Dr. James Andrews explains why Tommy John surgery is on the rise
Apr 10, 2014, 8:55 AM EDT
Dr. James Andrews was on Sirius/XM radio’s “Power Alley” with Mike Ferrin and Jim Duquette yesterday, talking about Tommy John surgery. He was asked why there seem to be so many guys needing TJ surgery these days.
His answer: it’s not an anomaly, it’s a trend. And an alarming one, he says, in that so many more of the surgeries he’s performing are for high school pitchers as opposed to professionals with a few years under their belt. Kids are bigger and stronger these days, and their ability to throw harder is outpacing the development of their ulnar collateral ligaments.
But the biggest risk factor he and his researchers are seeing: year-round baseball. The fact that not only do pitchers throw year-round, but that they are pitching in competition year-round, and don’t have time to recover. Also: young players are playing in more than one league, where pitch count and innings rules aren’t coordinated. Another factor: the radar gun. Young pitchers who throw over 85 or so are at risk, and all of them who are on a major league track are throwing that fast or faster, and are going up in effort when scouts with guns are around.
Ultimately, you can’t prevent these injuries. Even for the major leaguers, most of whom were damaged in high school only to have the UCL injuries happen once they’ve hit the pros.
Give a listen to the TJ expert.
May 28, 2014, 5:53 PM EDT
We have posted about this a few times when Dr. James Andrews has given interviews on the subject of what he calls an “epidemic” in UCL tears and attendant Tommy John surgery. But now he and his American Sports Medicine have released a position paper on the matter.
In it he outlines the risk factors for Tommy John surgery, common misconceptions about it and his recommendations for pitchers and teams to limit the risk of needing it. As for that last part, this recommendation is likely to get the most play and, if heeded, affect the most change:Do not always pitch with 100% effort. The best professional pitchers pitch with a range of ball velocity, good ball movement, good control, and consistent mechanics among their pitches. The professional pitcher’s objectives are to prevent baserunners and runs, not to light up the radar gun.
I think major league teams know that in practice once they have a pitcher and are developing him. But the defining trait of a scout is his radar gun, and young pitchers are conditioned to want to light it up when they see a scout checking them out. Good pitchers change speed and create movement. Young pitchers get noticed, however, when they throw in the 90s. It’ll be interesting to see if this changes that at all.
Anyway, consider thus must-click material. And something to bookmark if you’re at all interested in the subject.
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Dr. James Andrews and Dr. Kevin Wilk have released the "Throw Like A Pro" app, designed to help reduce the number of elbow injuries, specifically Tommy John surgery. They "anticipate a 60% reduction in overuse related baseball injuries in the coming years" if the app is used properly, according to the press release.
“For the people who think famous, major league pitchers are the only ones undergoing Tommy John surgery, we have news for you," said Dr. Wilk in the release. "We have seen countless youth and teenage baseball players with elbow injuries ... It's very unfortunate, sad, and in many cases, probably avoidable.”
According to EvoShield, the app includes four different features: recommendations, a preseason preparation guide, a pregame warm-up routine, and a pitch counter/rest calculator. Here are some screencaps, again courtesy of EvoShield:
The app runs $9.99 and is currently available on iTunes. There doesn't appear to be an Android version just yet.
How much will the app help reduce injuries? Who knows. That 60 percent estimation in the press release struck me as optimistic, but as long as it helps pitchers -- especially young pitchers in high school or earlier -- understand the importance of monitoring their workloads, then it's a good thing.
Baseball has lost several of its best pitchers to Tommy John surgery this year, including Jose Fernandez, Kris Medlen, Patrick Corbin, Jarrod Parker and Ivan Nova.
My summers growing up were consumed by “travel ball.” I feel like I saw most of the southeastern United States before I was 12 because every summer weekend meant another district tournament, state championship, world series, or showcase.
During the school year, football season overlapped with basketball season, which led right back into baseball.
I loved it. Unlike some of the other kids, I was fortunate in that my parents were always supportive, but never pressured me to do more than I wanted to. Other kids weren’t so lucky.
The father of one of the kids on my travel baseball team growing up was a firefighter. He would throw batting practice to his son almost all day. He would leave him sitting on a bucket in the batting cage just long enough to answer a call from the fire station, then return and get right back to it. They did that for years. The kid went on to play in the Atlanta Braves organization, so maybe it paid off. But while the rest of us were having fun, baseball for him was already a job at the age of 10.
When high school rolled around, there were days during the summer when basketball and baseball games would be scheduled on the same day. My basketball coach would bench me for weeks if I missed a game, so I played both on the same day whenever possible.
When it was time to decide what I wanted to play in college, I chose basketball. The NCAA had strict rules on the amount of time we could spend practicing, but by that point basketball for me was a year-round thing.
But as active as I was in sports growing up, it absolutely pales in comparison to what kids are being put through today.
I can’t recall a single friend of mine growing up from elementary school through high school who had to have surgery to repair an injury that could be attributed to overuse. Sure, there were some torn ACLs, a few broken bones and some severely sprained ankles — heck, most of my front teeth were knocked out — but nobody was going in for Tommy John surgery to fix a frayed ligament that resulted from throwing a curveball all summer in elementary school.
My how things have changed.
Nowadays it’s not abnormal at all for a middle-schooler to come in for a surgery to repair a repetitive stress injury, and world-renowned Alabama-based doctor James Andrews — orthopedic surgeon to the stars — has had enough.
“I started seeing a sharp increase in youth sports injuries, particularly baseball, beginning around 2000,” Andrews told The Cleveland Plain Dealer in an interview last year. “I started tracking and researching, and what we’ve seen is a five- to sevenfold increase in injury rates in youth sports across the board.”
In an effort to spread the word that there is an epidemic of repetitive stress injuries in youth sports, Andrews partnered with Don Yaeger, a former editor at Sports Illustrated, to write “Any Given Monday: Sports Injuries and How to Prevent Them, for Athletes, Parents and Coaches — Based on My Life in Sports Medicine.”
“I’m trying to help these kids, given the epidemic of injuries that we’re seeing. That’s sort of my mission: to keep them on the playing field and out of the operating room,” Andrews said. “I hate to see the kids that we used to not see get hurt… Now they’re coming in with adult, mature-type sports injuries. It’s a real mess. Maybe this book will help make a dent.”
Here are some other interesting nuggets from Andrews’ interview with the Plain Dealer:
“Specialization and “professionalism” are leading to a spike in youth injuries
Specialization leads to playing the sport year-round. That means not only an increase in risk factors for traumatic injuries but a sky-high increase in overuse injuries. Almost half of sports injuries in adolescents stem from overuse.
Professionalism is taking these kids at a young age and trying to work them as if they are pro athletes, in terms of training and year-round activity. Some can do it, like Tiger Woods. He was treated like a professional golfer when he was 4, 5, 6 years old. But you’ve got to realize that Tiger Woods is a special case. A lot of these kids don’t have the ability to withstand that type of training and that type of parental/coach pressure.
The whole youth sports system has gotten out of control
The systems out there in youth sports, particularly travel ball, have been important financial resources for the people who run them. Parents spend a fortune keeping their kids in a year-round sport, with travel and everything else. What’s happening is, the tail is wagging the dog. The systems are calling the shots: If your son or daughter doesn’t play my sport year-round, he or she can’t play for me. Never mind that your kid is 12 — I need year-round dedication.
Simply giving kids a little bit of a break could prevent most of these injuries
Kids need at least two months off each year to recover from a specific sport. Preferably, three to four months. Example: youth baseball. For at least two months, preferably three to four months, they don’t need to do any kind of overhead throwing, any kind of overhead sport, and let the body recover in order to avoid overuse situations. That’s why we’re seeing so many Tommy John procedures, which is an adult operation designed for professionals. In my practice now, 30 to 40 percent of the ones I’m doing are on high-schoolers, even down to ages 12 or 13. They’re already coming in with torn ligaments.
Give them time off to recover. Please. Give them time to recover.
There’s a lot more that can be gleaned from Andrews’ interview, and the full post at The Plain Dealer is worth a read.
But the bottom line is, as the summer wraps up and the school year begins, this might be a good time to give the superstars of tomorrow a break, and let them just be the kids of today.
John Smoltz calls out domineering travel-baseball culture at end of Hall of Fame acceptance speech
National Baseball Hall of Fame inductee John Smoltz speaks during an induction ceremony at the Clark Sports Center on Sunday in Cooperstown, N.Y. (AP/Mike Groll)
As Hall of Fame acceptance speeches go, John Smoltz's was not terribly entertaining. He was too careful to mention each and every person who affected his life, growing up as the son of accordion teachers in Michigan, to reach any sort of real connection with the audience during a rather lengthy half-hour.
Until, that is, the last five minutes. The loudest and longest ovation Smoltz received was for the most passionate point he made near the end of his time on the podium at Cooperstown on Sunday.
It was when he tried to talk some sense into all the parents who are relentlessly driving their kids through the nonstop treadmill that is travel baseball. He was speaking of all the kids whose arms are worn out and even damaged by their mid-teens. Whose passion for the game has long since been replaced by a hollow expression, whose onetime thrill in competition has dissolved into some vague sense of duty to their parents' commitment.
Smoltz prefaced his remarks early on when he spoke of an idyllic childhood playing all sorts of sports and games in Lansing:
"Thankfully, we didn't grow up in Florida or warm weather where you fall prey to playing every day or all year. Two months in Michigan is long enough."
He would take direct aim on summer baseball later on. It has completely devolved during my lifetime. And I don't think for the better.
It once was a sport played in wonderful parentless informality. Once school ended, that was the end of adult supervision. On any normal July day like today, 10 or 12 kids assembled together by themselves, ages mixing from about 7 to 13. The rules varied depending on the turn-out. Anything other than all-time pitchers and catchers was the exception.
Often as not, Wiffle ball was the preferred choice because you could attract a bigger number of kids more easily to somebody's backyard, just by word of mouth or bikes going by, than you could organize a group to the diamond at the school.
Our favorite was Ed Thibodeaux's yard because it included a fenced pen for their small dog that functioned as a short porch in right field, an enticement for the more ambidextrous to bat lefty and try for the cheap homer.
And once in a great while, somebody would hit it over the house, a momentous occurrence like jacking one over the roof at Tiger Stadium or onto the freeway at Crosley Field. It didn't happen often but when it did, it was the talk of the neighborhood for days.
That sort of kid-run game is just about extinct in a lot of places. That's because travel leagues have come to dominate the summers of even for grade-schoolers. Rather than run around among themselves, mixing basketball, touch football, games of Manhunt and afternoons inventing dives into the creek off a rope swing, kids as young as 7 are herded into travel baseball tournaments for entire weekends.
Parents are in charge of everything. There are uniforms, brackets, multiple locations for each tournament. It's insanity.
The clear carrot hanging from the travel league stick for many parents is the promise of a college scholarship. Which is, of course, in these times of spiraling tuition costs, no small reward. But so few kids are good enough to play at the college level. And those who are many times end up at schools where a meaningful degree is a secondary consideration.
The nuttiest part of the travel-league merry-go-round is how it drains not just the fun out of play but the life out of arms. Physical injury is occurring.
Smoltz is the first Hall of Fame inductee to enter after having Tommy John surgery on his pitching arm. He clearly felt a responsibility to guide parents, those who would point to his lengthened career after a surgery at 34, as some sort of indicator of a sensible path for their sons. So much so that he chose to say this at the climax of his speech:
"It's an epidemic. It's something that is affecting our game. It's something I thought would cost me my career. But, thanks to Dr. James Andrews and all those before him, performing the surgery with such precision, it's caused it to be almost a false read – like a Band-Aid you put on your arm."
And it's not, Smoltz emphasized. It's an avenue for veteran professionals as a last resort, not a preemptive procedure for the arms of stressed-out teenagers:
"I want to encourage all the families and parents out there to understand that this is not normal to have a surgery at 14 and 15 years old. That you have time. That baseball's not a year-round sport. That you have an opportunity to be athletic and play other sports."
He then went on to fire a shot at the moneymakers dangling empty promises:
"Don't let the institutions that are out there running before you, guaranteeing scholarship dollars and signing bonuses, that this is the way. We have such great dynamic arms in our game that it's a shame that we're having one and two and three Tommy John recipients.
"I want to encourage you, if nothing else, to know that your children's passion to play baseball is something that they can do without a competitive pitch. Every throw a kid makes today is a competitive pitch. They don't just go outside. They don't have fun. They're out there competing and maxing out too hard too early and that's why we're having these problems. Please, take care of those great future arms."
At this point, nearly everyone in the Cooperstown crowd applauded. Some stood.
You'd believe nearly everyone clapping was old enough to remember a different time and a different way. Before long, there may be nobody left who even knows what he's talking about.
I wasn't just making up that part about the rope swing and the creek from some Stand By Me imagination. My own son, now 16, spent countless hours with his friends climbing a sturdy old tree on the bank of Brandywine Creek via 1-by-4 steps someone had pounded into the trunk. They'd then dangle out a knotted marine rope hanging from a branch. They dove and jumped into the creek from every conceivable angle, back flips, gainers, belly flops.
Last summer, a county maintenance crew, surely alerted by some helicopter parent, identified the rope swing as a safety hazard. It was cut down. And then, so were the branches hanging over the creek.
You see, activities supervised by adults are so much healthier.
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