In July, baseball will take a break from its litany of big arms going under the knife to welcome into the Hall of Fame two pitchers who still have all their original ulnar collateral ligaments. Freaks.
Greg Maddux and Tom Glavine know Tommy John, but not in the Gray’s Anatomy sense. While today’s pitchers are riding an epidemic of elbow reconstructions — Tommy John surgery — these two old horses have had less work done on them than Jamie Lee Curtis.
“I guess we’re kind of the tail end of a dying breed, so to speak,” Glavine said. “There are not too many guys in today’s game pitching the way we pitched our whole careers.”
Hmmmm. Two fellows who lasted a combined 45 years. Both winners of better than 300 games. And both who did it all their own way, without sacrificing their entire youth on the altar of organized baseball or trying to throw every pitch through a wall. Wonder if they were onto something?
The current way our pitchers are being raised certainly doesn’t seem very efficient or effective. Too many stars are falling out with season-ending elbow tears, some of them, like Kris Medlen and Brandon Beachy of the Braves, now on their second round of ligament-transplant surgeries. The Tommy John surgery is becoming distressingly common, as ubiquitous in the pitcher’s world as the ice pack. A procedure originally intended as the last resort for an aged arm is now taking on the look of an inevitable cost of doing business for pitchers young and old.
Having lost a pair of starters to the surgery this spring, having lost more pitchers to damaged UCLs over the past 10 years than any major league club (a dozen), the Braves are uncomfortably familiar with the subject.
It was the Miami Marlins turn to cry this past week, when their 20-year-old phenom Jose Fernandez reportedly was diagnosed with a torn UCL.
Who knows whose turn it will be next week?
“It’s unreal. It seems like guys are going down right and left,” John, who underwent the first UCL ligament transplant 40 years ago, told his hometown paper in Watertown, N.Y.
Already this season, there have been 18 major league pitchers facing the surgery that requires close to a year of rehab. Joining Fernandez, Medlen and Beachy were such luminaries as Arizona’s Patrick Corbin, San Diego’s Josh Johnson, the Yankees’ Ivan Nova and Mets closer Bobby Parnell (that after losing ace Matt Harvey last year).
According to figures supplied by baseballheatmaps.com, there have been nearly twice the number of Tommy John surgeries performed on major leaguers in the past 10 years (184) as in the 30 before 2005 (96).
Theories abound as to why the steep incline in Tommy John surgeries, and ultimately the answer might well be a combination of them all.
- Pitchers are stronger these days. And in this radar-gun culture, they are encouraged to throw harder and harder, placing more stress on their joints. Something’s got to give.
Velocity has increased across the board — from 2008 to 2013 the major league average jumped from 90.9 mph to 92, according to baseball writer Tom Verducci of SI.com. A common assumption is that harder throwers would be more susceptible to injury, and that was the case in a 2010 study authored by Rome orthopedic man Brandon Bushnell. Over a three-year period, the nine Colorado Rockies pitchers who suffered various degrees of elbow injuries averaged 89 mph. Those in the uninjured group averaged 85 mph.
”People are bigger and faster than they were 20 years ago, they just are,” Bushnell said. “They are putting tons of strain on the same ligament. It’s not like their ligaments are getting bigger and stronger, but their muscles are.”
In many cases, the blow-em-away mentality is unsustainable.
“I don’t know if too many guys understand the concept of throwing at maybe 90 to 95 percent effort level and learning how to locate and make the ball move,” Glavine said.
“In my day you always heard that when a guy gets in trouble he ‘can reach back and get a little bit extra.’ It seems to me that nowadays guys are reaching back and trying to throw a little extra on every pitch. I don’t see how guys are going to stay healthy for very long with that type of approach.”
- The damage is being done long before the pitchers get to pro ball.
Major league organizations can hardly be more careful with their valuable, fragile mound investments. Ask the Washington Nationals and Stephen Strasburg. But none of their precautions seem to be enough.
Dr. James Andrews, THE Tommy John surgery doctor of the day, has long placed much of the onus on the high-demand youth baseball schedule. Too many games. Too many leagues. Too much year-round baseball. Too few breaks. Too much emphasis on impressing the radar gun. Too soon throwing the breaking ball.
Joe Chandler, the Braves’ consulting orthopedist, agrees.
“Where you see the problem is long before we ever get ’em,” Chandler said. “The questions we ought to be asking is not how fast do you throw now, but at what age did you start throwing hard and how many pitches a game did you average when you were 14?”
Tommy John surgery has certain miraculous properties, but, as Chandler said, “Prevention is a far better approach then treatment; if we can prevent an injury, that it’s far better than any surgery you can have.”
- The numbers naturally will increase as the ability to diagnose injuries becomes more sophisticated and faith in the surgery grows.
In 2009 when he was with the Angels, Ervin Santana, now with the Braves, rested what was widely reported to be a partially torn UCL and came back to average 210 innings per season afterward. That sort of approach was far more common decades ago before the surgery gained so many endorsements.
“Now they don’t want to give rest a chance because they know the statistics probably are not great they are going to get better with it,” Chandler said. “They are losing time — when you’re 25 and have a finite career, you don’t want to take the chance you’re going to miss two years instead of one year (if you don’t have the surgery up front).”
Statistically, players who have the surgery do return to the majors — 83 percent of them according to a 2013 study published in the American Journal of Sports Medicine. But their performance does not automatically improve, other studies have shown. There is no such thing as a sure thing in the operating room.
With these issues so ingrained in the game, reversing any part of the Tommy John trend will prove difficult. Suggestions range from lowering the mound in order to reduce the stress on the arm to expanding starting rotations or using more pitchers in tandem during a game. The more the warnings go out about the overuse/abuse of pitchers at the youth level, maybe a few more will be spared later.
In the meantime, hold your breath and hope your guy doesn’t join the conga line to the operating room.
Bushnell, the doctor who connected the dots between velocity and injury and is a big Braves fan, does.
Here’s a particularly chilling thought to tie up the topic.
“I still every morning think I’m going to wake up and read in the paper that Craig Kimbrel blew his arm out, as hard as he throws,” the doctor said.
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