Tommy John Surgery: Why Is It Increasing?

Tommy John pitches for the Dodgers in 1978, four years after he underwent the surgery now named for him - Getty Images

The surgery named after the pitcher who first had it is happening more and more often. Why?

A few days ago, Tim Huwe was wondering in the comments about the increasing prevalence of Tommy John surgery in baseball -- seems as if more and more (and younger and younger) pitchers are having it. I mentioned that I might explore this in an article. Here, then, is that article.

I want to say straight out that I don't have an answer to the question posed in the headline. Rather, I wrote this to include some facts and evidence and open up this question for your thoughts.

Here's an article which lists all the TJ surgeries in history -- and there have been 87 such procedures since 2012, including at least two pitchers (Daniel Hudson, Brandon Beachy) who have had it done twice. (If that link is too hard to plow through, here's a spreadsheet showing the same information in table format.)

Here's a recent Washington Post article that has some hints about why this "epidemic" might be happening:

For years, the industry has focused on mechanics — streamlining deliveries to be as efficient as possible — and on conservative development, such as limiting pitch counts and innings, as a means of preserving and protecting pitchers’ arms.

But this latest rash of elbow surgeries has caused baseball to question whether some trends that on the surface look like signs of progress — such as the specialization in youth sports that has many kids playing baseball year-round and the advances in biomechanics and strength training that have made it possible for young pitchers to throw harder than ever — might themselves be the biggest part of the problem.

"We’ve been serving a dual purpose, which is to help these players both maximize performance and maximize safety. We’ve been operating on the theory that those go hand in hand," ASMI’s Fleisig said. "You optimize performance and you stay [healthy]. Now there is concern that optimizing performance comes with increased injury risk. . . .

"Through mechanics and strength training and nutrition, we’ve trained baseball pitchers, as an industry, to where they’re optimized. You’re using the muscles correctly — but your ligaments and tendons are hanging on for dear life."

That sounds logical, but then, what's the answer? What is the solution? To not have pitchers throw as hard when they are younger? We are seeing younger and younger pitchers have TJ surgery (excellent example: Jameson Taillon of the Pirates, who is just 22 and who has yet to pitch in the major leagues). One of the reasons for that is the recovery time has shortened considerably. When Tommy John himself had the surgery, it took him about 18 months (from September 25, 1974 until spring training 1976) to resume pitching.

Now, pitchers can come back in a year, or perhaps less -- example: the Cubs' Kyuji Fujikawa, who had the surgery June 11, 2013, and could be back on the mound within a year from that date.

The "harder than ever" mentioned in the Post article is almost certainly one of the factors, too. Scouts and major-league executives salivate over hard throwers. And as you likely know, big-league strikeouts are up again this year, as they have been trending over the last decade. Through yesterday, 20.7 percent of all MLB plate appearances ended in a K. Compare that to five years ago (2009), when 18 percent of all PA were strikeouts, or 2004, when 16.9 percent of all PA were K's.

Hard throwers are clearly prized. Hard throwers get drafted higher. Hard throwers make more money, both in the draft and later in their careers.

But hard throwers also have more surgeries.

Is it worth the tradeoff?

Again, I don't have the answers here. Just wanted to open this topic up for discussion, especially since we still have several hours until tonight's game. Have at it.

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