Older, Starting, and Pitchers With Greater Increase in Pitch Pace Experience Elevated Injury Risk Following Pitch Clock Implementation

PURPOSE: To identify risk factors for pitcher injury during the 2023 inaugural pitch clock season and evaluate the relationship between pitcher injuries and changes in pitch pace between the 2022 and 2023 seasons. METHODS: Pitchers were included for analysis if they had ≥70 pitches recorded in the Major League Baseball Statcast dataset, in the 2022 and 2023 seasons. Injury analysis was performed for those on the injured list in 2023. Pitch pace was defined as the time (in seconds) between pitches. Increased pitch pace represented less time between pitches. Univariate analyses examined injury rates by starting versus relief pitchers; age; and pitch count, type, and pace, while multivariate logistic regression assessed age, position, and pace change. Subgroup analyses evaluated pitch pace changes by position and throwing arm injury. RESULTS: This analysis included 537 pitchers, with a median age of 29 years, and 319 injuries affecting 239 different pitchers. Pitch pace increased from 20.5 to 17.1 seconds between 2022 and 2023, and relievers increased their pace by 1.6 seconds more than starting pitchers. The elbow (18.8%) and shoulder (18.5%) were the most injured areas, and most injuries occurred in the throwing arm (64.3%). Each second decrease in time between pitches (i.e., faster pace) increased odds of injury by 19% (adjusted Odds ratio, 1.19; 95% confidence interval, 1.05, 1.34; P = .006). Each additional year of age increased the odds of injury by 11% (adjusted Odds ratio, 1.11; 95% confidence interval, 1.05; 1.17; P < .001). Starting pitchers had 120% higher odds of injury than relief pitchers (adjusted Odds ratio, 2.20; 95% confidence interval, 1.52; 3.21; P < .001). CONCLUSIONS: After pitch clock implementation, a greater increase in pitch pace, older age, and the role of starting pitcher emerged as significant risk factors for injury during the 2023 season. LEVEL OF EVIDENCE: Level III, retrospective comparative study.