Major League Baseball pitchers have been dropping like flies this season. Since spring training, more than 20 have been fallen victim to a tear or partial tear of the ulnar collateral ligament (UCL) of the elbow. In the best case scenario, repair of the UCL, an infamous procedure better known as Tommy John surgery, costs promising athletes effectively a year of their careers, teams a lot of money and fans the pleasure of watching guys like Jose Fernandez and Matt Harvey perform their craft. Even non-pitchers aren’t safe. This week, all-star catcher Matt Wieters of the Baltimore Orioles went down for the season to Tommy John surgery.
The epidemic of Tommy John surgeries got us thinking, so we asked orthopedic sports medicine surgeon J. Martin Leland, MD, can MLB do anything to prevent UCL injuries?
Martin Leland: I don’t think there’s much Major League Baseball can do other than slowing down the game. I don’t think you’d see this many injuries if the speed of a pitch in MLB were 60 miles per hour.
Here’s why. As pitchers hit higher and higher speeds on the radar gun, the only way to accomplish that is by having faster arm velocity. Although the kinetic chain of the throwing motion starts in the legs and travels through the rotation of the hips and torso, the speed of the ball ultimately comes from the speed of rotation in the arm. Pitchers cock their arm way, way, way back as they start throwing, putting incredible stress on the elbow. The UCL is the only thing keeping the arm from literally flying apart.
Pitch counts are also incredibly important. Five hundred pitches will obviously stress the arm less than 50,000. As does rest. Although the type of pitch matters —we still don’t feel like curveballs are good for young kids to be throwing — it’s much more important to keep track of pitch counts and rest. Athletes that pitch eight months or less have greatly reduced risk for a UCL injury.
When players come back from UCL repair, they frequently are treated more gently than a player that has not so as to not stress the repair. If you treat someone who’s never had a UCL injury as if they’re coming back from UCL repair, you may prevent injuries.
These aren’t great options for Major League Baseball, but they’re the only ones right now to really prevent UCL tears. However, there could be potential ways to reduce the risk of injury in the future.
People were asking the exact same question about ACL injuries ten to 15 years ago. There has been some very positive research, that by doing certain training exercises and warm up drills, that the risk of ACL injury can be cut in half.
In thinking about the future of UCL injuries, it will probably be along similar lines. Prevention to injury becomes about determining what exercises are most important and making sure what athletes are doing those, depending on their focus.
There’s also research on ultrasound of the UCL to try and predict when a player might have a higher risk of injury. There aren’t any clear conclusions yet, but perhaps if they look at more and more players, a pattern will emerge where if the UCL looks a certain way, it has higher risk for injury and the player can be shut down for rest.