Tommy John surgeries are slicing (figuratively) through Major League Baseball and hitting active pitchers at a rate of .250. You didn't read that wrong, every 1 in 4 pitchers has had Tommy John Surgery (In comparison, only 50 players from the National League had a better batting average then .250 last year). The 2014 Major League Baseball season was particularly historical and astonishing, as over 80 players had Tommy John Surgery. That's more in one year than the entire decade of 1990-1999 (70 surgeries to be exact). In fact, since the start of the 2000 decade, the number of Tommy John Surgeries has always been in the double digits. We've created a chart to show the number of Tommy John Surgeries by year since 1985:
So what exactly is a Tommy John injury? Medically it is akin to an ACL or MCL tear that is common in the knees. However, a Tommy John injury is a tear of the ulnar collateral ligament (UCL) in the medial elbow. Much like repairing ligament tears in the knee, Tommy John Surgery requires a surgical graft to replace the UCL with a tendon from elsewhere in the body. The name Tommy John is derived from the first major league baseball player to have the surgery and was performed by Dr. Frank Jobe.
Initially Dr. Jobe put the chances of a successful Tommy John Surgery (meaning the player would be able to resume his professional career) at 1 in 100. However, present day knowledge and medical advances put the chances of a player successfully resuming his professional career at 85-92%. Typically a full rehabilitation takes an entire year. While statistics show a player can resume a healthy career, that doesn't necessarily mean they will be able to perform at their previous level of competition. In fact, 1 out of every 5 pitchers (20%) will not be able to real the median level of their career statistics before the surgery.
Now we know the background and medical history of Tommy John Surgery, the other pertinent medical question to ask is what causes the UCL to tear in the first place? The simple answer is the repeated torque motion that pitchers make. This entails the cocking back of the arm that the pitchers making when going through their delivery. This repetitive motion causes the UCL to become stretched and frayed, and eventually the UCL will tear when it becomes overburdened.
Now let's overlay this with some science. When a professional pitcher makes a hard throw (a fastball that clocks in at 90+ mph), the elbow is experiencing 100 newton meters of torque. 100 newton meters is equivalent to 60 pounds of pressure. To give you a more simplistic comparison, that's roughly 7 gallons of milk, 18 two-liters of coke, or 6 toaster ovens of pressure being applied to the elbow on one given throw. This torque is the result of the arm speed in relation to the body. When a pitcher sets up for his delivery, his arm is moving back while simultaneously his body is moving forward. The force required to get the elbow to stop moving backwards and to whip it forward in one synchronous motion is where the most stress on the UCL is experienced.
Now to the million dollar question, what's causing the increase in Tommy John Surgeries? If you have the exact answer, MLB has a job for you. Every expert has their own opinion. Some suggest the injury is being found more frequently (whereas it may have been missed in the past), resulting in an increase in surgeries. Others suggest doctors are more willing to just perform Tommy John Surgery instead of other, less evasive rehabilitation ideas.
Other popular opinions include that patients are more willing to have Tommy John Surgery, especially those that believe the myth that Tommy John Surgery will make you a better pitcher then before. However, research debunks this myth. In a study conducted by The American Journal of Sports Medicine in 2013, a total of 179 pitchers with UCL tears who underwent Tommy John Surgery were evaluated. The good news was of these pitchers, 148 (83%) returned to play in the MLB. 26 pitchers (15%) were able to return to the minor leagues. Five pitchers (2.8%) were not able to return to competitive baseball at all. Pitchers also returned on an average of 10 months after Tommy John Surgery.
While the return rate was positive in the study, the level of competition was not. A control group of equally skilled, statistically similar baseball players without the surgery was established. In the study, pitching performance declined significantly in the case of those who had Tommy John Surgery versus the control group.
The most common notion for the rise in Tommy John Surgery is overuse. Pitchers are starting out younger, with pitch counts in the 60-80 range. When they reach the MLB level, there is already significant stress and damage to the UCL. Pitchers are practicing on average eight months per year, and pitching while fatigued has become all too common. The basic denominator seems to be overuse and excessive pitching. The human body is just not designed to pitch every fifth day.
Velocity is another concern that plays a factor. It's just that simple; pitchers are throwing harder and at a higher velocity than ever before. Couple this with poor mechanics and it results in extreme stress on the UCL.
So how does MLB stop this gigantic freight train barreling towards them at full speed? Advances in biomechanics and teaching coaches proper techniques are a big step in the right direction. This will take time to implement, though. Monitoring how hard and how many months a pitcher works is also key. It's no coincidence that a large number of pitchers who have lengthy, healthy careers are from the north (where pitching year-round is not possible) compared to pitchers from the south who can pitch year-round.