The Rise of Tommy John Surgery: Grantland

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When top Pirates pitching prospect Jameson Taillon had Tommy John surgery on Wednesday, he became the 20th pitcher to suffer that fate in 2014. And that number is growing. Surgery is likely for Moore, but even if he opts against it, the ranks will swell when Braves reliever Cory Gearrin and Angels prospect Brian Moran have the procedure in the coming days. The 2014 season is on pace to annihilate the previous record for Tommy John surgeries in a calendar year.

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“The big risk factor is year-round baseball,” Andrews said. “These kids are not just throwing year-round, they’re competing year-round, and they don’t have any time for recovery. And of course the showcases where they’re pitching for scouts, they try to overpitch, and they get hurt.”

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Kiley McDaniel, the scouting-oriented national baseball analyst for Scout.com, agreed. “This originated in the Dominican. In the DR, once you’re 17, you’re ‘old’ and don’t have as many opportunities to get rich or even sign at all, so the system is geared for both hitters and pitchers to peak as quickly as possible in terms of tools, with velocity being the biggest one for pitchers. Now that high school pitchers can get $5 million to $7 million and are scouted year-round from underclassmen ages, a first-world country has the right pressures in place to foster the same environment.”

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Some observers have grown skeptical of the strength training methods pitchers use, particularly teenage pitchers.

“It used to be that we didn’t see these injuries until they got into high-level professional baseball,” Dr. Andrews said. “But now, the majority of the injuries are either freshmen in college, or even some young kid in ninth, 10th, 11th, 12th grade in high school. These young kids are developing their bodies so quickly, and their ligament … isn’t strong enough to keep up with their body, and they’re tearing it.”

Dan Jennings got his first job in Major League Baseball as a scout with the Cincinnati Reds in 1986, then went on to become one of the game’s top talent evaluators over the next 28 years. He yearns for a time when young, developing athletes used methods other than maximum-weight bench presses and dead lifts to build strength.

“Back in the day, you’d be pitching melons in a field, doing things with your hands — that’s how you built strength, from your elbows to your fingertips,” Jennings said. “Because of the new strength and conditioning programs, that’s been taken out. By the 10th grade, you’re told to focus only on football, or only on baseball; kids no longer play multiple sports. You get these specialized regimens where you build large muscle groups, but not the small muscles around the rotator and UCL. The large muscles get developed so large that when you try to decelerate, you can get badly hurt.”

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There are several factors that lead to increased velocity,” one AL baseball operations official said. “I think what has happened is that, due to improved training and instruction, pitchers throw harder. Joints and related connective tissue are put under greater stress from the increased velocity. Many claim that they can reduce injury with ‘their program.’ There is no evidence to support those claims. I am afraid, in fact, that many of these programs — several of which are well designed — actually increase injuries. The conundrum is that they also improve performance.”

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“We are coming into an era where a lot more pitchers have had TJ in high school, college, or their early professional career over the past decade,” another respondent said. “TJs are not good forever, and we are getting to the point where many pitchers had their first surgery somewhere between five and 10 years ago. We have also gotten a lot better at rehabbing surgeries the first time, to the point where guys are able to return to the mound as something very similar to what they were before. The more successful first surgeries we have, the more second surgeries we are going to have.”

One quantitatively leaning NL front-office member noted that advances in medical imaging have likely contributed to increased Tommy John rates.

“Assessing UCL integrity is very difficult, but it’s easier than ever to identify partial tears that might lead a player to elect surgery rather than go the rehab route,” he said. “So as more young pitchers identify UCL issues and elect for surgery, we’ll probably see more and more second- or third-time TJs in the future.”

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“Every two weeks we get a weight check,” said 22-year-old right-hander and 2010 fourth-round pick Nick Kingham in an interview with Pittsburgh Tribune-Review writer Travis Sawchik. Weight checks are just the beginning, Kingham said. “We track our sleep, our water intake, our hydration and everything. Every day you have to do it. We have a point system, and you try to get as many points as you can. We are pretty heavy on health in this organization.”

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