The Creation of an Epidemic: Tommy John Surgery in Baseball (Part Two of Two)

*Part two to a two part story. Read Part one here

Kids today have nothing to fear about Tommy John surgery. The surgery has become safer than ever, more and more pitchers each year come back and reclaim their elite status after the surgery. Out of all the pitchers that receive Tommy John surgery, 80% make it back to the big leagues. Just take a look at the New York Mets, the 2015 National League Champions. Five of their best and most promising starting pitchers have had Tommy John surgery, which includes Zack Wheeler, Matt Harvey, Jake DeGrom, Steven Matz and closer Bobby Parnell. Kids today see the National League Champions with a rotation full of Tommy John surgery recipients, see their success with Tommy John surgery and begin not to worry about the negatives. Even newly elected Hall of Fame pitcher John Smoltz had the surgery, the first ever to have Tommy John surgery and make it into the Hall of Fame.

            With so many success stories, many people think that the surgery has a 100% success rate and pitchers can come back even stronger after surgery. Without any apparent repercussions for having Tommy John surgery, pitchers rationalize that a new and fixed ligament will basically give a clean slate when it comes to wear and tear on the elbow. These players believe that they can throw harder because of it as well, which will get them to the major leagues and the big paycheck, so pitchers elect for surgery if at all possible.

            However, the stereotype is very much false. Tommy John surgery is a transplant, meaning that a doctor replaces the ligament from somewhere else on the body. The doctor takes a tendon in the wrist, cuts it out, and connects it in replace of the broken ligament. However, the new ligament is no stronger than the old ligament. The inventor of Tommy John surgery, Doctor Frank Jobe, spoke in favor of this notion, saying “The surgery doesn’t make anyone better… It restores. That’s it." Doctors have not perfected the surgery either. In 2014, 11 out of 31 surgeries performed were for revisional purposes. Players underwent Tommy John surgery for a second time because the first surgery failed. According to Stephania Bell in an article on ESPN.com, since 1999, 32 pitchers have undergone revisional Tommy John surgery and a third of those revisions happened in the past year. Bell also tracked five starting pitchers and five relief pitcher’s velocities before and after surgery. Seven out of 10 pitchers had their velocity decrease post-surgery. The three pitchers that had their velocity increase, increased by tenths of a mile per hour.

     So why do pitchers elect to receive Tommy John surgery? Because of the money that comes with making it to Major League Baseball. The average annual salary for a Major League Baseball player in 2014 was $3.82 million dollars. Pitcher Max Scherzer inked a seven year, $210 million deal from the Washington Nationals last offseason. Almost all of the top tier pitchers ink nine figure deals. With pitching in such demand in Major League Baseball, organizations willingly spend insane amounts of money on a pitcher. These teenagers want part of that. Therefore, they feel the need to do anything they can in order to succeed as a pitcher, even if that means needing Tommy John surgery. At young ages, pitchers willingly do anything to net themselves a lucrative contract in the Major Leagues. They will throw hundreds of pitches at top speeds all year round in order to impress Major League scouts. These baseball organizations even encourage it, shown when scouts pressured Brady Aiken to pitch against doctor’s orders. Major League Baseball organizations use the money against these young pitchers. They have created their own conundrum known as the epidemic of Tommy John surgery. An inflation of Tommy John surgeries in baseball without any known long-term consequences is a scary path for baseball to head down. What could happen to these pitchers 10, 20, even 50 years in the future? Let us not wait to find out by taking initiative now.

The Creation of an Epidemic: Tommy John Surgery in Baseball (Part One of Two)

                In baseball, a player with the ability to throw a ball with uncanny velocity and incredible movement has become an indispensable resource. Teams will pay millions of dollars for this kind of talent. In consequence, young players will do anything to secure that million dollar contract by pitching year round, maxing out their inning limits and forcing themselves to throw harder than ever. In actuality, these kids are throwing until their arm falls apart. Throwing a baseball at velocities upwards of 90 mph puts tremendous strain on the elbow. Putting too much strain on the elbow leads to injury and eventually to surgery. This is known as Tommy John surgery, a reconstructive surgery for the ulnar collateral ligament in the elbow named after pitcher Tommy John. Within recent years, Tommy John surgery has plagued Major League Baseball. Pitchers have received the surgery at rapidly increasing rates, creating an epidemic within the game of baseball.

According to Pitch Smart, over the past three years, the number of baseball pitchers receiving Tommy John surgery has increased yearly. As of 2012, approximately 25% of Major League pitchers and 15% of Minor League pitchers have had the surgery during their career. The rate of players receiving Tommy John surgery has also increased by 50% since 1990. Overuse has caused this epidemic. According to Doctor Glenn Fleisig, the research director at the American Sports Medicine Institute and advisor to Major League Baseball, Tommy John surgery usually occurs in 15-20 year old pitchers throwing more than 80 pitches per game and pitch in eight or more months a year. Pitching beyond these constraints generally results in pitching fatigued, leading to overuse of the throwing arm. According to Fleisig, throwing 100 pitches a game every fifth day is unnatural for the arm. This excessive throwing year round causes the inflation of Tommy John surgeries in baseball.

            Nineteen year old pitcher Brady Aiken, provides a great example for arm fatigue. Drafted first overall by the Houston Astros, Aiken did not sign his professional deal because the Astros organization noticed elbow inflammation in his throwing arm, outlined within an ESPN article. In this article, the writer acknowledges Aiken’s rise as a dominant pitcher and the leading cause of his elbow problems. Up until his junior year of high school, Aiken pitched all year round. Once Aiken’s senior year came around and knowing about the rise in elbow problems in pitchers, Aiken and his coach developed a plan to reduce his innings in order to save his elbow. Aiken took the winter season off because of a doctor recommendation. They kept him on a pitch limit and avoided any pitching outside of his regular starts.

            However, a major league scout contacted the two of them and wanted Aiken to pitch at the MLB showcase for promising talent. The showcase would take place during the winter, when Aiken was not throwing. In order to pitch, Aiken would need to build up his elbow strength by throwing every day to ready himself for the showcase. At first, Aiken did not want to start throwing in order to save his perfectly healthy elbow, but the scouts pressured him into ignoring the doctor’s recommendation. The scouts told Aiken that pitching would secure his place in major league baseball, his ticket to a million dollars. Aiken decided to pitch at the showcase. The following baseball season, the same season the Houston Astros drafted Aiken first overall in Major League Baseball’s amateur draft, Aiken would feel soreness in his throwing elbow. The team picked up on the inflammation in Aiken’s elbow during his physical. Houston would retract their offer to Aiken and Aiken would elect to receive Tommy John surgery.

            The sad part about this story is that it occurs regularly in the game of baseball. In today’s world, athletes must accept injury if they want to survive in the world of sports. According to Doctor Mary Lloyd, the competitive nature of sports has programmed youth players to think that they must bend the borders of injury as far as possible, which leads to the increase in elbow injuries. Lloyd warned players about the temptations to push themselves in order to pursue money and scholarships, saying “The 21^st century athlete of any age or sport must throw faster, play harder, earn the scholarship, and don’t tell anybody you’re hurt." The money causes the students to push the barriers and major league baseball takes advantage of the player’s wants. Aiken did not receive Tommy John surgery for the benefit of his health. He received the surgery because without it, Aiken would never make it to Major League Baseball. The surgery saved his career and his chance at earning millions of dollars.

            Rarely does a baseball organization hold it against a pitcher like Aiken for throwing too much. Most baseball organizations do not keep track of potential draftee’s innings nor worry about the overuse of a pitcher’s arm. According to Sam Miller, the author of the article on Aiken, most teams draft players solely based on their velocity and ball movement. So pitchers also disregard their inning limits and force themselves to pitch harder than their arm can handle. If a pitcher destroys their arm in the process, Major League Baseball bares no responsibility either. As shown in the Brady Aiken case, the team just retracts their offer and saves their money while the player forces themselves to undergo Tommy John surgery in hopes of prolonging their baseball tenure.