The Tommy John Epidemic

By JakeElman
May. 19, 2014

The Tommy John rash, Victor Martinez's amazing start, and more on Around The Horn


Matt Harvey and Jose Fernandez, two young ace pitchers, both have undergone Tommy John surgery (AP)

Written by Jake Elman


There's a new epidemic in the world, and no, it's not the zombie pathogen.

We're about a month and a half into the new season of major league baseball, and to say it's been fun would be a major understatement. We've seen , , and an quickly etching his name in the history books.

Sadly, 2014's most memorable part of the baseball season may not be any of those, but the Tommy John epidemic. The way that 2007 was year of the milestone and 1998 was year of the home run, 2014 could quite possibly be year of Tommy John.

For readers who are unaware ,Tommy John surgery is when you replace an elbow ligament that's been injured. It's most commonly done on college and pro athletes, especially baseball pitchers, but athletes in other sports have had it as well (former Panthers quarterback Jake Delhomme comes to mind).

The surgery is named after former Los Angeles Dodgers pitcher Tommy John. In 1974, he underwent the first surgery of this type and would eventually win 288 games in a legendary career that spanned three decades.

Tommy John surgery is also called UCL reconstruction; UCL is short for ulnar collateral ligament. During Tommy John surgery, a surgeon replaces the injured UCL with a tendon taken from somewhere else in the patient's body. It's a painful procedure, but it's taken pitchers on the cusp of never pitching again and gave them new life.

The average number of these surgeries from 2000-11 among major leaguers fell just short of 16, but then the figure skyrocketed to a record 36 in 2012 before dropping to 19 in 2013. It's already at eighteen this year, and a source with knowledge of the situation told me that the Padres' Andrew Cashner, placed on the DL this weekend with an elbow injury, could be number nineteen.

"It seems like every year I'm doing more and more, so from my standpoint it's an epidemic,'' said Dr. James Andrews, the famous orthopedic surgeon who has become the go-to doctor for athletes with injuries, back in April. "There's so much information about how good the procedure is that players don't want to wait. They want it done. So it's a struggle. There's always room for conservative treatment.''

The list of players who have underwent Tommy John surgery in the past year is enough to have an All-Star pitching staff. Matt Harvey of the Mets; Jose Fernandez of the Marlins; Ivan Nova of the Yankees; Brandon Beachy and Kris Medlen of Atlanta; Matt Moore of Tampa Bay; Jarrod Parker of Oakland; Patrick Corbin of Arizona...the list goes on.

"We have committees with doctors and athletic trainers working on this now," MLB commissioner Bud Selig said last week. "We'll have reports out. It's a problem. There's no question about it.

"The fact that it's happening with so much regularity, over and over, is deeply troubling," Selig added, clearly upset that this is what'll be remembered of his final season. "That's why I said to all of our guys, 'Hey, we've got to find out.' It bothers me a lot. I'm very worried. Let's see if we can find out some answers.''

Tommy John surgery has been going on for forty years now, and we're still searching for answers. At some point, don't you think that something is going to come out and we'll be like "that, right there, is why so many pitchers are having TJ."

It's frustrating that we're not there yet, because more and more pitchers are losing their future to this epidemic. Your favorite pitcher may be out there getting thirteen strikeouts one day, and you won't see him for two seasons the next day.

I reached out to a friend of mine, Aaron Mccune, a top high school pitcher down in Florida and a writer for , to understand what the deal with the Tommy John epidemic is. The insight from a pitcher is interesting, as you'll see below.

Jake: You said that you talked to a trainer and got info from them on Tommy John surgery - what was it that you guys talked about with regards to TJ?

Aaron: The harder that pitchers throw, the more likely that they are to have elbow pains. While having good mechanics helps prevent elbow injuries, at the same time it works against you because it helps you throw harder. It's a double edged sword.

Jake: Makes sense - a lot of the guys who have had Tommy John lately are guys who constantly reach mid to high nineties with their fastball. Matt Harvey, Jose Fernandez, [Stephen] Strasburg, they all throw hard. Do you think the inning limits that teams install on their pitchers are connected to TJ?

Aaron: Yes, I believe that some people, not all, are capable of throwing 130 or 140 pitches in a game. But the inning limits that they have don't stretch them out enough, especially if you're going, say, six days without starting. This causes them to have a lower ceiling than they originally had.

Jake: The average number of TJ surgeries between 2000-2011 was around fifteen, but then the figure skyrocketed to a record 36 in 2012. Last year, it dropped down to 19, and we're already at eighteen this season. The question remains why it's jumped so high in recent years, so I'm wondering what you think.


Detroit Tigers pitcher Joba Chamberlain underwent Tommy John surgery in 2011, and has the scar to prove it - it's now a smiley face! (Detroit Free Press)

Aaron: Well, since many pitchers are pitching with speeds of at least 94 MPH, it's going to cause an increase in arm injuries. There has also been a major increase in breaking balls thrown; I know that in a game this year, Jose Fernandez threw 54 breaking balls of 109 pitches.

Jake: That's nearly half. That translates to roughly fifty percent; half.

Aaron: Exactly. Breaking balls put more stress on the elbow because the arm isn't supposed to bend like that.

Jake: How can the Tommy John surgery epidemic stop, and will it stop anytime soon?

Aaron: That's a great question. Pitchers are going to need to stop throwing as hard - maybe stop trying to throw 97 all the time and just stop at 93 instead. Another solution is just teaching kids that curves and sliders aren't always the best pitches; a good changeup or cutter is just as effective.

Jake: Smart ideas. I definitely see where you're coming from.

Aaron: The epidemic isn't going to end until we stop showing the importance of the radar gun, honestly, but that won't be soon. It may be a whole generation before this is fixed, but it starts with the younger kids.

Aaron brought up some great points, namely how this is going to fall on the younger generation to pitch differently. The earlier you tell kids not to do something in sports - in football, for instance, tackling with your head - the better it'll work.

But why the sudden increase in Tommy John surgeries? For starters, pitchers are throwing harder than ever - and on a year-round basis at a younger age - both of which can add stress to a very delicate ligament. Even on our high school team, we have a couple kids who throw over or close to ninety miles per hour.

I feel like part of it just arises from this desire at a young age to be the next Roger Clemens, or the next Pedro Martinez. Young kids believe that to be the best pitcher, you have to throw hard; that's despite the fact that some of the game's best pitchers both today and historically weren't strikeout pitchers.

You look at Tom Glavine and Greg Maddux, both of whom are headed to the Hall of Fame this summer with 300+ wins and a World Series ring, and they still have their UCLs intact because they weren't trying to emulate, say, Steve Carlton or Nolan Ryan. Maddux got 3,000 strikeouts not because of his fastball, but because his stuff was so good that hitters couldn't catch up.

I think back to Chien Ming-Wang, who before being injured with the Yankees was an elite pitcher because of his sinker pitch. Wang had 19 wins in 2006 and 2007 not by striking guys out, but by utilizing his strengths to his advantage.

On the flip side, you have the Matt Harveys of the world who are so good with their fastball speed, but believe that that's the only way that they'll succeed. The facts show that you can succeed with three to four effective pitches; why waste your arm on just a fastball?

"There's so much information about how good the procedure is that players don't want to wait,'' Andrews said. "They want it done. So it's a struggle. There's always room for conservative treatment.''

As a baseball fan, I can't bare to watch another young, promising pitcher lose his potential and his career because of Tommy John surgery. This is not football with concussions - there's a way to prevent this all, we just need to figure it out.

I have faith in the game of baseball that we can begin the steps to preventing Tommy John surgery, or at least stopping this epidemic before it gets too far.

MLB Random Fact of the Week: Victor Martinez of the Tigers has ten home runs this year compared to nine strikeouts.

MLB Random Fact of the Week, part two: Something from the Math Isn't Fun Department - the Oakland Athletics are 27-16 and have a 96% chance of making the playoffs according to ESPN. The Milwaukee Brewers are 26-17, only a game behind, and only have a 54% chance. I'm not the best at math, but something seems a little sketchy.

Quote of the Week: "The one message is that there's never an excuse to back off the effort. If times are tough, you can't back off it. If times are good, you don't back off and take it for granted. You just remind them who's watching. Your fans are watching." - Hall of Fame manager Tony La Russa, who became the new chief baseball officer for the Arizona Diamondbacks this weekend.

Power Rankings:

1. Oakland Athletics 27-16

2. Milwaukee Brewers 26-17

3. Detroit Tigers 26-12

4. San Francisco Giants 28-17

5. Colorado Rockies 23-17

6. New York Yankees 23-20

7.Los Angeles Angels 24-19

8. Atlanta Braves 23-19.

9. Washington Nationals 23-20

10. Toronto Blue Jays 23-22

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