What is causing the spike in Tommy John injuries?

In several previous posts I’ve urged caution when speculating about apparent increases in injuries. The spike of Achilles ruptures in the NFL preseason of 2011. The rash of ACL injuries in the 2013 NFL preseason. Even the seemingly increasing number of Lisfranc injuries in baseball on pitchers moundfootball falls into this category.

In each instance, I hesitate to rush to judgment that some problem exists with the sport or that training or competition is to blame. Without a long-term perspective over many years, it’s hard to draw definitive conclusions.

Also read:
Is the NFL lockout to blame for a spike in injuries?
The ACL epidemic in NFL training camps

The 2014 spike in Tommy John surgeries

The epidemic of Tommy John injuries in the early weeks of this Major League Baseball season does not fall into this wait-and-see category, in my opinion. I’m afraid we are witnessing the start of a continued rise in these season-ending injuries.

According to Grantland’s Jonah Keri, 20 MLB pitchers have undergone Tommy John surgery so far this season, and others will have it soon. The nearby Atlanta Braves have lost three pitchers alone.

Basics of Tommy John injuries

By now, most baseball fans have a basic understanding of the injury. The ulnar collateral ligament, a small ligament on the inside of the elbow, gradually wears out over time as it tries to stabilize the elbow against stress with each pitch. The surgery essentially uses a tendon from the wrist to make a new ligament. The pitcher misses 12 to 18 months of baseball while regaining motion and strength of his arm. Eventually he returns to the mound.

A number of studies show good success rates with UCL reconstruction. Generally greater than 80% of pitchers return to the same level of pitching as before injury. As Braves starters Brandon Beachy and Kris Medlen have shown this season, though, the surgeries might not hold up for the rest of pitchers’ careers.

Also read:
Tommy John surgery offers pitchers long-term success
Ask Dr. Geier – Tommy John injuries

Prevention just as important as treatment

More importantly, while getting a majority of throwers back is crucial, we need to figure out ways to prevent these injuries in the first place. More professional baseball teams are using complex analysis of pitching techniques and tracking all kinds of baseball and health metrics. The injuries early this season suggest they haven’t figured out a solution.Youth Pitcher

I would suggest that clubs have little ability to prevent these injuries because the root of the problem lies outside of their control. The heart of the Tommy John injury problem lies in youth and high school baseball.

What could be causing this increase?

Unlike most of the adults reading this column, kids today are encouraged to pick one sport and play it year-round as early as seven years old. The best young baseball pitchers now give up their summers instead of taking a break from baseball. They pitch in showcase events for scouts and a chance at millions of dollars. They play travel ball and pitch straight through the year.

With essentially no time to rest, these kids pitch month after month for years on end. These tiny ligaments just can’t withstand that constant stress without periods of rest. We shouldn’t be surprised that Tommy John surgeries, which were only performed on pro athletes 10 and 20 years ago, are increasingly done on college and high school pitchers. And if a kid has his elbow reconstructed at age 16, should he be surprised to need a repeat operation when he’s 26 and pitching for a Major League team?

I’m afraid that the spike in Tommy John surgeries in 2014 will be part of a long-term trend when we look back years from now. And I doubt the professional clubs will have much ability to slow the rise.

Also read:
The misperceptions of Tommy John surgery
What Stephen Strasburg can teach young pitchers

One solution

The people who can fix this problem are the young pitchers themselves and their parents. I realize many youth and high school coaches largely pitch kids into the ground in order to win. But no coach can make a kid pitch if he and his parents say no.

Parents should discourage kids from pitching in showcase events where kids try to throw even harder than normal despite tired or sore arms. Pitching with shoulder and elbow pain has been shown to dramatically increase the rates of arm surgery. Instead, all pitchers at the high school level and younger need to take three months a year off. Or play another sport that allows them to stay in shape while resting their arms.

Young athletes and their parents need to approach pitching with a long-term perspective. Instead of viewing Tommy John surgery as inevitable or a safety net to justify throwing harder and longer, they should do everything possible to try to avoid the knife altogether. In the coming years, we will see if kids are listening.

Note: A modified version of this post appears as my sports medicine column in the April 17, 2014 issue of The Post and Courier.

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