56.7% of Tommy John Surgeries Now Performed on Teens 15-19

YIKES!!

This may not be shocking.

 

The group of baseball players aged 15-19 encompasses nearly all high school varsity players, many college freshman, and nearly all hard throwing pitchers with bad mechanics and poorly conditioned bodies.  

 

They probably outnumber college and pro players older than 19 by at least 10 to one.  

 

I'd have guessed a number higher than 56%

 

(My reckoning assumes minimal numbers of surgeries before age 15 and among rec players older than 19.)

 

 

TJ surgery cause debate to start in 3....2....1

You should let people know what its like to rehab and recover from TJS, as a professional, who would ever really want to go through that as an amateur is beyond my comprehension.

 

Folks, 

Pay attention to  the part about research numbers suggesting that young athletes believe having UCLR surgery may (the key word here) might get them a better scholarship or to MLB someday.

They left out something very important. Its the PARENT who decides that their minor child will have major surgery.

Also about the need to "evaluate further to help prevent overuse injuries in kids from the beginning of the season when most issues arise". 

 

The mindset I get from many is, its ok what you do when you as a youth pitcher because he can have surgery when his ligament or shoulder fails.  This is on the parent.

 

JMO

Why is this shocking?  Who else would be getting TJ?

 

There are only a few MLB players.  The rest are youngsters.

 

Just a thought....

 

but it seems that year over year, young folks are having more and more arm care issues.  Meanwhile, year over year, the rules regarding pitch counts and overuse are getting more and more stringent.  It doesn't make any sense.  There should be a widening of the gap between use and injury.  All of this suggests to me that a counterintuitive view might be in order.  Maybe the issue is not that kids throw too much, but perhaps that they don't throw enough.  I know that there are plenty of old timers who subscribe to this view.  And to be clear, I am generalizing.

 

 

Don't buy into the "don't throw enough" argument.  I suggest that much has to do with the intensity with which each pitch is thrown.  Explosiveness, aggressiveness, throwing as hard as possible, getting everything into a pitch and making each pitch count seem to me to be the foundation for UCL's failing over shorter periods of time.  These factors are not, or have not, or are not able to be measured in an objective way yet for any individual pitcher.

The problem is a logic one. You can't look at the number of kids having surgery and relate that to injury rates. It's possible that injury rates might be up, but this stat only proves that SURGERIES are up. The two are not necessarily logically related. For example, artificial heart replacements are WAY up, but this doesn't mean heart disease is on the rise, it simply means that many more patients are taking advantage of the advancements in technology. Same here. The fact that there are more TJ surgeries only proves that there are more TJ surgeries being done - nothing more and nothing less.

It makes complete sense.  The pitch recommendations are made in a vacuum.  

The other side of the issue is lack of preparation.  

Every year I see the same thing.  Kids (high school age) who are completely unprepared physically to pitch ending up with sore/dead arms and being put on the shelf.  It becomes a self fulfilling cycle.  Sore/tired arm, rest.  Happens again, more rest.  On and on.  

Pitch limits are good things and need to be enforced.  However, pitch limits really only speak to pitching not throwing and certainly not prep work.  

In my opinion by the time a kid is a mid teenager (15-17) and if he is going to be serious about pitching he should be on a year round throwing program.  Breaks can be built into that if he needs, but, consistent throwing really should be a priority.  

Kids playing year round travel ball etc is part of the problem.  I have seen many teams that tout "throwing programs" and "arm care and health" being a priority pull guys from the infield or outfield to come pitch in games.  So, a guy gets 8 warm up throws and thats it?  How can a team/coach that cannot even give a player a proper warm up be believed about arm care?  The other end of the spectrum are kids that play 3 or 4 other sports.  So, they have a week to get ready for their baseball season, play the season and then move onto the next sport.  They dust their glove off for 3 months a year and thats it.

Both situations can lead to a lack of preparation and problems.  

The idea that more rest and more time away from the activity of the sport (I am talking about throwing and not pitching form a mound) is somehow going to protect kids from injury is just silly.  There needs to be balance.  Using recommendations that are set for pro pitchers, again, in most cases won't apply.  Four months contiguous rest for a 15 year old who pitched 22 innings of middling velocity over the summer? No need.  A pro guy who threw 180 innings of high stress, high velocity baseball? Yes. 

Over use is a problem.  Under training is just as much a culprit as over use.  The rest aspect is easy, so, it gets a lot of talk.  At some point however, there needs to be more done.  Doing nothing (rest) is not doing something. 

I know of several kids in this age range who have gotten sore arms.  Their coaches had them rest, not pitch.  So, they went a season without pitching.  Next season comes around and they run into the same issue....again, rest.  The missing piece is what is happening between the sore arms and the next season which generally is next to nothing. 

Rest, recovery, arm care, throwing, physical preparation....there needs to be a balance of all of these things.  Other wise you end up with what may be going on now.  

^^^ +++ 

When I played high school ball in the early 80s I wonder what the injury rate was for pitchers?  There was no TJ surgery widely available but we definitely had no fall ball leagues and summer league consisted of making the local legion team.  For most players you didn't play baseball from June to February.

True enough.  

Guys also were probably not "specializing" in one sport at a young age.  Most guys who enjoyed sports played multiple sports, which is a good thing.  The injury rate is hard to know.  I think guys lost control and velocity and many probably went undiagnosed.  The old terms of "dead arm" or "he threw his arm out" covered a lot of ground.  

not having access to the " PearlDiver Supercomputer to identify UCLR procedures" 

are they saying that the total amount of surgeries performed in that 4 year span were less than 700?

 

If so if there were "only 400" TJ surgeries performed on ages 15-19,( based on the articles %'s) is that an epidemic?  How many thousands of youth pitchers are in that age group.  Even with the best of training and arm care precautions injuries are going to happen. Are these numbers that out of control?

 

I don't mean to trivialize the #'s or the injury,  but just trying to get a feel for the total number of procedures done.

 

 

 

 

 

I saw it stating that the information was used from a single insurance provider.  

Who knows the actual number.  I am sure the number is going up. 

What constitutes an epidemic?  Who knows.  Remember much of the focus on this is coming from the top down in terms of its origins.  A lot of attention from MLB orgs regarding this because of hundreds of millions spent on guys missing time.  

My son has had three injuries since he started playing baseball in high school.  One was an elbow injury (happened while skiing) one was a dislocated finger on his throwing hand (done while shagging fly balls) and one was an misdiagnosed back injury while he was playing ball at college.  Now a transcript of would read something like, a pitcher with two injuries that caused missed time.  One elbow and one finger.  However, the only injury that was caused by playing baseball went misdiagnosed while he was at college.  His performance suffered and he was cut.  But, the school has no documentation of the injury because it was not diagnosed.  

My point is not about my son, but, rather injury rates and reporting can be shaky at best. Using medical facility records and insurance info is the best but causation is left wide open.  This study included girls as well.  

Not really a surprise.  College coaches and scouts don't look for young men that can pitch.  They look for young men that throw hard.  Young men know this so they train and train and train to throw hard with very little attention being paid to HOW to throw properly.  The system is set to reward the flamethrower.

Agree with roothog66 though.  More surgeries doesn't necessarily mean more injuries.  There are probably just more doctors who are willing to do the surgery now.  It used to just be Dr. Andrews.

The numbers are up due to the frequency of TJ surgery now. A valuable statistic would be the percentage of 15-19yos having TJ surgery now versus 5,10,15, 20 years ago. I'm willing to guess the current percentage is higher than 15-20 years ago. There seems to be more overzealous parents, more travel teams and more academies now. more kids are pitching more frequently.

 

I'm not blaming travel ball and training academies. They just present an opportunity that can be used or abused based on proper judgement.

Agree. Has anyone here known a pitcher who needed TJ -- who didn't throw hard?

I agree with jp. Unfortunately, the hardest throwers are the TJ candidates. Dr Andrews explained to me that any pitch over 85 had the potential to tear the UCL. That will include a very large number of young pitchers in that 15-19 group.

 At least with Travel Teams players get a chance to learn about arm care, this seems to be missing in rec teams playing for dad and Uncle Jack who wants to win the local league.

Agree 100% regarding preparation. My 2015's high school team wanted him to relieve this year. I told him, no prep work, no pitching. The problem is that many kids don't know how to prepare, and many more are not willing to put in the work. For those kids I say, don't pitch.

This is the most definitive statement about this injury I've ever read (but I'm not well-read on TJ).

 

Wouldn't this dispel a whole lot of other suggested causes? Like breaking pitches at a young age, overuse, lack of preparation, etc.? The way I read this, virtually no pitcher who tops out in the low 80s will tear his UCL.

 

Of course, for pitchers who throw hard, overuse, lack of warmup, etc. might contribute -- but it seems that it's the very act of THROWING HARD that puts pitchers at risk.

Gatornate,

 

Why do you suppose those college coaches and scouts don't look for kids that can pitch?

 

Maybe they are looking for those flame throwers who can also pitch.  Or maybe they believe they can teach the flame thrower how to pitch.

 

There is never just one thing college coaches and scouts consider when placing a value on a pitcher. After all, would you rather have a great arm and a bad pitcher or a great arm and a great pitcher?

 

Now if we are comparing a poor arm but good pitcher to a great arm but poor pitcher, which would you pick?   For tomorrow's game you might take the poor arm, good pitcher But who would you rather have in the future?

 

There are great pitchers that throw below average velocity.  There are great players with below average tools.  But that player with plus tools will normally have the higher ceiling with development.

Something to consider,  there are some non pitchers getting TJ surgery. Though it is a small percentage.

These are exactly the kind of statements from Andrews that drive me crazy. he is an accomplished surgeon and very knowledgeable in that area, but then he'll make blanket statements like this based on nothing but speculation and we eat it up based on his credentials. 85? Why not 83 or 87? Is this number based on physiological research concerning the stress levels at which the ucl sustains measurable damage? Other fields don't throw around such speculation. A construction engineer doesn't say a particular beam will fail at xx pounds per square inch based on...ehh, my best guess as an expert. No. We'd expect something to back that up if we were going to make decisions based on that advice. 

Worse is the way that cold weather states handle high school practice dates. They don't allow practice until a particular date which is usually very close to the start of the season. Many pitchers in states like mine (Colorado) don't pick up a baseball until baseball practice starts and then are expected to go out and throw full force within a couple of weeks in under 30 degree weather.

Root, it actually was based on physiological stress levels that the typical UCL can withstand. I did not take the statement as 85 will rupture the UCL but 84 will not. He said the ligament can only withstand "x" amount of force and that equated to around 85 mph. I cannot remember the exact conversation as it occurred almost 5 years ago. I can assure you that James Andrews is the foremost authority on this subject and he is focused on prevention instead of treatment. Even he admits that he doesn't know why the UCL breaks down in every situation. He does believe that overuse is a big culprit as well as pitching while fatigued. I do not want to speak for Dr Andrews. I was just trying to relay what I took from our conversation. Hard throwers are the ones at risk, not the other end of the spectrum. I have never read a single instance of a kid topping out in the low 80s that tore their UCL. It could have happened or may happen in the future, I just haven't heard about it.

Even more of a situation where the player/parent has to be their own advocate and make sure they are prepared to throw.  

The coaching isn't good if they are expecting kids to go full bore after doing nothing.

But it is on the kids/parents if the kid hasn't picked up a baseball until team practice starts.  

Good point.  I guess my point wasn't real clear.  I'm not trying to talk about colleges coaches/scouts.  My point was more an indictment of the current state of the game.  Certainly there are flamethrowers that CAN pitch.  My point was more that it shouldn't surprise us that more TJ surgeries/injuries are occurring in 15-19 year olds because they know throwing hard is more likely to get the scholarship than becoming a pitcher.  I believe that a college would pick a kid throwing 86-88 who was wild (and try to teach him better mechanics) rather than a kid throwing 81-83 who hits spots/changes speeds exceptionally well.  I would do the same.

Andrews has pretty much a standard presentation that he has been given for 10 years or more.  These are some of the numbers he usually recites:

 

1.  Kids that throw over 80 mph are 200% more likely to be injured than kids who throw less than 80 mph.  I have never heard him specify the type of injuries, be they elbow or shoulder injuries.  Nor have I heard him specify how much throwing 85 or 90 versus 80 increases the risk, but it stands to reason that it does.  So, for those of you who don't think that overuse is an issue, you are correct that just throwing harder increasing the risk of injury.

 

2.   Kids that throw more than 80 pitches per game are 380% more likely to sustain injury than those who throw less than 80 pitches.   For you pitch count haters, that's right, 80 pitches, not 100. 

 

3.  Kids that pitch competitively for more than 8 mos. per year are 500% more likely to suffer injury.  Think about that as you make your fall ball plans.

 

4.  Kids who pitch while fatigued are 3600% more likely to suffer injury.  Think about that the next time you move a kid from catcher to pitcher, or throw him on back to back days.

 

It all comes down to what kind of risk you are willing to accept.  If you are convinced, based on no evidence other than your own intuition, that your kid has the genetics of a Nolan Ryan or a Satchel Paige, by all means, throw him until he drops.  Or, if you trust a travel ball coach who doesn't know a UCL from an LCL, or some internet guru working out of his mom's basement, more than the foremost orthopedic on the planet, go ahead and let Junior pitch as much as possible.  It's a free country.   

 

Are the opinions of Andrews, Kremchek, ElAttrache, and virtually every orthopedic on the planet totally flawless?  Of course not. Some of these opinions will undoubtedly change over time.  But, for now, they're the best we've got. 

Not the case really. Anyone can put together a "Travel Team" including dads. many coaches out there that can manage a team, make a lineup but have no experience in developing P arms. 

       
       

I read an ASMI report a while back that said they learned how much force a UCL can take by testing the UCL of cadavers. They literally stressed them to the point of rupture. They have also done studies with whatever measurement devices they can put on a pitcher that measures the amount of stress that a pitch puts on the elbow. I believe what they found is when a pitcher throws 85mph, it produces the same amount of force on the elbow as what the cadaver UCL ruptured. That's a layman's interpretation of the report. The actual scientific findings were much more specific. I have looked a couple times recently for that report, but haven't been able to dig it up.

When Dr. Andrews throws out those numbers, it is from scientific research, it's not just something he threw out there off the top of his head.

Assuming that is true (and, honestly it does sound vaguely familiar to me - I'll have to look at my collection of ASMI studies), then that's a horse of a different color.

Actually, I remember now where that 85 came from. They did test ucl's on cadavers. If I remember right, they found that, theoretically, the normal ucl should tear with those forces almost immediately. It actually stumped them as to how guys can throw 90+ at all. Their research tended to conclude that it should be theoretically impossible. I'll have to find that.

One hiccup, though is that if we accept that velocity is the major factor, then we have to accept that there is little we can do about the problem.

Well, when you put it like that...

It is my understanding that the muscles in the forearm will somewhat protect and take on some of the stress put on the UCL. Obviously, you can't get a UCL "in pitching shape". A UCL cannot get fatigued. So, when we talk about these things, I think we're talking about he muscle groups around the UCL which help take some of the load off. So, while there is only so much force a UCL can take ( and I would think that some can take more than others, genetically), strengthening those muscle groups surrounding the elbow and in the forearm in particular, can help. Maybe I'm wrong, but it would make sense.

No, you're not wrong. It makes perfect sense. In fact, I develop my whole pitching program for my students around the assumption that it is correct.

The one thing often over looked in all of the TJ talk is that large number of pitchers that never had TJ surgery.  That is the survey or study that I don't believe anyone has done yet.  If we can figure out that a certain velocity (in this case 85mph) is a problem. Then we need to study those thousands and thousands of pitchers that throw 85 or higher yet have never had a UCL problem.  What did they do, were they over used, how much time did they take off, how many pitches did they throw, did they play travel ball, etc.?

 

I'm not very smart, but it seems like we need to study both those that received surgery and those that didn't in order to get a clearer picture of things.

 

We have actually done a partial study based on all pitchers we have in the database.  It includes MLB pitchers like Greinke, Kershaw, Gray, Cole, Bumgarner, and many of the best pitchers in baseball.  It also includes MLB pitchers like Jose Fernandez and others who have had TJ surgery. All these guys obviously throw much more than 85mph.  Bumgarner arguably was over used last year, especially in the World Series. Some pitch from February to November.  Some pitch on winter ball.  How has their UCL stood up to all of that, so far?  Do they have something or done something extremely important in common?  If so, wouldn't we want to know what that might be?