Photo Courtesy Cathy T via flickr

Press Box Perspective: Liaisons with ligaments

The Tommy John Surgery epidemic in the MLB and what it means.

By Peter Melling /// Sports Editor

Something alarming has taken shape in Major League Baseball. The number of pitchers

requiring the Tommy John Surgery has risen dramatically. The Tommy John Surgery, originally

performed by Dr. Frank Jobe on pitcher Tommy John, is a procedure that treats a tear in the ulnar

collateral ligament (UCL) caused while playing by replacing a section of it with a tendon from

elsewhere in the body. This procedure takes pitchers out for the rest of the season, as it requires

lengthy rehab to get the arm healthy enough to pitch again. According to Jon Roegele’s database,

in the first two months of the season (April and May), 28 pitchers have had to undergo the

procedure. Compare that to last year’s total over the first two months, 17. It is not just no-name

hurlers going under the knife either, but well-known pitchers like Miami’s Jose Fernandez (2013

NL Rookie of the Year) and Atlanta’s Kris Medlen. What could be causing this surprising surge

in Tommy John Surgeries?

The Hard Toss

One of the most obvious reasons for this rapid increase of surgeries could be a shift in pitchers’

mechanics. Over the last decade, velocity has become one of the most important qualities for

pitchers. Teams want guys who can throw at incredibly high velocities, especially pitches like

the fastball and slider. Players like these have become the backbone of many rotations and

bullpens, throwing harder than ever before. The pitching motion naturally places stress on the

elbow, with the UCL bearing most of the brunt. When the amount of energy placed in a pitch

increases, the UCL weakens to the point of a tear.

Teams have tried to accommodate for this by imposing pitch count limits on their starting

pitchers, especially during recovery from injuries (i.e. Washington’s Stephen Strasburg had an

innings limit placed on him in the season following his Tommy John Surgery in 2011). The

pitch count limits/inning limits do help alleviate some of the problem, but shifting away from the

harder style with minor tweaks to delivery and mechanics are probably the best way to guarantee

a pitcher’s successful recovery from the operation. Advanced medical technology has also

increased the amount of pitchers that receive the surgery, whereas in previous years, the injuries

would have been ignored until the situation for the pitcher’s arm became more dire. It would take

a noticeable cultural shift amongst organizations to discourage the harder style, but the problem

does not start within the MLB and the minor leagues.

Problems in Youth Baseball

While the competition level in youth baseball has become significantly more intense. The

best teenage pitchers receive coaching that pushes them to rapidly develop their best stuff at a

young age and constantly perform at a high level. While this may not be so bad if the kids have

time away from pitching, many of these young pitchers pitch for 12 months a year in leagues,

practices, and conditioning sessions with coaches, and across multiple teams (summer leagues,

high school teams, etc.). This drive to “pitch harder” has convinced many parents and coaches

that limits on use are irrelevant, and that the only way to further their kids’ careers is make

the kids dedicate all their time to pitching and pushing their bodies to the limit. This culture

of hard pitching is not conductive to the development of healthy pitching arms, even leading

to the occurrence of Tommy John Surgery amongst college-level players. This epidemic has

been brewing for some time amongst all levels of the sport, and these recent cases have sparked

interest in fixing this problem.

Is there a fix?

Well, there is and there isn’t. UCL tears will always happen with pitchers, and no advancement

in medical technology can prevent all UCL issues (even though regular examinations could lead

to a way to alleviate the problem before it becomes a significant issue for the player). However,

the best way to stop the epidemic is through a significant culture shift amongst youth leagues

and the major leagues. At the youth level, impose stronger limits on the use of pitchers and

discourage outside activities that involve pitching (i.e. 12-month pitch conditioning). Amongst

the higher levels, ease pitchers into a harder style. If it becomes obvious that the harder style is

causing problems for the pitcher, assist them in shifting their mechanics away from speed and

towards such things as location and offspeed pitches. While a culture change like that is unlikely

to happen entirely, even gradual change can slow the epidemic down to a crawl, and restore

some health in pitchers’ arms.

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