2 Risk Factors For Tommy John Surgery: A Concerning Trend

20 Major League Baseball pitchers have had Tommy John surgery (i.e. Ulnar Collateral Ligament (UCL) Reconstruction) since the end of the 2013 season (this was originally posted April 2014), and all are under age 30.  As a healthcare professional, I find that very disturbing.  What may be worse , there are likely tons more pitchers who are continuing to throw through chronic UCL damage, even as early as in middle school and high school.  I was listening to sports medicine/elbow guru Dr. James Andrews discuss this topic in an interview with Sirius/XM Power Alley’Mike Ferrin and Jim Duquett.  This, along with an NJ.com article by Michael Fensom on the same topic, lead me to want to blog on this topic.  I care tons about the health and performance level of those ballplayers I come in contact with, and I feel this “trend” needs to be a key topic of discussion with all youth baseball players, parents, and coaches.   Some background on my perspective:  I played 18 years of competitive baseball (little league through sophomore year of college into beer-league fast pitch softball) and I’ve worked with a great number of middle school through college baseball players in the last 10 years of my sports medicine and performance-training career.  In listening to Dr. Andrews, he was spot-on with a number of concerning issues I’ve come across as an athletic trainer.  I agree with Dr. Andrews that this is “a trend” due to significant changes which have seemed to take place in the world of baseball, especially over the last decade.  A significant number of young ballplayers play baseball year-round, specializing in the sport at earlier ages.  Additionally, many players participate on multiple teams during the same season.  In the past, UCL tears were typically seen only in the highest levels of baseball into adulthood.  Nowadays, Dr. Andrews finds the significant amount of high school-aged Tommy John surgeries he performs alarming.  Let’s take a closer look at these two risk factors:

Early specialization vs. multi-sport athlete

It seems that a lot more ballplayers are playing baseball year-round these days, even as early as in middle school.  This is a significant reason why more high school athletes (in all sports) are being treated for overuse/chronic injuries that used to only typically occur in older athletes.  This repetitive strain from the same sports motion 12 months a year leads to increased risk of injury to bones, ligaments, muscles, and tendons.  I recognize that it can be difficult combating the “everybody’s doing it” peer and coach/instructor pressure.  We have to ask ourself: is it really the player who wants to play baseball year-round, or are they being pressured into it for the benefit of others? Experts have found that early sport specialization does not correlate positively with future professional athletic success.  Simply put – the earlier you specialize, the earlier you tend to peak.  In addition to a physical toll, early sport specialization can lead to mental burn out.  Think of it this way: what is your favorite food?  I personally love chicken wings.  But what would happen if I ate chicken wings 5 or 6 days a week for 12 months?  Besides gut girth likely increasing, I would probably (and sadly) never want to eat chicken wings again! Taking a different approach, multi-sport athletes develop greater athleticism due to cross-training. Playing multiple sports is a great route to overall athletic and personal development.  More and more college coaches are going on the record stating that they want multi-sport athletes as opposed to ones who only play their sport.  They don’t want players who are bored, burned out, and oft-injured.  Additionally, these days college coaches generally find division 1-caliber players regardless of where they are.  In other words, playing year-round for an expensive club is not always necessary to “make it big”.  Now, I fully recognize the great benefits to playing on a travel baseball club – it’s a great opportunity for players.  The point I’m making is, wherever they do play, we have to watch the overall toll that their throwing arm is taking.  This takes accountability from the athlete, parents, and coaches, all working together cooperatively.  To avoid this year-long training breakdown, I recommend taking 1 season a year to play a different sport from your “primary” sport, ideally choosing a sport that stresses the body in a completely different manor (i.e. contact vs non-contact, upper extremity-focused vs lower extremity-focused, or high volume vs low volume running).

Playing for multiple teams during the same season

Let me paint a picture for you of the extreme (yet too common): Nolan just finished his middle school baseball game (Let’s call them Team A).  Mom picks him up, and in a rush he scarfs down two Taco Bell chalupas and a Gatorade on the way to another game for his travel baseball team (Team B)  He pitched 5 innings in his middle school game, and now he’s been told by his other coach he is going to play outfield in his travel team’s game tonight.  I forgot to mention: Nolan is late to the game because mom drove to the wrong field, assuming he was playing for team C today (but that’s on Saturday!) instead of team B.  Nolan jumps right out of the van and into the game, assisting in 8 plays during the course of the game and throwing an average of 10 long-toss balls between each inning.  65 + 8 + 60 = 133 throws, not counting pre-Team A game warm ups.  Two days later, Team C is short handed, and it’s a “must win game”, so coach puts Nolan in to pitch the final 3 innings of the game… Maybe I don’t have to write anything else.  You get the picture.  It is situations like this where pitch counts and total throwing volume get “lost in translation” between multiple coaches and parents, rest periods are way inadequate, and nagging injuries occur.  This is not only isolated to baseball and softball – the same thing occurs in soccer, lacrosse, and basketball.  However, the significant strain to the elbow and shoulder is what makes baseball and softball players even more likely to fall victim to this preventable situation. Outside of these two areas, other risk factors for elbow and shoulder problems in ballplayers include (which I plan to cover in more depth in a future blog):

  • Improper pre-season/early season acclimation (going 0-60mph in 0.5 months?)
  • Improper off-season training program (is core, rotator cuff, hip strength, endurance conditioning, and functional mobility being addressed properly?)
  • Improper In-season maintenance program (are you avoiding GIRD and hamstring/posterior chain restriction, while maintaining core conditioning and staving off arm decelerating-muscle fatigue?)
  • Delayed management of throwing-related pains (are you putting things off that should have been addressed yesterday?)

Bottom line: Athletes, parents, and coaches need to maintain open lines of honest communication between all involved parties, and we health and athletic performance professionals need to promote safe training habits with the focus on long-term health and success.

Be well,


Ryan Stevens, MPS, LAT/ATC, CSCS


1 thought on “2 Risk Factors For Tommy John Surgery: A Concerning Trend”

  1. Great information to keep in mind before surgery. The best thing to do is to address the issue as soon as it arises. Thanks for posting!

Leave a Comment

Your email address will not be published. Required fields are marked *