Five Myths about Why So Many Pitchers Require Tommy John Surgery

In these enlightened times, why is it so difficult to dispel simple myths?

For instance, modern science has conclusively proven that:

  • People don’t catch colds from cold weather;
  • Feeding a cold and starving a fever is irrelevant;
  • Chocolate is not the root cause of acne;
  • Too much sugar does not cause hyperactivity in kids; and
  • Coffee does not sober you up.

Such folly persists in modern culture because it’s all repeated so often from so many sources that myths such as these become accepted as unquestioned fact. People like unquestioned facts; there’s no work involved in believing them.

As such, anecdotal evidence is substituted for cold, hard evaluation, and someone ultimately becomes poorer for it.

Which leads us to the modern day baseball pitcher. Of any age. Even a casual follower of the sport knows they’re falling like embers from an explosion, injuring their arms with such frequency that the terms UCL (ulnar collateral ligament) and Tommy John roll off a fan’s tongue as if he actually knows what he’s talking about.

So, let’s start with those two basic facts:

- The UCL is a thick, triangular band of gristle in two sections – anterior and posterior – whose purpose is to connect the arm’s humerus and ulna bones. Since the UCL is vital in holding the elbow joint together, it is not a good thing for a pitcher to injure.

- Tommy John was a serviceable starting pitcher for the Dodgers. More to the point, he was a lefty starting pitcher, and MLB teams want those guys to last forever. Ironically, John was a soft-tosser, featuring a killer sinker. When his UCL blew out in 1974, Dr Frank Jobe – the Dodgers’ team surgeon – went all Six Million Dollar Man on John and performed a radical new procedure whereby he took a ligament from elsewhere in John’s body and synthesized a new UCL. It succeeded. The southpaw won 288 games in his career, with 165 of them coming after the surgery.

These days, Tommy John, the pitcher is a virtually meaningless combination of words, while Tommy John surgery is an assumed salvation. But is it? MLB is now experiencing a growing list of two-time UCL losers – including Oakland’s Jarrod Parker and Atlanta’s Kris Medlen – and as of this dateline, 35 others. Then there are José Rijo, Scott Williamson, and Chad Fox, who have undergone Tommy John a mind-blowing three times.

What’s more, almost all of these players are in their 20s, in their alleged career peaks. What’s going on here?

Many are seeking answers. But while a well-researched fact or two would come in handy, what do they settle for?


Myth No 5. – Pitchers are throwing too hard.

Jayne Kamin-Oncea-USA TODAY Sports Images

This contention is ridiculous by definition.

Again, the man for whom the procedure is named – Tommy John – was a junk pitcher. He won with guile, not velocity. And yet, he wrecked his UCL.

Since the days of Bob Feller – and for all we know, Christy Mathewson and Walter ‘Big Train’ Johnson – when speed measurements were beyond primitive, it’s been well established that the 100mph range, plus or minus, is and has been a power pitcher’s high-end parameter. Glenn Fleisig, a biomechanical engineer who studies pitching at the American Sports Medicine Institute in Birmingham, Alabama, has further established that the energy-stress limit on a pitching elbow is 80 Newton-meters (a unit of torque). That happens to be the torque involved in a 100mph fastball.

If this limit has been a constant, then why didn’t the likes of Feller, Nolan Ryan, and Bob Gibson, to name a few, blow out their arms? Yes, there are outliers in every study group, but if too many appear, then they’re more than mere anomalies. And baseball has seen a steady flow of successful fireballers throughout its history.

Some observers, such as Tom Verducci of Sports Illustrated in his article on 15 April 2014, claim this phenomenon to be a uniquely American malady, with young hurlers throwing too hard, too soon. He cites anecdotal evidence. But anecdotal is not scientifically relevant. Even if it was, how does he explain the Yankees’ Michael Pineda, a Latin player whose arm blew up in 2012, causing him to miss most of that season and all of 2013?

Verducci also cites Zach Greinke, Cole Hamels, and Matt Cain as hurlers who ‘grew into’ their velocity after achieving adulthood, thus limiting the risk of throwing hard in their youth. Not true. The Perfect Game organization clocked Greinke at 94mph prior to his senior season in high school. Hamels broke the humerus in his pitching arm playing street football but still threw 94mph. And while Cain did ‘grow into’ his velocity, he fractured his pitching elbow after turning professional.

While throwing hard should obviously be accompanied by a sensible training and conditioning program, it is not the reason more players today are rupturing their UCLs.


3 Myth No 4. – The Verducci Effect: Pitchers are over-used, especially in their youth.

Don McPeak-USA TODAY Sports Images

It seems like once a year, Verducci posts a column warning that pitchers 25 and under who increase their workload by 30 innings the next season are prime candidates for injury.

Those who have looked closely at his anecdotal evidence have trashed this theory. The most thorough rebuke was published by Russell A Carleton in the Baseball Prospectus, a virtual bible for seamheads. His conclusion:

The problem of the Verducci Effect formulation is that the sample is far too heterogeneous to expect coherent effects out of it. Maybe the real frontier here is in breaking players down into sub-groups … It's much more complex, doesn't fit nicely onto the page of a magazine, and it's the way that real research is done.

The University of North Carolina conducted real research into pitching injuries. Here’s a chart of their findings that concentrated on the shoulder:

Shoulder Injury Risk Factors

An interesting sidelight is their discovery that sliders have the potential to be much more damaging than curves. However, More Years of Pitching places even lower than curve balls do.

Higher Average Innings Pitched and Pitching in a Showcase place in the middle of the pack.

The inference here is that it’s not the frequency of use that causes injuries, but duration of incidence. That can be resolved by instituting Pitch Count Programs, which places lowest on the chart. MLB medical and training personnel have long considered 120 the red line. Little League has a sensible set of limits. That basically means high school, college, and travel teams need to get with the program, which leads us to the next myth.

2 Myth No 3. – Baseball coaches know what they’re doing.

Tommy Gilligan-USA TODAY Sports Images

As Minnesota Twins manager Tom Kelly once sardonically mused, managing in the National League – what with its double switches and no designated hitter – isn’t rocket science.

Kyle Boddy of Driveline Baseball spelled out the point more bluntly:

The gold standard for coaching at higher levels of baseball is the fact that the coach played professionally or at a high college level, as if this is some good way to evaluate someone who will have a large role in keeping your arm healthy. It is, of course, the best example of falsely appealing to authority.

Refer again to the Shoulder Injury Risk Factors chart on the previous page. Prior Shoulder Injury is at the top of the list. Some are accidents, of course, but many come from amateur volunteers at younger ages who are oblivious to throwing’s proper mechanical techniques.

And as mentioned earlier, the chart provides data that mitigates the myth about curve balls being risky for young arms to throw. The slider, with its firm-wrist finish that requires the arm to resist a pronatal position, should be of much greater concern.

Perhaps volunteers can be grudgingly excused, but at the higher levels, there can be none for coaches and managers who don’t make themselves aware of basic kinesiology and the current training and conditioning programs compatible with it. And if they have trouble understanding the concepts, it’s not that difficult for them to find someone who does. After all, the 21st century is supposed to be the Information Age.

As Boddy so succinctly puts it, “Expecting the average 14-year-old to keep up on graduate-level kinesiology isn’t exactly fair.”

1 Myth No 2. – The five-man pitching rotation is easier on the arm.

Steve Mitchell-USA TODAY Sports Images

Hall of Fame manager Earl Weaver was the master of stripped-down baseball strategy, and his logic was impeccable. Why did he favor four-man rotations? Simple. “It's a lot easier to find four good pitchers than five.”

Regular use of the five-man rotation emerged in 1974 with two-thirds of the majors emulating the New York Mets. According to Craig R Wright and former major league pitcher Tom House in The Diamond Appraised, with Tom Seaver, Nolan Ryan, and Jerry Koosman having long and productive careers, other teams took note of the Mets’ policy of four days’ rest between starts and added an extra man to their rotation.

Weaver was the lone holdout. He still won games and titles with the four-man, but when he retired in 1982, that system retired with him.

Few teams produced as many 20-game winners as Weaver’s Orioles. In fact, his teams recorded a remarkable 22 of them during his career, with four of them – Jim Palmer, Dave McNally, Mike Cuellar, and Pat Dobson – accomplishing the feat together in 1971. It’s the only team to boast that many winners in the same season other than the 1920 Chicago White Sox.

The Orioles experienced few serious arm injuries during that time. Of course, Weaver actually managed his pitching staff, maneuvering it intact through rainouts and off-days while only occasionally employing a spot starter.

Leo Mazzone, pitching coach for the Atlanta Braves during their mind-boggling run of 14 straight division titles, agreed with Weaver:

I believe in throwing more often, with less exertion, and emphasizing touch, changing speeds, spin and control. The thing I'm most proud of isn't the 20-game winners we've had or our Cy Young Award winners. It's our health record. People said we couldn't throw as much as we do and be successful, but we've done it. I like proving people wrong.

Kyle Boddy of Driveline Baseball puts it even more directly, “How do you get better at something by not doing it?”

So, what’s the hold-up in a return to Old School? Money and perception. Teams want to protect their investments, and incredibly, they do so by relying on myths.

Myth No 1. – Tommy John surgery makes the arm stronger.

The Toronto Star, in an article dated 6 September 2013, reported that “As the success of Tommy John surgery became famous, a powerful myth took hold among many young pitchers and their parents: the procedure would make you throw harder.”

Other research has alarmingly revealed that as many as one-third of pitchers, coaches, and parents subscribe to this fallacy.

There’s a difference between an upgrade to bionic and a repair job. Only the latter exists in the real world.

Here’s how the surgery works:

- The arm is opened up at the elbow;

- Holes are drilled in both the humerus (upper arm bone) and ulna (one of the two lower arm bones);

- A tendon taken either from elsewhere in the body or a cadaver is woven in a crisscross through the holes and then affixed;

- The ulnar nerve is displaced to avoid pinching from the resultant scar tissue.

The only real distinction between this result and Mother Nature’s version is that the tendons are crisscrossed. This provides additional support to the joint, but has nothing to do with additional strength. Only muscles can get stronger, and even then, there is only so much stress the elbow can take. 37 major league pitchers requiring a second Tommy John surgery are evidence of that.

Since 2000, an average of 16 major league pitchers a year undergo the procedure. That’s a total of 224, with the number of two- and three-time losers growing. And still, the myths persist.

Promising developments are out there but are far from becoming commonplace. Boddy at Driveline Baseball, for example, counts up-and-coming hurlers like Cleveland’s Trevor Bauer and Atlanta’s Ryan Buchter among his clientele and cites confirmation that not one pitcher in his program has had as much as a sore arm.

He correctly predicted that Stephen Strasburg’s poor mechanics would land him on the surgeon’s table, and now, seeing no difference whatsoever in the Washington National ace’s post-TJS delivery, believes he’s the latest prime candidate for another one.

And so it goes.


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