An unfathomable amount of pitchers have experienced what is a pitcher's worst nightmare this season. Ulnar collateral ligament reconstruction, more commonly known as Tommy John surgery, has ended the seasons of nearly 40 pitchers this year (as of May 29), and the list continues to grow.
Jeff Passan of Yahoo! Sports provided a comparative stat that puts how serious this problem is into perspective.
Dodgers RP Chris Withrow the latest to need Tommy John surgery. Brings count to 45 known cases this year. Last year, just 25 through May 29.— Jeff Passan (@JeffPassan) May 29, 2014
Quick housekeeping: Earlier today said it was 45 known TJs this year. Actual number is 44. Apologies. Handy list: https://t.co/fjO4yqFM1x— Jeff Passan (@JeffPassan) May 30, 2014
Mets ace Matt Harvey, who has been out since the end of 2013, will in all likelihood miss the entire 2014 season. Jose Fernandez, Patrick Corbin, A.J. Griffin, Ivan Nova, Jameson Taillon and Matt Moore, some of the game's best and brightest, have all gone down this season. Jarrod Parker, Josh Johnson, Kris Medlen and Brandon Beachy have all undergone the surgery for a second time in their careers.
According to a position paper released by Dr. James Andrews' American Sports Medicine Institute (ASMI), the rising trend of Tommy John surgeries is cause for concern.
"During the past few years there has been an 'epidemic' rise in the number of professional pitchers requiring ulnar collateral ligament (UCL) reconstruction," the paper says in its opening.
Commissioner Bud Selig made it known at the MLB owner's meetings that he is aware of the problem as well.
I'm very worried over the fact that it's happening with so much regularity, over and over. We have some great young arms, and it's very sad.
Just what is causing the high number of UCL injuries? Before jumping into contributing factors, ASMI points out several misconceptions regarding the injury and the surgery that follows.
One of those dispelled misconceptions is that pitchers who receive the surgery will throw harder after the fact.
While there may be instances of pitchers throwing faster after returning from Tommy John surgery, this was due to the surgeon fixing the problem followed by the pitcher working intensely with the physical therapist, athletic trainer, strength coach, and pitching coach. The rest after surgery may have also helped the athlete’s body. However, performance usually decreases over time for MLB pitchers after Tommy John surgery (similar to the typical decrease over time for healthy MLB pitchers).
Simply put, a pitcher's performance post-op is based mainly on the work he is willing to put in when it comes to rehabilitating his own individual injury. Have some pitchers come back and thrown harder after the surgery? Yes, there have been such examples, but the surgery was not the cause. Tommy John surgery needs to stop being looked at as if it were a surefire way to add a few miles per hour to a heater.
ASMI also argues against the idea that throwing curveballs at a young age increases one's risk factor, saying there has been no proven connection between the pitch and elbow injuries. Instead, the institute looks at the rise in "competitive pitching" amongst younger ballplayers. This competition, whether it be in Little League, at the high school and college levels or in travel ball, leads to young players often pitching while fatigued, and that is where there is a greater risk for injury.
Still, Andrews cautions against throwing the curve too soon, or as he puts it, "Until a kid can shave." In a piece by ESPN's Jerry Crasnick and Stephania Bell, Andrews said the following on the subject.
Kids don't typically have the neuromuscular control to properly throw a curve. If you add in fatigue, they're even likelier to have poor mechanics and end up with an injury.
ASMI also said that lowering or removing the mound would serve no purpose, as studies have shown that elbow torque remains about the same when throwing regardless of the angle and elevation one is throwing at. The last misconception was that Latin American pitchers have a lower prevalence of the UCL injury, however, ASMI disproves this.
A recent survey (unpublished) revealed no difference in the prevalence of Tommy John surgery between pitchers from the U.S. and pitchers from Latin America. The survey showed that 16% of U.S. born-pitchers and 16% of Latin American pitchers in professional baseball have a history of Tommy John surgery.
So, what can be done in order to limit the number of injuries and protect pitchers? In its statement, ASMI outlines nine recommendations for professional pitchers and teams to follow in hopes of reducing the risk of injury.
Perhaps the most interesting recommendation is that pitchers need to tone it down a little.
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 base runners and runs, not to light up the radar gun.
This is easier said than done. Professional athletes are amongst the world's fiercest competitors. You expect them to just hold back? It is certainly a change in a pitcher's psyche, one that even at the risk of his own well-being, is unlikely to be welcomed by professionals.
Another surprising recommendation made was that pitchers should avoid winter ball. "The UCL and body need time to recover and build strength," ASMI said. In other words, treat the offseason as just that—the offseason.
Other proposed instructions were rather obvious, including focusing on proper mechanics, communicating with one's coaching and medical staffs, being up front with medical information past and present and making sure pitchers receive proper amounts of exercise and rest as well as following proper nutritional guidelines. ASMI warns that performance-enhancing drugs (PEDs) can make muscles disproportionately strong, causing greater wear and tear on the UCL.
The paper signs off with one final recommendation.
Pitchers with high ball velocity are at increased risk of injury. The higher the ball velocity, the more important to follow the guidelines above.
Of course, some of the game's hardest throwers have gone under the knife for tears to their UCLs in recent years, including Harvey, Fernandez, Moore and Stephen Strasburg.
In the wake of this statement and all of these injuries, it's time Major League Baseball, its teams and pitchers themselves began taking these recommendations seriously. Tommy John surgery can destroy a team's and a pitcher's season and at times career. Yet, as ASMI has clearly stated, there are precautions that can be put in place.
Now that these steps have been clearly outlined, why not start taking them seriously?
ASMI was founded in 1987 by Dr. James Andrews. Its mission is to improve the understanding, prevention and treatment of sports-related injuries through research and education.
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