The MLB’s Newest Health Crisis: A Rise in Tommy John Surgeries

AP Photo/Jeff Roberson

You may have noticed that in the past few years, there has appeared to be a rise in the number of pitcher injuries that require the infamous “Tommy John” surgery.

You aren’t the only one who’s picked up on it.

New York Mets pitcher Matt Harvey underwent Tommy John surgery on Oct. 22. (AP Photo/Jeff Roberson)
New York Mets pitcher Matt Harvey underwent Tommy John surgery on Oct. 22. (AP Photo/Jeff Roberson)

On Wednesday, the American Sports Medicine Institute published a document outlining their most recent findings, through research, about the injuries. The article also offers recommendations for keeping youth and professional pitchers healthy.

It happens so often enough nowadays that it might be the injury you think of when you see a pitcher wince and grab at their throwing arm, and if it does require Tommy John surgery, you worry if the pitcher will ever be the same.

The injury itself involves a complete ulnar collateral ligament reconstruction done through surgery, and the recovery time is generally considered to be about a year.

The report was published by Dr. James Andrews, one the sports world’s most well-known orthopedic surgeons, and it also featured the research of Dr. Glenn Fleisig.

This infogram shows the number of UCL tear (Tommy John) injuries that have occurred in the major leagues over the past ten seasons.

As you can see on the data, the number of injuries has been gradually growing, including a major take-off in 2012. The numbers for 2014 are just through the season up until this point, so if any more injuries occur, 2014 could mirror 2012.

More than a dozen major league pitchers have needed Tommy John surgery this year. NL Rookie of the Year Jose Fernandez is among others headed to elbow ligament-replacement surgery. (AP Photo/File)
More than a dozen major league pitchers have needed Tommy John surgery this year. NL Rookie of the Year Jose Fernandez is among others headed to elbow ligament-replacement surgery. (AP Photo/File)

Some of the most notable names getting pinched with the injury bug are 2013 NL Rookie of the Year winner and Miami Marlins pitcher Jose Fernandez, Tampa Bay Rays pitcher Matt Moore, New York Mets pitcher Matt Harvey, Washington Nationals pitcher Steven Strasburg, New York Yankees pitcher Ivan Nova, and Boston Red Sox pitcher John Lackey.

Some misconceptions about the injury, according to the report, are often the following:

“Pitchers should get Tommy John surgery over with as soon as possible, as they will be better and throw harder after the surgery.”

This is not the case, as the report states: “While there may be instances of pitchers throwing faster after returning from Tommy John surgery, this was due to the surgeon fixing the problem followed by the pitcher working intensely with the physical therapist, athletic trainer, strength coach, and pitching coach.  However, performance usually decreases over time for MLB pitchers after Tommy John surgery (similar to the typical decrease over time for healthy MLB pitchers).”

The biggest risk factor for elbow injuries in young pitchers is the curveball.”

Also incorrect. “Too much competitive pitching and pitching while fatigued are the biggest risk factors. The first steps (for mechanics) should be to learn, in order: 1) basic throwing, 2) fastball pitching, 3) change-up pitching.

“Lowering or eliminating the mound would reduce the stress on the elbow and reduce the number of UCL injuries.”

Again, wrong. “Elbow torques during full-effort pitching on a mound and full-effort throwing on flat ground are about the same. The real solution is for young pitchers to do less full-effort pitching and more throwing (practice throws, playing other positions, playing other sports).”

So, with the popular myths debunked by the researchers, what do they recommend to reduce the risks of developing a UCL tear?
  • “Do not always pitch with 100% effort. The best professional pitchers pitch with a range of ball velocity, good ball movement, good control, and consistent mechanics among their pitches.” Essentially, what the doctors are warning the youth of here is that young pitchers should not be trying to light up the radar gun, and instead be focused on proper mechanics.
  • “Open communication between a pitcher and the professional coaching and medical staff is paramount. The pitcher’s elbow and body are living tissue. Pitching and training create small tears in the tissue; rest, nutrition, and hydration repair the tears. A pitcher and his team should have a plan, but that plan needs to be monitored and sometimes adjusted depending on how the pitcher feels. Specifically, the pitcher should keep his trainer or coach up to date about any soreness, stiffness, and pain.” The pitcher’s elbow and body are a living and active tissue, and necessary healing time and proper attention paid to care of the elbow needs to be included in baseball activities. Keep a close eye on anything abnormal in your arm.
  • “The pitching coach needs to watch for signs of fatigue on the mound. This could be seen in-game as well as in bullpen sessions.” Coaches need to take as much responsibility as the pitcher of preventing an overworked arm.
  • “Be wary of pitching in winter league baseball. The UCL and body need time to recover and build strength, so the concept of annual periodization should include adequate rest from full-effort pitching.” Young pitchers shouldn’t overwork themselves by pitching full-force out of season. Rest and proper healing are key to reduce the risks of a serious injury.
  • “Performance-Enhancing Drugs (PEDs) may enable the athlete to achieve disproportionately strong muscles that overwhelm the UCL and lead to injury.” This situation speaks for itself, simply because players shouldn’t be taking PED’s anyways, but the cons surely outweigh the pros when it comes to using banned substances.

While the ASMI’s research gives solid suggestions for reducing the risks, it can’t promise that this new research will be able to prevent these injuries entirely. It is up to the players and coaches to make sensible decisions about training and game action. Heed these warnings, and make smart decisions while playing the game.

Even with professional training by world class trainers, Tommy John surgeries have become a noticeable issue in the majors. If these steps are followed from even basic level youth pitching, you can greatly reduce the risk of going under the knife. Here’s to seeing if this report can help ease the pain.

READ: Entire document released by the ASMI

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