Cora NelsonPaul Skenes' 97 mph Fastball in 2026: What a Hall of Famer's Tommy John Warning Really Means
Paul Skenes is the best pitcher in baseball right now, and almost everyone agrees on that. Through his first nine starts of the 2026 season, the Pittsburgh Pirates ace is posting a 2.20 ERA, a 29.3 percent strikeout rate, and a 97.2 mph average fastball — nearly throwing a no-hitter against the Colorado Rockies on May 12. But Hall of Fame pitcher John Smoltz is sounding a different kind of alarm: he has publicly urged the Pirates to protect Skenes' arm, warning about the risk of Tommy John surgery. As Skenes' workload climbs steeply year over year, sports medicine doctors are paying close attention.
The Workload Ramp-Up That Has Experts Worried
In 2024, Skenes threw 133 innings in his first major league season. In 2025, that number jumped to 187 innings. His 2026 workload trajectory projects past 210 innings — a 58 percent increase over two seasons. For a pitcher with electric velocity and a mechanically flagged delivery, that ramp-up is precisely the kind of pattern that precedes ulnar collateral ligament (UCL) injuries in the pitching elbow.
Smoltz, who underwent Tommy John surgery himself in 2000 and returned to win a Cy Young Award, put it plainly: "I'm never a fan of" sharp workload increases for young power pitchers. His concern echoed widely in baseball medical and scouting circles.
Skenes also has a noted mechanical quirk: he raises his right elbow above the shoulder plane before reaching his loaded throwing position. While analysts note he is generally "on time" mechanically — a protective factor — that elevated elbow position places additional stress on the UCL under high-velocity conditions. Over hundreds of pitches across a long season, those marginal stresses accumulate.
What Is Tommy John Surgery, and Why Does It Matter?
Ulnar collateral ligament reconstruction — known universally as Tommy John surgery after the Los Angeles Dodgers pitcher who first underwent the procedure in 1974 — involves replacing the UCL in the elbow with a tendon graft from elsewhere in the body. The surgery has become routine in professional baseball, with recovery times typically ranging from 12 to 18 months, and sometimes longer for pitchers returning to full velocity.
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), repetitive overhead throwing motions are among the leading causes of elbow ligament injuries in athletes. The risk factors include high pitch velocity, heavy workloads, pitching year-round without adequate rest, and mechanical patterns that place excessive valgus stress on the elbow during the acceleration phase of throwing.
For Paul Skenes, several of those factors converge: elite velocity, an aggressive workload increase, and a mechanical pattern that analysts continue to watch closely.
Why Young Elite Athletes Are Particularly Vulnerable
The paradox of being a young power pitcher is that the attributes that make you dominant are exactly the ones that put you at risk. High fastball velocity correlates directly with UCL stress. The harder you throw, the greater the force your elbow must absorb on every pitch.
Research on pitching injuries consistently shows that the combination of age, velocity, and rapid workload increases creates a predictive profile for UCL injury. Pitchers who throw harder than 95 mph and who increase their innings by more than 30 percent in a single season are substantially more likely to require surgery than their peers. Skenes checks all three boxes.
The Pirates' medical staff is aware of this calculus, and they have managed Skenes' rest carefully. But the competitive pressure of a playoff-contending team — and Skenes' own desire to pitch — makes conservative workload management a constant negotiation.
What Athletes and Families Should Know About Arm Health
For young baseball players who idolize pitchers like Skenes, the lesson is this: elite performance at the major league level is the product of years of careful arm development, and that development is fragile. Sports medicine physicians who specialize in pitching biomechanics recommend several protective strategies:
Year-round rest periods matter. The UCL needs recovery time. Playing multiple sports in the off-season or pitching on a travel team immediately after a demanding school season dramatically increases injury risk.
Velocity is not free. Throwing 90-plus mph at 16 years old may help a player get recruited, but it also puts the UCL under stresses that undeveloped adolescent tissue cannot always tolerate. Gradual velocity development — aligned with physical maturity — is safer than maximizing velocity early.
Mechanics are worth investing in. A qualified pitching coach or biomechanics specialist can identify mechanical patterns that increase UCL load, often before an injury occurs. For young pitchers showing the kind of elbow position Skenes is known for, early mechanical assessment can make a meaningful difference.
Pain is a signal, not a badge of honor. Elbow pain during or after pitching — especially medial elbow pain on the inside of the joint — is a warning sign. Continuing to pitch through UCL discomfort accelerates the timeline to surgery. An orthopedic sports medicine specialist can evaluate elbow health with imaging before a partial tear becomes a complete rupture.
When to See a Doctor About Pitching-Related Elbow Pain
Any pitcher experiencing medial elbow pain that persists between outings, reduced velocity without illness or fatigue as a clear explanation, or a sudden sharp pain during a throw should stop pitching immediately and seek evaluation. A sports medicine physician can order an MRI or ultrasound to assess UCL integrity and recommend whether continued pitching, rest, physical therapy, or surgical consultation is appropriate.
Paul Skenes is not the only young pitcher navigating this risk. The question of how to protect elite throwing arms — at the major league level and far below it — is one of the most important in sports medicine right now. For athletes and parents navigating these decisions, early consultation with a sports medicine specialist is not a sign of weakness. It is the most effective prevention tool available.
Disclaimer: This article provides general health information only and does not constitute medical advice. If you or an athlete you care for is experiencing elbow pain or arm discomfort, consult a qualified sports medicine physician.
