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Throw the Perfect Fastball and Prevent Tommy John Surgery in Baseball

by Paul Kohler, MS, OTR/L, CHT2 Comments

Major League Baseball (MLB) has had home run eras, base stealing eras, and dead ball eras.  Now, we have the “velocity” era where starting and relieving pitchers are throwing harder than ever.

  • 2007 | Pitchers 25 years or younger threw a fastball with an average velocity of 90.8 mph.
  • 2008 | 13 different relievers threw a fastball at an average of 95 mph or greater.
  • 2013 | The number of relievers that threw 95 mph or greater grew from 13 to 46.
  • 2013 | The same age group of pitchers (25 years or younger) averaged 92.5 mph fastballs.

This is no surprise to the average baseball fan who has a chance to watch Major League play. As fastball speed increases, throwing mechanics may break down causing increased strain on the elbow leading to reconstruction surgery of the ulnar collateral ligament (UCL). This ligament is within the elbow and the need for the procedure is more commonly known as Tommy John Surgery (TJS).

Dr. Frank Jobe performed the first ulnar collateral ligament reconstruction of the elbow on Dodger’s left handed pitcher, Tommy John, in 1974. John went on to pitch for 13 more seasons. His success was attributed to the surgery and a change in his pitching mechanics through the tutelage of Kinesiologist, Mike Marshall. By 1984, 10 years after Dr. Jobe’s initial procedure, only 11 MLB players had undergone the same procedure. However, over the past few decades the number of Tommy John Surgeries in the majors has grown rapidly.

The problem doesn’t stop with the MLB. The number of college, high school, and even elementary level baseball players undergoing Tommy John surgery is growing. Physicians in attendance at this year’s American Sports Medicine Institute (ASMI) Conference agreed that they have been treating more UCL tears in the youth population over the past 10 years, as seen in the grid below.

Year # of TJS that year % of youth/HS at ASMI
1984 2
1994 9 0%
2004 33 20%
2012 *46 *2008: 32%
2014 29 **2011: 23%
**Most recent data

Click to learn more about Tommy John as a rising epidemic in youth athletes.

There are a number of theories and reasons why this trend is taking place. Below are key points regarding risk factors and prevention of ulnar collateral ligament injuries based on presentations by Dr. Anthony Romeo, Dr. Steve Jordan, Dr. Michael Axe, Dr. Glenn Fleisig, Mike Reinold PT, CSCS, and Kevin Wilk, DPT.

Pitchers High Risk for Future Tommy John Surgery
Dr. Anthony Romeo, Dr. Steve Jordan, Dr. Michael Axe, Dr. Glenn Fleisig
Mike Reinold PT, CSCS, and Kevin Wilk, DPT.

  • Poor throwing mechanics
  • Throwing with pain (especially when felt in the late cocking and acceleration phases)
  • Pitch counts higher than USA Baseball Recommendations
  • Throwing/pitching when fatigued
  • Frequently throwing at high velocity
  • Decreased internal rotation in the throwing shoulder

Prevention for Tommy John Surgery
Dr. Anthony Romeo, Dr. Steve Jordan, Dr. Michael Axe, Dr. Glenn Fleisig
Mike Reinold PT, CSCS, and Kevin Wilk, DPT.

  • Have a good balance between time spent practicing pitching/throwing mechanics and game pitching/throwing
  • Promote open communication between coach, parent, and player regarding pain in thee throwing arm (and don’t throw through pain)
  • Abide by USA Baseball recommendations for pitch counts and days of rest
  • Commence pitching when the player shows signs of fatigue
    (sluggish, arm angle lowers, poor command)
  • Understand that if your children and/or players have the strongest arm, they have a high risk of injury and need to continue to rest and condition when appropriate
  • Stretch the external rotators and posterior capsule of the throwing shoulder
  • Strength and condition the external rotators, posterior shoulder muscles, and scapular muscles
  • Consult with a medical professional (MD, PT, CHT, ATC) if you/your player experience throwing arm pain
  • Work with a Physical Therapist that specializes in the overhead athlete to develop a forearm strength and conditioning program to decrease their risk for UCL injury.

If you would like to learn more about enhancing your baseball performance and preventing throwing injuries, check out our Video Throwing Analysis.

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The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

Fleisig, G. S., R. F. Escamilla, and S. W. Barrentine. “Biomechanics of pitching: mechanism and motion analysis.” Injuries in Baseball. Philadelphia, PA: Lippincott-Raven (1998): 3-22.
Fleisig, Glenn S., et al. “Kinematic and kinetic comparison of baseball pitching among various levels of development.” Journal of biomechanics 32.12 (1999): 1371-1375.
Wilk, Kevin E., et al. “Deficits in Glenohumeral Passive Range of Motion Increase Risk of Shoulder Injury in Professional Baseball Pitchers A Prospective Study.” The American journal of sports medicine 43.10 (2015): 2379-2385.
Udall, John H., et al. “Effects of flexor-pronator muscle loading on valgus stability of the elbow with an intact, stretched, and resected medial ulnar collateral ligament.” Journal of Shoulder and Elbow Surgery 18.5 (2009): 773-778.
Buffi, James H., et al. “Computing muscle, ligament, and osseous contributions to the elbow varus moment during baseball pitching.” Annals of biomedical engineering 43.2 (2015): 404-415.
Kerut, Edmund Kenneth, et al. “Prevention of arm injury in youth baseball pitchers.” J La State Med Soc 160.2 (2008): 95-98.

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  1. Jason West

    I think the injuries are more related to the fact that kids play 9 months or longer every year. Pitch counts are certainly a problem, our 13u team played a game just 2 weeks ago where their pitcher threw 156 pitches. And he threw hard. I also believe that
    “Tommy John” is so popular that doctors are performing the surgery more often that they would have 10 years ago for same type of injury.
    I guess in my opinion the way the ball is being thrown is not the problem

  2. Paul Kohler

    Jason, I think you are absolutely right about the amount of time spent playing baseball and the number of pitches thrown in a game, tournament, and season. Good pitching mechanics can reduce a pitchers chance for injury, but they mean nothing if the player is forced to throw beyond his safe limits. Thanks for the comment. I hope you are a coach because you get it!

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