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Article: The Twins and Tommy John

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#1 Seth Stohs

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Posted 13 May 2014 - 03:31 AM

You can view the page at http://www.twinsdail...-and-Tommy-John

#2 Sconnie

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Posted 13 May 2014 - 05:40 AM

Well said Seth. I think there may be something to the notion of improved diagnosis techniques and improved success of the surgery. There's more TJ surgeries in part because the medical staffs at all levels of baseball diagnose the issue better, are more willing to prescribe the surgery, and those that opt to have it done are more successful afterward than ever before. I wonder how many players in the past played until they couldn't, and retired early.

#3 CRArko

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Posted 13 May 2014 - 05:50 AM

It will be interesting to see if this research provides any help:

http://www.drmagazin...endon-injuries/
Verrrrrry Interesting!

#4 Kirby_waved_at_me

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Posted 13 May 2014 - 06:52 AM

Man, Joe Mays. I wonder if Joe had had the benefit of today's understanding of Tommy John Surgery and rehab if he would have lasted longer in the majors post surgery. He was pretty much done after (though the season leading up to the procedure was not going all that well, either).

#5 nicksaviking

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Posted 13 May 2014 - 09:16 AM

Velocity and strikeouts are up in the league while guys are throwing fewer pitches and going fewer innings.

It would seem that guys are exerting more effort these days to try to miss batas. I would think if a guy is exerting max effort on each pitch to keep the ball out of play instead of pacing himself, he would have a higher likelyhood of needing reconstructive surgery. We're not that far removed from the days when a 5.5 K/9 was above aveage and 91 MPH fastballs were impressive.

Of course that would make most of the current Twins pitchers safe from the procedure.

Edited by nicksaviking, 13 May 2014 - 09:19 AM.


#6 ND-Fan

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Posted 13 May 2014 - 09:53 AM

I think the weight training programs are leading to this sudden rise in elbow injuries and shoulder problems this extra strength has put more strain on both elbow and shoulder more than they are capable of handling over period of time. Also the emphasis on big tall pitcher I believe has led to elbow problems with weight training has created velocity that arms can not tolerate this torque that is generated. Just 15 years ago it was considered you had power arm that reached into the 90's and now that is required norm and now its become common to have pitchers reach middle to upper 90's. Also number of pitchers are reaching 100's but the problem is very few now have seen there arms stand up to this pitching. I would believe if Tommy John surgery hadn't come along baseball teams would be training their pitchers differently to protect their arms. Also some of smaller pitchers would have been looked at more seriously to see they could have developed into major league pitcher. I look at Greg Maddux today would he have been given a job today and given time to develop into the pitcher he became. A lot of this has been reaction to change in strike zone in MLB with strike zone shrunk to try to help bolster the offense and see more home runs hit. I think were coming to critical point where baseball may have to revaluate how they are training and developing players with cost they are incurring because of all the injuries. At some point its going effect numbers of players being developed and players organizations demanding something be done about all these injuries.

#7 Brandon

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Posted 13 May 2014 - 10:13 AM

When I first started following baseball in the late 80's rotator cuff surgery was a lot more common place. I don't see that as much anymore. Does anyone know why?

#8 Kirby_waved_at_me

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Posted 13 May 2014 - 10:34 AM

I couldn't find a specific study showing the frequency of rotator cuff injuries, but some recent notable players that had the operation:

Jessie Crain
Mark Mulder (twice!)
Johan Santana
Roy Halladay

Here's an interesting article on Rotator cuff injuries from January of this year- Tommy John surgery seems to be the bigger headline right now, but Shoulder injuries that require surgery are still plaguing pitchers:

http://www.philly.co..._MLB_teams.html

#9 twinsfan34

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Posted 13 May 2014 - 10:45 AM

Great question Brandon.

#10 ScrapTheNickname

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Posted 13 May 2014 - 11:35 AM

oops

Edited by ScrapTheNickname, 13 May 2014 - 11:39 AM.


#11 ScrapTheNickname

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Posted 13 May 2014 - 11:39 AM

I was watching a Dodgers' broadcast and Orel Hershiser was asked about the rash of Tommy John surgeries over the past years and first of all he said he didn't know, but he thought maybe it had to do with specialization - as Seth said may be one of the reasons - at younger and younger ages; that is, in his day kids plays multiple sports and by doing so used all or many parts of their bodies, while nowadays a pitcher will only pitch and thus over-tax his arm and not really develop the rest of his body. I'm saying it crudely, but that was his general point.

#12 Lefty74

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Posted 13 May 2014 - 12:21 PM

The whole TJ issue seems to be a mystery, even to those who perform the surgery. Last week I had a chance to meet and talk with Dr. David Altchek for a few minutes. Altchek performed surgery on Sano, Santana and tons of other MLB guys. He said he was on a panel on MLB network the previous day with Costas, Kaat, Smoltz and Verducci talking about TJ. He said Smoltz was very much against blaming it on pitch counts. Altchek's personal opinion is specialization and kids throwing at early ages off a mound and with radar guns logging speed. He said kids will tend to overthrow due to the guns and that the mound creates a tremendous amount of lag in the elbow which multiples the forces on the joint. He thinks these 2 things cause damage over time and believes that in youth baseball the mound should be removed.

There is also a lot of tracking being done by Boyds World and Baseball Prospectus. They track Pitcher Abuse Points (PAP) for college and professional pitchers. The basic premise is that when college or pro pitchers exceed a threshold of around 125 pitches they are in greater danger of injury--in particular if they exceed it frequently. I haven't studied their conclusions in detail, however they do seem to have data supporting the theory that high pitch counts tie to problems for many pitchers.

#13 KOHG

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Posted 13 May 2014 - 01:31 PM

[FONT=Verdana]

I was watching a Dodgers' broadcast and Orel Hershiser was asked about the rash of Tommy John surgeries over the past years and first of all he said he didn't know, but he thought maybe it had to do with specialization - as Seth said may be one of the reasons - at younger and younger ages; that is, in his day kids plays multiple sports and by doing so used all or many parts of their bodies, while nowadays a pitcher will only pitch and thus over-tax his arm and not really develop the rest of his body. I'm saying it crudely, but that was his general point.

[/FONT]

[FONT=Verdana]I agree with the idea of specialization and specific weight training is the cause. Looking at stats of inning of pitchers in the 20-40s its amazing how much throwing they did. The thing is - those players also worked for a living. They had jobs on the farm in the off season giving their body more of an overall workout especially when they where young. Now a days a kid goes to school and all he does is throw a baseball once every 5 days. Weight lifting is "specific" it targets one group of muscles. However, the other muscles, ligaments, bones aren't keeping up strength wise because they are not being strengthened at the same rate because they are not being targeted. Its like building a brick house and using wood glue for the motar..eventually its going to break. Also, they used to throw alot more when they where younger building up arm strength targeting the exact muscles, bones, and ligament that they would be using - the key was constantly and consistently. Another way to look at it...My dad was a sheet metal worker for 25 years he would lift and adjust a sheet metal slab for his lazer cutter he never had back problems or muscle problems he would come home and then work in the yard. I did that one time along time ago for a couple of weeks and I thought my legs and back where on fire and I couldn't move the next day. Its about consistency over a long period of time, its about an "overall" workout which strengthens all parts of the body at the same rate. Its also about some of these justin beiber, metro sexual kids who spend all of there time with there face in a tablet or pc not really doing any type of physical labor work over along period of time, when all of the sudden they have too and things break. Also, they just don't throw enough early and often, they should throw more not less. These guys just aren't as tough as the greatest generation because they don't have to be. This is my theory anyway[/FONT]

#14 spycake

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Posted 13 May 2014 - 02:19 PM

Man, Joe Mays. I wonder if Joe had had the benefit of today's understanding of Tommy John Surgery and rehab if he would have lasted longer in the majors post surgery. He was pretty much done after (though the season leading up to the procedure was not going all that well, either).


Mays also saw his K/9 drop by an average of almost 1 K/9 per year, for each of the 4 years prior to his surgery.

#15 Heezy1323

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Posted 13 May 2014 - 02:28 PM

When I first started following baseball in the late 80's rotator cuff surgery was a lot more common place. I don't see that as much anymore. Does anyone know why?


Great question. The answer is because the results of cuff repair in pitchers have been miserable in regards to return to play. In fact, the results of surgery to address ANY shoulder pathology in pitchers (SLAP tears, partial or full-thickness cuff tears) are quite a bit worse in terms of return to play than elbow surgery. Currently, most sports surgeons ascribe to the 'only operate on the shoulder when you have no other choice' school of thought. There is quite a bit of controversy as to how to handle cuff tears once it becomes clear that a pitcher is unable to continue without surgery. Most surgeons would probably lean toward just cleaning up the cuff (debridement) without doing an actual repair even if a full-thickness tear is present due to the poor results of return to play after a cuff repair. Hope this answers your question.

#16 mike wants wins

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Posted 13 May 2014 - 02:35 PM

From what my doctor friends tell me, no one wants to to shoulder surgery for anything for anyone anymore, if it can be helped. Just too hard/not effective enough for the risk.

As for TJ......I would never presume to opine on why there is more TJ, or how to avoid it, since teams are probably spending more time and resources and expertise to solve for this than I ever could....
Lighten up Francis....

#17 Brock Beauchamp

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Posted 13 May 2014 - 02:41 PM

Great question. The answer is because the results of cuff repair in pitchers have been miserable in regards to return to play. In fact, the results of surgery to address ANY shoulder pathology in pitchers (SLAP tears, partial or full-thickness cuff tears) are quite a bit worse in terms of return to play than elbow surgery. Currently, most sports surgeons ascribe to the 'only operate on the shoulder when you have no other choice' school of thought. There is quite a bit of controversy as to how to handle cuff tears once it becomes clear that a pitcher is unable to continue without surgery. Most surgeons would probably lean toward just cleaning up the cuff (debridement) without doing an actual repair even if a full-thickness tear is present due to the poor results of return to play after a cuff repair. Hope this answers your question.


Interesting. Thanks for explaining that to us non-doctors.

#18 Heezy1323

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Posted 13 May 2014 - 02:47 PM

[FONT=Verdana]I agree with the idea of specialization and specific weight training is the cause. Looking at stats of inning of pitchers in the 20-40s its amazing how much throwing they did. The thing is - those players also worked for a living. They had jobs on the farm in the off season giving their body more of an overall workout especially when they where young. Now a days a kid goes to school and all he does is throw a baseball once every 5 days. Weight lifting is "specific" it targets one group of muscles. However, the other muscles, ligaments, bones aren't keeping up strength wise because they are not being strengthened at the same rate because they are not being targeted. Its like building a brick house and using wood glue for the motar..eventually its going to break. Also, they used to throw alot more when they where younger building up arm strength targeting the exact muscles, bones, and ligament that they would be using - the key was constantly and consistently. Another way to look at it...My dad was a sheet metal worker for 25 years he would lift and adjust a sheet metal slab for his lazer cutter he never had back problems or muscle problems he would come home and then work in the yard. I did that one time along time ago for a couple of weeks and I thought my legs and back where on fire and I couldn't move the next day. Its about consistency over a long period of time, its about an "overall" workout which strengthens all parts of the body at the same rate. Its also about some of these justin beiber, metro sexual kids who spend all of there time with there face in a tablet or pc not really doing any type of physical labor work over along period of time, when all of the sudden they have too and things break. Also, they just don't throw enough early and often, they should throw more not less. These guys just aren't as tough as the greatest generation because they don't have to be. This is my theory anyway[/FONT]


I have spent a lot of time thinking about this question of 'are kids throwing too much nowadays or not enough?' What I have come to think is this: the main difference between the situation you describe above and throwing injuries (specifically UCL injuries) is that in the scenario above you are mainly talking about exercise of muscles. Muscles have the ability to hypertrophy (get larger) when worked out. This helps protect them from future injuries. In fact, this is exactly what is happening when someone lifts weights- the muscle is being partially broken down and subsequently repaired along with the muscle cells increasing in size. Ligaments, however, are different. They do not hypertrophy in response to repetitive loading and do not have the same capability to heal themselves as muscle does. This has to do with many different factors (which I won't pretend to completely understand) but some include blood flow (excellent for muscle, much less so for ligaments) and composition (primarily protein for muscles, mainly collagen for ligaments).
In sum, I do not ascribe to the argument that kids now do not throw enough. I'm certainly not saying I'm absolutely correct, just stating my opinion. I fall more in to the camp that believes kids throw too much. Too many innings, too many different teams, not enough time off to recover between seasons. IMHO a ligament has a finite life span (which is different for everyone) and once this is reached, the ligament is no longer able to do its job. For some people, this may be a few seasons in middle school, for others (elite pitchers) their ligament is inherently stronger and can take more punishment. Some go an entire career without ever having a problem; many do not.

#19 Heezy1323

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Posted 13 May 2014 - 03:03 PM

The whole TJ issue seems to be a mystery, even to those who perform the surgery. Last week I had a chance to meet and talk with Dr. David Altchek for a few minutes. Altchek performed surgery on Sano, Santana and tons of other MLB guys. He said he was on a panel on MLB network the previous day with Costas, Kaat, Smoltz and Verducci talking about TJ. He said Smoltz was very much against blaming it on pitch counts. Altchek's personal opinion is specialization and kids throwing at early ages off a mound and with radar guns logging speed. He said kids will tend to overthrow due to the guns and that the mound creates a tremendous amount of lag in the elbow which multiples the forces on the joint. He thinks these 2 things cause damage over time and believes that in youth baseball the mound should be removed.

There is also a lot of tracking being done by Boyds World and Baseball Prospectus. They track Pitcher Abuse Points (PAP) for college and professional pitchers. The basic premise is that when college or pro pitchers exceed a threshold of around 125 pitches they are in greater danger of injury--in particular if they exceed it frequently. I haven't studied their conclusions in detail, however they do seem to have data supporting the theory that high pitch counts tie to problems for many pitchers.


Very interesting stuff. Certainly hard to discount anything Altchek says (he is a giant in the profession) but I was at a conference recently (Altchek was also there, but not sure if he was at the particular session I am talking about) where a study was presented stating that the stresses on the elbow when pitching from flat ground were nearly identical to the stresses seen when throwing off the mound. This was a biomechanics study and was, in my opinion, very well done. Because of that study, I have some questions about the mound issue. It makes sense intuitively, but I'm not sure the science backs it up at this point. Personally I think specialization and radar guns are much more influential.

I think the pitcher abuse points thing is very interesting, and can help give some guidelines, but ultimately my belief is that every pitcher is different. Their mechanics are different, as is the inherent strength of their UCL. Things like this can be helpful, but at the end of the day a single set of guidelines is unlikely to be universally applicable. My (perhaps foolish) dream is to find a way to somehow measure the strength of an individual's UCL and be able to monitor this over time so the we could tell when the ligament is beginning to break down and perhaps catch some of these injuries before they get to the point of requiring surgery. We certainly know a lot more about these injuries today than we did ten years ago, but also have LONG way to go.

#20 Thrylos

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Posted 13 May 2014 - 05:09 PM

I'd add a couple of notables to the list:

Scott Erickson
Joel Zumaya (2 Spring Trainings ago.)

#21 LaBombo

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Posted 13 May 2014 - 05:27 PM

Nice writeup. Amazing that a third of the 1st round high school pitchers from 2010-12 have already had TJ when you consider that probably the oldest would be 23 by now, with the average age probably 21 or a little less.

But possibly even more disturbing is the fact that those those 2010-12 HS pitchers blew out their elbows at a rate 5 times what HS pitchers drafted in the top 30 from 2002-2009 did. That's probably at least partly small sample anomaly, but if it represents even a modest increase in injury frequency then it's a very alarming trend.

SI's Tom Verducci has a good writeup about the subject. He ends it with a plug for lowering the mound, and it will be interesting to see if the debate about mound height effect on pitcher mechanics and stress intensifies as the injuries mount.

Edited by LaBombo, 13 May 2014 - 05:34 PM.


#22 Lefty74

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Posted 13 May 2014 - 07:15 PM

Very interesting stuff. Certainly hard to discount anything Altchek says (he is a giant in the profession) but I was at a conference recently (Altchek was also there, but not sure if he was at the particular session I am talking about) where a study was presented stating that the stresses on the elbow when pitching from flat ground were nearly identical to the stresses seen when throwing off the mound. This was a biomechanics study and was, in my opinion, very well done. Because of that study, I have some questions about the mound issue. It makes sense intuitively, but I'm not sure the science backs it up at this point. Personally I think specialization and radar guns are much more influential.

I think the pitcher abuse points thing is very interesting, and can help give some guidelines, but ultimately my belief is that every pitcher is different. Their mechanics are different, as is the inherent strength of their UCL. Things like this can be helpful, but at the end of the day a single set of guidelines is unlikely to be universally applicable. My (perhaps foolish) dream is to find a way to somehow measure the strength of an individual's UCL and be able to monitor this over time so the we could tell when the ligament is beginning to break down and perhaps catch some of these injuries before they get to the point of requiring surgery. We certainly know a lot more about these injuries today than we did ten years ago, but also have LONG way to go.


I agree with everything you say. Some guys seem to be able to throw 120+ pitches every game and get stronger. I always say the human body is a miracle and trying to make connections between 2 people and injuries is so difficult.

It was kind of funny to talk with Altchek and have him ask if I played golf, after which he demonstrated lag by taking a golf swing without a club. I thought if he doesn't know what causes these injuries then we are a ways from getting answers.

#23 Zephrin

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Posted 13 May 2014 - 11:30 PM

Looking at that list, Liriano is still the one that haunts me. What could we have done in 2006 if Liriano and Santana had maintained that 1-2 punch into October? Sigh.

#24 The Wise One

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Posted 13 May 2014 - 11:57 PM

Mike Marschall, one time pitcher, PHD id how the body works, and also a different thinker wrote this:

Baseball pitchers tear the connective tissue fibers of their Ulnar Collateral Ligament from mis-use.
That mis-use starts with taking the baseball out of their glove with the palm of their pitching hand on top of the baseball.
As a result of taking the baseball out of their glove with the palm of their pitching hand on top of the baseball, baseball pitchers cannot swing their pitching arm downward, backward and upward to driveline height in one, smooth, continuous movement.
Instead, with the palm of their pitching hand on top of the baseball, baseball pitchers can only swing their pitching arm downward and backward to forty-five degrees behind their body.
From this position, to move their pitching arm to driveline height, baseball pitchers have to raise their pitching forearm vertically upward.
When their pitching forearm approaches pointing vertically upward, the baseball pitchers’ glove foot lands and baseball pitchers immediately and powerfully start to rotate their hips and shoulders forward.
This means that baseball pitchers start pulling their pitching upper arm forward.
Unfortunately, with the pitching forearm pointing vertically upward and the pitching upper arm jerking horizontally forward causes the pitching forearm to dramatically move downward to the height of the pitching elbow.
When the pitching arm reaches horizontal, without the protection of the muscles that attach to the medial epicondyle of the pitching elbow, their Ulnar Collateral Ligament alone absorbs the force of the downward bounce of the pitching forearm.
With each ‘Reverse Pitching Forearm Bounce,’ baseball pitchers tear some of the connective tissue fibers of their Ulnar Collateral Ligament.
After thousands of ‘reverse bounces,’ the Ulnar Collateral Ligament ruptures.
Unfortunately, unlike tendons, ligaments do not have pain sensors.
Therefore, baseball pitchers have no idea that they are tearing their Ulnar Collateral Ligament.
Fortunately, to prevent Ulnar Collateral Ligament tears, when baseball pitchers take the baseball out of their glove, baseball pitchers only need to turn the palm of the pitching hand from on top of the baseball to under the baseball.
With the palm of the pitching hand under the baseball, baseball pitchers can vertically pendulum swing their pitching arm downward, backward and upward to driveline height in one, smooth, continuous movement.
This pitching arm action activates the muscles that attach to the medial epicondyle, such that the Ulnar Collateral Ligament does not receive any stress.

#25 Hosken Bombo Disco

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Posted 15 May 2014 - 10:49 AM

Interesting topical story here:

http://m.espn.go.com...toryId=10935698