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Dr. James Andrews explains why Tommy John surgery is on the rise

Apr 10, 2014, 8:55 AM EDT

tommy john surgery

Dr. James Andrews was on Sirius/XM radio’s “Power Alley” with Mike Ferrin and Jim Duquette yesterday, talking about Tommy John surgery. He was asked why there seem to be so many guys needing TJ surgery these days.

His answer: it’s not an anomaly, it’s a trend. And an alarming one, he says, in that so many more of the surgeries he’s performing are for high school pitchers as opposed to professionals with a few years under their belt. Kids are bigger and stronger these days, and their ability to throw harder is outpacing the development of their ulnar collateral ligaments.

But the biggest risk factor he and his researchers are seeing: year-round baseball. The fact that not only do pitchers throw year-round, but that they are pitching in competition year-round, and don’t have time to recover. Also: young players are playing in more than one league, where pitch count and innings rules aren’t coordinated. Another factor: the radar gun. Young pitchers who throw over 85 or so are at risk, and all of them who are on a major league track are throwing that fast or faster, and are going up in effort when scouts with guns are around.

Ultimately, you can’t prevent these injuries. Even for the major leaguers, most of whom were damaged in high school only to have the UCL injuries happen once they’ve hit the pros.

Give a listen to the TJ expert.

  1. sdelmonte - Apr 10, 2014 at 9:06 AM

    Whoever decided that baseball should be a year round thing for high school students is a moron.

    • psousa1 - Apr 10, 2014 at 9:27 AM

      Not just high school. All the way down to 10 years old. It is perverse. The only sport this year round play has yet to permeate (from where I live – may not be the case everywhere) is football. These coaches also tell these kids that if they are not playing year round then they will lose their spot when the main season starts.

      The most refreshing thing I heard were two visiting hockey coaches from Finland addressing a youth hockey group. They said if you want to be one of the best 12 year old players around then play year round. But if you want to still be a good player when you are 16 or 17 then drop the game when your season is over and play other sports that interest you because eventually water seeks its level and others will catch up or your zeal for the game will be greatly diminished.

      • gothapotamus90210 - Apr 10, 2014 at 11:03 AM

        Football is leaning towards year round as well. There are a lot of spring football programs around for kids at the Pop Warner levels.

        I coach football at the 11-13 year old level. We lost in the regional final the day after Thanksgiving. We had the kids out for voluntary conditioning the following Saturday, which included non-contact / non-equipment football drills. With our program, we don’t hold it against the kids for playing another sport – we encourage it because it develops different athletic skills, as well as different social skills in a different team dynamic.

    • echech88 - Apr 10, 2014 at 10:59 AM

      Result of new generation of parents who want to make their young son or teenager’s baseball experience live up to what they’re seeing on ESPN all day.

      Would love to see MLB look at this information and lead some sort of initiative on establishing a standard of restrictions for youth baseball (pitch counts, outlawed curveballs etc).

    • hk62 - Apr 10, 2014 at 11:30 AM

      When I was 17 (35 years ago – ugh), I was pretty good – but a hitter not a pitcher. Starting in March every year I played on three teams straight through until the start of football practice in August. At least one game every night for 5 and half months. In the summer almost always two games a night. This is not something new. We had a few pitchers that didn’t play football, so they also pitched through a mini Fall ball season. Many of the ones that threw serious gas did end up with shoulder or elbow issues in their early 20’s, as well. But year round baseball and multiple team/league situations have been around a long time – if you are/were in Texas (where I was), or FL, AZ, CA, LA.
      I think its the too much too soon situation – 12 year old travel teams are rediculous, much less 9 and 10 year olds.

  2. tfbuckfutter - Apr 10, 2014 at 9:11 AM

    Scary thing is even if they get a handle on it at the high school level now we have a generation of damaged players to work through.

  3. sportsdrenched - Apr 10, 2014 at 9:32 AM

    “But the biggest risk factor he and his researchers are seeing: year-round baseball. The fact that not only do pitchers throw year-round, but that they are pitching in competition year-round, and don’t have time to recover.”

    I’ve only done some hobbyist reading regarding sports science and muscle recovery, but this seems like common sense to me. You have to have down time. I don’t care what your thing is; whether it’s mental or physical, you’ve got to spend some time away from it.

    I know from personal weight lifting experience that often what holds me back isn’t that the muscle can’t handle the load, it’s the ligaments that get sore and flare up, and thus I have to back off for a little bit.

    • paperlions - Apr 10, 2014 at 9:41 AM

      Of course it is common sense. For decades there have been college coaches that have been notorious for ruining pitchers in their program. Everyone in the industry knows use during HS and college years is a problem, but they don’t have the power or influence to effect use patterns at those ages.

      Kudos to MLB for getting this interview. Hopefully, players and parents will become sufficiently aware that they will protect themselves and coaches/leagues will adapt to have the players best interests at the forefront.

  4. renaado - Apr 10, 2014 at 9:43 AM

    I guess Aroldis Chapman’s an exception..For now.

  5. thedoubleentandres - Apr 10, 2014 at 10:07 AM

    I think I’m taking this with a pinch of salt but would love to hear what someone with knowledge of the surgery has to say.

    Tommy John surgery knocks the players out for a year or so but in Dirk Hayhursts bullpen diaries he said the reason was because of scar tissue from the surgery and that he had a teammate who, after the surgery, ripped his arm straight breaking the scar tissue and he was able to pitch again in about 3 weeks.

    • paperlions - Apr 10, 2014 at 10:47 AM

      You don’t have to have knowledge of TJ surgery to know that story is BS. The drill holes in the bone to insert a new tendon (taken from elsewhere in the patient’s body or from a cadaver)….that will not heal and result in a functional tendon in 3 weeks….or even 3 months.

      • thedoubleentandres - Apr 10, 2014 at 10:57 AM

        Yeah, I mean I said I’m taking it with a pinch of salt, I don’t know if thats a phrase y’all use in the US but it means I’m not really buying it but I thought I’d share it to see if there was any way at all it could be possible.

        He was talking about a pitcher who was about to get cut from the Single A team so would be desperate enough to try something like that.

      • paperlions - Apr 10, 2014 at 11:08 AM

        Yeah, we use that phrase….I was just confirming your suspicions about the story. If a pitcher tried that, the most likely outcome is that he’d tear the tendon out of the bone and have to have surgery again. At that stage of recovery, the muscle attachment to the tendon isn’t strong enough to be able to throw a baseball either.

        Another odd aspect to the story is that teams are responsible for the medical care of injured players until they are recovered….there would be no reason to cut an guy recovering from TJ surgery as the team would have to provide the necessary care and facilities for his full recovery…any team would just keep him around in case he came back better than before.

    • hammyofdoom - Apr 10, 2014 at 10:57 AM

      Well, wouldn’t the man who is the premier Tommy John surgeon in the United States (perhaps the world) be “someone with knowledge of the surgery”?

      • thedoubleentandres - Apr 10, 2014 at 11:00 AM

        Steady on old chap, I was just sharing something I read in a baseball book, I am in no way saying this is true.

  6. randygnyc - Apr 10, 2014 at 10:39 AM

    Exactly what I said just a few days ago on here. Players are now coming to the major leagues with 2X the mileage on their arms. The normality of all year round sports started in the mid to late 80’s. before then, it was the exception. Now it’s the rule.

  7. gothapotamus90210 - Apr 10, 2014 at 10:58 AM

    Playing year round is a factor, but it’s probably more due to pitchers with bad mechanics throwing year round.

  8. bottleandcellar - Apr 10, 2014 at 11:32 AM

    This speculation seems a bit much for me. We keep blaming things with next to NO empirical evidence.

    Throwing a baseball is entirely unnatural. But the only two things that have changed immeasurably across the board since 1970s are youth pitch counts, which have infiltrated up the ranks into the major leagues.

    There is some evidence that types of pitches thrown and stress to throw them on the elbow might be a contributing factor, but at the same time that has not been done with exact data gathering and a strong sample set.

    Still, what I would give credence to in Andrews hypothesis, is that with ANY physical activity and exercise there needs to be a logical repair. I think with baseball today, pitchers particularly I do wonder if there is a time to work and a time for the body to shut down and repair.

  9. senioreditor2 - Apr 10, 2014 at 12:05 PM

    My son played year round baseball for many years………thankfully he was not a pitcher! Most of the good pitchers that threw hard, suffered significant arm injuries in high school and were done. In my opinion there is too much emphasis on throwing hard and very little put on teaching one how to pitch (set up/confuse/fool) hitters. When I coached, I instructed my pitchers to watch Greg Maddux pitch. He never really threw above 92 mph and VERY rarely threw a curve/slider.

  10. aziceman - Apr 10, 2014 at 12:55 PM

    Part of the blame has to be on the era we live today…..the INTERNET age.
    Twenty five years ago, a kid had a slim chance of getting noticed by a professional organization or Division 1 program. Now thanks to technology, an entire industry has propped up training, developing and promoting kids who have “big league” potential. Gone is the goal of making a high school team….now it’s travel leagues and year round “training” Just like in any other business, explosive growth leads to numerous unqualified and spurious persons filling the many new roles in training, coaching and player development. For girls it is gymnastics, for boys it is baseball. But it’s the same notion…we can train and get your kid exposed. All it takes is $$$$$$$$$$$$$$$$$$

  11. Tim's Neighbor - Apr 10, 2014 at 1:06 PM

    Every kid (10-12 yrs old) who I’ve given pitching lessons to wants to throw a curve ball because someone in their league was doing it. I wouldn’t allow it during our sessions. It was always long toss, mechanics, location and change-ups and then I’d tell them no pitching the next day, just long toss at most. Someone suggested that they’d throw a curve anyway and that I might as well teach them the right way, but I couldn’t do it. It’s too much, too early.

  12. aiede - Apr 10, 2014 at 1:48 PM

    Like most everything involving children, it’s on the parents. I managed my son’s team in the lowest level of kid-pitch Little League last year and I was very careful to follow the pitch count and rest day rules, not because anybody was checking up on me but because I wanted to keep my kids safe and healthy.

    I had two separate fathers who tried to get me to let their sons pitch more than they were allowed to by the rules. One tried more than once, and it was all I could do not to tell him that his son had told me he didn’t like pitching, but please don’t tell his dad. Kid was a really good infielder, too.

    The one time I bent the rules was when I let a boy pitch one day earlier than he technically should have because his wheelchair-bound grandfather was making his only spectator visit of the season. Grandpa had been a college pitcher and wanted to see his grandson pitch for the first time. I gave the kid an inning and sat him back down.

  13. stevesherman161 - Apr 10, 2014 at 4:59 PM

    This is also (part of) the answer to the question about reduced participation in baseball by blacks: it is only the affluent that can afford year-round baseball.

  14. sawxalicious - Apr 11, 2014 at 2:45 AM

    I don’t think year-round baseball is necessarily bad, but year-round pitching does. I think that if kids want to have one league a year to pitch in and play another position the rest of the year, they would be able to rest their arm from the specific stresses of pitching. It would take a lot of discipline from the players and coaches. I agree with an earlier poster about keeping young pitchers on a strict regime of fastballs, change ups and learning the strike zone. Breaking pitches appear to put a lot of stress on the human body and would probably best be learned when a player’s body is more developed and able to hand more and different stresses. When it comes down to it, pitch location and speed variation is the nuts and bolts of pitching and should be emphasized early on.

  15. ideabook2014 - Apr 11, 2014 at 1:35 PM

    Funny how the people who think year round baseball is ok totally disagree with the Dr. and think injuries are either freaks of nature or due to poor mechanics. They totally miss his point: that playing the game year round is bad, and no matter what you do in the interim is hurting the kids until they stop playing year round. Just bounces right off their heads. Find a way to beat the system. Of course, the Dr. is good but doesn’t know what he’s talking about.

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