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TCB Daily Boil: Tommy John and Pitcher Development

Dr. James Andrews speaks and the sports medicine world listens. But, what does his comments about Tommy John surgery mean in regards to pitching development.

Tommy Gilligan-USA TODAY Sports

If you have read just a small fraction of my articles on this site, you know that my main interest with baseball is pitching and minor league development.

If you know anything about me, you probably know that I am finally at the end of my formal education to a Physical Therapist and that most my personal life revolves around that. In this world of P.T., we have a close relationship with the orthopedic surgeons that send us patients for therapy. It's important for us to stay up to date with advances in surgical techniques, success rates, and so on because that directly affects what we do as therapists and more importantly, our patients. It's also important for us to know who the leaders in the field are.

Needless to say, in sports medicine, that leader is Dr. James Andrews. You can't turn on ESPN anymore without hearing at Dr. Andrews and how another high profile athlete is going to see him about a major injury. In this sports medicine world, when Dr. James Andrews speaks, we stop and listen.

This week, he went on MLB Network Radio to discuss this recent trend of increasing incidence of Tommy John surgeries.

In the interview he talked about some of the factors they have seen to be most prevalent for Ulnar Collateral Ligament rupture. Those include year round pitching, pitching in multiple leagues at the same time, poor mechanics, early usage of breaking balls for youth pitchers, and the radar gun. He focused a lot on the incidence with youth/amateur pitchers and how it is very prevalent with senior's in high school as they are trying to earn scholarships or get noticed for the draft.

His bar for increasing risk in this age group was about 85 MPH. Think about that for a second and think about the draft. Raise your hand if you read an internet report about a high school senior who throws 85 and immediately disregard him as a potential draft pick. We are all guilty of it.

The reason that Andrews gives is that the due to the pitching schedule of pitching year round has lead to physical development that exceeds the structural integrity in youth pitchers that are not fully developed and do not have the necessary downtime for recovery in the off-season.

The main pitchers that stick out in my mind for the Astros as having TJ recently are Alex White, Vincent Velasquez, and Jack Armstrong.

Velasquez worked out at one of MLB's Urban Youth Academies out in California and likely threw quite often while in high school and also threw well over 85 in high school.

Jack Armstrong threw hard in high school and participated in the Cape Cod League.

Alex White threw hard in high school.

This isn't direct comparison. Velasquez was the only who needed TJ the year he graduated high school. I'm not trying to prove a point here.

Per Medscape, a major league pitcher creates up to 60 Newtons of valgus force at the elbow. The ulnar collateral ligament is the static structure that is supposed to withstand valgus force. The problem is that the UCL's from cadavers fail at significantly less force than that. The correlation is that a single pitch exceeds what that structure is supposed to hold.

So, how does it not fail with every pitch? Dynamic stability via musculature that crosses the joint. I won't bore you with all of that though. Driveline Baseball has loads of literature on that very subject if you want to read more.

I'm not trying to disagree with Andrews, I'm never going to be as smart as he is nor will I know what he knows. However, I do want to call attention to the importance of proper pitching development with training of specific musculature to help prevent injury. Dynamic stability is obviously a huge factor, otherwise the incidence would be much higher than it is based on cadaver studies.

Mechanics and training are an integral part of a healthy pitcher. Regular throwing is important, but I think breaks for competition may have a good benefit. Unfortunately, that would put less emphasis on off-season leagues. But, look at Brady Aiken and his velocity spike after taking the winter off.

I know this post is kind of scrabbled and I don't provide any real conclusions, because it's impossible to put everything into one article. I also tried not to bias it one way or the other. Only simply to bring it up to provoke some thought on pitching development and how Andrews comments should be applied to the minors and the draft.