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