Baseball’s Elbow Problem Starts With Young Pitchers

Increasingly, baseball players of all ages are turning to "quick-fix" surgery to keep their pitching skills strong.

Part of the tradition of baseball has always been its love affair with statistics, especially the ones that seek to predict what will happen on the field—the chance of getting a hit, the odds of making an error. But there’s one record-setting statistic that baseball isn’t celebrating—the increasing occurrence of arm surgeries among its young pitchers. With already 46 “Tommy John” elbow surgeries in Major League Baseball at the midpoint of the season, this year is on pace to exceed the number of elbow surgeries in 2012, the year with the current record. But no statistic has been able to determine why pitchers are getting injured at higher and higher rates. Frustratingly, for the teams with these high-value young throwers, scrutinizing numbers like pitch counts and innings pitched in an attempt to predict or limit risk seemingly hasn’t stemmed the rising tide of hurt players.

In the baseball world, no injury has captured more attention than the “Tommy John” surgery. Named for Los Angeles Dodgers pitcher Tommy John, the first player who underwent successful surgery for repair of a torn ulnar collateral ligament (UCL), the surgery restores the stability of the elbow.

Originally performed by orthopedic surgeon Frank Jobe in 1974, the procedure involves removing a tendon from the thigh or forearm and grafting it into the elbow to reconstruct the damaged ligament. Tommy John’s name is now known more for his contribution to sports medicine than his long baseball career, even though he went on to win more than half of his 188 professional games following his comeback from what was previously a career-ending injury. Today, the surgery has become so successful it’s virtually become a rite of passage—one in seven Major League Baseball pitchers has had it.

However, these days elbow injuries and Tommy John surgeries are occurring at a record pace, and it’s not just grizzled veteran players with thousands of innings under their belts who are getting them—it’s young pitching phenoms like Matt Harvey (age 24) of the Mets and Jose Fernandez (age 21) of the Marlins. These highly-valued pitchers are getting injured even though they’re being held to strict pitching limitations designed to keep them healthy.

Part of this increase is due to players increasingly opting for the surgery (perceived as a “sure thing” cure) at the first sign of elbow problems, rather than the uncertainty of rest and rehabilitation. Well-established research points to an 80 percent rate of return to a prior level of professional performance after the surgery. “Players want the instant gratification of getting it fixed right away,” agrees Bobby Evans, assistant general manager of the San Francisco Giants.

But for all the high-profile pitchers that need the surgery, it’s the increase in young baseball players needing elbow reconstruction that has researchers concerned. This continued rise in arm injuries among baseball players has become so alarming that the American Sports Medicine Institute (ASMI), headed by the doctor who performs many of professional baseball’s surgeries, Dr. James Andrews, hurriedly issued a statement in May aimed at young players, their parents, and coaches. The position statement warned that the rises are indeed connected; after all, today’s pro pitcher in his twenties was an adolescent pitcher a dozen years ago. In many cases, the injury process leading to Tommy John surgery in today’s young pro pitchers actually began while they were adolescents, in some part explaining why limiting the innings and pitch count of young professional pitchers doesn’t always prevent injury.

Although youth baseball is as American as apple pie and July 4, in those innocent beginnings lies part of the reason for the rash of professional baseball injuries. For some, youth sports are no longer innocent and carefree. While previous generations of youth athletes played a sport for a three- to four-month season, single-sport year-round competition and training are becoming increasingly common for children and adolescents. The hope for many of these parents and children is that this will lead to college scholarships or spots on Olympic teams—despite the low odds that argue the contrary. Unfortunately, without an offseason or recovery period, year-round sports greatly increase the risk of burnout and overuse.

Experts blame this year-round format of competitive baseball, in which young players may play 70 to 80 games per year, for increasing the rate of injury. Research by Dr. Glenn Fleisig, also of ASMI, concluded that “adolescents who competitively pitch more than 85 pitches per game, more than eight months out of a year, or with arm fatigue are several times more likely to require elbow surgery.” Another study highlighted those players who pitched more than 100 innings in at least one calendar year as having about 3.5 times the chance of serious arm injury as those who pitched less.

Nino Giarratano, head baseball coach for the University of San Francisco has developed three of his pitchers into first round Major League Baseball draft picks. He agrees that much of the problem lies in the development of young athletes. “Youth coaches push their kids too hard without first making sure they are strong enough to handle the stress of throwing 100 pitches 10 to 15 times a season,” Giarratano says. When recruiting, he steers clear of overpitched high school throwers with obvious mechanical flaws, emphasizing, “It’s usually only a matter of time before a baseball player that throws at max effort with poor mechanics will break down.”

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Ian McMahan is a writer and sports-medicine professional based in San Francisco.

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