More Tommy John Surgeries

I'd like to know if the premise is true, and if so, this is more rambling than theory...

 

Year round "scientific" training giving bigger, stronger more explosive muscles but ligaments are the same size as 100 years ago? 

 

The cutter (says Dan Duquette)

 

Maybe some of the pitching "mechanics" that are taught are yielding higher velocities, but more strain on the elbow/shoulder ligaments?

 

 

Go44dad, you could be right.  I believe today's athletes are much bigger and stronger than they used to be, but I'm not sure if ligaments and tendons actually get bigger and stronger like the muscles do.  More power and strain, same parts holding the arm together.  I'm not a doctor, so I really couldn't tell you.  I know even MLB and the commentators are talking about how many of them there have been.  

 

What I'm surprised about is more Marshall guys not chirping up about their mechanics.  There have always been two main guys selling the Marshall way and I have not seen either of them on any of the boards I go to.  Not sure if they've given up the ghost or just been banned on all the boards, but I'm surprised there haven't been some I told you so's from that camp.

A lot of this is driven by the expectation of success from the procedure.

 

Decades ago, a career would end over persistent elbow pain.  It happened all the time.

 

Or, a guy who threw hard would reinvent himself as a junk baller to try to prolong his career.

 

A decade ago, more guys opted for the procedure, but many would try to get by with a rehab program designed to strengthen the support system around the elbow.  Some would succeed, some would fail.

 

Now, it seems like people feel the success rate will be higher if you have the surgery and spend a year rehabbing.  Instead of limping along or trying to get by, people are opting to try to regain their best performance levels.  Even less than full tears are now commonly handled with surgery.

 

With MLB average pay now at $4 million and many of those getting surgery earning much, much more, you can see why guys would rather get this done while they are under contract and have to be paid anyway, thereby salvaging their future years -- years in which they might not get paid at all unless they can recover fully.

You also see this more often at the teen level because in the modern era, there are a lot of surgeons with experience in the procedure, and at least 85% of the populace can pay for it via their insurance.

 

Not too long ago, this would've been denied coverage as "experimental" or even "elective."

Following Go44's lead of throwing something out for discussion, does anyone think there is a possibility that part of the reason is as simple as guys are throwing harder a lot more often today than in the past?  Obviously pitchers have always thrown max effort pitches (and guys have always blown out arms), but I wonder if the hyper focus today on pure velocity and the prevalence of radar guns from an early age is a big part of the uptick in these injuries.  When I was In HS in late 70s early 80s and later started coaching 11-12 yo's in 1987 or so, you rarely saw a radar gun... It was a novelty.  You rarely saw one at the small D3 program I was at... Never at practice as I recall.  Can't speak for bigger programs at that time.  Anyway in general I think it's very safe to say that over the past 20-30 years, the radar gun has become much more a part of a pitcher's world... To the point where today's pitcher is being gunned basically at least monthly from the time he's maybe around 11-13 years old and onward.  So in a way, every pitch starts to become a "max effort" pitch starting ever younger... Or if not every pitch, a much greater number of total pitches than in previous times.

 

Put another way, obviously the young Bob Gibsons, Nolan Ryans, and Bob Fellers were blessed with an ability to bring serious heat when they wanted to draw on it. But how often did they have to draw on it early on?  Nobody was teaching these guys to find an extra 5-7mph and having them strive for this day after week after month after year.  My guess is they reached for something extra when they needed it based on competition... and they weren't playing 60-90 games a year.  So I'm suggesting all the usual stuff I guess... "Kids are playing more games...", "guys are bigger and stronger" etc.  But I think the single biggest culprit is probably the radar gun... Too early and too often.  I'm probably just stating the obvious... Just typing out loud.

Has anyone else seen the studies saying that STATIC  STRETCHING can be harmful and cause injuries to tendons/ligaments?  I ve seen so many pitchers warm up this way first and I guess some new info is saying that is bad way to warm up and can also work against velocity numbers. 

Don't think there is one right way of doing things and keeping everyone healthy. My sons coach is still saying kids should jog day after pitching to get  rid of lactic acid. How misinformed is that? 

 

Before Tommy John himself had the surgery, Zero MLB pitchers had TJ surgery.

 

Now 1 of every 3 MLB pitchers has had TJ surgery. It is more common than the Flu!

 

Here is how I look at it... If one third of all MLB pitchers have had TJ surgery, why do we worry so much about those having TJ surgery?  It seems to work out well for most.

 

I know the rehab is tough and it's bad if it happens to you, but the success rate is excellent. There are other far more serious (career ending) injuries.

There is no evidence to report that higher velo pitchers get TJS surgery more often.

Many of the guys my son knows that had the surgery were lefties.  Because they lacked the velo they threw lots of off speed, breaking stuff, etc. Still doesn't prove that is what causes TJS either.

I think lots of pitchers who have had TJS just pitched a lot and often when they were younger.  Parents of young pitchers must follow guidelines.

Pitching is what causes TJS.  There are risks (injury) and there are rewards.

TJS is not always 100% successful. The key is in the rehab and recovery, and why it is more successful on the ML level (yes that's the MLB level where the rehad and care is the best)  than in the milb or college or HS level.

 

 

Did I really just read that?!?!? Yeah ACL injuries happen quite often too! Oh yeah, those are still a big deal. When you're talking major surgery, were talking major surgery. It remains a big deal! 

Yeah, and I'm sure it works out well for the surgeons, anesthesiologists and surgi-centers as well.  Frankly, wouldn't it be better to focus a bit more attention on "why" and on possible reduction and prevention, rather than just accepting the very expensive surgical fix?  Granted, given that this is a sports-related medical condition, as opposed to say something like type-2 diabetes, I understand the "why" and prevention aspect has a different twist to it than a disease-condition, particularly when applied to MLB players and their earning potential, and the ownership investment in these players.  However, if a dramatic increase can be shown in the amateur levels, that is a different conversation.

 

Here's a hypothetical question:  If a high school junior partially tears a UCL and the family would like a TJ surgery, would an insurance company be within the boundaries to investigate if this was medically necessary before pre-approving?  What would be the criteria? - pre injury radar gun readings and scouting evaluations?  Absurd question, maybe, but maybe not.

There are many reasons for the increase in Tommy John surgeries in recent years. Velocities over 85MPH and pitching over 100 innings in a season have been identified as reasons for shoulder and elbow injuries. Obviously, many/most professional pitchers are going to exceed both of those marks.

 

There is a common belief that you will be a better pitcher after surgery. Increased velocity is said to be a common improvement after Tommy John surgery. Guess what... do the rehab portion before you get injured and you'll see those same results! 

Did I say it wasn't a big deal? It sure was for my son!

 

My point is that it is so common (one of every three MLB pitchers) some more than once. Why do we worry about it so much.

 

The more successful results will produce even more surgeries.  At one point in time there were no open heart surgeries.  Now there is one every minute! Obviously any surgery is a "big deal"!  Rehab is hard! But one third of all Big League pitchers have done it. The other two thirds are great candidates.

Mound height.For the last 30+ years everything has been geared for the hitter.Maybe the mound doesn't need to go back where it was but, how bought split the difference and take all the combat gear away from the hitters.Thats a start.

What does "body armor" have to do with an arm injury???

 

You realize 30 years ago we didn't have all the travel teams and showcases either. Get rid of them too...

The original Op states a Dback and spring training.@ here our travel teams don't get any spring training nor play the Dbacks.In the second section Op is just sharing possibilities from his point.Others have brought up max pitch velocity.Pitchers these days back a guy off and the benches clear.This thread did not start with "travel teams or what ever"

And that post makes little sense. But let me try. If you follow the thread, you'll see the question was asked about why there are so many Tommy John surgeries now. I've answered that question: velocity >85MPH and pitching >100 innings in a year. Then you said something about "combat armor" which makes little sense. My comment about showcases and travel baseball has much more to do with the topic than the "combat armor" batters are wearing or bench-clearing brawls.

Here is an interesting twist to this. Of all the recent TJ surgeries that I know of at the HS level most have been position players. I think Go44Dad is on the right track. As muscles get bigger and stronger and are used to their max ability it is the connective tissue, i.e.. ligaments, that bear the brunt of the damage. Remember it isn't that the muscles have gotten larger or stronger it is the constant taking them to their maximum abilty that causes ligament damage in this scenario. Example are power and weightlifters. Making constant max lifts lead to tendon and ligament damage. This may transfer to baseball in the way that constant max effort will cause some connective tissue issues. Along with socket damage. This also gives one to think about Soylent Greens post as he also may have a real good point as these two issues are joined at the hip.

 

 

 

 

I have a hard time believing 85 mph, over 100 innings is responsible.  Did pitchers 30 years ago throw 85 mph or more?  A little research will show pitchers years ago actually threw many MORE innings than pitchers today. Walter Johnson, Nolan Ryan, Bob Feller all threw much harder than 85 mph according to historians.  All threw "far" more innings than any pitcher that is playing now.

 

Back when Johnson or even Feller pitched there were ZERO TJ surgeries!  Now one of every three MLB pitchers has had TJ surgery.

 

Higher overall velocity? Maybe, because there is no doubt that overall pitchers throw with more velocity today than in the old days.  Lately, there has been some that claim the problem isn't overdoing it, but that we are babying pitchers too much.  With his background it's not surprising that Nolan Ryan is one that has said this.

 

I'm sure there are several reasons for the increase in TJ surgery, But the main #1 reason there are so many more these days is because the surgery didn't even exist 40 years ago.  Even then it wasn't considered a good option until the 90s.  Not many even knew how to perform the surgery. 

 

How many artificial hip surgeries were there in the old days?  Very common these days, maybe more common than TJ surgery.  Is the reason we are nowabusing our hips more than before?  Or is it just a result of artificial hips are now common and available?

 

Regarding younger age TJ surgeries.  There is a very fine line between putting in the necessary effort and pushing the envelope vr. Not doing enough to come close to realizing your potential.  This actually holds true in most anything in athletics.  Safest is to pitch very little and not throw very hard!  Actually safest is to not pitch at all.  But you don't realize the next level that way.   Most every pitcher that makes it to the top, has challenged his arm and body in order to reach that level of excellence. Pitchers separate From each other based on performance.  So is the way to reach the top to take it easy, be careful, don't overdo it, baby that arm?  Do hitters get better by hitting less? Do piano players get better by playing the piano less? Do skydivers get better by jumping less? Do stock car drivers get better by racing less?

 

Many things require risk in order to be one of the best.  No doubt... Pitching is one of those things. Sure you can be smart about it and use some caution.  But every pitcher is one pitch away from an arm injury.  Every race car driver is one second away from even more serious injury or even death.

 

Of course TJ surgery is a big deal!  But in some cases it can actually make the ligament stronger than the one you were born with.  We might have some different names in the Hall of Fame had it been available in the old days.  

 

Study done by Olsen, Fleig, Dun, Loftice, and Andrews in 2006. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. American Journal of Sports Medicine 34(6), 905-912.

 

"The injured group pitched significantly more months per year, games per year, innings per game, pitches per game, pitches per year, and warm-up pitches before a game. These pitchers were more frequently starting pitchers, pitched in more showcases, pitched with higher velocity, and pitched more often with arm pain and fatigue. They also used anti-inflammatory drugs and ice more frequently to prevent an injury. Although the groups were age matched, the injured group was taller and heavier. There were no significant differences regarding private pitching instruction, coach’s chief concern, pitcher’s self-rating, exercise programs, stretching practices, relieving frequency, pitch type frequency, or age at which pitch types were first thrown."

 

"Pitching practices were significantly different between the groups. The factors with the strongest associations with injury were overuse and fatigue. High pitch velocity and participation in showcases were also associated with increased risk for injury."

 

http://ajs.sagepub.com/content/34/6/905

 

Have they done a study on how much all this relates to getting scholarships or getting drafted.  Every first round pitcher in the past 10 years has done many of the things exactly that the study shows is the problem.

 

I can't think of a single pitcher among the top prospects over the last 10 years that s didn't attend a showcase.  

 

I don't doubt they found all of that out.  Shouldn't even needed to do any research to figure that out.  The more you do anything, the more likely you will have a problem.

 

I wouldn't expect someone throwing 10 pitches a year to be seeing the clinic.  Let's see I'm going to ask all these questions to someone that is having TJ surgery.  I wonder if throwing too much will be one of he answers?

 

Originally Posted by PGStaff:

Did they have a shortage of "top prospects" 20 years ago? 30 years ago? 

 

And I wouldn't expect them to do that kind of research... they specialize in medical research...

 

So tell me, the medical research has shown that increased pitching, showcases, and travel ball have all contributed to injury rates that have skyrocketed. What has YOUR organization done to curb that?

More showcases, more camps, more travel ball, more off season instruction and  more year round play.

These are difference makers that have increased overuse injuries.  As we know injury is accumulative. 

My daughters BF son just diagnosed with an overuse injury, he is 10.

I didn't know any 10 year olds that had those injuries when my son was 10.

Young athletes don't have strong enough muscles to support  ligaments, do they?

 

 

Provide talented young kids opportunities!  What is your problem?

 

Get serious, what have YOU done?  You seem to be against travel ball, against showcases!  In the meantime we are talking to Doc Andrews about a partnership at Lakepoint in Georgia.

 

Read everything I posted again! Rather than continually repeating the same thing. Of all baseball activities, showcases use pitchers the very least.  No pitcher was ever abused at our showcases. Unfortunately I can't say the same for our tournaments.  Pitchers are abused at every level Except showcases that are monitored closely.  You see, we don't need 100+ pitches or 7 innings to evaluate a pitcher.  No one is going overboard in order to win a game.

 

Of course, most pitchers that have TJ surgery have talent.  Not many cases of the kid throwing 65 mph needing TJ.  As I mentioned before, most talented pitchers DO attend showcases.  Therefore if you ask a kid who needs TJ what he has done... One of those things most often will be he attended showcases.  Just like all those guys in the Big Leagues have done the past 10 years or more.  Just like most every top DI pitcher.

 

I've also heard the "throwing to the gun" arguments.  That is just silly, good pitchers all throw to a radar gun at some point.  Maybe we should outlaw radar guns. Maybe we should blame the MLB scouts and college coaches who go to these showcases and gun all those pitchers So they can figure out who to draft or recruit.

 

More than 50 years ago I would throw the baseball as hard as I could.  Didn't need a radar gun in order to show off how hard.  

 

Please understand that velocity is, and has always been, in great demand. Back in the old days they only had Pro Tryouts, in fact, they still do.  These tryouts were basically SHOWCASES, with radar guns and pitchers trying to throw as hard as they can.  Showcases are older than I am, they were just called Tryouts.  Many would go to several Tryouts trying to impress scouts. It has been around for ever. Travel ball is simply playing baseball.  Legion has been around for ever.  I saw a legion player a few years ago laying on the mound holding his arm.  Being the teams ace he was overused in the interest of winning a legion tournament.  There is AAU, USSSA, USA Baseball, Connie Mack, etc.  are all those things OK, but TRAVEL BALL is the culprit.  How about a little common sense.  

 

I suggest you stick to what you know rather than trying to start a problem.  I don't really care for round about snide remarks like what are you doing about it.  But if you must know, we do more than most when it comes to injury prevention.  We are extra careful with pitchers when we can control what is going on.

 

Dylan Bundy begged us to let him pitch an inning in the PG All American Game.  He had just pitched a couple days early so we didn't take the chance.  He was the top pitcher in the country!  Wonder how many running an event on National Television would have told him no?  BTW, he had TJ surgery last year while on a MLB roster. Yes he attended showcases. So did just about every young pitcher in the Big Leagues.  So did most every pitcher at the top colleges.  They all pitch a lot, because they are very good.  The only event they don't pitch a lot? Showcase!

 

 

I'm going with high mileage arms caused by travel ball and and hyped up competitive environment at an early age.

 

My dad was a Big Ten football player. He understood what it took to get there or to a high level in any sport. When I was a kid he didn't care if my teams won or lost or whether I was the star or stunk until high school. All he did was show up and cheer.I was never pushed until high school. My motivation came from within. There wasnt any training. How many parents are like that now?

 

There weren't travel teams when I was a kid. LL started at nine. We had to make it. I didn't get any chance to pitch until I was eleven. I didn't pitch regularly until I was twelve. Then came Babe Ruth ball (13-15). A 13yo wasn't going to pitch. I pitched regularly at fourteen and fifteen. Then came high school and Legion. Once again I had to wait a year for my turn. I pitched regularly at seventeen and eighteen.

 

Many of today's kids start pitching travel at 9u. They are regular pitchers every year from nine to eighteen. I'll bet most of today's fourteen year olds have more mileage on their arm before they are physically developed than I had when I finished high school and Legion.

 

 

I will give my personal example.  If you have been here a while you may remember my son's story.  I coached my son up until age 12 or so.  We were always very careful with pitch counts before that was the rage.  When son was in little league ball, our organization, Dixie Youth, went by innings pitched.  That made no sense to me at the time, and I knew basically nothing.  But common sense told me what if a kid threw 30 pitches  per inning because of control issues.  So we decided to go by number of pitches thrown.  We always kept our kids around 60-65.  Our goal was to develop as many arms as we could.  Granted, we had our couple of aces that we always tried to set up in the better games, but we did not do anything at a kids expense.  Fast forward to age 15.  Son was at the second stage of a USA Baseball tryout to make his regional team.  During outfield work, he felt a "pop" in his elbow with pain.  We immediately shut him down.  He had a MRI and was told he had a UCL tear and would need TJ surgery.  Our local surgeon did not do the surgery, so we were referred to Dr. Andrews.  He saw Dr. Andrews a couple of weeks later.  On examination, Dr. Andrews was rather perplexed.  Son exhibited no pain, but the tear was evident on the MRI.  He sent son home for 6 weeks of rehab and then returned for a new MRI.  He was told that the ligament tear had scarred over and he would not require surgery.  He was placed on the post TJ throwing program and was cleared to return to pitching some 3 months later.  In that time, I have gained a ton of knowledge on arm injuries.  I have come to believe that a lot of injuries are just gonna happen.  Now I'm not saying that there are not things that increase your risk, but I have to agree with PG Staff that most of the TJ patients are the better players that throw harder and possibly their body broke down from an anatomical issue.  Yes Dr. Andrews did say to us that he thought overuse was a big problem, but then he also put his hand on my back and assured me that I did nothing wrong in my son's specific case.  I explained to him that we were very cautious on pitch counts and did not throw curves until high school, etc.  The trainers there basically said the same thing.  The first question they asked him was "How hard do you throw?"  When he told them low 80's, the trainer said that is who he typically sees with arm issues.  Maybe it's because the harder throwers throw more and get over used, but that is not the case for my son.  I'm sorry that this was so long, but trust me, I laid awake countless nights wondering what I could have done different.  My answer, nothing.  I truly believe his injury was gonna happen no matter what.

It's great you're working to team up with Dr. Andrews! As we all know, he's the leader in sports medicine in the country. He's also one who has been critical of all of the "travel ball, etc." And all of the overuse injuries.

 

I said travel ball. I said nothing about a particular league or organization other than to ask what PG was doing. I agree that AAU and many of the other organizations are guilty of overuse. That's why I wasn't specific! And yes, I'm against those activities in all sports! Overuse injuries are rampant in so many sports now it's unbelievable!

 

Stick to what I know? Guess what.. I AM! I know sports injuries. It's what I do for a living. And I've provided research to support my claims. Who else has done that here? 

 

http://www.cleveland.com/dman/...r_james_andrews.html

Huh, glad I asked.  Lots of insightful posts.

UIL, Nations, AAU, USSSA, triple crown, Little league, just name the sanctioning body, they are not guilty of overuse....it's up to the parents to understand, have a plan, communicate the plan, count the pitches and say no, my son is not available to pitch today.  If your son is under 18, it's ok to tell the coach the limits.  If he does not adhere, it's ok to walk out on the field and put it in a language the coach will understand. 

 

I watched the Shepherd HS kid pitch a couple weeks ago.  He is 1-1 high school prospect.  His advisor was in the stands.  When he reached 60 pitches, advisor walked to dugout, told coach that's it.  Out he comes.  His team is 1-13.  That's a plan.  And you could hear it sizzle.

 

https://www.youtube.com/watch?v=0GJe3SwH4aI

Honestly....the fact that we're beginning to see more "2 time" TJ Surgeries makes me more nervous.... Beachy, Medlen,Parker, Hudson, to name a few recent MLB pitchers. Why is this happening?

As a youth coach in travel-ball/little league, I kept strict pitch counts on all the kids, including my son.  As a former HS/Collegiate pitcher myself, I studied mechanics and sought out additional advice to help the kids.  With all my precautions (pitch counts, video taping, etc...) and "proper pitching mechanics", I still witnessed three kids undergo TJ Surgery prior to age 20 (including my son) that I coached. 

We're going to have to figure this out.  The other thing to keep in mind, regardless of what everyone else thinks...not everyone comes back throwing harder following their UCL surgery!

60 pitches seems a bit low to me to come out. If an advisor told our coach to take kid out at 60 u would hear some choice words. If they have a plan before game/season how to use a pitcher that's one thing but for someone to come from stands and get involved during a game is disrespectful. What if the coach benches the ace and colleges ask why? He can say I couldn't pitch him over 60 .  Yes pitchers arms need to be protected but this was taking it too far imo.

I think colleges will get a busy signal.

Well, my son's doctor (one who works with the highest level of pitchers) told him in a recent exam for his elbow strain that every single time a high level pitcher throws a pitch he is coming within 10% of tearing the ligament. 

 

Stands to reason that if you throw more pitches in your lifetime you create more opportunities to tear it - right?

 

is the root cause overuse...or just creating more opportunities?  Whether it's the former or the latter, should the strategy to reduce risk be any different?  interesting questions. 

Over 100 MLB pitchers have had TJ surgery.  Does anyone know exactly how even one of those pitchers injured himself?  Just one?

I am going to assume that at some point in time, some event happened that could be a precursor to having surgery.

 

Not sure why you guys are going at it, no one really knows what causes an injury, we all know that throwing a baseball continually can cause issues.

 

A pitcher on a ML roster having to undergo TJS is in a lot better position than a lower level milb pitcher who unless is a high pick, has a rough chance later to make a ML roster just because he has to have surgery.  So in my opinion having to undergo any procedure is devastating to anyone who has to undergo the knife.   What about the HS player just beginning the recruiting process?  Try telling him that he will throw harder or be better because of a new ligament means nothing when that college coach suddenly stops calling.

 

 

I am convinced that there are preventative steps that can be taken so that a pitcher can successfully get through HS, college without having issues.  The whole thing is in educating parents, LL coaches, travel coaches, HS coaches as well as college coaches. 

 

Would be wonderful if all of those involved in this game that involves amateur players would offer more than just guidelines to follow or research that no one but the professionals bother to read. 

 

Sometimes you can do all the right things and still injury happens.

 

FWIW, parents must be more responsible as to knowing what would be appropriate for all amateur players playing any type of sport. In this day of available info on the internet, no excuses for, "I didn't know".

 

There are 2 time TJS because the procedure has improved since many guys first had it.  Ligaments come from all different places these days!

 

So much good stuff here. What I think:

 

- Pitching puts the ligament at risk.

 

- Young pitchers throw more in aggregate than boys used to - and that's just the way it is

 

- Prior to TJ, MLB pitchers just disappeared; the local sports team didn't explore and report the "why"

 

- Today, every time that POP happens, we hear about it -- at practically every level

 

- The way it is today is almost certainly the new normal, so thank God there's a procedure to repair it

 

All that said, does anyone know if the incidence of torn ligaments is as high - as a percentage - in Japan?

I believe their mound is lower so you will not find this as common.
some people believe since they changed the mound height pitchers are more injury prone.

Good question.  I've been told that TJ surgery is rare in Japan compared to USA.  And that brings up yet another debate!  The pitchers in Japan typically throw MUCH more than our pitchers.  There are other factors to consider though.

 

In my lifetime I have seen players break their arm throwing a baseball four times.  One an outfielder, one an infielder and two pitchers.  Three were younger kids and one was in the Major Leagues.  I don't know this for sure but I would think breaking a bone would be harder than damaging a ligament.  

 

Not sure we will ever get this figured out.  We only know that throwing a baseball carries some risk.  Problem is no two people are the same.  Too many for some, is a piece of cake for others.  Too much and your likely to get injured.  Too little and it's likely you will not be successful.

Japan pitchers throw off a flat mound. In the National HS tournament all pitchers are X- rayed before after they pitch. They all throw easy between inning.

Balance of the body and mind is the rule.

 

Bob

GoodwillSeries 1983-2014 

 

TPM,

 

You are right about the mounds in Japan, I believe.

 

However, we actually lowered the mound 3 inches here sometime during Bob Gibson's career.