Tommy John was a professional baseball pitcher for 26 seasons, playing for 7 teams and winning 288 games. He was a four-time all-star, a borderline Hall of Famer, a coach, and a broadcaster. That was Tommy John the player, and I am sure he is a great human being and can be trusted around your athlete.

However, there is an uglier side to Tommy John, and that is the surgery that bears his name. Tommy John Surgery is a surgical graft procedure where the ulnar collateral ligament (UCL) in the medial elbow is replaced with either a tendon from elsewhere in the patient's body, or with one from a deceased donor, and it is frequently performed on children!

Once considered a surgery for professional athletes, the Tommy John Surgery was designed to save pitchers amid their professional careers and add a little life into their arms. Devised in 1974 by Dr. Frank Jobe, Tommy John (the pitcher) was the first to undergo it.

John, 31 at the time and in his 9th professional season, was thought to have had a career-ending injury, and this surgery added 15 years to his career.

At this point, you are probably asking: “Why should a successful surgery like that be avoided with our young athletes?” The answer is clear, concise, and simple! The Tommy John surgery repairs UCL tears, a ligament that often only tears due to overuse, specifically in baseball pitchers. Meaning for a youth athlete to reach the point of needing Tommy John, means their arms have been damaged through repeated strain and overuse.

So commonplace has the surgery become in young athletes, that former Major League Pitcher Tommy John, the surgery namesake had this to say when asked about it:

A study released in 2015 reported that 57% of athletes who underwent Tommy John Surgery were between the ages of 15-19 (high school to college freshman age), indicating that pitching injuries due to overuse are a significant problem in youth sports, and are only worsened when the athlete chooses to specialize in a sport such as baseball with a sub-specialized focus of pitching. When combined with poor technique and lack of recovery, the immature elbow will eventually see damage. 

When interviewed about UCL Damage in Young Pitchers, Orthopedic Surgeon Weimi Douoghih stated regarding specialization and arm injuries, “It is so important to educate families to what the risks are.” Douoghih is an opinion of merit having operated on a pitcher who was ten years old, based on the fact his parents and coaches had him throwing curveballs with poor technique on an underdeveloped arm without proper rest causing the tear.

So how did the surgery go from a point where the average age of patients dropped from 27 to 17?  The answer is overuse! Overuse injuries occur when tissue is damaged due to repetitive demand over an unspecified period, occurring when a constant repetitive motion with or without correct biomechanics causes tissue to become inflamed, torn, or damaged.

Even worse especially before full development is the fact that they (the athlete) are micro-fracturing their bones, and micro-tearing their muscles and tendons. When the micro-fractures and tears are not given the appropriate amount of time to heal, the condition can worsen through overuse and cause an overuse injury to become an acute injury, an injury that requires surgery and significant recovery time. Regarding the UCL tear, it has been directly connected to overuse and insufficient rest.

So how do we keep Tommy John away?

Dr. James Andrews a leading expert on orthopedic surgery, said the following suggestions should be considered:

Proper Warm-up

Warm up properly by stretching, running, and easy, gradual throwing. A dynamic warm-up specific to the motions an athlete would use on the mound, followed by a gradual pitching warm-up is recommended to prepare the body for the challenge ahead.

Rotate playing other positions besides pitcher

Various positions on the baseball field require different movement patterns of the body. Alternate positions to allow certain parts of the shoulder to rest.

Concentrate on age-appropriate pitching

A common problem in baseball, that is exacerbated by specialization, is pitch selection on immature (pre-pubescent) pitching arms. Breaking balls (pitches that rotate or move horizontally before descending and being caught, put a tremendous amount of stress on the wrist, elbow, rotator cuff, and shoulder. The repeated usage of those pitches can result in an overuse injury that can harm the development of the immature arm. According to a review by Dr. Trent Tamate titled “Curveballs in Youth Pitchers: A Review of the Current Literature,” it was determined that age-appropriate pitches exclude ALL breaking balls until approximately age 14.

Patience

We as parents, and coaches must be patient when developing our pitchers, mindful of pitch counts, usage, and discomfort, and focused on development. We must see past the nose on our faces and commit to a long-term athletic development approach if we want to reduce potentially catastrophic injuries and succeed in keeping Tommy John away from our kids.

This guest post was written by Jon Orr, M.SC. He is a Veteran of the United States Navy, an educator, coach, and Founder of the Sports Reclamation Project. As a former athlete and sports parent, he looked at the youth sporting landscape and began to wonder if things were being done the wrong way. He found that 70% of athletes quit by the age of 13 and the biggest cause for the exodus is simply that it is just not fun anymore. The goal of the Sports Reclamation Project is to reduce the 70% attrition rate in youth sports through coach and parent training and education.