More not always better: Tommy John surgery effects ruining young pitchers

The three most devastating words in baseball, and perhaps sports as a whole, continues its spike over recent years in alarming frequency. Pitchers are getting injured an increasing rate of 10% and at younger ages, between 9-18 years old, which commences with someone uttering the three words that can ruin their careers:

Tommy John surgery.

Named after the first MLB player to ever undergo the procedure, Tommy John surgery first developed in 1974 by Dr. Frank Jobe and essentially reconstructs the ulnar collateral ligament, or UCL. At the time, a torn UCL held responsibility for the term “dead arm injury,” and Jobe’s personal expectations put the odds for John’s complete recovery at 1 in 100. John spent 18 months in rehabilitation and continued to pitch for another 13 years.

Present day, the success rate of these surgeries ranges from around 85%-90%, a drastic improvement from Jobe’s initial odds, and recovery lasts anywhere from ten to 18 months. However, if a player requires a second surgery, their success rates plummets to 33% (75% for MLB pitchers).

According to Baseball Reference, an average of 16 MLB pitchers per season underwent Tommy John surgery during the 2000s. 2012 marked a record year for the surgery, resulting in 36, with 25 in 2013 and 30 in both 2014 and 2015. 11 pitchers have torn their UCL’s so far in 2016. In 2014, an estimated one-third of all pitchers in the MLB required the procedure at least once in their careers.

Injury rates continue to increase at a dangerous level, and not only for Major League pitchers. Torn UCLs’ prevalence continues to rise for teenagers and college students as well, where success rates prove not nearly as high.

Dr. James Andrews, the most trusted orthopedic surgeon in sports, reported that 25%-30% of teenagers who underwent the procedure do not play baseball competitively just two years later.

Andrews and his colleague Glenn Fleisig reported in 2000 that they sent 17 youth or high school pitchers under the knife for Tommy John surgery, good for 18% of all the treatments they performed. Ten years later, Andrews reported 41 surgeries performed on the same demographic, resulting in 31% of their personal procedures for the year.

Although an exact reason does not exist for this increased trend in torn UCLs, NC’s baseball coach, Tom Callahan, theorizes his beliefs.

“Blaming summer ball seems to be kind of the go-to response,” Callahan said. “Kids specializing in one sport and literally throwing ten, 11 months out of the year. And I understand that, but I think there’s more to it than just that. When [kids] throw, they’re always throwing max effort, and that’s gonna put additional strain on the arm. You look at average velocity from kids getting drafted out of high school, they’ve gone up dramatically in the last eight or ten years. Kids are getting stronger, but they’re also putting more and more stress on their arm by trying to get a radar gun rating.”

Proper mechanics also determine the likeliness for a torn UCL. The release point for pitches, arm extension, and pitch type, along with other variables, can affect injury probability.

“We rely on the player’s feedback and his feedback is gonna be important but it’s more what we see,” Callahan said. “The mechanics impacted, and part of it is conditioning, not just arm strength, but about lower body conditioning, core work, so their mechanics don’t suffer as they fatigue. Obviously fatigue is gonna be a part of throwing 110 pitches, but we try and delay that fatigue as long as possible by being physically fit.”

With an increased emphasis on lighting up the radar gun, more pitchers spend time focusing on strength and weight lifting rather than flexibility and overall fitness. Take pitcher Jake Arrieta, for example. Arrieta, the 2015 NL Cy Young award winner, credits pilates for his newfound success in the MLB. Pilates targets the body’s core, legs, and glutes, not arms. WebMD also describes pilates as “low-impact” as “you’ll engage your muscles in a strong but gentle way.”

Along with benefitting from flexibility and core, allowing a pitcher to lower the strain on their arm and instead dividing the workload evenly throughout the body, the exercise also works with a pitching component as, if not more, valuable: the mind.

Dr. Melinda Ratini states, “[pilates] also has a strong mind/body connection, so you may like it if you enjoy yoga but need a more intense core workout.”

Although pitch and inning counts play major roles in preserving a pitcher, high-stress situations can also contribute significantly. A pitcher throwing 100 pitches  without allowing hits or runs may feel less fatigued than the same pitcher throwing 80 pitches in several runners-on-base situations, due to their mental state and the amount of maximum effort pitches thrown.

Elite pitchers can usually avoid several high-stress innings, but most cannot, meaning they must pay more attention to pitch and innings limits. This means that players may switch from strikeout power pitchers to ones whom induce soft contact.

“If you look at guys that are high-strikeout pitchers and they go deeper into counts on every batter, so one of those things about learning to pitch is pitching to contact, especially early in a ballgame,” Callahan said. “A one-pitch groundout is better than a five-pitch strikeout.”

Pitchers can find trouble adjusting to allowing contact, as they can often miss their spots or lose velocity on pitches. The best pitcher in the AL this season, Chris Sale, changed his style from a power strikeout pitcher to inducing ground balls and trusting his defense, and the results are startling.

Sale paces to average the most innings pitched per nine innings in his career, while posting a significantly lower strikeout total than the majority of his playing life, while posting the lowest ERA (earned run average) of his career. Even more interesting, Sale’s WHIP (walks hits per innings pitched) is a career low despite putting up a career high in contact rate.

Sale, on pace to pick up his first Cy Young award, struggled with injuries earlier in his career and uses an unnatural delivery that poses a higher risk for shoulder and elbow breakdown. He decided to switch his style to match his ability to spot a baseball in the perfect position to induce weak contact, while others in the same endeavours are not as accurate, instead allowing hard contact and fly balls.

Callahan balances the issue of proper mechanics and personal comfort for his pitchers.

“Proper mechanics are obviously stressed throughout, but there are just some kids that develop a natural style,” Callahan said. “If it puts additional strain on the elbow then we tweak their delivery a little bit, like if they’re flying open or on the side if they tend to drag their elbow, it can cause strain.”

NC lost its top pitcher this season, Tristan Dobbs, for two weeks due to elbow tendinitis. Callahan had to determine the best way for his rehab assignment along with the season’s stake, in the middle of a playoff hunt.

“It’s one of those things where you want to be cautious, because the consequences are pretty severe,” Callahan said.

NC’s Athletic trainer Angie Guggino deals with student athletes and keeps track of their rehab assignments. Callahan immediately sent Dobbs to her for consultation.

“We work with Ms. Angie trying to set up rehab,” Callahan said. “The key is diagnosis and making sure they go to a reputable physician who’s spent some time in sports related injuries as opposed to a pediatrician who’s gonna tell him to take six weeks off and rest it. The rehab is really about rest first and then slowly easing back into it. We’ve got a throwing program with the idea that they can’t just go from zero to 60.”

A substantial problem maintains with such a short high school baseball season. For a majority of baseball players, they play the sport year-round, including summers, resulting in an inability for adequate rest or healing time before the high school season begins.

“You’ve got to take some time and be healed, but the problem is that the baseball season is 12 months a year, what time does that take? We really try and advocate shutting down in early-to-mid fall and basically taking time off until high school season starts again,” Callahan said.

With constant playing, pitchers can wear out their arms quickly. This constitutes mandated pitch and innings limits. With seven innings per game (excluding extra innings with ties), the GHSA (Georgia High School Association) mandates that a pitcher cannot throw more than ten innings in one day or 14 innings over four games. No pitch restriction exists.

This creates a dangerous proposition for both pitchers and coaches. Just last month in Illinois, Genoa-Kingston pitcher Brady Huffman went nine innings and dazzled with 17 strikeouts, but over a whopping 167 pitches.

Callahan provided insight on his personal limits he puts on NC pitchers. He describes the differences between individual players and situations.

“There’s not a pitch count that, for whatever reason 100 pitches has become the umbrella, but some guys tire far before 100 pitches and we just know prior experiences with those guys that 75 to 85 might be the max we get out of them when other guys, might just  because of their musculature are more suited to throw deep in ballgames,” Callahan said. “Obviously you’ve gotta take adrenaline out of the equation because we get geared up in big games and kids want to continue to pitch because the game’s on the line. That’s got to be a factor especially early in the season. We’re not just playing for today, but for the season as a whole.”

However, there maintains a fine line between certain pitchers’ ability to go further into games and pure lack of care for a player’s well being. When a player throws 167 pitches like Huffman, the innings amount matters less, as he essentially pitched two full games.

Huffman’s coach, Roger Butler, quoted with a cringe-worthy line after the game, saying, “Brady is the kind of pitcher that gets better as the game goes on. I’ve worked with Huffman since he was six years old. He told me that he could keep going. I trust him when he says that he has something left.”

Butler’s initial problem stands as the fact that he believes his pitchers will tell him when they need to stop pitching. From a player’s perspective, nobody will tell their coach “Hey, I am tired. You should pull me.” This proves truthful especially when the player performs as well as Huffman did.

Callahan demonstrates a more responsible approach to keeping his pitchers fresh and relates the issue back to the previously mentioned stress and situations, along with an innings count.

“You worry about guys that are successful and throwing deep into every ballgame, because it’s going to take an innings toll on him,” Callahan said. “So I don’t think it’s the number of pitches so much as it is the high-stress innings and innings total.”
This problem of pitchers being overworked does not start even at the high school level, however. It begins in recreational leagues, and although most leagues provide an innings limit of three maximum in one game, these kids continually work during games, practice, with parents, and often with trainers and take lessons to play better, resulting in an inflated workload.

“You start throwing a ton of innings, you’ve got the kids that develop early, and at nine, ten years old, they’re starting pitching for their Little League team, and they’re the go-to guy from there to high school, it’s got to have a cumulative effect on their arm,” Callahan said.

With all of the precautions and increased information and studies on injury rates for younger pitchers, coaches and traines can often attempt to lessen the impact, but families can risk that valuable information becoming overlooked for a variety of reasons, including ignorance or a desire to improve and potentially play professionally.

With MLB pitchers receiving monstrous contracts like Max Scherzer’s 7-year, $210 million, young pitchers and their families try and push for success at any rate so they can one day land deals like that. As recently as last week, former Tommy John surgery recipient Stephen Strasburg signed a $175 million contract, the largest ever for someone who underwent that surgery and for a player that only threw over 200 innings once and records a career ERA of 3.08.

The recent pitcher contract explosion in the MLB influences young, talented pitchers to keep throwing as much as they can to master their craft, but can and does result in blowing out their arms and jeopardizing their professional careers.

So how can teens and the baseball world fix this issue and save their prized possessions? It starts with the outside influences: coaches and parents.

“The pitch limits in Little League are certainly a start in the right direction. The desires for success… you wanna push your kid to succeed and sometimes you push them into the danger zone. You’ve gotta recognize physical limitations. Sometimes more isn’t always better,” Callahan said.