3 Reasons Why Young Baseball Pitchers Are Having Tommy John Surgery

The ulnar collateral ligament (UCL) is the primary stabilizer of your elbow during throwing.  When a baseball pitcher tears their UCL it is surgically reconstructed.  This is commonly known as ‘Tommy John Surgery”.  The rates of these surgeries are on the rise. Most strikingly, the incidence of Tommy John surgery in the 15 to 19-year-old age group is increasing at an average rate of 9.12% per year.  This article reveals 3 of the biggest reasons why.

#1 Pitchers are Competing with Arm Fatigue

Pitching with arm fatigue is the biggest predictor of having an arm injury.  A 2020 study proved that youth pitchers who compete with arm fatigue are 13.32 times more likely to suffer a shoulder or elbow injury.

Pitch counts and innings limits have been established to help minimize the negative impacts of pitching with a tired arm.  However, arm fatigue is a more complex factor than simply counting pitches or innings.

Pitchers today are practicing and competing in games more throughout the year.  There is no true off-season for some.  This means more high effort or maximum throws to stress the arm.  Other factors that contribute to arm fatigue include playing both pitcher and catcher and playing on multiple teams.

#2 Pitchers are Throwing at High Velocities

Higher fastball velocity is one of the biggest predictors of arm injury in baseball pitchers.  This is especially true as pitchers get older, bigger, and stronger.  A 2016 study from The American Journal of Sports Medicine proved higher fastball velocity was the biggest predictor of Tommy John surgery in MLB pitchers.

Peak pitch velocity was significantly higher among injured pitchers compared to uninjured pitchers (93.3 mph vs 92.1 mph).  Also, average pitch velocity was higher in injured MLB pitchers (87.8 mph vs 86.9 mph.

Many high school pitchers are now throwing in the upper 80’a and low 90s.  It is no coincidence that we are seeing injury rates rise along with these higher velocities.

#3 Pitchers are Specializing in Baseball 

Early sports specialization involves intense, year-round training in a single sport at the exclusion of other sports.  Some coaches, parents, and players believe specialization is necessary to develop the skills to compete at the highest level.  However, there is no strong evidence that early sports specialization is a requirement to achieve elite status in baseball.

A 2020 study out of San Diego State University looked at the effects of early specialization in over 500 high school baseball players. Highly specialized players were 3.7 times more likely to report an arm overuse injury compared to those who did not specialize.  Also, those who played baseball for more than 8 months per year were 2.03 times more likely to report an arm overuse injury.

Early sports specialization baseball
Early sports specialization is a contributor to elbow injuries in young pitchers

Some medical professionals and coaches recommend athletes should not specialize until around age 15.  Ideally, athletes should delay specialization as long as possible.  This is especially true for baseball pitchers who place unique demands on their throwing arm.  Becoming a well-rounded athlete, by playing multiple sports, is protective against arm injuries.

Steps to Reduce Your Risk for Tommy John Surgery

Avoiding pitching with arm fatigue and playing multiple sports are easily modifiable factors that will minimize your risk for injury.  Of course, maximizing your throwing velocity is not something you want to modify or avoid.  However, how you go about obtaining high velocity is important for your overall arm health.

Arm care programs are now a part of the game and most pitchers’ lifestyles.  It is best that your arm care program is specifically tailored to your body and physical abilities.  Seeing a physical therapist for an evaluation will help you target your exercises to get the best results.

BSR Physical Therapy
Schedule a free screen with your physical therapist

It is also imperative that you engage in a year-round lower body and core strength and conditioning program.  More and more research is showing a strong link between your lower half and arm injuries.  Start at a young so age so you develop good habits in the gym.

Another factor that can help condition your arm is a solid well-rounded long toss program.  These programs build arm strength, endurance, resilience, and mobility.  And when performed properly, long toss programs will improve your mechanics and velocity.

Final Thoughts on Tommy John Surgery

Undergoing Tommy John surgery is in no way a good thing. It does not guarantee higher velocities or better performance.  At best, 8 out of every 10 will make it back to the same level of play.  Even those that do return to pitching usually do so with poorer results.

Do what you can now to avoid overstressing your elbow.  Trust me, rehabbing for a year or two is no fun.  Taking the steps necessary to improve your arm’s health is going to make you a better athlete and a better pitcher.  Take care of your arm, get yourself into the gym, and play multiple sports.


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