{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T23:07:06Z","timestamp":1788476826669,"version":"build-2803163510"},"reference-count":19,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The implementation of the Major League Baseball (MLB) pitch clock in 2023 aimed to shorten game durations and enhance pace of play. However, concerns have been raised regarding its potential effect on pitcher health, particularly related to musculoskeletal and elbow-specific injuries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To determine if recent MLB pitch clock rule changes have affected total pitch counts, time to first injury, total injury time, pitches per inning, total batters faced, or total musculoskeletal injuries for the 200 highest-volume pitchers across 2 full seasons postimplementation (2023 and 2024) as compared with 2 seasons before the change (2021 and 2022).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Descriptive epidemiology study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Pitching and injury data were collected from the MLB official website for the 2021-2024 seasons. A total of 800 high-volume pitcher-specific seasons were evaluated, representing 290 individual pitchers over the 4 seasons. The 200 highest-volume pitchers by pitch count per season were included. Outcomes included total pitches, batters faced, time to first injury, total injuries, and injury type. Statistical comparisons were made between the preimplementation (2021\u20132022) and postimplementation (2023\u20132024) periods via\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      tests, chi-square tests, and Cox proportional hazards modeling. An injury was defined as a musculoskeletal injury resulting in a player being placed on the injured list or missing at least 15 consecutive days of game time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The total number of injuries decreased significantly, from 50.4% in the preimplementation period to 39.3% in the postimplementation period (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .003), and mean time to first injury increased from 142.8 days to 160.9 days (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). While the number of batters faced rose significantly from 525 to 575 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), total pitches and pitches per inning remained stable. Although elbow injuries increased in 2024 after declining in 2022 and 2023, the overall rate did not significantly differ from 2021 to 2022.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The current study shows that after the implementation of the MLB pitch clock, injury rates among high-volume pitchers decreased and time to first injury increased, with no significant rise in elbow injuries. These findings suggest that the pitch clock has not increased short-term injury risk, although ongoing research is needed to assess its long-term effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671251403066","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T17:26:48Z","timestamp":1769794008000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Pitch Counts and Injury Incidence in Major League Baseball: Responses to Pitch Clocks and Defender Rule Changes"],"prefix":"10.1177","volume":"14","author":[{"given":"Aaron","family":"Lavi","sequence":"first","affiliation":[{"name":"College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tasneem","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jake","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ameer","family":"Tabbaa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Voyvodic","sequence":"additional","affiliation":[{"name":"College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afshin","family":"Razi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA"},{"name":"Faculty of Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron","family":"Gilat","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA"},{"name":"Faculty of Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, New York, USA"},{"name":"Faculty of Medical and Health Sciences at Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orry","family":"Erez","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"2023 Rule changes at a glance. MLB.com. Accessed March 25 2025. https:\/\/www.mlb.com\/glossary"},{"key":"e_1_3_2_3_2","unstructured":"Axisa M. Why are MLB pitching injuries on the rise? Four possible causes from pitch clock to changes at amateur level. CBS Sports. April 9 2024. https:\/\/www.cbssports.com\/mlb\/news\/why-are-mlb-pitching-injuries-on-the-rise-four-possible-causes-from-pitch-clock-to-changes-at-amateur-level\/"},{"key":"e_1_3_2_4_2","unstructured":"Blum R. Players\u2019 union head blames quicker pitch clock after series of pitcher elbow injuries. Associated Press. April 6 2024. https:\/\/apnews.com\/hub\/mlb"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsams.2020.06.015"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465221104490"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1519\/JSC.0b013e31827e1509"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546506293025"},{"key":"e_1_3_2_9_2","unstructured":"Feinsand M. MLB issues response to PA statement on pitcher injuries. MLB Advanced Media LP. April 6 2024. https:\/\/www.mlb.com\/news\/mlb-response-pitcher-injuries-2024"},{"issue":"1","key":"e_1_3_2_10_2","first-page":"1","article-title":"A description and comparison of cardiorespiratory fitness measures in relation to pitching performance among professional baseball pitchers","volume":"4","author":"Gillett JS","year":"2016","unstructured":"Gillett JS, Dawes JJ, Spaniol FJ, et al. A description and comparison of cardiorespiratory fitness measures in relation to pitching performance among professional baseball pitchers. Sports (Basel). 2016;4(1):1-10.","journal-title":"Sports (Basel)"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-322-16"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/23259671211012364"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546504266071"},{"key":"e_1_3_2_14_2","unstructured":"Passan J. Spider Tack goo cops and an open secret: answering 20 questions about MLB's foreign-substance mess. ESPN. June 9 2021. https:\/\/www.espn.com\/nba\/story\/_\/page\/nbapowerrankings44403347\/nba-power-rankings-30-teams-pacers-nuggets-playoffs"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967121999646"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jor.2024.06.022"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2023.07.009"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1080\/02640414.2016.1150600"},{"key":"e_1_3_2_19_2","unstructured":"Statcast BS. Pitch tempo leaderboard. Accessed March 25 2025. https:\/\/baseballsavant.mlb.com\/"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000001048"}],"container-title":["Orthopaedic Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259671251403066","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23259671251403066","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259671251403066","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:31:26Z","timestamp":1777595486000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23259671251403066"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1177\/23259671251403066"],"URL":"https:\/\/doi.org\/10.1177\/23259671251403066","relation":{},"ISSN":["2325-9671","2325-9671"],"issn-type":[{"value":"2325-9671","type":"print"},{"value":"2325-9671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"article-number":"23259671251403066"}}