Tommy John was prominent during his day, but, with the recent spate of arm injuries, his name has never been more popular. In this era of science and specialization, we should expect injuries of all types to be on the decline, but the number of elbow ligament surgeries continues to rise. It’s almost as if the Tommy John procedure has become part of a pitcher’s development, like learning to throw a breaking pitch or getting accustomed to a major league strike zone. However, despite the success rate of the surgery, the 18-month minimum layoff is still no joke. So, what gives? Why is Tommy John baseball’s new poster boy?
One explanation gaining steam places the blame on youth and amateur baseball programs. Those who work with Dr. James Andrews, a noted practitioner of the procedure, and John himself seem to subscribe to this theory, which argues that the increased stress levels on young arms are manifesting themselves in the professional ranks. However, if that were true, shouldn’t we expect Tommy John surgery to be prevalent among Japanese pitchers (see here for a translated list of Japanese pitchers who have undergone the procedure), whose baseball culture is notorious for high pitch counts at young ages (see here and here)? Also, are we really to believe that youth baseball coaches are more reckless than in the past, especially considering the greater scrutiny that exists today? These seeming contradictions don’t completely exonerate youth baseball, but they do suggest that some blame shifting might be involved. After all, it’s easy to pass the buck to the nameless, faceless coaches at lower levels than take responsibility for the problem at the big league level.
Instead of looking back to a pitcher’s childhood, maybe the reason for the Tommy John outbreak exists in the present. If so, what about the game today is much different from five or 10 years ago? The most obvious answer is PEDs, or the lack thereof. Maybe the elimination of steroids, hormones and amphetamines have created a physical vulnerability from a pitching population in collective withdrawal? It’s impossible to dismiss that claim, but logic would dictate a return to pre-steroid era injury levels, not an acceleration to epidemic proportions.
Although PEDs themselves may not be the direct link, there could be residual effects. At the risk of delving into conspiracy territory, could it be that MLB, in an effort to skew the game back toward pitching (and away from the inflated offensive levels synonymous with the PED era), decided to make a few minor tweaks: a slightly larger/heavier ball or subtle increase in the slope of each mound perhaps? If so, it could be that these imperceptible changes are having a very noticeable impact on major league arms.
Are we really in the midst of a Tommy John epidemic? Maybe we just have better diagnostic tools capable of uncovering cases that would have otherwise gone unnoticed as recently as five years ago? Or, the ubiquitous influence of the information age might be exaggerating the surgery’s prevalence. One way or the other, major league baseball needs to take a more proactive approach to injury prevention. The alternative is to keep increasingly investing in diagnosis and treatment, two areas that, despite helping to prolong many careers, still have diminishing returns.