There’s No Such Thing as a Tommy John Epidemic



If you know me at all, then you know that I’m a baseball fan. I grew up playing the game as a kid, continued playing at Yale University, and now have the honor of coaching my two oldest boys as they learn to play the game.

But lately, I’ve noticed something very alarming about the game I love. There is an increasing number of elbow injuries popping up throughout the game. From Little League to the Major Leagues, players, and specifically pitchers, are going down with elbow injuries.

The diagnosis is almost always the same: A torn ulnar collateral ligament (UCL) in the player’s elbow.

The blame is almost always the same: Too many pitches thrown in a season, or throwing a curve ball at too young of an age, or too many innings pitched in a year, etc.

The solution is almost always the same: Reconstructive surgery (also known as Tommy John Surgery, named after the player who first had the procedure done).

Yet the cause is almost always missed: Today’s player, despite being bigger, faster, and stronger than ever before, is exponentially more dysfunctional than his predecessors.

You see, when an elbow (or a knee, hip, intervertebral disc, etc) sends its first painful signal, the pain is at the end of a series of dysfunctional dominoes that have fallen. It’s the effect, not the cause. While the process for determining the cause should include a global, full-body assessment of how the rest of the body is functioning, all too often the elbow–or for some of you, the location of your specific symptom–is zeroed in on, the torn UCL is found, and surgery is scheduled. The player can count on missing roughly 12 months of baseball activities, and he may or may not get back to being the player he was before.

The rate of Tommy John surgeries in professional baseball is eye-opening. According to Johan Keri of, 25% of active MLB pitchers have had Tommy John surgery as well as 15% of current minor league pitchers. In 2014 alone, more pitchers had Tommy John surgery than in the entirety of the 1990s.

Scary. Scary. Numbers.

Players are stronger than they’ve ever been, yet they’re breaking down at an alarming rate. They’re throwing harder than ever before (16 of the 21 players to throw over 102 MPH have been since 2002), yet their bodies can’t sustain the workload.

So, the question that we have to ask is simple: Why?

Why are players rapidly breaking down when they have access to the most up-to-date technology, supplements, and training compared to their predecessors?

As I stated above, I believe the answer is simple: Players today are more dysfunctional than their predecessors. Despite all the bells and whistles available to them, they are becoming more and more fragile.

What MLB is calling an overuse injury, I’m calling a hip underuse issue.

What MLB calls a UCL issue, I’m calling a shoulder position issue.

What MLB is calling is an “epidemic,” I’m calling a byproduct of the player’s daily environment.

Let’s look at the Washington National’s Stephen Strasburg, one of the hardest throwing pitchers in the game, as an example. He also happens to be a veteran of Tommy John surgery. He is told his elbow pain is a “mechanics” issue–Let’s simply change your delivery, and we can prevent this from happening again. But what’s actually happening is that he can’t load is left hip when his lead foot (his left foot) hits the ground during his delivery. He has lost the congruency between his left hip, knee, and ankle. Those joints are no longer working together as a spring-loaded mechanism, allowing him to efficiently transfer his weight from his back side to his front side. As a result, he stays very stiff on his front side and his upper body essentially pegs over-top of his lower body. Check it out for yourself:

When it’s all said and done, he’s left throwing 100 MPH almost entirely with his arm. His upper body is being asked to compensate for his lack of hip function, and his shoulders begin rounding forward placing an incredible amount of stress on his elbow until…

There’s not.

His body warned him. His body told him he was headed this direction. And on one pitch in 2010, all that built-up stress “released” when his UCL tore. Keep in mind that his UCL tore because that is precisely what tendons and ligaments are designed to do when under excessive amounts of stress and pressure. Yet, all the powers-that-be in baseball were quick to tell the Nationals, “We told you so!” Everyone assumed that because Strasburg threw 100+ MPH his elbow was going to break down eventually. In the eyes of the baseball world, it was only a matter of time.

But I don’t believe Strasburg’s 100 MPH fastball is to blame for his UCL tear. Neither is his slider or change-up, for that matter. It’s the body coming to the pitching mound. Remember what I said earlier about what his left side was doing? Or more importantly, what his left side wasn’t doing? The key to a pain-free delivery is hip function and establishing synchronicity between the lower and upper body. Strasburg has to get his hips functioning properly. In fact, all players who are experiencing elbow pain need to get their hips functioning properly. Remember, the hip bone is connected to the shoulder bone, and the shoulder bone is connected to the elbow bone. As the hips function better, the shoulder will function better, and the elbow will function better.

Remember, if the elbow pain was at the end of a series of dysfunctional dominoes, then that means a pain-free elbow will be at the end of a series of functional dominoes. Major League Baseball doesn’t have a Tommy John epidemic on their hands. What they do have are more players who are exponentially more dysfunctional compared to players of past generations.

QUESTION: If you’re an athlete experiencing elbow pain, what has the focal point been throughout the rehab process?