Charles LeClaire-USA TODAY Sports

Ramblings On Tommy John Surgery


Sigh. Chris Withrow went down yesterday. According to team doctors (…), he has a torn UCL as Stacie noted yesterday, is seeking a second opinion to presumably go forth with the deadly surgery. If it feels like there has been an increase in UCL repairs in the past calendar year, it’s because there has been. Good pitchers all around the United States have been diagnosed with shredded elbows. Whether it be last year with Matt Harvey, to Kris Medlen this spring, Brandon Beachy, to the middle of the season with Martin Perez, and (most notably) Jose Fernandez. The whole situation is sad, so everyone is looking for answers. The greatest surgeon on the planet just published some points on what he believes to be the fundamental problem, and how to prevent the surgery. So I thought I’d just throw out what I think could be the cause of this madness. I have read some decent amount of information regarding pitching mechanics, and what in a pitcher’s delivery gives the elbow a higher chance to bust.

If you haven’t already, go read the excellent Chris O’Leary. That link will give you some incredible information that gives insight as to how a pitcher’s elbow explodes. There’s a reason that Chad BillingsleyScott Elbert, Ross Stripling, and now Chris Withrow have/will have their elbows stitched up. To sum up my views on why there are so many unfortunate, young baseball players who have to sit out a year of the game they love so dearly because their elbow exploded, it’s because most pitchers are throwing in ways that cause large amount of stress on the arm. More specifically the relation between the location of the hand and arm, and the moment the pitcher’s foot strikes the ground.

I could just spit out O’Leary’s arguments for you, but the basic things you need to know lie here. As is the case with many pitchers nowadays, their arms are not in a position ready to throw the baseball out of their hand as soon as their landing foot hits the bottom of the mound. You can see in that Matt Harvey article what that means.

It’s easy to see what O’Leary means when looking at pitchers like Chad Billingsley:

Gary A. Vasquez-USA TODAY Sports

Notice where the arm is at footstrike. Lagging behind, ball facing centerfield, and in order for him to deliver the ball to the catcher, he must whip his arm forward, causing unnecessary stress on the elbow and shoulder. Just for reference, lets show Scott Elbert at footstrike:

Gary A. Vasquez-USA TODAY Sports

The wrist is positioned awkwardly and causes copious amount of stress on the elbow, which would explain the 3 elbow surgeries he’s had in the past 2 years. Lets look at Ross Stripling:

For the sake of visualizing it better for you, I took a screencap that illustrates the timing problem that O’Leary talks about:

Screen Shot 2014-05-30 at 7.27.44 PM

See the “timing problem”? He is barely lifting his forearm while his foot is already down and ready to throw the ball to home plate. Arm lag causes a pitcher to exert energy on their arm, making them more of a risk for Tommy John surgery.

Finally, Chris Withrow

His fingers are on top of the ball, and that arm has a long way to go before it’s ready to throw that baseball, which in all likelihood caused the dreaded surgery.

All Dodger pitchers that have undergone tommy john surgery within the past year have something in common, their arms aren’t in the proper position at footstrike and their elbows suffer for it.

You could say that “it seems like that comes with the territory of pitching.” And you’d be right, if you want to throw really hard, these inefficiencies make you throw harder, dragging your arm and whipping it towards home plate causes more velocity than just throwing a baseball to your catcher. And unless you’re Nolan Ryan, it’s hard to have perfect mechanics. But striving for excellency is possible. There’s a reason Mariano Rivera, Tom Seaver, Justin Verlander, Nolan Ryan have never really had significant arm problems. It’s because their mechanics reduced the stress on their arms to a point where even when they sustained torn UCL’s (in Nolan Ryan’s case), it was in the last start in their respective careers. Guys like Cliff Lee have lasted 13 years without arm problems. It’s possible to last a long time with good, sound mechanics. If you notice, these guys weren’t scrubs in the velocity department, they threw/throw hard. It’s not a matter of tradeoffs, you don’t need to sacrifice velocity for mechanics, if you learn how to throw the right way, you will be just fine.

However according to O’Leary, it seems like there is a problem with the way kids are being taught to throw. Mix this in with the outrageous amount of year round throwing these kids do (that speaks to the concerns Dr. Andrews brought up recently), and you have a generation of hurlers that are going to be injury prone, which is what we’re seeing now with the epidemic of tommy john sufferers.

It seems that in order to fix this, it has to go through the beginnings of baseball, the youth game. Correct the bad habits, create good ones, and rely not on a temporary remedy that doesn’t even work 100% of the time in tommy john surgery, but rely on good coaching and solid rest/throwing programs. Not playing winter ball, resting, strengthening your core muscles are all good ideas as Dr. Andrews has brought up.

I’m by no means an expert. However, from the readings that i’ve found, it seems very important, even as a fan who isn’t involved directly in the community of baseball, why these injuries are occurring. Tommy John surgery has taken some of the most talented pitchers on the planet away from us in Jose Fernandez and Matt Harvey. I don’t want the next wave of hurlers to have the same issues this generation is having. I shudder to think what pitchers may be next.

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Tags: Los Angeles Dodgers Tommy John Surgery

  • Kristen Spencer

    Time for me to chime in again, here. I totally agree that there are multiple factors leading to the torn UCL epidemic. Pitching places an astronomical amount of stress on the elbow and shoulder, which, in itself, will elicit a certain amount of UCL tears. However, there are elements that can be changed. Some of which are pitch count, pitch velocity, hand placements (as O’Leary mentions), etc. Others of which are mechanical. I would add that chest position, rib position, and pelvis position at footstrike or pre-acceleration phase are all contributing factors… and factors that can be addressed off the mound. Take a right-hander. If the pelvis is lagging behind (doesn’t rotate around the left thigh) or the chest is rotating toward the left too early (leaving the right shoulder behind), excess stress is placed on the vulnerable elbow joint. It is not difficult to screen or correct these issues under the hand of a properly-trained clinician. I have seen, first hand, several Tommy John surgeries prevented in partial UCL tears by correcting these imbalances.

    Again, only one piece of the pie. But, I am a firm believer that taking away any x-factors is worth a shot. Let’s hope it gets better before it gets worse.

    • Adrian Garcia

      thanks for the comment and read, Kristen! Pitching is a delicate process. And at no point did I say “if you pitch this way, you’ll never, ever, ever tear your UCL”. Pitching most definitely places enough stress to where UCLS are going to tear, but that doesn’t mean making fixes to the way you throw the ball, and the frequency in which you throw said ball won’t help you throw baseballs at a high level for a long time. Nolan Ryan blew out his UCL in his last start of his career, this was after 20+ years of pitching, so I completely agree with this assessment.
      It just sucks because well over half of the pitchers in baseball are “risk factors” if you take into account the mechanics, and amount of pitches they have thrown in their careers.

      • Kristen Spencer

        Agreed. I didn’t mean to imply that you felt there is an absolute way to avoid all UCL tears. Just wanted to be sure that I was also clear in that stance. ;)