There are a lot of things we can debate in Fantasy Baseball, like buy low trade targets, top 10 players, best player rest of season, is it time to cut bait? etc. There is one thing that is not debatable. It is not debatable that season ending Tommy John Surgery (Ulnar Collateral Ligament Reconstruction Surgery) is one of the most dreaded phrases an owner of a contending team can read about in the daily notes about his players. It is also not debatable that the frequency of Tommy John Surgery is on the rise, an epidemic some, like Dr James Andrews himself, says(1). It is also not debatable that the injury is most prevalent in the ranks of the young studly aces in their first three MLB seasons(2). You know, those guys you draft in the early rounds because you are sure they are the next coming of Tom Seaver or Roger Clemens or Pedro Martinez, and you are sure that they will carry your team on their broad young shoulders deep into September. The only problem is that it is not their shoulders that we are worried about anymore. No, it is that now household named body part called the Ulnar Collateral Ligament.

We can take some solace in that the injury is seldom career ending, as it was prior to 1974, when it was believed to be the leading cause of “Dead Arm”, a mysterious injury that lead to the premature retirement of many a pitcher in the 21st Century.(3). Now 85-90% of TJ patients return to pitching at or above their level prior to the injury after a 12-15 month rehabilitation period (1). Dr Andrews can expertly extract a tendon from your hamstring, foot or even your forearm and deftly transplant it into your medial elbow by weaving the tendon in a figure 8 pattern through holes drilled in the ulna and humorous bones in place of the frayed, tattered, worn out, abused and torn original ligament(3). It will certainly end your ace’s season though and quite possibly a big chunk of next season as well. There is even about a one in ten chance that a month or so of rest will be all the pitcher needs to heal those tatters and tears and he’ll be pitching again for you in no time, though he’ll likely refuse that conservative treatment and want to get it “fixed now”(1). Yeah, in all but the deepest of Dynasty or Long Term Contract formats you may as well just drop him, his tattered elbow, the 12-15 month re-hab period, and move on. He’s not going to be giving you quality starts any time soon.

Myself along with everyone else who is reading this knows all too well how it feels to watch a pitcher that we drafted in the first 5 or so rounds walk off the field gripping and flexing his elbow after walking 7 and giving up 6 runs in 3 innings. Nice knowing you, and thanks for nothing. Sure, go ahead and cry for that long minute while Matt Harvey, Matt Moore, or Jose Fernandez walks off the mound with that bewildered, “I know this ain’t good”, look in their eyes. Wipe those tears quickly, because now you have work to do if you don’t want to let this calamity derail your whole season. I’ve been saying this for years now, I’ll only say it once here, and maybe once more in my conclusion. Don’t rely too heavily on young pitchers! Oh, the reasons may have changed a bit over the years, but the result is the same. Whether it is wildness, lack of command, inconsistency, trouble going around the league a second time, sophomore jinx, or the dreaded words “appointment with Dr James Andrews”. It is near fantasy suicide to pin your hopes on a pitcher or pitchers in their first 1-3 years of major league service. I’m not saying don’t use them, just don’t pin all your hopes on them. Why is it that we suddenly have to worry that the next 96 mph fast ball may be the last pitch we see from him until 2015 or so?

Let’s be sure of one thing right off the bat. I don’t have the answer. We are not going to solve the TJ puzzle in the course of this article, but it might be a fun distraction to discuss the many theories that are floating around trying to explain the phenomena. Like the closer Merry-Go-Round, or base runners sliding headfirst, we can’t control the cause & effect of these epidemics. All we can do is form a plan to deal with them that won’t scuttle our championship goals for this year, or next. My first bit of advice (ok, so I lied, this will be the 2nd time I say it) is as old as Fantasy Baseball. Don’t draft pitchers in the first few rounds. Build a durable, powerful offense first and foremost. Then, maybe in the 3rd through 5th rounds (I know many successful owners who won’t draft a pitcher until the 10th) grab that one anchor SP that you know is money in the bank. Felix, Bumgarner, Greinke, Price, Lee, Hamels, etc. Yeah, Kershaw is gone already, but so what? At the end of April how many Kershaw owners were glad they drafted him in the first round this season? How many of you saw Jose Fernandez go off the board before the 3rd round? Yeah, me too, but not on my teams. It is not a cliché that you can find good pitching late in the draft and throughout the season. That type of security blanket drafting is not the scope of this article, but can you think of a better way to avoid owning the next 2nd year stud who has an appointment with Dr Andrews before your tomato plants have flowers on them? That’s right, you should already be looking for owners willing to give you a ton for Julio Teheran, Gerrit Cole, or Yordano Ventura. Sell high now before you have to endure that one minute walk that leaves you crying in your beer. It may not be too late to get the 175 or so innings left in 2014 for Price, Lee, Verlander, or Hamels on the cheap. Ok, so maybe that was laced with a tinge of sarcasm. But, can you tell me I am wrong?

So, what the hell is going on?

First, we should do a quick history lesson. It’s only May, so I think I’m allowed to do that. In 1974, about the year I got my first kiss, a story I’ll spare you, Dr. Frank Jobe took a tendon from Tommy John’s hamstring and successfully implanted it in the left arm of that same Tommy John, who was a 34-year-old Major League Starting Pitcher. What? You didn’t realize he was a real player? Nah, I know you did. Dr.Jobe gave him 1 in 100 odds that he would walk up a Major League pitcher’s mound ever again. He not only did, but he pitched until he was 46, logging more MLB innings after the surgery then he had prior to it. As stated earlier, the success rate is now all the way up to 85-90% that a pitcher will again pitch. I don’t know if it is irony or tragedy, but Dr Jobe passed away early this Spring right before what is now a record-breaking season for Tommy John patients. There have been a record 34 Tommy John surgeries so far this season, and that is not including the 2 that are scheduled for next week. At the time of Jobe’s passing it was calculated that 1/3 of all major league pitchers have had the Tommy John procedure at least once since turning pro. 1/3. Is it a rite of passage? It was just the opposite when Tommy John was playing. Players were expected to man-up and play through pain. Some players even called Tommy John a pussy for having the procedure.(2) I wonder if they still felt that way when Tommy was earning his World Series rings with the late 70’s Yankees while they were home sipping Bud’s and cutting the grass sore elbow and all.

One would think the best, most in-depth theories would come from ex major leaguers themselves. Instead you are apt to get ill thought out rants of disgust from ex players who believe their era’s players were tougher then current players when it comes to injuries and ability to withstand and play through pain. Nolan Ryan, for instance, believes that pitchers are babied too much now with innings limits and pitch counts. Ryan thinks that it is all about teaching proper pitching mechanics(4). Perhaps his theory would hold more water if his own Texas Rangers did not have a pitching disabled list the last few years that rivals every other major league team. While they are not all TJ related injuries, the Rangers have lost Neftali Feliz, Alexi Ogando, Tanner Scheppers, Josh Harrison, Derek Holland, and Joakim Soria for extended periods the last few seasons. Tom Seaver seems to agree with Nolan. Here is a less then eloquent quote from Mr. Seaver, easily one of my favorite players from my lifetime, when he was interviewed after the injury to Matt Harvey in 2013.

“You can’t predict these things, and there’s really not a whole lot you can do to prevent them other than refining your mechanics Rube (Walker Met’s Pitching Coach) did with us. But one way I know doesn’t do anything to prevent them is babying these kids like they do…

“Imagine if these computer geeks who are running baseball now were allowed to run a war? They’d be telling our soldiers: ‘That’s enough. You’ve fired too many bullets from your rifle this week!'”(5)

Thanks Tom, but it seems to me that a steel rifle barrel has a different level of ability to handle abuse and a shorter recovery time between uses than a very slim elbow ligament has. This may be one of the biggest clues to the rash of TJ incidence that I’ve read about. Much of my research points to conditioning as a theory for the TJ incidence. From a young age our athletes are taught strength and nutritional programs designed to increase muscle mass and build endurance. They are also taught mechanics for throwing with more torque, and thus more velocity. There is one problem with that though. The muscles associated with arms, shoulders & elbows, thus the machinery used to hurl a baseball 96 mph, get stretched out and strengthened far more than the thin ligaments & tendons that hold them in place. There is far less nutrient delivering blood flow going to tendons and ligaments then there is to muscle and bone(1). So imagine putting a larger engine and transmission with a lot more torque in a subcompact car. Then imagine beefing up the suspension with thinner axle shafts, and then also add smaller wheel bearings and tires. Now hammer that gas pedal! Something is liable to snap if the car does not go off the road first.

Another popular theory goes back even further and points to parents. Youth leagues in an effort to prevent a lot of the injuries that befall pitchers have instituted strict innings limits and pitch counts, but if you want your phenom to get noticed he has to pitch. Chicks may dig the long ball, but scouts now are looking for velocity over anything else. To impress a scout a kid has to be honed plus throw hard, and since one never knows when a scout may be watching, well, he better keep on pitching. To circumvent the innings caps parents allow their kids to join multiple leagues, and can arrange it so kids can pitch year round. Between Travel Leagues, Fall Leagues, Spring Leagues, Winter Leagues, School Leagues, Camps, Tournaments and other leagues it is not hard to pitch year round and overlap so he/she is pitching for two teams at once. Some southern states, countries in South America, Central America, and the Caribbean have warm weather 12 months of the year which allows them to play year round in many cases. Many kids in the last decade are pitching up to three times the innings they would have 20 years ago.(2)

So, we have muscles too strong for their ligaments, too many innings pitched at a young age, and how about specialization? Prior to the last decade, athletes were encouraged to play multiple sports so they could play year round, but usually with different types of strain on their bodies. Now, the trend toward specialization has kids and parents focusing on just one sport, but also year round. Parents are hiring personal trainers and strength coaches for their kids as early as Little League because they know scouts are now “body discriminating” when it comes to pitchers. Instead of looking for the kids whose body styles may be more geared towards stamina and longevity, they are looking for kids who can throw with velocity. The American Sports Medicine Institute in Birmingham Alabama cites overuse and specialization as the leading causes of the dramatic incidence at a young age of TJ surgery.(6) They estimate that teenagers who pitch over 100 innings per year are 3 times more likely to sustain a UCL injury then teenagers who don’t. And that does not even include all the innings logged in practice and side sessions, etc. Considering that parents are encouraging kids to pitch, pitch, pitch as early as 5 and 6 years old, “UCL injuries are injuries happening as opposed to injuries waiting to happen.” (2)

Besides being stronger, throwing harder, and throwing year round, how about what they are throwing? Kids are being taught to throw cutters and sliders and curve-balls at very young ages before the bones, muscles and tendons are even finished growing and developing. Dr Glen Fleisig, Research Director of The American Sports Medicine Institute in Birmingham Alabama mentioned above, has seen young pitchers come in as teenagers after having been throwing breaking balls and high torque fastballs since little league. He says that they often have arm bones that are actually twisted at the joints from so much torque during developmental stages. Throwing a baseball 95 mph is not a natural, nor a healthy movement for the human arm.(6)

Ok, so what about the MLB pitchers? Aren’t they getting diagnosed with UCL injuries younger, and earlier in the season? Stan Conte, VP of Medical Services for the LA Dodgers is the lead investigator of a study started in 2012 to examine just that question. They found that from 2003 to 2013 most UCL diagnoses came in June. This season they are coming in April and May and in record numbers. He also found that from 2000-2011, on average 16 MLB pitchers had the surgery. This jumped to 36 in 2013 and this season is already ahead of that schedule and we are not in June yet. He says that part of the reason is that players are deciding earlier to have the surgery and be done with it. Dr Andrews states that more pitchers are now refusing the more conservative approach and opting immediately for the surgery. Much of this is pressure from agents such as Scott Boras who represents a fair number of TJ patients, and is also affected by the player’s contract status, location of the injury, attitude of the player, and time of the season. If a pitcher has the surgery in April there is a good chance he will be ready to go next Spring. Conte also said that while the surgery is not foolproof, there is a misconception among pitchers and agents that TJ is an automatic get well card and many think they will throw harder after the surgery then they did before it. “Have you ever seen a pitcher who is not proud of his Tommy John surgery scar?” says Conte. But, he and Dr Andrews both believe that phenomenon has more to do with the rigorous conditioning the pitchers go through during TJ recovery then the replacement ligament itself.(7)

Well, there goes my theory of having EVERY minor league pitcher have TJ surgery the year they move from AA to AAA. Why not get it over with before they end up on your roster right? My theory, and it was not a hard one to come by, is that it is a combination of all these factors that has led to the frequency and earlier incidence of Tommy John Surgery. Parents encouraging their kids to specialize, coaches starting them throwing hard with torque at an early age, as well as breaking pitches, pitching all year with no down time, strengthening the muscles, and building strength through nutrition that tendons & ligaments cannot keep up with, and finally babying all the pitchers once they are in the pros. It sounds to me like the last one is the least of the causes. By then it is just too late. So now we know we can’t avoid this as long as the Scouts dig the fastball and the Agents dig the immediate surgery. So what can we do aside from blaming Parents, Coaches, Scouts, Agents and Personal Trainers? Stop relying on Starting Pitchers in their first 1-3 years in the majors. After that there is a much better chance that they will have better control, better command, less reliance on the high heat, and better odds that they won’t get to meet Dr Andrews unless they are visiting one of those younger team mates. Please take that advice with a grain of salt and the tinge of sarcasm it was delivered with. Some guys love to draft the newest flavor and will probably not change. Very few of those pitchers will fall far enough in the draft to be on my rosters. Good Luck and Less TJ. Next week we’ll talk about disabled list frequenters whose injuries should be more controllable. Sliding fingers first into bases. Uggghhh.

References:

(1) Jorge Ortiz; “Tommy John Surgery Now an Epidemic”, USA TODAY Sportswriter, April 11, 2014

(2) Dirk Hayhurst; “Hard Truths: MLB needs a priority shift”, Sports on Earth, May 15, 2014.

(3) Baseball-Reference.com > Bullpen > Tommy John

(4) Texas Rangers owner and former MLB pitcher and Hall of Famer, Nolan Ryan, 2013

(5) Former New York Mets pitcher and Hall of Famer, Tom Seaver, 2013

(6) Glenn Fleisig, Rsearch director for the American Sports Medicine Institute in Birmingham, Ala., March, 2014

(7) Stan Conte, vice president of medical services for the Los Angeles Dodgers, March

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