While ruinous of careers and dreams, in the scheme of things, the epidemic initially wasn't that big of a deal.

It was more of an inconvenience than anything major.

Jeremy Bonderman

The worst case scenario when it came to elbow and shoulder problems was that pitchers would have a hard time combing their hair or brushing their teeth with their pitching arm. However, that was easy to work around, given that ex-pitchers could always use their non-pitching arm.

Problem solved.

The Stakes

The increasing incidence of Pitching-Induced Coagulation Syndrome (PICS), which includes Thoracic Outlet Syndrome, has raised the stakes considerably.

Jeremy Bonderman

The problem with TOS is that you aren't just talking about limiting the range of motion in the pitching elbow or a shoulder that aches when it 's going to rain.

Instead, and increasingly, you're talking about blood clots.

Matt Harvey

The really nasty, and scary, thing about blood clots is that you can't predict where blood clots are going to migrate and what effect they are going to have on the body.

Matt Harvey

Maybe they will stay in non-vital areas.

Maybe they will migrate, but to non-vital areas.

Like the bladder?

Matt Harvey

Or maybe the blood clots will migrate to the lungs, heart, or brain and cause strokes and other serious injuries?

Dillon Gee

Think I'm exaggerating? Well, that's exactly what Dillon Gee is dealing with as I write this.

A week ago, (Gee) stood inside the visitors clubhouse at Comerica Park and could barely breathe.

Root Cause

Why are more and more pitchers having problems with Thoracic Outlet Syndrome?

I believe it's due to pitchers' being taught to get their elbows up either as part of a Scap Loading movement like the Inverted W or because of a misunderstanding of the nature of Arm Slot that results in...

Hyperabduction

Once Rare, Now Routine

Dillon Gee and Matt Harvey weren't the only pitchers to have a problem with Thoracic Outlet Syndrome (just) this year. Also affected were...

The fact that the incidence of Thoracic Outlet Syndrome seems to be climbing rapidly is extremely troubling, especially when viewed in historical context.

J.R. Richard was a pitcher, and one of the few pitchers to have a stoke during his playing days. Maybe that was solely due to his medical history. Or maybe that was related to how he moved when he threw the ball.

Regardless, the increasing incidence of serious problems like Thoracic Outlet Syndrome means the epidemic isn't about inconveniences any more. By pushing harder and harder against the limits of the body, the pitching mechanics industry is increasing the odds that pitchers will start experiencing life-changing problems.

Maybe we can work around those problems by removing ribs and other compressive structures.

But what if we can't?

First Steps

What can be done to reverse the course of the epidemic and keep it from progressing until it takes a life?

Matt Harvey

The first step is to stop teaching pitchers -- and all throwers -- to get their elbows above their shoulders.

Matt Harvey

I would argue that the reason why Matt Harvey is having a problem with Thoracic Outlet Syndrome or TOS is because of the height of his pitching arm side elbow when his front foot plants and his shoulders start to rotate.

Matt Harvey

There's no (good) reason to teach pitchers to get their elbows up at foot plant, because it has nothing to do with arm slot and the ability to stay on top of the ball.

David Price

David Price's pitching arm side elbow is below the level of his shoulders at foot plant and he's been both dominant and durable.

Justin Verlander

Justin Verlander also had a fabulous year and, at foot plant, his pitching arm side elbow is just below the level of his shoulders.