The repair of medial collateral ligament (MCL) tears, commonly known as Tommy John surgery, has become increasingly common in athletes under the age of eighteen, and even among the younger pitchers in the professional leagues. The MCL is the prime stabilizer of the elbow while pitching. The act of pitching stresses the ligament to its maximal capacity, which can lead to a tear.
So why is this happening so frequently among young players? As Clinical Supervisor of the Overhead Athlete at the HSS Sports Rehabilitation and Performance Center, I deal with this question a lot. The latest research indicates that the amount of pitches thrown is a significant factor. Unfortunately the biggest and strongest players (who tend to throw the hardest) are often overused, and therefore tend to have more injuries and more surgery.
Another factor may be that children who live in states like Florida, Texas, and California, where the weather is good year-round, often don’t take a break over the winter months. The USA Baseball Medical & Safety Advisory Committee advises three months of active rest for every pitcher a year. Active rest may include playing another sport besides baseball or following a specialized strength and conditioning program. In fact, in my observation, children who play other sports are usually better overall athletes than those who are trained only to pitch. Young athletes who play more than one sport often have better core and leg strength, and don’t find themselves having to rely on only their talent to perform at a high level as pitchers.
Young people who only pitch also often display GIRD-glenohumeral internal rotation deficit and they lose internal rotation of their shoulder. While there isn’t necessarily a causative relationship, studies have demonstrated a correlation between GIRD and torn MCLs. Pitchers become so accustomed to drawing their arms back (rotating externally), that they lose the range of motion necessary to bring their arms forward (rotating internally), the motion that helps to protect not just the shoulder but the elbow.
The take home message is that the reason behind the increase in Tommy John surgeries for young pitchers is multi-factorial. Throwing harder is not the whole story of being a successful pitcher, and a lot of players focus too much on isolated exercises when they may be better served by a program that conditions their entire body, especially the shoulder and the scapula.
Thrower’s analysis programs and baseball-specific training sessions, such as those available at the HSS Sports Rehabilitation and Performance Center, can help educate a player on how to train and condition the right muscles. There is no one simple solution, but taking enough time off from pitching each year, playing another sport during the break, and following an appropriate, well-rounded training program can help keep the risk of injury at a minimum.
Michael Levinson, Physical Therapist and Certified Strength and Conditioning Specialist, is a Clinical Supervisor at the James M. Benson Sports Rehabilitation Center at Hospital for Special Surgery. Michael is on the faculty of Columbia University School of Physical Therapy. He has published numerous chapters and articles on Sports Medicine Rehabilitation, and has lectured extensively on various subjects regarding the shoulder, elbow, knee and ankle. Michael serves as physical therapist for the New York Mets Baseball Club. He has been a consultant to numerous youth, high school, collegiate and professional athletes.