Have We Passed Peak Tommy John?

There was a fear back in 2014 and 2015 that professional baseball was merely experiencing the early stages of a Tommy John epidemic.

There were concerns that sports specialization, the focus on velocity over feel for the craft, was stressing arms even before they arrived in the majors. It seemed possible that rising league-average velocity marks — for which there’s now a new record set each year — were creating demands on pitchers’ elbows that their bodies couldn’t withstand.

Tommy John surgeries reached a record level in 2014, a level surpassed again in 2015. Velocity kept inching up. Pitchers with medical histories and red flags kept flowing into the game via the draft. Said Pirates GM Neal Huntington to this former newspaperman in 2014:

“They were blown away by the number of significant injuries high school and college pitchers had this year compared to three years ago, five years ago. The level of injuries is growing exponentially,” Huntington said. “We are just starting to get to the front edge of this (Tommy John surgery) wave. We might not even be through the worst of this yet.”

That was not an encouraging sentiment from someone with a commanding view of the game. The wave of Tommy John surgeries did seem to have become an epidemic that was growing in strength, one which would cost both pitchers and teams millions upon millions of dollars.

And then a funny thing happened: the surgeries began to decline.

After professionals endured a total of 145 Tommy John surgeries in 2015, including 81 sustained while pitching, the total numbers have declined in each of the last two years, according to FanGraphs’ analysis of Jon Roegele’s database. In fact, of the players listed in Roegele’s database, only 86 underwent the procedure last year, the lowest mark since 2011 and the first time the total has fallen below triple digits since 2011.

In the following chart, I separated players who’d suffered torn ulnar lateral ligaments into three groups: MLB pitchers; all professional pitchers; and then all known players, including position players and amateurs either drafted with torn ligaments or having already undergone the procedure.

Roegele is confident he’s collected all MLB Tommy John procedures from the last decade and has captured more complete minor-league data since 2015. So, if anything, the pre-2015 TJ numbers could be even higher at the minor-league levels.

So what is happening? Is it just a small-sample lull? Will TJ cases eventually increase again?

Rob Arthur and Ben Lindbergh observed the decline in May of 2016, and the rates have since continued to decline over the following 20 months.

This year’s reduced injury toll may come down to timing and plain old good fortune. As Kyle Boddy, founder of the pitching performance and research facility Driveline Baseball, told us: “The easiest and most likely explanation is that Tommy John surgeries were abnormally high last year and are somewhat low this year.”

Boddy’s comment could very well represent the most plausible answer.

But I also want to believe that human beings are good problem solvers, that we’ll eventually be better able to keep pitchers healthy. Teams, of course, are also motivated to find ways to save the hundreds of millions of dollars being spent upon injured pitchers each season.

While the declining numbers could simply be the result of a small-sample lull after an outlying surge of injuries, maybe teams have become better at injury prevention. There has certainly been much more focus on injury prevention and player efficiency. Teams have become more interested in kinesiology, arm maintenance, and workload management. There is better technology in place to understand how athletes are fatiguing. Players have more information on how to manage their bodies and avoid injury. We’ll have to see. That will take time. The first athletes raised in the sports-specialization culture of the 21st century are now just reaching the major leagues.

But it would be a fascinating development if pitchers were suddenly better able to avoid the most common season-ending, career-altering injury: the UCL tear. That would lessen the risk for clubs of acquiring pitchers and would have an impact in the amateur draft, as well as on trades and free-agent market valuations. More than anything, keeping the game’s best pitchers on the field more often would be good for the sport, and for all of us who enjoy observing and analyzing the game.

So here’s hoping this isn’t a small-sample blip, but rather a sign of progress.