister knows Ragans well. When the southpaw was a member of the Rangers’ organization, the orthopedic surgeon performed Tommy John surgery on Ragans twice. (Ragans has also battled a rotator cuff strain this season and has been out since early June.)
“These velocities and these spin rates are very worrisome,” Meister said. “And we see that in, in and of itself, just in looking at how long these Tommy John procedures last.”
Throwing hard is not an overnight experience. Brewster shared a stern warning for the pitching development process, using weightlifting as an example. He said weightlifters can try to squat 500 pounds daily without days off, or attempt to squat 500 pounds with their knees caving in and buckling because of terrible form. There’s no 100% safe way to lift 500 pounds, just like there is no fail-safe way of throwing 100 mph. There’s always risk. It’s all in the form. Lifting is a science, and so is pitching — finding the safest way to train to increase velocity without injury.
“The responsible way to squat 500 pounds would be going up in weight over time, having great form and monitoring to make sure you’re not going too heavy, too soon,” Brewster said. “When it comes to pitching, you can manage workload. You can make sure that mechanically, they don't have any glaring red flags.”
Brewster added that Tread, as of July, is actively creating its own data sets to explore how UCLs are affected by training methods, and how to use load management to skirt potential injuries.
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MLB admitted to a “lack [of] comprehensive data to examine injury trends for amateur players” in its December report. It points to a lack of college data as well, where most Division I programs use such technology.
The Andrews Sports Medicine & Orthopedic Center based in Birmingham, Ala. — founded by James Andrews, the former orthopedic surgeon to the stars — provided in-house data within MLB’s report, showing that the amount of UCL surgeries conducted for high school pitchers in their clinic has risen to as high as 60% of the total since 2015, while remaining above 40% overall through 2023.
Meister said baseball development companies may look great on the periphery — sending youth players to top colleges and the professional ranks — but it’s worth noting what they aren’t sharing publicly.
“What they don't show you is that [youth athletes] are walking into our offices, three or six months or nine months later.”
This story originally appeared in Los Angeles Times.
