Two decades ago, the “Tommy John Surgery” was unheard of for teenagers, but now a quarter of the surgeries are on baseball pitchers who are still in high school.
Many teens are chasing their dreams of playing baseball, and are buying into longer running, exclusive programs that guarantee exposure and elite competition.
Jeremy Brushie coaches a “12 and under” fall ball team in Southington.
Despite strict rules on pitch counts and playing multiple positions, he hears parents all the time wanting to get their child into a program.
Many children have dreams to make it to a stage in Cooperstown, New York, and into the Baseball Hall of Fame.
When John Smoltz made it and achieved his dream, he had a warning for the dreamers.
"I want to encourage the families and parents that are out there that this is not normal to have a surgery at 14 and 15 years old. That you have time, that baseball is not a year-round sport. That you have an opportunity to be athletic and play other sports. Don't let the institutions that are out there running before you guaranteeing scholarship dollars and signing bonuses that this is the way,” Smoltz said.
Smoltz was one of the great pitchers of his generation and is now an analyst at the MLB Network, and an outspoken critic of what he calls “the business of youth baseball.”
He also said to parents “I want to encourage you, if nothing else, know that your childrens' passion and desire to play baseball is something that they can do without a competitive pitch. Every throw a kid makes today is a competitive pitch. They don't go outside, they don't have fun, they don't throw enough - but they're competing and maxing out too hard, too early, and that's why we're having these problems. Please, take care of those great future arms."
Smoltz said he is angered that children are being pressured to pick just one sport earlier, and earlier, and to participate in competition year-round, often on multiple teams.
“They've marketed to the best, they've said this is your child's chance to get scholarship dollars and to make it to the pros, so invest in us, and they don't really touch anything other than this is the opportunity,” Smoltz said.
He said he thinks it is the attitude of 'all baseball, all the time' that has led to what he calls an epidemic of Tommy John Surgery, the procedure that is named for the former pitcher who had it first.
It surgically replaces the ulnar collateral ligament, the workhorse of the elbow that connects the upper arm bone to the lower arm bone.
The repair usually involves a bone graft with a ligament from somewhere else in the body.
At age 34, Smoltz thought his elbow pain meant his career was over, but Tommy John Surgery gave him another half dozen good years.
Now, as surgeries happen more often, and the patients get younger and younger, Smoltz has a startling prediction—he thinks he’ll be the only Tommy John Surgery patient to make it to Cooperstown.
“The success rate is only for the percentage who were in the big leagues, who know how to pitch, know what it takes, and obviously were good enough before and typically are going to be good enough afterwards, but we don't see the fall off of those who don't make it. There are a ton who have ‘Tommy John’ and don't make it to the big leagues,” Smoltz said.
If an ACL is torn, and that person is a major league pitcher, their first stop might be to see Dr. David Altchek, at the Hospital for Special Surgery.
As medical director for the New York Mets, Altchek has put pitching arms back together for some of baseball’s biggest young stars, including Mets players Zack Wheeler and Steven Matz.
He said the number one risk to the elbow is actually a tired shoulder.
“If I told you to stand here and hold your arm up for the next hour, you'd get fatigued and your arm angle would drop. Same thing happens to pitchers, they get fatigued and drop their arm angle and that seems to increase the load on the elbow a lot,” Altchek said.
Load on the elbow is key, and no matter their age, pitchers create speed by pushing forward off the rubber and falling down the slope of the pitcher’s mound.
For just a fraction of a second, their arms lag behind the rest of their body and then explode forward, creating velocity on the pitch.
During that lag, the UCL is the ligament that stretches, putting more pressure or load on the elbow.
Too many stretches, or one that pulls too far, and the UCL can give way.
“One is gradual wear and tear and the other is literally an explosion of an otherwise pretty good ligament,” Altchek said.
Plans aimed at avoiding surgery are complicated. Coaches have long preached the value of good mechanics but Altchek said that can actually be worse, at least on the UCL because good mechanics creates more lag.
The player throws harder and may appear more successful, but the extra forces on the elbow means a bigger risk of injury too.
“You only have the ligament that you have so if you get better at lagging your elbow, you're bending your elbow more but you only have what God gave you and you're kind of stuck,” Altchek said.
For parents of players, Altchek said to think about that lag that is created by falling off the mound while trying to generate pitch speed.
Before high school, that lag cannot only damage ligaments, but it can also injure the growth centers in the arm, which can be even more serious long-term.
“Little kids who are not fully grown should not be pitching off a mound, and that's radical I know,” Altchek said.
If the throws happen on flat ground, there’s no downhill force and less lag. That means the speed is coming from the muscles with fewer forces on the elbow.
Altchek said if he had a teenage son with an especially strong arm, he’d send him across the infield so he makes the most of his throws from flat ground.
“I would not let him pitch off the mound, have him play an infield position, be the rocket armed shortstop. You know I very rarely have to operate on those kids. But I operate on a lot of adolescent kids who are extremely talented who hurt themselves pitching off a mound,” Altchek said.
For high school juniors and seniors, and college players, Altchek said he knows pitchers want to pitch, and that means the Tommy John Surgery business will never go away.
He said while you can’t keep a pitcher off the mound forever, you can limit his competitive throws and make sure the whole body is geared toward avoiding the type of fatigue that puts even more pressure on the elbow.
“Build an athletic body, don't just build a baseball body,” Altchek said.
That is the same point that Smoltz said he wants to make: play the game, but play smart.
Smoltz grew up in Michigan and played baseball for a few months out of the year, and by the age of 34, his UCL was still shot.
He now tells parents to avoid year-round baseball and to keep their children away from radar guns that can encourage maximum effort pitches.
He said the key is to pitch less but throw more.
While only a handful of men are lucky enough to play a boy’s game for a living, getting talented boys to adulthood with a healthy elbow may be tougher than any competition a pitcher could face.
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