Sports Medicine

Tommy John Surgery, a Rising Epidemic?

 by Jason Myers | Leave a Comment

If you follow professional baseball, I am sure you have observed an alarming rate of pitchers who have underwent ulnar collateral ligament reconstruction (“Tommy John surgery”) already this year.  Miami Marlin’s rising star, Jose Fernandez, became the 18th professional pitcher in 2014 to undergo this surgery, equaling the total number of pitchers to have Tommy John surgery all of last year.1

Why does this trend continue to rise?

According to the American Sports Medicine Institute’s (ASMI) Position Statement for Tommy John Injuries in Baseball Pitchers, many of these injuries actually began when these pitchers were young.2Mike Reinold, a nationally known physical therapist in the baseball community, states, “we are starting to see the results of what these kids did 10 years ago.  The excessive pitching from youth and high school baseball is catching up.  There is a lifespan on your ligament.”3

In addition, more and more young athletes undergo this surgery. In 2008, 32% of individuals undergoing Tommy John surgery at, the Andrews Sports Medicine & Orthopaedic Center were youth and high school pitchers.4

Risk Factors for Adolescent Pitchers:

  • Pitching on more than one team with overlapping seasons will increase the risk of overuse injuries5,6,7
  • Pitching year round:
    • It is recommended to take at least 3 consecutive months off from pitching per year5,6,7
  • Pitching with elbow or shoulder pain.
    •  Pain with throwing plus tenderness in the elbow or shoulder are hallmark signs of overuse injuries. These signs should be taken seriously.5,6,7
  • Pitching with arm fatigue, as well as pitching while fatigued increases your risk of injury 3 to 5 times6,7

Recommendations for Adolescent Pitchers:

  • Focus on pitch control, accuracy, and good mechanics rather than the pitch velocity5,6,7
  • Be cautious of the following steps when practicing:
    • First focus on basic throwing mechanics, second on throwing a fastball, and third the change-up5,6,7
  • Avoid breaking pitches until physically mature. A good rule of thumb is to not throw breaking pitches until you are old enough to shave regularly5,7
  • Make sure to properly warm-up prior to pitching.
    • Exercises may include jogging/running, stretching, and gradual throwing warm-up5,7
  • Avoid catching and pitching during the same game, as both positions are physically taxing on your arm6,7
  • Follow pitch count guidelines (see tables below) 5,6,7

Maximum Pitch Count


Pitches Per Game

7 to 8


9 to 10


11 to 12


13 to 16


17 to 18


Required Rest Days (Based on Pitches Thrown)

Ages 14 and Under

Ages 15 to 18

Required Number of   Days Rest

1 to 20

1 to 30


21 to 35

31 to 45

1 Calendar Day

36 to 50

46 to 60

2 Calendar Days

51 to 65

61 to 75

3 Calendar Days



4 Calendar Days

Source from the STOP Sports Injuries Website and the work of Dr. James Andrews and Glenn Fleisig, PhD. 5


1. “Notable MLB Pitchers Had Tommy John Surgery This Year.” ESPN. 16 May 2014. Web. 04 June 2014. .

2. “Position Statement for Tommy John Injuries in Baseball Pitchers. American Sports Medicine Institute. May 2014. Web. 04 June 2014. .

3. Reinold, Mike. “5 Reasons Why There Are So Many MLB Tommy John Injuries.” 21 April 2014. Web. 04 June 2014. .

4. “Youth UCL Surgery (“Tommy John Surgery”).” American Sports Medicine Institute. Web. 04 June 2014. .

5. “How Can Overuse Baseball Injuries Be Prevented?” STOP Sports Injuries. Web. 04 June 2014. .

6. “Position Statement for Youth Baseball Pitchers.” American Sports Medicine Institute. April 2013. Web 04 June 2014. .

7. Andrews, James R. “Baseball.” Any Given Monday: Sports Injuries and How to Prevent Them, for Athletes, Parents, and Coaches – Based on My Life in Sports Medicine. Scribner, 2013. 73-87.


Josh Sandberg

Josh Sandberg is the President and CEO of Ortho Spine Partners and sits on several company and industry related Boards. He also is the Creator and Editor of OrthoSpineNews.

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