Is Tommy John Surgery Preventable?

Apr 19, 2014; St. Petersburg, FL, USA; New York Yankees starting pitcher Ivan Nova (47) throws a pitch against the Tampa Bay Rays at Tropicana Field. Mandatory Credit: Kim Klement-USA TODAY Sports

The talk of the town so far this season is the Tommy John surgery epidemic. Every day it seems like another pitcher is going down with an elbow problem and needs the famous elbow reconstruction surgery. This year, we have seen 18 pitchers have the surgery with the latest notable victim being Miami Marlins’ phenom Jose Fernandez. The question everyone is asking now is why is this happening and how can we prevent this trend from continuing?

The Yankees are taking a very cautious approach to protecting their prospects from the elbow epidemic. An example of how the Yankees are treating arm injuries right now is pitching prospect Bryan Mitchell. The 23-year-old righty was shut down April 25th with elbow discomfort. Even though he said it wasn’t a sharp pain, the discomfort was telling enough that he should not be pitching until his arm feels normal. Trenton Thunder pitching coach Tommy Phelps explained how they don’t allow their pitchers to throw until they are pain free, and each is required to rehab whenever they are inactive due to soreness.

"If they have any soreness or any discomfort, they aren’t going to throw,” Phelps told Nick Peruffo of The Trentonian. “The trainer gets ahold of him and does what he has to do to get them back to where he is feeling healthy. If the strength is there and the flexibility is there, we start him on a throwing progression to build him up.”"

I have the fortune of training with one of the premier strength and conditioning specialists in the country in Eric Cressey. With over 80 professional athletes coming to Massachusetts every off-season, he clearly knows his stuff. Luckily for me, Eric specializes in baseball training and has produced what feels like a million collegiate baseball players from the New England area. If you are not familiar with Eric’s work, head on over here and check him out. After seeing the Tommy John surgeries pile up over the years (myself included), I was curious to get his take on why this is happening. At the end of the day, it’s not one specific thing, but rather multiple factors that are causing the outbreak in elbow injuries. Here is his list of 10 factors that lead to Tommy John surgery nowadays.

1. Guys are damaged goods at a young age now.  Almost all young throwers have calcification on their UCLs from being overused and pitching year-round.

2. Guys are throwing harder than ever. 

3. Guys are heavier than ever before (as I recall, after MLB weight has increased by 12% over the past 20 years).  Force = mass x acceleration, so bigger guys will throw harder and put more stress on their elbows.

4. Improved diagnostic imaging makes it easier to determine who needs surgery.

5. The surgery is more “accepted” now as being successful, so players are more likely to go that route, as opposed to conservative management.

6. Guys are throwing a lot more sliders and cutters, which are very tough on the elbows.

7. Some new mechanical teachings (inverted W and power T) may also be contributing to the problems.

8. Guys are ramping up for the season too quickly. When you don’t have sufficient external rotation (which you gain as you throw more and more) at the shoulder, the elbow must compensate. This is why you see so many guys blowing out in Feb-Apr, but not later in the year.

9. More and more guys are trying to “just get by” with lower grade injuries by taking cortisone shots, popping NSAIDs, etc. The problem with these is that they weaken the soft tissue structures over time and may contribute to a more significant injury down the road.

10. We’re now seeing guys blow out second and third times. A replacement ligament will never be as good as the one God gave you, unfortunately. You’re asking a tendon to become a ligament, and you’re also drilling a good sized hole in the medial epicondyle and ulna to attach it. Any time you change someone’s anatomy, a lot can go wrong (as your experience certainly proves!).

Eric has done wonders for guys coming off of the surgery and in preventing it altogether. I’ve worked with him for two years now and my only regret is not working with him earlier. Is Tommy John surgery 100% preventable? Probably not, but there are extremely smart people out there (Eric Cressey) who are doing a pretty dang good job.

A very special thank you to Eric Cressey for his input in creating this article.