The Tommy John Epidemic: What can we do to protect our pitchers?

Countless young pitchers dream every day of making it to the big leagues. They dream of taking the mound in the World Series and striking out batters with 98 MPH fastballs in front of thousands of cheering fans. While dreams of million dollar contracts and mile-long lines of fans eager for an autograph fill their heads, one thing they certainly aren’t dreaming about is laying on an operating table while their elbow is rebuilt. Considering the fact that more than one third of pitchers who started this season on an active Major League Roster have had to undergo Tommy John Surgery, maybe the realities of being a big leaguer are not what they seem.

Brandon Beachy is one such young player who had major league aspirations that eventually came true. After making his major league debut with the Atlanta Braves on September 20, 2010 at age 23, he earned a spot in the Atlanta Braves starting pitching rotation for the 2011 season. He won 7 games and ended the 2011 season with a 3.68 ERA. In June of the following season, he was placed on the disabled list because of discomfort in his elbow. Tests showed he had a partially torn ulnar collateral ligament (UCL) in his right elbow and as a result, he underwent Tommy John surgery on June 21, 2012.

Named after the professional baseball player who first underwent the procedure, Tommy John surgery is known in medical terms as ulnar collateral ligament reconstruction. In the procedure, the UCL in the elbow is replaced with a tendon from somewhere else in the body. What causes the need for Tommy John surgery? The repetitive stress of throwing can cause the UCL to become stretched, frayed, or completely torn. The procedure has a reputation for being incredibly successful and lengthening the career of athletes that might otherwise be cut short by the failure of the ligament. The original Tommy John, a major league pitcher, won 124 games before his procedure and after 18 months rehabilitating his arm, he went on to win 164 more.

After his surgery in June of 2012, Beachy spent the rest of the 2012 season rehabbing and remained on the 15-day disabled list to start the 2013 season. When another Braves starting pitcher got injured in July, Beachy’s opportunity to rejoin the rotation presented itself and he returned to major league action just 13 months after his procedure. After several starts he left a game in late August after feeling discomfort in his arm. He underwent an MRI and, lucky for Beachy and the Braves, no structural damage was found in his repaired elbow. There was inflammation and fluid build-up, but the ligament was intact. Although he didn’t actually re-tear the ligament, the soreness landed him on the disabled list.

His return to the disabled list calls in to question many of the practices common in today’s baseball culture. First is whether or not he spent enough time recovering. Recovery time on Tommy John surgery is listed as 12-18 months. These days, it is very rare for a pitcher to wait the full 18 months, largely due to the pressures many feel to get back on the field. Tommy John waited the full 18 months, and with great success. Players like Beachy, who rush back to action, can experience setbacks. His renewed pain also calls into question what the greatest factor is in the deterioration of the UCL. While current practice places the focus on limiting the total number of pitches a pitcher throws in a season to prevent a UCL injury, others believe a mechanical flaw may be more often to blame. Justin Orenduff of Baseball Rebellion believes that the reason the arms of pitchers are breaking down so often is because of poor mechanics, often incorrectly taught from a young age, that are never corrected. He believes that a mechanical adjustment can go a long way in improving a pitcher’s ability to stay healthy or to avoid a second bout on the disabled list after a Tommy John surgery. In his video below, he breaks down Beachy’s mechanics and the adjustments he thinks could prevent another trip to the operating room. Orenduff believes that Beachy’s current pain might be because Beachy has done nothing to correct his mechanics, which may have caused the UCL problem in the first place.

Orenduff isn’t the only person who believes that mechanical issues are causing players to injure their UCL’s and that the current focus on keeping pitch count low is not productive. Tom Seaver, the most famous pitcher ever to wear a Mets uniform, did not hesitate to speak up about his feelings when he heard that current Mets superstar pitcher Matt Harvey had injured his UCL in his second year in the major leagues.

 “Naturally, I felt terrible for the kid. He’s got such a bright future. But at the same time, all I could think of was how it just goes to show how all this babying of pitchers — pitch counts and innings limits — is a bunch of nonsense. You can’t predict these things, and there’s really not a whole lot you can do to prevent them other than refining your mechanics as (’60s and ’70s Mets pitching coach) Rube (Walker) did with us. But one way I know doesn’t do anything to prevent them is babying these kids like they do.” 

Seaver, like Orenduff, clearly believes that mechanics are more important than pitch count, and cites the number of players in the hall of fame who didn’t worry about pitch count and never required Tommy John surgery. Harvey had a pitch limit last year and one planned for this season. The Mets were reportedly planning on letting him loose to pitch as many innings as possible next season, perhaps one season too late.

While the media asks if it’s inevitable for pitchers to blow out their arms, it’s possible that the problem starts long before players get to the majors. If young pitchers were taught better mechanics, would they need to be as worried about pitch count in their older years? Orenduff and Seaver believe not. No matter which side of the line you fall on in terms of what causes UCL injuries or what the best method is for prevention, it’s widely agreed that there are no guarantees. Injuries are the most painful part of baseball dreams becoming reality. As more young players spend time dreaming of the major leagues, finding a way to preserve their long-term health is vital to the future of baseball.



  1. "These days, it is very rare for a pitcher to wait the full 18 months, largely due to the pressures many feel to get back on the field."

    I'm not sure that is why pitchers are coming back sooner now than before. Is the pressure really any higher now than 20 years ago? I assume it's a faster pace because teams know how to rehab the injury better and more efficiently than they used to. For sure, some players come back relatively quickly and get hurt again, but plenty come back that soon and do just fine.

    Otherwise, I do agree with the premise that bad mechanics lead to the injuries and reinjuries.

  2. I'd say its the rear-back-and-fire mentality that is adding to the injuries. Pitchers in the past didn't throw as hard as they could on every pitch. They could change speeds and only threw a hard one when it was necessary. A 90 mph fastball used to be a good pitch.

  3. great analysis and article