Tommy John surgery doesn’t fix everything

Sunday, April 29th, 2012

The so-called Tommy John surgery keeps pitchers in the game, but it doesn’t address the underlying biomechanical flaw in their technique:

Thirty-seven baseball seasons have passed since orthopedic surgeon Frank Jobe performed the first UCL reconstruction on Dodgers southpaw Tommy John, whose name would become synonymous with the procedure. [...] Jobe’s procedure soon proved so successful that it became the norm. Today, about 50 active major league pitchers have undergone Tommy John surgery — around one in seven.

Despite the inevitable yearlong stint on the DL that rehab from the surgery requires, teams and pitchers seem to barely flinch at the diagnosis of a compromised UCL. “It’s become an accepted side effect of the job,” says George Paletta, the Cardinals’ head team physician and orthopedic surgeon. That’s because the surgery works; 92 percent of elite pitchers with reconstructed UCLs return to their prior level of competition for at least a year.


Problems usually begin below the waist. The most telling moment in a pitcher’s delivery, for instance, is the foot strike. When the foot makes contact with the mound, the pitching arm must be up and ready to throw. A righthanded pitcher should be showing the baseball to the shortstop, a lefty to the second baseman. (Among active hurlers, Cliff Lee is a good example.) But if a pitcher’s elbows come higher than his wrists and shoulders, with the ball pointing down, he’s demonstrating an “inverted W” — a sign that his sequence is off and he’s fighting his own body. Such poor timing leads to arm lag, evident when the throwing elbow trails the shoulder once the shoulders square to home plate. Strasburg exhibits both problems, forcing him and others like him to rely more on the arm’s relatively small muscles instead of the more massive ones in the legs and torso. Throw after throw, the shoulder and elbow are under extra stress. The higher the pitch’s velocity and the worse the flaw, the more the arm suffers. And the more a pitcher throws, the worse it gets.

Arm lag and improper sequencing were likely to blame for Strasburg’s UCL tear, as well as for those of almost everyone else knocked out by the injury. “The timing is subtle,” says the American Sports Medicine Institute’s Glenn Fleisig, who has analyzed more than 2,000 pitchers and is one of the world’s foremost authorities on pitching biomechanics. “It’s the difference between good and great and healthy and injury-waiting-to-happen.”

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