With the likes of Matt Harvey, Jose Fernandez and numerous other pitchers undergoing Tommy John surgery just this year already, there has been plenty of talk about the surgery and why it keeps happening.
In response to the sharp rise in Tommy John surgeries, Dr. James Andrews, one of the world’s leading surgeons, released a paper discussing the injury that causes the surgery to be necessary, and how to prevent it.
During the past few years there has been an “epidemic” rise in the number of professional pitchers requiring ulnar collateral ligament reconstruction (“Tommy John surgery”).1 This is like déjà vu, as a similar sharp rise was seen in adolescent pitchers near the turn of the century.2,3 These two rises are indeed connected; that is, today’s pro pitcher in his 20’s was an adolescent pitcher a dozen years ago. Thus in many cases, the injury leading to Tommy John surgery in today’s young pro pitchers actually began while they were adolescent amateurs. Observations by orthopaedic surgeons support this link, as the torn ulnar collateral ligament (UCL) in a pro pitcher usually looks like it has worn out over time.
He also took the time to debunk some common myths about the procedure and what causes it.
“The biggest risk factor for elbow injuries in young pitchers is the curveball.”
Not true. Too much competitive pitching and pitching while fatigued are the biggest risk factors.4,5,6 While biomechanical research8,9,10 and epidemiologic research4,6 have not shown a strong connection between curveball and elbow injuries, a youth pitcher may not have enough physical maturity, neuromuscular control, and proper coaching instruction to throw a curveball with good mechanics. The first steps should be to learn, in order: 1) basic throwing, 2) fastball pitching, 3) change-up pitching.
Finally, Andrews gave some recommendations on how to prevent the surgery from being necessary.
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. The professional pitcher’s objectives are to prevent baserunners and runs, not to light up the radar gun.
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.
Andrews knows his stuff, so hopefully this information will start to become common knowledge–especially at youth levels, where there is usually not the same kind of coaching and medical care available.