Tommy John surgery is the name given to the procedure of repairing a ruptured ulnar collateral ligament (UCL). The UCL is located on the inside part of the elbow and secures the elbow joint. This type of injury is very commonly seen in baseball players and more specifically pitchers. Until recently the injury was reserved for major league pitchers who had experienced high pitch counts. Unfortunately, this type of injury is becoming more and more prevalent among youth pitchers.
One study sought to show the percentage of youth players and more specifically pitchers who advanced from the Little League World Series (LLWS) to the Major Leagues and of those pitcher who then required UCL reconstruction. They also looked at former players from the Little League World Series who exceeded the current pitch recommendation, which is anywhere from 85 to 95 pitches depending on the age of the player and also specialized as a pitcher meaning that at least 8 months out of the year they were playing baseball and were primarily focused on pitching during those 8 months.
What they found was that only 10% of pitchers who played in the Little League World Series went on to play professional baseball in either the minor or major leagues. Of that 10% of pitchers who played professional baseball nearly 5% needed to undergo UCL reconstructive surgery. They also found that almost half of the kids who exceeded pitch limits while playing in the Little League World Series needed to have Tommy John surgery later in life while only 2% of the kids who did not exceed the pitch limit had to undergo surgery. After 2007, a pitch count limit was introduced in the Little League World Series and since then there has not been a LLWS who needed UCL reconstruction.
Based on their results the researchers concluded that diversification of an athlete and following current pitch limit and rest regulations may protect young pitchers against having to undergo UCL reconstruction.
Reference:
Erickson, B., Chalmers, P., Axe, M., & Romeo, A. (2017). Exceeding Pitch Count Recommendations in Little League Baseball Increases the Chance of Requiring Tommy John Surgery as a Professional Baseball Pitcher. Orthopaedic Journal Of Sports Medicine, 5(3), 232596711769508. http://dx.doi.org/10.1177/2325967117695085
I read a book called Hacking the Kinetic Chain, by Kyle Boddy, founder of Driveline Baseball. He speaks a lot about injury prevention in players. Namely, he mentions the physics behind peak force, and the association with throwing hard. In essence, you need to throw hard enough to be at risk for UCL injury (somewhere around 85 MPH, minimum). So it makes sense that the LLWS pitchers going on to play in the MLB are at risk. Additionally, UCL injury is associated with force distribution in the mechanics of the throw. From first hand experience, I know that the baseball community is very 'classic' and does not change many things because "that's how they've done it for ages." Unfortunately, a lot of the biomechanics that are taught to young pitchers are inefficient, unproductive, and dangerous. Boddy mentions that the implementation of weighted ball use, arm path patterning, and proper recovery is crucial to arm health. Unfortunately, this all takes a lot of time everyday, and most players do not want to put in this time. Finally, Eric Cressey, founder of Cressey Performance in Massachusetts, talks a lot about anatomical changes that occur in young pitchers, such as the development of a valgus carrying elbow, which puts one at a greater risk for UCL injury than someone with a straight elbow.
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