Tommy John Surgery

Tommy John

I have been a pitcher all of my life and have had a chance to meet many great pitchers. I only know one player that has had a Tommy John surgery and another friend of mine received surgery on his growth plate for his left elbow. My friend was young enough where they were able to repair it without the use of the Tommy John procedure. It seems like into today’s game there are many players that have to go through this, due to tearing the ulnar collateral ligament in their pitching elbow. After reading articles on Tommy John surgery, I wanted to share with you who and what Tommy John surgery is, how it got its name, and how to possibly prevent it.

So who is Tommy John and how did the procedure, Ulnar collateral ligament reconstruction (USL) get its name? Tommy John Surgery was named after Tommy Edward John Jr. (b.1943) a Major League pitcher with a career total of 288 wins, he is ranked seventh all time for most career wins for a lefty throwing pitcher. John made his Major League debut in 1963 with the Cleveland Indians and was known as a soft throwing lefty who knew how to hit his spots. Tommy John was mainly a ground ball pitcher and was sinker baller who was great at off speed pitching. Being this type of pitcher most likely had some involvement in tearing his UCL. He was elected to the All-Star team in 1968 prior to tearing his UCL.

While playing with the Dodgers, Tommy John started the 1974 season at a record pace of 13-3 before damaging this ulnar collateral ligament in his left arm permanently. Tearing his UCL lead to a revolutionary surgical operation. It was on September 25, 1974 when Dr. Frank Jobe pioneered and preformed this optimistic procedure. The process of this procedure is very detailed. Holes are drilled into the ulna and the humerus of the elbow, and a harvested tendon, which in Tommy John’s case they used his right elbow’s tendon to replace the damaged left one. Dr. Frank Jobe, than used that tendon and wove a figure eight through the holes of the Ulna and humerus of Tommy John. At the time of surgery Dr. Jobe gave this operation a 1 in 100 success rate. After his surgery Tommy John spent the whole 1975 season on the bench rehabilitating his arm before returning in 1976. He was out a total of 18 months. During his first year back he posted a record of 10-10 on the year, which was mind blowing, giving the odds that he would never pitch again. The next three out of four years he was a 20 game winner and was selected to the All-Star game in 78′, 79′ and 80′. He also pitched in three World Series. Pre-surgery wins for Tommy John was 124 games, post-surgery 164 games won. Tommy John went on to play until he was 46 years old! Talk about a long career. Today’s Tommy John Surgery has recovery rate of 85-92 percent, not to bad from it’s 1 percent odds.

How UCl Develops and Prevention

Like stated above the UCL is located on the inside of the elbow and connects the humerus and the ulna. Athletes that pitch have a highest risk of developing a tear. Every pitcher is different, but the ones who tend to have a jerky motion and are slider/curveball throwers tend to put extreme stress on their elbow. Over time the UCL can tear and stretch until the point where it is so weak it cannot hold the bones together tightly for throwing a baseball.

There have been many studies to find out what can be done to prevent getting to the point of needing a Tommy John Surgery, and simply to create a healthy pitching career. First of all conditioning of the body and making sure your body it strong enough to handle pitch after pitch is key. When getting tired on the mound, pitchers tend to rely on other muscles, which can change their motion possibly putting more stress on the elbow. Below is a study I found which explains that a higher pitch count has a bigger risk than the type of pitch being thrown, in relation to develop injury when throwing.

A 2002 study examined the throwing volume, pitch type, and throwing mechanics of 426 pitchers aged 9 to 14 for one year. Compared to pitchers who threw 200 or fewer pitches in a season, those who threw 201–400, 401–600, 601–800, and 800+ pitches faced an increased risk of 63%, 181%, 234%, and 161% respectively. The types of pitches thrown showed a smaller effect; throwing a slider was associated with an 86% increased chance of elbow injury, while throwing a curve ball was associated with an increase in shoulder pain. There was only a weak correlation between throwing mechanics perceived as bad and injury-prone. Thus, although there is a large body of other evidence that suggests mistakes in throwing mechanics increase the likelihood of injury it seems that the greater risk lies in the volume of throwing in total. Research into the area of throwing injuries in young athletes has led to age-based recommendations for pitch limits for young athletes. (Tommy Johns surgery wikipedia page)

Due to the popularity of the procedure, and players saying that they can throw harder than they did before their surgery. Many baseball parents have asked doctors to preform the surgery to help make their sons throw faster. However, Dr. Jobe, who invented the surgery, says that it could be two factors due to increased performance. One, the pitcher may be doing more conditioning then they did before. The second is that it takes years for the UCL to fully tear and deteriorate, slowing down velocity each year. While a newly healed pitcher can throw the same or a bit higher velocity before the UCL started to decline.

If the pitcher wants to get back in the game quickly, they need know the recovery is quite a process. After some searching I found a rough schedule (yougoprobaseball.com) of what goes on. Here is what they had to say.

Week 1: The elbow will be in a hard brace and held at 90 degrees, you will be able to move your hand and do light gripping exercises.

Week 2: More movement is added, the elbow extension is gradually increased and light exercise movements. Your arm will be in a brace for about 6 weeks.

Weeks 4-8: The player can start to do range of motion exercises. Must be medium to light weights.

Week 10: Simulating a throwing motion is added.

Weeks 12-14: More resistance will be added to throwing motion to strengthen the new UCL.

Week 16: Throwing drills will begin, starting soft and at a close distance, eventually building strength and throwing longer and longer.

Month 6 – 7: Slowly begin throwing only fastballs off the mound and breaking balls off the flat ground.

Months 8-10: Start practicing game conditions and all of the above.

Month 12: If everything went well during rehab, time to begin game play. Once back to pitching it will take some time to get a form similar to before the injury occurred.

Here are some Notable Pitchers who went through Tommy John Surgery:

Tommy John, Stephen Strasburg,  Adam Wainwright, Brian Wilson, Rick Ankiel, A.J. Burnett, Joba Chamberlain, Chris Carpenter, Manny Corpas, Scott Erickson, Daniel Hudson, Francisco Liriano, Jamie Moyer, Ben Sheets.

At the end of it all, good mechanics from wind up to delivery, proper conditioning, and learning from a young age the do’s and don’ts of pitching will hopefully help you keep everyone on a healthy pitching career.

– Matt Ingle