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.
A Cleveland native, FanGraphs writer Travis Sawchik is the author of the New York Times bestselling book, Big Data Baseball. He also contributes to The Athletic Cleveland, and has written for the Pittsburgh Tribune-Review, among other outlets. Follow him on Twitter @Travis_Sawchik.
I think you are amiss to neglect to mention the increased use of alternative treatment options for relatively lighter UCL damage. We haven’t gotten better at preventing UCL damage; we’ve just gotten more conservative at actually putting pitchers through the procedure.
Good point. Garrett Richards and Tanaka are the two that immediately come to mind for alternative treatment. One would hope as well that usage (the sometimes dreaded pitch count and rest between starts/games) has trickled down to the college and high school levels and this might be an effect. Perhaps this is the start of a multi-year trend as the average age of draftees is now 19 or 20 and most likely they haven’t been abused as much as those drafted in 2005-2013 were?
And Otani (presumably).
I would assume that TJ is up markedly in the amatuer ranks – good luck finding that data though!
I suspect you’re correct that alternative treatments have increased …but I wish we had better access to injury and procedure data. Anecdotally, it seems some pitchers have been able to avoid TJS through
10 day DL is going to help to reduce surgeries as well as rest becomes a more plausible option… even if it is just kicking the can further down the road.
… and if there are real strides being made in reducing invasive surgery and the lengthy rehab that follows, well, that’s a big deal
I want to add that there are other elbow surgeries being performed such as debridements and moving the ulnar nerve, as done for both Steven Matz and Jacob deGrom. In degrom’s case it was after his Tommy John surgery. Teams are trying to avoid the TJ surgery with these surgeries as well as PRP injections. Players are concerned about down time after the surgery, but if they are patient, good results have come from the surgery. There are still more cases of TJ surgery when compared to shoulder surgeries, which have a worse prognosis. There was a new type of “UCL repair” done on Seth Maness last year and he did come back sooner than typical TJ surgeries (Results are still out on him). I do not think that instances of Tommy John surgeries have peaked as much as they have leveled off. Based on the graph above, the peak was in 2012. Also, we have not had a lot of high profile pitchers go for the surgery as much recently which may lead people to believe that this surgery has peaked.
There was also that former Royals pitcher signed by the twins who had the artificial tendon used to reinforce his existing damaged UCL instead of replacement, which was supposed to have only about a 6 month rehab. I don’t remember how his season ended up turning out, but he was a fringe bullpen guy anyway so I dont know if his results would tell us much about the quality of that procedure.
Move over torn UCLs. Thoracic Outlet Syndrome is the new malady in town.
It seems that there is a lot of inherent randomness involved in TJS to begin with (why has Verlander been fine his whole career while Strasburg needed it after one season?, etc etc) So diagnosing what is a “normal” or “high” rate strikes me as a bit futile.
Personally, I think you can chalk up almost all fluctuations from one season to the next as just luck/randomness.
Agreed. I think we need a few more years of data, before I’d believe it that teams/players/doctors have gotten better at preventing pitcher injuries (either as a whole or just for elbow/TJ specifically).
With velo increasing all the time, it seems logical there will be more injuries, not fewer.
I think the best bet is when real doctors are allowed to experiment with low doses of HGH & steroids, with the express purpose of healing and preventing injuries, rather than the way players previously have tried to mostly just increase performance.
My hope is that pharmacology can someday be used to help prevent injuries, and extend players’ careers in a way that isn’t dangerous to their long-term health.
I dont think its so much randomness as much as that we don’t have any pubic data (and in many cases probably no private data) about kinetics and how different players’ deliveries place different amounts of stress on their ligaments.
The answer is almost certainly that Justin Verlander has better mechanics that both allow him to better distribute stress across his entire body while throwing at insane velocity with command, and other pitchers like Strasburg end up with mechanics that place more stress on the arm and elbow in order to maintain command of their pitches.
Guys who are physically able to both protect themselves and have command at the same time are the ones who look fortunate and never have arm problems.
Mechanics obviously have some impact but the reality is, as you alluded too, we just really dont know why guys arms blow out. And most likely it a combination of a bunch of factors and not one smoking gun. Even guys who supposedly have bad mechanics keep going with no issues. Hell, we cant even agree on what is bad mechanics with any consensus.
Whether you call it randomness, luck or lack of info the point is the same. Without knowing why something happens its pretty tough to decipher if it happening at a higher rate than normal.
pubic data – hehehe
Don’t point the ball towards 2nd base before accelerating. The extra spin gives you a few mph but it’s not worth it. See the White Sox and Mets for conflicting views on this subject.
I’d love to see an article/link about this… pretty interesting postulate there.
There’s a lot of “experts” who disagree on the subject but the bottom line is there’s a lot more that can go wrong when you’re forcing that timing to be perfect. If you commit your back hip while pointing to 2nd base you’re putting a lot of pressure on the elbow and shoulder to catch up.
It’s not a natural motion, and if look at some extreme cases (Harvey and Jose Fernandez) it’s not hard to spot.
The Mets’ taught all of their young phenom sps to wait longer on this switch… what they got is wacky stuff and lots of DL stints.
Do you think that the increase in TJ is attributable at all to increase in diagnostic capability? Pitchers have likely always suffered from torn UCLs, but the MRI did not arrive until the 80’s, and Tommy John did not have his eponymous surgery until 1974. I could see this being a similar situation to the NFL and concussions where increased awareness and willingness to not “tough it out” are factors.
The top TJS doctor does not bother not bother with MRI’s. They miss many small tears and those they catch dont always need TJS. Basically MRI just confirms clear cut cases where the tear is sonlafgenor complete that a physical exam has already led to a diagnosis
Raise your hand if you saw this and Googled “sonlafgenor”.
The easiest explanation would be the lowered innings for starters. Have you broken that down by starter/reliever?
Also could the rate of conservative treatment (pt, prp injection like tanaka) be up?
Also players with forearm pain get shut down earlier.now some foremarm discomfort is basically automatic DL.
Youth Travel Baseball has just in the last 3-4 years began to limit pitch counts more. I think another 10 years of peak. I would also add the current decline in numbers has to be affected by the new ways of dealing with partial tear “ucl sprains”
If you pool the 2010 – 2015 data, and pool the 2016 – 2017, are they different by a statistical test?
A statistician would know how to do a real time series treatment, but this would be a start.
Some many questions, so few answers. Is it just velocity or is it the amount of effort expended to achieve that velocity? Is the pitcher capable of throwing 100 less like to injure himself if he limits himself to 95? Does the pitcher who maxes out at 90 have a greater likelihood of injury than the pitcher mentioned above if he uses all he has to throw 90? For years we were told that it was breaking stuff that caused arm injuries, now it is the fastball. What is it? How did Johnson, Feller and Ryan, the preeminent fireballers of their eras, go on forever? As mentioned by Shirtless George Brett “It seems there is a lot of inherent randomness involved in TJS”. That is the point of everything. Why does Chris Sale, who was considered a likely candidate to break down, hang tough, while Kerry Wood, whose delivery was considered flawless, disintegrated. As of now there are still no answers and the only difference is that the questions are changing, because all the previous approaches have failed, in hope of a new path to understanding why some arms fall off and others go on forever.
Forgive me if this is a stupid question as I’m not a Doctor and my knowledge of Tommy John surgery is very limited but how does one get to the point of fully or partially tearing their UCL? Is this something that gradually happens over time or is it one single event where it tears based on one single pitch or movement? Perhaps it can happen both ways but I can’t recall seeing a pitchers going from being completely fine to immense pain after one pitch. My point being, if it is from gradually straining/wearing down the UCL over time, why are teams not having precautionary elbow MRIs, and shoulder MRIs for that matter, on a regular basis? If this was caught early enough, isn’t it possible that rest could cure the problem and the pitcher would come back faster and just as strong? If that’s the case, I don’t understand why teams wouldn’t insist all their pitchers have mandatory elbow and shoulder MRIs every month. Perhaps I’m way off and this wouldn’t help at all but it’s seems that so much is being left to chance and this would be a small inconvenience and price to pay and ultimately save clubs millions of dollars and help them win more games along the way.
It can be either. Some guys get there through repetitive stress to the ligament, just from putting a little more stress on it than it can handle on every single pitch.
Other guys injure the ligament catastrophically, usually when pitching through some other kind of injury. For example, you see teams be extremely cautious when players have forearm muscle injuries, becuase the forearm muscle shares most of the rotation force with the UCL. If the muscle is damaged and can’t carry its part of the force, it’s all transferred to the ligament which is not able to handle it by itself. In that kind of situation a player can cause lasting damage to their UCL in as little as a few individual pitches- sometimes before they feel the pain from their forearm due to the adrenaline.
Thats why flexor/pronator muscle strains are an immediate and automatic DL stint now. This can also be guys who start to throw more with just their arm because of a leg or lower body injury limiting the power they usually generate from their stride and hip movement.
The UCL is just like most other major ligaments in athletes; as athletes get bigger and stronger and more powerful, their muscles get stronger and are able to keep pace with the tremendous force and power they are generating. The ligaments and tendons, however, cannot be strengthened and they become the weak point of the system.
In lesser athletes (ie normal people), the weak points are the muscle systems themselves and you see the muscles get strained or torn.
I suspect more teams/players are trying conservative/alternative treatments. As those fail or are shown to be a temporary fix we should see an uptick in surgeries.
Alternatively or maybe in addition MLB perhaps has relaxed the testing/enforcement on HGH. TJS escalated with the introduction of HGH testing which undoubtedly scared some pitchers off and caused UCL injuries. As MLB realized their policy was costing owners a great deal they backed off. Just a theory of course
. From 2010-2017 starting pitchers collectively have thrown the fewes innings in 2016-2017 and the combined number of splits and cutters , both TJS suspects , have been the lowest.
Obviously RPers have TJS as well so it would be nice to break TJS down by a pitchers role to see if any of these roles is experiencing more of a benefit to dropping TJS rates
Another consideration, the ball MLB is using today has lower seams. No idea how this could affect TJS rates although I suppose it could influence pitch selection.
I’d also look at median nunber of innings pitched as starters and relievers (MLB and minors combined) to see if they are slipping. Seems more teams are making use of the AAA shuttle and only a few pitchers on each team rack up a lot of innings relative to the mean
This reduction in TJ coincides with alternatives like PRP injections. As the range of treatments grow, TJ will decline – it doesn’t mean anything about arm health.
Fewer pitches per player across the board at the pro level has helped. I won’t commit to “peaked” because it is a small sample. However, with balls flying faster and further than ever before, pitchers and coaches will adjust their mechanics to get back on top.