Under the knife: Experts speak on Tommy John surgeries

First, let’s all be clear about something. ... Nobody knows everything. Citing a supposed expert without allowing for doubt is known as argument from authority, and it’s a classic logical fallacy. Nobody knows everything.

But when it comes to pitchers and how they get hurt whilst pitching, Drs. James Andrews and Glenn Fleisig, the leading lights of the American Sports Medicine Institute, do seem to know quite a lot. Thursday, AMSI released a “Position Statement for Tommy John Injuries in Baseball Pitchers” ... and it’s a fine primer on the subject.

You know how everybody says young pitchers shouldn’t throw curveballs because they’ll get hurt that way? “Not true. Biomechanical research and epidemiologic research have not shown a strong connection between curveball and elbow injuries. Too much competitive pitching and pitching while fatigued are the biggest risk factors.”

Oddly, just last year the AMSI released a position paper on youth pitching that says throwing curveballs might be risky, and young pitchers should focus on learning the proper mechanics and throwing fastballs and changeups. So I don’t know what we’re supposed to think.

You know how everyone says young US-born pitchers are at greater risk than foreign-born pitchers, because of the rigorous workloads? “Not true. A recent survey [unpublished] revealed no difference in the prevalence of Tommy John surgery between pitchers from the US and pitchers from Latin America. The survey showed that 16 percent of US-born pitchers and 16 percent of Latin American pitchers in professional baseball have a history of Tommy John surgery.”

AMSI has nine recommendations for keeping professional pitchers healthy ... but quite frankly, I don’t know that many (any?) of the recommendations will be at all surprising to any of the organizations that actually give a tinker’s damn (which is all of them, I suspect). Essentially, the recommendations boil down to these:

1. Optimize pitching mechanics.

2. Rest, rest, and rest some more.

3. Stay fit and don’t take drugs.

Gee, when you put it like that ... Actually, there’s one more thing on the list:

Pitchers with high-ball velocity are at increased risk of injury. The higher the ball velocity, the more important to follow the guidelines above.

I found this particularly interesting because Joe Sheehan, in his subscription newsletter, has just been speculating about this very possibility. Thursday, Joe wrote that “starting pitchers who average 95 mph are about twice as likely to have Tommy John surgery as pitchers who average 93-94.9 mph.”

Granted, he also wrote (referencing "The Right Stuff"), “I don't think it's that simple. I honestly don't. I do think there's reason to be wary of the demon, though.”

I don’t think it’s that simple, either. It does seem that more and more pitchers are pushing the physical limits of pitching, and it seems that pushing the limits would lead to a higher risk of injury.

It also seems that getting the adults — whether parents and coaches of young pitchers, or actual professional pitchers — to behave differently is a heck of a lot easier said than done. Aside from all those pesky surgeries, a whole lot of coaches and parents are getting exactly what they want: The coaches are getting victories and the parents are getting sons with college scholarships and professional contracts. The professional pitchers are getting contracts worth millions of dollars, which continue to pay even if the pitcher tears his elbow ligament.

For roughly 15 years of a pitcher’s career — say, from ages 13 to 28 — the culture is rigged against the thin, tender ligament that holds his elbow together. The culture has already changed once; young professional pitchers don’t throw nearly as many pitches as they once did. So maybe it can change again.

But it won’t be easy, and it won’t be quick. AMSI’s position paper references an epidemic of Tommy John surgeries. Considering how many young pitchers have been immersed in the current culture for many years, the epidemic will probably get worse before it gets better.