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Verducci’s solution to the Tommy John scourge? Lower the mound.

May 14, 2014, 12:30 PM EDT

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Almost all of us who talk about Tommy John surgery are not doctors and are not versed in biomechanics. So that should give you pretty fair warning that, for the most part, we’re just spittin’ into the wind when it comes to the “what should be done?” part of this conversation.

Personally I’ll defer to Dr. Andrews and people like him and take them for their word that most of the ligament damage in young pitchers happens well before they’ve hit the big leagues and likely happened well before they made it to pro ball. The development of kids’ muscles are outpacing the development of their ligaments, Andrews says, allowing them to put more stress on a UCL than it was designed to handle. That plus kids simply being overworked and pitching year-round in multiple leagues means that the TJ cake is already baked by the time we know who these dudes are.

Tom Verducci is in lock step with Andrews with all of that, so I’ll go along with his ideas on the topic to a certain degree. Against that backdrop he suggests doing something to limit the amount of strain on those still-developing UCLs: lower the mound:

What can be done? It’s time for Major League Baseball to lower the mound — and for the entire amateur market to follow its lead. When I took part in an MLB Network roundtable discussion last week on the epidemic of Tommy John surgeries, what struck me as most profound was the statement of fact by both Mets team physician Dr. David Altchek and biomechanics expert and former pitcher Tom House that the greater the slope of the mound the greater the forces that are applied to the arm. Reduce the height of the mound and you reduce the forces upon the arm.

Of course, given that he and Dr. Andrews both say that the problem really occurs before the guys get to the bigs, I don’t know that lowering the mound at the MLB level would do much to solve the problem and the byproducts of that — most likely dramatically increased offense — will end up putting the same sort of pressure to develop pitching that we saw in the 1990s and 2000s, the fruit of which is being harvested today. That in turn would place even more of a premium on hard-throwers and would incentivize kids and their parents to churn out even more impressive pitching phenoms, no matter the cost. So many unintended consequences. Like, say, kids throwing even gnarlier pitches their arms aren’t ready for. Leagues not really lowering the mounds because, hey, who’s gonna measure them?

I don’t know that you can crack that nut without Major League Baseball actually becoming a hands-on authority over youth baseball to one degree or another. The incentives are just too detached right now to ensure change. Youth coaches and parents are aimed at winning now and/or having their kids get drafted and paid at 18-21, and they don’t give much of a toss to what happens at 25. MLB has little if any interest in ensuring the well-being of their own minor leaguers, so how in the hell do we expect them to take any kind of ownership or exert any kind of authority over youth baseball?

I don’t think there are any solutions here. At least those that MLB can just impose via a rules change. This is a medical and a societal issue and those sorts of things aren’t amenable to quick fixes.

  1. dondada10 - May 14, 2014 at 12:33 PM

    An idea I had after Harvey went down with TJS is that perhaps pitchers aren’t throwing enough variety of movements in their lives. I remember the Atlanta Braves used to throw a football on their off-day. It’s akin to weight lifters who over train a particular muscle group only to see it get injured. Perhaps using the elbow to make an assortment of throws will give the UCL more of a well-round strength.

    • kruegere - May 14, 2014 at 3:51 PM

      Gonna side with Andrews here and say that TJ is an overuse injury. I don’t know if more throwing is the answer.

      The part about muscles growing too fast for ligaments to catch up is similar to how some weightlifting injuries happen, though.

      If I’m misunderstanding you and you’re going with the ‘muscular imbalance’ idea. Maybe, backwards throwing? I know Eric Cressey is all about doing various sorts of pulling exercises to pre-hab his clients (mostly pitchers.) He says that this helps make the entire shoulder girdle more well-rounded.

    • cohnjusack - May 14, 2014 at 4:28 PM

      Pitchers in Braves organization who had Tommy John while Leo Mazzone was pitching coach:
      (includes Majors leagues and Minor Leaguers)

      Mike Bielecki – 1992
      Pedro Borbon – 1996
      Damien Moss – 1998
      Kerry Lightenberg – 1999
      David Cortes – 2000
      Andrew Brown- 2000
      John Smoltz – 2000
      Odalis Perez – 2000
      Jose Capellan – 2001
      Paul Byrd – 2003

      During that time period, the Braves had the 3rd most instances of Tommy John surgery, behind only the Dodgers and Cardinals.

      So no, the Braves organization was not especially good at preventing Tommy John.

      • cohnjusack - May 14, 2014 at 4:28 PM

        source: http://mlbreports.com/tj-surgery/

  2. koufaxmitzvah - May 14, 2014 at 12:33 PM

    How about not throwing sliders or curveballs until the player’s bones have fully grown? Personal responsibility should trump institutionalized changes.

    • rollinghighwayblues - May 14, 2014 at 12:41 PM

      I give 15-20 pitching lessons a week and I’m with you on the curveball debate. I really don’t like seeing the kids throwing hammers until 14-15 years old. I’ve had good feedback from the kids with showing them how effective and nasty a non-straight change up can be and also a cut fastball since it’s almost the same release as a four seam.

      • furryroadkill - May 14, 2014 at 1:07 PM

        Agree 100%. Fastball/changeup and just learning to change speeds and put the ball where you want it will get almost any high school or summer league player out, you can develop a hook or something more taxing later. Love the changeup cuz 10 people can grip and throw it the same way and it could do something different for each person that throws it.

      • padraighansen - May 15, 2014 at 11:04 AM

        Agree 100%. i wasn’t allowed to throw anything besides a fastball & change until my senior year in high school. Changing speeds & learning how to locate are more fundamentally more important at that age, as well.

  3. seanmk - May 14, 2014 at 12:50 PM

    I’m confused, i was under the impression a higher mound meant you have to do less to your arm to get the break you want in your pitches. throwing a breaking ball from flat ground is harder not easier

    • moogro - May 14, 2014 at 1:03 PM

      That’s true. But the snap is distributed more through out the body. From a mound, the arm cantilevers out, moving the force more to the fulcrum, which in this case is the elbow.

      • moogro - May 14, 2014 at 1:08 PM

        >gack<

        ….making throwing from the mound more effective, but more of a strain.

  4. gothapotamus90210 - May 14, 2014 at 12:58 PM

    I wonder if historical data of major elbow injuries could be pulled for pitchers born in Latin America since they’ve been playing baseball year-round much longer than in the U.S. There should be a large enough sample size from Latin America to see if their MLB level pitchers were any more prone to TJ/major elbow injuries since 1970 (I don’t believe U.S. born players would yield conclusive results since the push to play baseball year-round originated in the late 1990s).

    A point not to be forgotten: the # of pitchers used in the MLB has roughly doubled in the last 30 years due to expansion and specialization. My hypothesis is with a more watered down pool of pitchers (the lower 50 percent), you’re getting guys who don’t have as good of mechanics and/or don’t have the physical make-up as pitchers did 30 years ago. Of course, this doesn’t explain the likes of Fernandez, Strasburg, Wainright, etc. who would’ve made the cut 30 years ago.

    • gothapotamus90210 - May 14, 2014 at 1:00 PM

      * by doubled I mean pitchers used in a season across all of MLB.

    • raysfan1 - May 14, 2014 at 1:56 PM

      I very strongly doubt you’d find good statistics from the Dominican Republic or any other developing nation. Many of the leagues aren’t organized. Medical care does not come close to our standards. You could tally how many major and minor leaguers get UCL injuries, but there’s no way to get the numbers of high schoolers.

      As for there being more MLB pitchers now than 30 years ago–sure. However, there is also a much deeper pool of talent from which those players are drawn now thanks to much more international scouting. Also TJ surgery did not exist until 40 years ago and was still not common 30 years ago. Most pitchers then who developed arm problems simply became former pitchers or, if they did keep playing, were never the same.

      • gothapotamus90210 - May 14, 2014 at 2:25 PM

        I was referring to pitchers who made it out of the DR and pitched in the big leagues. Also, I intentionally referenced major elbow injury to account for TJ surgery’s short history. It wouldn’t be an easy study however you dice it, but I think it’s not as simple as throwing more as a child.

      • raysfan1 - May 14, 2014 at 3:45 PM

        I’ll agree there, as I don’t think there are easy answers anywhere, only partial ones.

    • roundballsquarebox24 - May 14, 2014 at 5:01 PM

      I think that the difference is that in Latin America, kids THROW a lot, not necessarily PITCH a lot. This is a big difference. Of course, there are “real” baseball diamonds where kids go and play occasionally (nowhere near “Little League” standards, but a diamond with a mound). However, most of the throwing is done on the streets, on dirt fields, etc. Also, they are not always throwing a baseball, and trying to make a “pitch”. Kids throw rocks, makeshift balls made out of stuffed up socks, and anything else they can throw. We used to play this variation of “long-toss” where we would stand very, very far from each other(about long-toss distance), and throw a mango or something like that. Then, on the other side, the other kid tries to hit it with a “bat” (tree branch? broomstick?). Also, growing up, we would work, a lot. At the age of 7 or 8 we were helping carry heavy barrels of water, cutting firewood, herding horses/donkeys/mules/cattle, etc. You look at a 12 year old kid back on the island and he has the body definition of a man. Not necessarily in terms of size and muscle mass, but tonal definition. I think that in the USA, youth pitchers in year-round baseball are always pitching. They are on the mound all the time, executing pitches day in, day out. In the DR we learned to throw a “breaking pitch” with the water-cap to the big water barrels. It is a completely different type of strain on the body.

  5. scoutsaysweitersisabust - May 14, 2014 at 1:01 PM

    The idea is a sound one, and it’s based off a simple principal. That if MLB enacts a change, that the lower leagues will follow suit. It’s the same basic concept when dealing with the NFL and concussions, that if the NFL mandates safer helmets that it will eventually seep down to Pee-Wee leagues around America. The Big boys are essentially leading by example here.

  6. sabathiawouldbegoodattheeighthtoo - May 14, 2014 at 1:06 PM

    How big of a problem is this really? Yes, it seems like there are more pitchers with this injury. I wonder if it is merely being diagnosed and/or treated with surgery more frequently now.

    I don’t think any injuries are good, but these guys lose a year and come back as more or less the same pitcher after surgery. If guys were losing their careers over this it would certainly be a terrible thing, but losing a single season is a bummer, but not a tragedy. Athletes get hurt.

    • paperlions - May 14, 2014 at 1:46 PM

      Yeah, pitchers will always get hurt, but that doesn’t mean you throw up your hands and don’t work to reduce the problem. People will always get cancer, doesn’t mean that life-style changes to reduce the chances aren’t worth while. If you lower the mound and that reduces torn UCL frequency by 10%, would that be worth it?

      Also, plenty of guys never come back from TJS good as new. Torn UCLs still end careers.

    • raysfan1 - May 14, 2014 at 2:05 PM

      Yes, athletes get hurt–always have and always will. However… MLB, the teams, and trainers all need to constantly look for ways to reduce the injuries. Preventing injuries is always preferable to treating injuries. Scar tissue is not as strong as the original uninjured tissue. Major joint injuries also lead to arthritis down the road and can shorten the player’s career even if he comes back strong from the surgery. Baseball is best when all the best players are healthy and on the field.

  7. udub - May 14, 2014 at 1:07 PM

    I don’t think you can really dismiss the notion of lowering the mound with it happens before pitchers get to the majors. If MLB lowered the mound others would follow and lower as well.

    I think lowering the mound would help, but it’s not a magic solution to end all elbow problems.

  8. dowhatifeellike - May 14, 2014 at 1:17 PM

    Youth players do little actual pitching from the mound, all of their practice and warmups are usually done on flat ground. I’m sure the slope of the mound plays a part, but in my experience, it’s overzealous coaches who make their kids throw too many pitches on too little rest that mess up arms.

  9. mikhelb - May 14, 2014 at 1:42 PM

    In that same roundtable Kaat and Smoltz said they barely had injuries due to their training regime, which consisted of throwing extensively twice in between starts (Smoltz) or even three times between starts (Kaat) on flat ground avoiding to throw with high speeds, they just worked in location and to strengthen their arms, and it worked for the pitchers in the staff who followed that regime imposed by Kaat’s former pitching coach in the Saint Louis Cardinals (the Braves’ coach Leo Mazzone was a disciple of him).

    And to some extent they are correct in saying pitchers need to be teached proper training to strengthen their bodies, maximize their cardio workouts, to finesse their control and command, to find their optimal delivery (biomechanics) to avoid putting more stress in their arm, which is present when coaches using biomechanics ask them to pitch in certain way but pitchers never get comfortable due to lack of training.

    • paperlions - May 14, 2014 at 1:47 PM

      It is worth noting that the Braves lead MLB in most players that have had TJS.

  10. mikhelb - May 14, 2014 at 1:52 PM

    In hispanoamerica there are no official records except for those teams might keep regarding “Tommy John” surgeries, basically the same as in MLB where a lot of work has been done to corroborate wheter pitchers had a TJ surgery or not, heck, Rijo’s supposedly 5 TJ’s were found to be more of a myth than reality.

    But there is also one thing: in hispanoamerican leagues, pitchers throw even when they do not feel particularly fine, and their bad seasons, decrease in velocity or even potential career ending injuries are called “tired arm” or such things as it happened in MLB up until the late 90s.

    There are risks present by allowing pitchers throw whenever they want to, even if they feel tired, but there can also be rewards for them by training the same way MLB pitchers used to when their workload was higher, they were in better shape and had long careers by relying on pitching and not on throwing rocks to the plate (cases like: Pineda, Fernández, Nova, Campos, etc. are not representative of hispanic pitchers because they were trained in the US under the mentality of: higher velocities are better, and the less they pitch the better they are).

  11. danaking - May 14, 2014 at 2:01 PM

    I don’t know enough to contribute to the medical argument. I can cite the immediate and obvious logic flaw in Verducci’s suggestion: the experts said greater slope exacerbated the problem, so Verducci wants a lower mound. It’s apples and oranges. The mound can be left at 10 inches with a more gradual slope; the two are not mutually exclusive. It will just take more distance to reach ground level.

  12. tysonpunchinguterus - May 14, 2014 at 2:15 PM

    I think a more effective strategy would be to hold a seance to appease the ghost of Dr. Frank Jobe. To suggest anything else is a waste of time and, quite frankly, crazy talk.

  13. sabathiawouldbegoodattheeighthtoo - May 14, 2014 at 2:31 PM

    Do pitchers in Japan get this injury at a lesser rate? Perhaps the 7 day rotation would save arms.

    • raysfan1 - May 14, 2014 at 3:49 PM

      I can’t tell you about rates, but it does happen. Attached is a list of NPB players who have had the surgery as of last year…

      http://www.reddit.com/r/baseball/comments/1lg5ov/tommy_john_in_japan/

  14. barrywhererufrom - May 14, 2014 at 4:04 PM

    I wonder how many pitchers had their elbows blow out in the 50-70’s. We will hear the comment that pitchers didn’t have the number of elbow injuries then. Is that true? I know that the mound was raised in the year of the pitcher in 68′ Something must of changed because you can not refute the amount of th surgeries is eye popping. The solution of lowering the mound sounds plausible. On a personal note a family friend was drafted by the tigers two years ago and he had tj surgery last year. As a coach and someone who pitched and has a child who pitches, I hope that they game we all love finds a solution to this problem. It so disheartening to see so many young talented players miss time because of an elbow I jury. Any idea to solve this should be looked at.

  15. pbastille - May 14, 2014 at 4:30 PM

    Its been a while since I took anatomy. Which ligament is the Tommy and which is the John?

  16. supitsdan - May 14, 2014 at 6:34 PM

    and the Mets are known for their great track record of player health.

  17. crackersnap - May 15, 2014 at 8:55 PM

    Would lowering the mound change the force dynamics significantly for ALL pitchers, or just for pitchers in some certain height range? If the good doctor can answer that I would be inclined to listen. Otherwise, he might as well be promoting the significance of RBI’s.

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