More and more MLB pitchers, and even position players, undergo a particular surgical procedure in order to repair damage to a ligament in their throwing elbow. Only in 2012, more than 40 professional baseball players underwent the surgery, most notably Neftali Feliz, Joakim Soria, Randy Wolf, Ryan Madson, Brian Wilson, Daniel Hudson and Carl Crawford.


But what is exactly this surgery and who was Tommy John?


The Tommy John surgery, known in medical practice as ulnar collateral ligament (UCL) reconstruction, is a surgical graft procedure in which a ligament in the medial elbow is replaced with a tendon from elsewhere in the player's body (often from the forearm, hamstring, hip,  knee, or foot of the patient).


The procedure was first performed in 1974 by Dr. Frank Jobe, who today serves as a Special Advisor to the Los Angeles Dodgers, and is named after former major league pitcher Tommy John, whose 288 career victories ranks seventh all time among left-handed pitchers.


Holes to accommodate a new tendon are first drilled in the ulna and humerus bones of the elbow. A harvested tendon - from the forearm of the same or opposite elbow, below the knee (known as the patellar tendon), or from a cadaver - is then woven in a figure-eight pattern through the holes.


At the time of Tommy John's operation, Jobe put his chances of recovery at 1 in 100. In 2009, or 25 years later, prospects of a complete recovery had risen to 85-92 percent. Following his 1974 surgery, John spent 18 months rehabilitating his arm before returning for the 1976 season. Before his surgery, John had won 124 games. He won 164 games after surgery, retiring in 1989 at age 46 with the New York Yankees.


Before this groundbreaking surgery, UCL tears ended careers of baseball players. But now a full rehabilitation takes about one calendar year for pitchers and six months for position players.


Baseball writers John Roegele and Jeff Zimmerman were even able to compile a list of 488 players who have with reasonable certainty underwent Tommy John surgery: 2012 DL Information.


Former Cincinnati Reds pitcher, Jose Rijo, appears to be the all-time leader in Tommy John surgeries, with five.


One of the most impressive comebacks was made by Toronto Blue Jays pitcher Steve Delabar after a successful elbow surgery, which proves that this surgery can also enhance performance. His entire right elbow was destroyed, wired and screwed back together to stabilize the joint. His pitching velocity increased by 5 or 6 mph after the surgery. He is a proof that following the reconstruction of the UCL and the joint, a pitcher can have a better chance of performance enhancement if he implements a pitching velocity training program like Steve Delabar did post surgery.


But why UCL tears are so common?


Science proves that the valgus load applied to the elbow of most pitchers during external rotation exceeds the amount of stress the ligament can withstand before tearing. In fact, ulnar collateral ligament injury in high school baseball players is associated with overuse, high-velocity throwing, early throwing of breaking pitches (before the age of 14), and improper warm-ups.


UCL damage can be prevented with strength and conditioning of the throwing arm, pitch counts and proper pitching mechanics, especially for pitchers younger than 15 years of age. Proper pitching mechanics (called pronation) will go a long way into preventing damage to the joint. The proper pronation of the arm at release is when the thumb finishes down after the pitching motion and the arm is fully extended.


Improper pronation at release can be the result of poor mechanics and aggressive off speed pitches. Physics proves that during the velocity phase of the throwing arm, the pivot or elbow, must remain stationary until after release. This means the elbow must extend to release to prevent the elbow from moving down during the throw. This not only supports pitching velocity, but protects the elbow from resisting high amounts of deceleration forces. Extending the elbow to release also protects the rotator cuff during the deceleration of the arm.


Should I allow my kid to throw curveballs or sliders?


The debate is still raging as to whether young pitchers should throw curveballs, sliders or change-ups on a regular basis. For decades, most parents and coaches were trying to prevent their young hurlers to throw something else than fastballs mainly because of contorting elbows as it puts more strain on the joint than arms can handle.


However, a recent study showed that curveballs pose no greater risk than that of other pitches. Moreover, many studies have recently shown that the greatest threat to young arms is not throwing curves, but making too many pitches of any kind. For pitchers with proper mechanics, the force of throwing a curveball is no greater than for a fastball. The problem lies in the fact that most young pitchers don't have proper mechanics or enough neuromuscular control to throw curveballs.


The pitch count of youth-league pitchers (younger than 15 years of age) should be monitored carefully as studies have shown that it's the most likely cause of UCL tears. Still, while curveball pitches should not be banned from youth leagues, they have to be closely monitored and limited to ensure young pitchers are using proper mechanics and are not putting to much stress on their throwing elbow.


In the spring of 2012, Little League Baseball enforced proactive measures to reduce the number of young pitchers who undergo Tommy John surgery before graduating to college baseball by imposing limits of 85 pitches a day for 11- to 12-year-olds and 75 pitches for 9- to 10-year-olds. Rules also mandate days off between pitching appearances and forbid pitchers from playing catchers.


Finally, the above measures are a step in the right direction and surgery should always be avoided at all cost due to its unnatural abuse to the body.




Images from over at Beyond The Boxscore.


You can also follow me on Twitter at @FredPoulin98 to ask questions or talk baseball.


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notoriousjim said:

... thing thing about younger kids development is not about what you can see, in this case it is what you are not seeing. Without an MRI there is no way to know if he elbow is ready, even if he is a mountain of a kid. In all honesty, if he is a big kid there is a higher chance that it will hurt his elbow since ligaments often do not grow and get strong as fast as the rest of the body parts.

I actually have done will with TJ gambles in the past few years in fantasy baseball. Stratsburg 2 years ago, Brett Anderson this year, and Luebke is being held over for next year. I know i am going to lose on one of these guy eventually, but they are all top 30 SP (strasburg top 10, anderson top 20). It is starting to look more like a rite of passage for a lot of pitchers.
November 14, 2012
Votes: +0

Mallow Hunt said:

Mallow Hunt
RE: TJ The biggest thing for me as a LL coach, is making sure the kids have the right mechanics and that they're playing the right way. We don't push them and let them develop naturally.

The biggest dilemna however comes with my youngest brother Norman. He is only 12, but has repeatedly asked me to work on a slider with him, since a "bender" the only piece he's really missing from his already solid pitching repertoire (2 seam, 4 seam, and changeup).

I ask myself all the time if Norman could probably physically handle throwing a curve/slider and the answer is yes. He's fast approaching the six-foot mark and had spent the last two years absolutely dominating our league (160 K's over 71.2 IP), so he should start preparing to face stiffer competition. He's dedicated to being a better baseball player, but we're trying to be cautious with him before we trainwreck his development. For now we're gonna have him continue to work on the three that pitches he can throw well and hope he can adapt to a curve when the time comes.

This article ( was also eye opening on TJ surgery.
November 13, 2012
Votes: +2
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