How To Avoid Tommy John Surgery
Baseball is one of the most popular sports in the U.S., with an estimated number of about 4.5 million participants in a year. According to a journal published in NCBI, it is considered one of the lowest overall injury sports, although players risk losing time out on the field if they do become injured. Tommy John Surgery is something every baseball player wants to avoid.
With 56%-76% being the number of time lost from injures. 67% is the overall number that accounts for upper extremity injuries, which belong primarily to pitcher injuries. In the Major League, pitchers account for almost half of the disabled list in the league. The most common injury is ulnar collateral ligament fracture. The only way to repair a UCL fracture is with Tommy John Surgery, a prevalent surgery in Major League Baseball. Let’s talk about what it is and then get into how to prevent it.
What is Tommy John Surgery?
Ulnar collateral ligament surgery was first introduced and performed by Dr. Frank Jobe M.D. The goal was to stabilize and restore the stability and range of motion in the elbow. Thomas Edward John, Tommy John, was a pitcher for 12 seasons in Major League Baseball (MLB) and pitched for the Cleveland Indians, Los Angeles Dodgers, and Chicago White Sox. Tommy John agreed to a surgical trial procedure to return to pitching. He was the first patient that Dr. Frank Jobe performed this procedure in 1974, and the reason why the surgical procedure is named Tommy John Surgery.
A Tommy John eligible injury is a common ligament tear in the ulnar collateral ligament (UCL), the ligament that runs from the elbow's inner side, which connects the ulna with the humerus. The ligament is one of the central support systems for a high endurance sport that involves constant motions such as throwing.
This motion is why pitchers are the most at-risk players for this injury and surgery. Damage to this ligament can cause loss of motion and stability. The cause of the injury is due to overuse (wear and tear) from repetitive activities. However, surgery isn't always needed for this type of injury. Sometimes a player just needs rest, ice, reduced elbow movement, and rehab as alternative options depending on the severity of the damage.
Common symptoms of the UCL injury:
- Elbow pain
- Audible popping sound
- Weakness in the handgrip
- Loss of function in the arm and elbow
- Numbness in hand and fingers
- Visible bruising
- Arm swelling
To repair this type of injury, the surgeon will drill holes into the humerus and ulna ignorer to weave a new tendon to stabilize the elbow. The new tendon is harvested from the patient's body or a donor in some cases. The tendons can be graft or taken from various tendons in the body. The procured is performed anywhere from 60-90 minutes, but a high risk of infection can occur due to anesthesia. Recovery from surgery is about nine months to a year with extensive physical therapy and rehabilitation. A typical range of motion can be seen in two to four months following surgery.
How to detect a UCL injury
Different tests can be done to confirm there is an ulnar collateral ligament tear. Muscle skeletal ultrasound can help identify the company of an early injury. Ultrasounds will help determine the damage in the ligament, apophysis (growth plate), and flexor muscle. MRI can show injuries to the elbow. UCL can be evaluated with stress radiography in some cases, and this test will show partial tears as 0.1mm and fun tears as 0.6mm.
The Success Rates
It's estimated that one out of four major league pitchers will go through Tommy John Surgery in their professional career. Clinical data from the American Sports Medicine institute states that between 1994 and 1998, UCL reconstruction accounted for 7% of the younger population. By 2004-2008 the number went up to 26% in younger athletes. This increase was due to changes in training, capabilities, and amount of participation in the game.
During 2000 thirteen major league pitchers had ulnar collateral ligament reconstruction. Twelve years later, the number increased from thirteen to thirty-two pitchers having ulnar collateral ligament reconstruction surgery. This trend suggested that the impact translated to adolescent athletes with a 50% increase of UCL surgery.
During 2012 the percentage of UCL reconstruction increased to 193% from 15 years old to 19 years old in New York State. The increase is due to the pressure on young athletes to perform at their peak level to gain scout attention for college scholarships. There is a 500% risk increase for players that pitch more than eight months out of a year, translating to a 400% risk increase for pitchers that throw 80 pitches per game.
The success rate for Tommy John's surgery is anywhere from 80% to 90%. According to the American Journal of Sports Medicine, in a study conducted on 179 pitchers who underwent Tommy John surgery, 148 out of the 179 pitchers returned to pitch professionally to the MLB. 174 out of the 179 returned to either major league or minor league, making a combined percentage of 97.2% returning to pitch at a professional level. 5 out of the 179 pitchers were not able to return to either major or minor league baseball.
There are many ways to prevent Tommy John Surgery in athletes. One of the leading training techniques is working on flexibility in small muscles to ensure a low risk of injury. By working with these techniques, players will increase the range of motion in small joints and muscles.
Being consistent with a progressive flexibility routine for both pre-game and post-game will ensure an entire optimized mechanical movement to its full potential. According to experts, it is recommended that young athletes continue a consistent warm-up routine due to the higher chances of injury from too much pitching or overworking their bodies. An essential tip is to continue a present number of pitches to allow the body to heal correctly and prevent it from failing due to stress or overuse.
The USA Baseball Medical and Safety Advisory Board did collaborative research with clinical experts to recommend young players baseball players with high risks of injury that include guidelines that specify limits for baseball season and yearly training.
Pitchers between the ages of 13 and older are recommended to do 75 pitches per outing, 125 pitches per week, 1000 pitches per season, and 3000 pitches per year. These guidelines are recommended to reduce the risk of UCL fractures throughout the baseball season.
Monitoring throwing limits and allowing the appropriate time for recovery is fundamental, especially in young players. Keeping a schedule and routine that will enable proper rest will let players throw at their peak expectations when needed.
One day of rest for every 30 pitches, two days of rest for 40 pitches, three days of rest for 60 pitches, and four days of rest for every 90 pitches thrown can reduce the risk of injury in young adults especially high school athletes looking for scholarships.
There aren't any guidelines in major league baseball or college-level baseball. Although the evolution of pitching mechanisms isn't a primary focus for injury prevention, it will help reduce the Valgus stress put on the elbow in pitchers.
Five parameters can help lower elbow Valgus load, leading to lower risk in UCL fractures. The following parameters are
- lead with the hips, hand on top position
- arm in throwing post
- closed shoulder position
- stride foot toward home plate
If three or more of the parameters are performed, this will help reduces UCL fractures according to high-tech lab analysis.
Another mechanism is maintaining a glenohumeral range of motion, and scapular functioning will aid in injury prevention. Much of the internal loss of a range of motion is due to posterior shoulder tightness. Stretching the posterior shoulder muscles and joints can help improve performance and agility and decrease the risk of injury. Modified sleeper stretch and crossed body stretching can help with posterior shoulder tightness.
Sleeper stretch is performed by laying on your side with your body stacked on your arm and stretching the arm to a 90-degree angle. This position allows the elbow to be perpendicular to your torso. Additionally, the elbow should be bent 90 degrees while using the arm as a torque lever. Once in the designated position, gently press the forearm to the floor while maintaining a 90-degree angle and hold for 60 seconds. We recommend doing the sleeper stretch before and after a game or practice, but it can be done as frequently as needed.
The cross-body stretch is performed by standing upright and using the opposite hand to move the specific shoulder horizontally toward the body’s midline. This stretch will help the humerus receive the proper stretching it needs for better game performance. A focus strengthening program primarily for scapular stabilization and shoulder strength should be regular exercise among pitchers. Maintaining a normal range of motion, shoulder strength, and scapular control will help decrease the stress in the medial elbow, leading to a lower risk of UCL tears.
UCL tears are something every player wants to avoid. We highly recommend consulting a physician before looking into a custom Ryan Weiss mobility program to continue to work toward a healthier pitch.