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 this 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 far and away 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 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 or 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 a 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.

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 lifestyle.  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.

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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 health is going to make you a better athlete and better pitcher.  Take care of your arm, get yourself into the gym, and play multiple sports.

Returning to Sports after Knee Replacement

It is estimated that the number of knee replacement surgeries in the United States will increase 673% from 2005 to 2030.  A large portion of these surgeries are being performed on people under 60 years old.  Also, people are living longer than before and expecting to stay as active as possible up to and after retiring.  Many people desire to return to high level activities and sports such as golf, hiking, jogging, or tennis.  Returning to sports after knee replacement surgery is a common and worthy goal that can be achieved.  This article highlights realistic expectations and timeframes for returning to your favorite sport.

Health Benefits of Physical Activity and Sports after Knee Replacement

knee arthritis

Knee replacement surgery has an unquestionable positive impact on your health and fitness.  This is because decreased pain and improved function following surgery allows you to resume previously restricted physical activities.  In fact, research proves the risk for serious cardiovascular events is reduced by 12.4 % after hip or knee replacement surgery.  So undergoing a knee replacement not only reduces your knee pain, it also decreases your risk of a heart attack or stroke.

Can I Play Sports after My Knee Replacement?

Research shows you are extremely likely to return to low impact activities after your knee replacement.  The majority of people (94%) will safely return to walking, biking, swimming, dancing, and playing golf.  People hoping to return to moderate impact activities do so with a success rate of 64%.  This includes sports such as bowling, skiing, hiking, and doubles tennis.  Those who desire returning to higher impact sports do so at a lower rate (43%).  This includes activities such as softball, basketball, jogging, and singles tennis.

aerobic exercise back pain

Several factors will increase or decrease your chances of returning to sports.  People who are overweight or obese are less likely to return to any sport.  Younger people (< 70 years old) are more likely to return to their favorite sport.  Also, research shows men are slightly more likely to return to sports after their surgery.  Women, don’t let this discourage you!

When Can I Get Back to Playing Sports?

Many people we rehabilitate desire returning to golf after their knee replacement.  As long as there are no post-surgical complications, everyone is expected to return to playing golf within one year of their surgery.  Some people (13%) may return as soon as 12 weeks after surgery.  Most people (44%) resume playing a full round of golf between 4 to 6 months after surgery.

Golf exercises

The average time to return to other low impact sports (biking, swimming, and dancing) is similar to golf.  Moderate impact activities (doubles tennis, bowling, and hiking) are resumed between 3 to 4 months after surgery.  In most cases, people looking to resume high impact activities (singles tennis, softball, and jogging) do so no sooner than 6 months after surgery.

During jogging, loads 5 to 10 times your body weight are imparted through the artificial knee joint.  Not all joint replacements are designed to withstand these forces.  Studies show higher wear of the artificial joint surface in people who run after knee replacement.  However, there is no evidence that running increases your risk of undergoing another operation.

Final Thoughts on Sports after Your Knee Replacement

Discouragement from your surgeon, mainly to high impact sports, may be a barrier for you.  Surgeons usually approach these recommendations on a case by case basis.  We recommend you discuss your situation with your surgeon. The pros and cons of returning to sports should be weighed.  Pain, weakness and a loss of confidence are other reasons why you may not return to your favorite sport.  Your physical therapist can help in these cases.  It is important to keep an open communication with your therapist.  This includes shared decision making about your goals and reasonable expectations. If you would like help returning to your sport after your knee replacement surgery, give us a call.

Barnegat 67: A New Year’s Update

BSR Physical Therapy is on schedule to open at Barnegat 67 by the end of January 2019.  Things are proceeding quickly with construction.  This week the ceiling goes up and the first coat of paint will be applied.  Over the next two weeks, we expect the ceiling and lights to be completed.  Shortly thereafter, the floors, cabinets, countertops, and final coat of paint goes in.  We can’t wait to get in the new space.  We will keep everyone posted about our grand opening and open house at Barnegat 67!


Blood Flow Restriction Training

What is Blood Flow Restriction?

Blood flow restriction (BFR) exercise occurs with external pressure over the extremities. The applied pressure is sufficient to maintain flow through the arteries.  However, it decreases venous flow distal to the restricted site. The goal is to enable patients to make greater strength gains while lifting lighter loads.  This reduces the overall stress placed on the joints and muscles.

What is Blood Flow Restriction Training used for?

Normal strength and hypertrophy (increasing muscle size) are achieved with lifting resistance close to 70-80% of a one repetition maximal effort (1RM).  When a muscle or body part is injured, lifting at such a high level of resistance may be contraindicated.  BFR exercise allows one to achieve strength/hypertrophy gains with only 20-30% 1RM without stressing the injured areas. This potentially has a use for patients post-op surgery or injury.  Also, a recent study looked at BFR exercise in a patient with Parkinson’s disease and found they were able to improve their walking ability.

Is Blood Flow Restriction Safe?

Medical grade tourniquets have been used for a long time without adverse effects.  Think of surgeries where tourniquets are applied for long hours (ie., hip replacements, ACL reconstruction, etc).  Today’s medical grade tourniquets are able to dynamically accommodate the pressure to occlude blood flow but also maintain a safe level throughout an exercise.  A 2016 large systematic review looked at BFR exercise and found little to no research showing a higher risk than typical exercise at higher resistance loads.

However, one should not take a simple rubber band or strap and wrap it around a limb to occlude blood flow.  This strategy is not FDA approved and without proper training can increase the risk of bodily harm or injury.  Also, those with chronic medical conditions, a compromised cardiovascular system or other medical problems could be a contraindication to BFR.  Only a trained medical professional can help you decide if this intervention would be right for you.


Blood flow restriction is an intervention skilled physical therapists can utilize to help patients increase strength with a significant decrease in load on the joints and muscles.  Research so far has been quite promising for different injuries and populations especially for those recovering from injury or surgery.

Written by Dr. Mark Daitol, PT, DPT

Fall Prevention: Strength Training with your Physical Therapist

More than one out of four adults, 65 and older, fall each year.  Falling once doubles your chances of falling again.  One out of five falls causes a serious injury such as a broken bone or head injury.  More than 95% of hip fractures are caused by falling.  One in five hip fracture patients dies within a year of their injury.  Women fall more often than men and are more likely to break a bone.  Over the last 10 years, death from falls has increased by 30% in United States.  It is estimated by 2030, falls will result in one death every seven hours.  Clearly, fall prevention programs are needed.

Falls are associated with extrinsic and intrinsic factors.  The extrinsic causes are related to the home environment such as rugs, stairs, and poor lighting.  The intrinsic causes are related to problems with balance or gait, muscle weakness, poor vision, cognitive deficits, the presence of chronic disease, abnormal blood pressure or medications.  Research shows the most effective interventions for preventing falls are based on balance and strength training.

Fall Prevention: Lower Body Strength Training

Fall prevention exercise programs for older people not only reduce the rates of falls but also prevent injuries resulting from falls when they do occur.  Not only does strength training improve muscle size and strength but it also improves bone density.  Therefore, strength training improves an individual’s protective responses during a fall.  The result is a more resilient older adult who is less likely to sustain a debilitating hip fracture from a fall.

Older adults are advised to perform weight-bearing lower body strength training a minimum of 2 to 3 days per week.  Most research studies show that a minimum duration of 26 weeks is needed to achieve the best results.  Body weight exercises, such as squats, are often performed.  However, research shows better improvements in strength and balance when external resistance, such as weights, is used.  Substantial improvements in strength can be achieved with light, moderate, or heavy loads.  Multiple sets of each exercise produce greater improvements in strength compared to single set routines.  Performing 6 to 12 repetitions per set is a great way to achieve improvements in strength and muscle size.  Perhaps most importantly, all strength training exercises initially focus on proper form and then loads are progressively increased over time.

The most frequent exercise utilized in fall prevention exercise programs is the sit-to-stand exercise.  This exercise involves an activity which older adults perform frequently in their daily lives.  The ability to perform this activity without the assistance of the hands has been linked to fall risk in older adults.  It can be easily performed in the physical therapy clinic, any community exercise studio, or in the home.  The exercise is progressed by lowering the height of the chair or by holding weighted objects such as a medicine ball or kettle bell.  Other lower body exercises commonly prescribed include step-ups, hip, and ankle strengthening exercises.


Fall Prevention: Trunk Muscle Strengthening Exercise

Although an important component of any fall prevention program, performing lower body exercise does not guarantee reduced fall risk.  Improvements in lower body muscular strength may not transfer to improved balance if other factors are at play.  One such factor which can influence fall risk is core or trunk muscle strength.  The trunk muscles are composed of the abdominal, pelvic, hip and low back muscles.   These muscles are responsible for transferring forces from the lower to upper body during whole-body movements such as walking or climbing stairs.   The trunk muscles are highly active during a trip suffered while walking.  These muscles act in order to stabilize the trunk over the feet when loss of balance occurs.  The ability of the trunk muscles to react to unexpected disturbances (i.e., suddenly being thrown off balance) has been shown to be delayed in older adults.  Poor ability to activate the trunk muscles has also been linked to an inability to transfer from a chair to standing unassisted.

Trunk muscle exercise focusing on strength and the appropriate timing of contraction can significantly improve balance in older adults.  Trunk muscle strengthening programs can be individually prescribed and progressed by doctors of physical therapy.  Also, many personal trainers, strength coaches, and Pilates instructors are skilled at instructing older adults in these exercises. Exercise can be performed in various positions such as lying on the back, stomach, side, or in kneeling and standing positions.  Trunk strengthening exercises may also be performed using unstable training devices such as exercise balls or balance pads.  Often, resistance bands, light weights, and medicine balls are incorporated based on the individual’s goals.  The 90/90 leg lower and Pallof press are two examples of trunk strengthening exercises but there are many more.


Closing Thoughts

Research supports the benefits of both lower body and trunk strengthening exercise for reducing falls in older adults.  The importance of the trunk muscles for balance and mobility in older adults has been underestimated and often overlooked.   Fall prevention exercise programs are optimized by including individually prescribed lower body and trunk strengthening exercise.   If you are not sure about how to get started, give your physical therapist a call.