warning Hi, we've moved to USCANNENBERGMEDIA.COM. Visit us there!

Neon Tommy - Annenberg digital news

The Secret To Avoiding Tommy John Surgery

Evan Budrovich |
April 7, 2015 | 2:39 p.m. PDT

Staff Reporter

For the countless stories about pitchers going down with Tommy John Surgery, the secret to long-term health in baseball is tangible and probably more simple than ever imagined.

“You should throw every day, but remember to only pitch to (your) working totals,” said former MLB closer Tom House, who is both director of the Rod Dedeaux Research and Baseball Institute  and founder of the National Pitching Association.

What House argues is that pitchers spend far too much time pitching, and not enough time developing their arms away from the mound.

The former USC Trojans pitching coach (2008-2011) was accompanied by World Series champion Robb Nen, biomedical engineering professor Jill McNitt-Gray and USC School of Medicine orthopedic surgeon Dr. Seth Gamradt for a USC Visions and Voices event titled 'Velocity and Vulnerability: Baseball Pitchers and the Limits of Human Performance' held at USC's Dedeaux Field on March 31.

The panel of (L to R) House, Gamradt, Nen and McNitt-Gray speaks at Dedeaux Field (Evan Budrovich/Neon Tommy).
The panel of (L to R) House, Gamradt, Nen and McNitt-Gray speaks at Dedeaux Field (Evan Budrovich/Neon Tommy).

Their biggest concern came from the overload of innings parents have placed on their kids, especially those ages 6-12, expecting children to become Major League prospects without fail.

It can be argued that the necessity for immediate results on the field has led to a dangerous trend in which the safety of young arms is being sacrificed for superficial rewards like faster speeds on the radar guns.

“(The) baseball pitching motion accelerates the joint as fast as it can go,” said Gamradt, who, along with his regular medical practice, has spent extensive time with the USC baseball program. 

House, meanwhile, has overseen the development of young arms since his first official big league gig with the Texas Rangers back in 1985, when he became acclaimed for his work with Hall of Famer Nolan Ryan.

Thirty years later, his widely respected level of insight comes from biomechanical examination of motion, taking “what we consider to be just balls and strikes and providing hundreds of milliseconds worth of concrete data on the throwing motion.”

The newest findings suggest a trend about what today’s pitchers are doing, or in this case not doing, to properly preserve shoulders and elbow ligaments --mostly the ulnar collateral ligament (UCL)-- and avoid the Tommy John procedure that has turned Dr. James Andrews into one of the most well-known doctors in American sports.

A key discussion revolved around what pitches players should be throwing. House and his team suggested that the curveball, when thrown correctly, is the safest pitch to throw. While it's a strongly debated subject, both House and Nen strongly feel that throwing motion is drastically important.

“It’s more about the torque of the throwing motion combined with rapid velocity that hurts the arm,” said Nen, as opposed to the stress that is placed on the elbow from throwing a curveball.

Nen pitched more than 715 innings in the big leagues. His argument on torque makes the next point all the more interesting: House and company argue that of all the pitches in one’s arsenal, the cutter, which has been rapidly growing as an alternative to the slider, makes for the most dangerous delivery on the arm.

Growing into a trustworthy pitch at the college level, the cutter has become a major strikeout pitch to complement the fastball-curveball combo. “This year is the first year I’m throwing it, but I feel very comfortable with the pitch,” USC junior right-hander Brent Wheatley said.

What the cutter does is combine the speed of a fastball with the sharp bend in the elbow that comes from a curve, placing a lot of stress on the UCL. It doesn’t mean Wheatley is drastically risking his career by living on that pitch. It just shows that relying heavily on a cutter, without the training in place to rest and strengthen the elbow, might be costly down the road.

That begs an all-important question: why are players inclined to throw so many innings instead of keeping their arms in shape? The answers lie in the system that creates these expectations, both in the collegiate and professional game.

Pitching mechanics are improving rapidly, with experts such as Gamradt being hired to deal with the surgical process of repairing shoulders and elbows to then strengthen those joints back to normal.

Still, the growing number of reported cases for Tommy John surgery raises a major red flag, especially as pitchers are being throw harder and faster than ever before without the proper rest period.

“Get your kids to play multiple sports, because they aren’t going to become a professional from what they do in ages six to 12,” Gamradt advised.

From 2000 to 2011, there were an average of 15.4 Tommy John surgeries per year in the major leagues. But over the past three years, the average has almost doubled to 28.3 per season. Those numbers have also skyrocketed at the youth level. In 2010, Andrews reported that there were 41 surgeries on kids at his center, making up 31 percent of the overall Tommy John surgery procedures. Those numbers nearly tripled over the last half-decade.

Granted, part of these findings arise because families were once not aware of surgical opportunities for pitcher. Still, what has been suggested is that prep coaches and parents are feeling the overwhelming pressure that throwing a certain miles per hour on the gun, or having an assortment of pitches at a young age, can translate into a college scholarship.That is certainly possible, but the specialization at such a young age has detoured kids from the proper development of their entire body.

By having the cause and effect relationships clearer and clearer, we have a better understanding of what might be the loading that is going on and the stress that takes place in the shoulder and elbow,” McNitt-Gray said.

The panel encouraged the notion that getting kids on the mound and “competitively pitching” at such a high rate does very little. It arguably hinders their development both as athletes and as baseball players.

It's important to remember that even those who have Tommy John Surgery enter a position where their chances of an increased velocity or performance are rather questionable. In order to alleviate those concerns, kids must be throwing. Whether that be tossing the baseball, football or even skipping rocks across a lake for that matter, kids should be keeping their arm loose as much as they possibly can without a structured baseball routine always in place.

House suggests that kids mostly need a mentally and physically healthy throwing plan to correctly prepare for success. So when young pitchers toe the rubber for their next game, the focus needs to shift away from the quickest route to young success and instead toward throwing the ball the right way.

Reach Staff Reporter Evan Budrovich here or follow him on Twitter.



Craig Gillespie directed this true story about "the most daring rescue mission in the history of the U.S. Coast Guard.”

Watch USC Annenberg Media's live State of the Union recap and analysis here.