The Truth About
Tommy John Surgery

10/20/2007

There's this idea going around that Tommy John surgery will enable a pitcher to throw harder than they could before the surgery and that young pitchers should get Tommy John surgery even if they do not need it.
     That is simply not the case.
     All that Tommy John surgery can do — and only 80 to 90 percent of the time — is return a pitcher to their pre-injury level of performance. Any real or perceived gains over a pitcher's pre-injury levels of performance are likely due to a number of factors...

     - Improved conditioning.
     - Improved mechanics.
     - Gradual UCL degradation.

The UCL can degrade over the course of several years before breaking completely. As a result, after the procedure a pitcher will often find that they can throw harder than they could just before the procedure was necessary. However, they will not be able to throw harder than they could before their UCL started to degrade.
      Dr. Frank Jobe, the creator of the procedure, says as much in this article that he did with Baseball Prospectus and this is available on ESPN.com. The relevant lines are bolded and in red.

Baseball Prospectus: Speaking of getting back to where you were before and getting back to elbows, we've heard from quite a few pitchers, swearing they throw harder after Tommy John surgery than they did before. Is this possible?

Frank Jobe: When a pitcher comes in with elbow problems, you often see that their ligaments were already wearing out well before. Maybe four or five years ago they could throw a 95 mile an hour fastball, but they've had that ability diminished as the ligament's been stretched. What the surgery does is restore the ligament's stability to where it was four or five years ago. A pitcher might say the operation did it, but it's just more stability in the arm contributing to better mechanics.

Baseball Prospectus: Would a pitcher ever consider getting elective Tommy John surgery, just hoping to get that fastball?

Frank Jobe: It wouldn't help if you didn't have it before. All the surgery does is get you back to your normal elbow. You either have the stuff or you don't. A player that reaches the majors, he's spent years in the minors improving, making his mechanics better, with his muscles getting stronger.

Before I close, let me point out one other interesting piece of information regarding young pitchers and curveballs.
     Over the course of the past few years, I have started to regard problems related to curveballs in young pitchers as an overuse problem rather a problem with the curveball itself. I started to think about this after reviewing the research and finding that throwing a standard curveball doesn't appear to subject the arm to tremendous forces. What I think is going on in terms of young pitchers who throw the curveball is that their arms may be being damaged by all the practice that is required to learn to throw a good curveball. To throw just one curveball in a game, you have to throw hundreds or thousands in practice.
     I believe that all of those curveballs thrown in practice may be what is actually destroying the arms of young pitchers.
     It appears that Dr. Frank Jobe agrees with me. Again, the relevant lines are bolded and in red.

Baseball Prospectus: What about high school pitchers or younger? Would you limit their pitch counts? Or have them not throw curves possibly?

Frank Jobe: I don't think throwing the curve puts that much more stress on the arm. I think learning how to throw it does. That's why Little League kids get in trouble. They want to throw a curve so they spend every afternoon throwing to their dads, trying as hard as they can to get it. Then if they're good, the coach wants to win. If it's the playoffs, the same kid might pitch three days in a row.