With Major League Baseball (MLB) on track to see a record number of pitchers undergoing Tommy John surgery for ulnar collateral ligament (UCL) injuries, experts are beginning to investigate the reasons behind the "epidemic"—including the possibility that more intensive youth sports are a major contributor to the problem.
Last week, star pitcher Jose Fernandez underwent the surgery, becoming the 18th pitcher to receive the procedure in 2014. Since Fernandez, that number has risen to 20, a rate that already exceeds season averages for 2000 – 2011. On May 18, a panel of MLB researchers convened to begin looking at the causes for the rise, and will be considering the link between increased UCL tears and youth sports intensity.
A recent article in the Washington Post explored the jump in Tommy John surgeries and interviewed experts who agreed that the ever-increasing speed with which pitchers throw is putting enormous strain on the ligament. While 100-mph fastballs have been achieved partly due to a better understanding of biomechanics, they say, a large contributor has to do with the intensity of youth sports programs. Some high school-aged pitchers are now throwing hard year-round, and suffering increased overuse injuries because of it.
The Post article describes a youth baseball culture in which young pitchers play from March through the fall and then attend special camps and tournaments the rest of the year, with some even receiving regular individual training. The lack of sustained rest starts the pitchers on a path to injury that is surfacing as a full UCL tear earlier and earlier in their careers, with many high school-aged athletes now undergoing the procedure.
The problem is further complicated by a perception that Tommy John surgery is a risk-free guaranteed way to actually improve a pitcher's performance. In the Post article, sports orthopedist James Andrews—himself an experienced Tommy John surgeon—is quoted as saying "There's a myth that there's a 100 percent success rate and pitchers come back throwing harder. It's not true. If pitchers come back throwing harder, it's not because of the ligament. It's because of the rehab and core-strength training."
APTA offers resources on UCL tears and the role of the physical therapist in treatment through its MoveForwardPT.com website. The increase in elbow injuries in professional baseball was among the topics discussed in a recent episode of Move Forward Radio.
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