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'The need for speed': Tommy John surgery has become most prevalent in youth baseball players

'The need for speed': Tommy John surgery has become most prevalent in youth baseball players
Posted at 1:10 AM, May 24, 2024

(NBC 26) — It's the 50th anniversary of when Tommy John surgery was invented. It was first performed by Dr. Frank Jobe on his patient — a Dodgers pitcher named Tommy John.

An injury that was once considered career ending for baseball pitchers has now become prevalent for MLB players and is now becoming an enormous problem at the youth level.

“I think we’re seeing an explosion of these injuries at all levels,” said Dr. Kevin Shepet, an orthopedic surgeon with Bellin Health.

“It's a huge issue and the biggest issue is that it’s mostly preventable,” said Dr. Ben Zellner, a hand to shoulder specialist with OSMS.

Like all MLB fans it’s always tough to watch your favorite major league baseball pitchers undergo Tommy John surgery as they’re out for a year or longer. West De Pere graduate Jason Berken had the surgery when he pitched at Clemson before his career in the majors. 

“it was tough,” Berken said. “It was devastating, it’s hard. It’s the worst case scenario for a pitcher.”

Traditional Tommy John surgery is the reconstruction of the ulnar collateral ligament in the elbow. 

“That means we’re taking a graft from a donor ligament most commonly from the forearm called the palemerus, sometimes a hamstring tendon can be used and making a new ulnar collateral ligament,” Dr. Shepet said.

It took Berken two years to feel 100% on the mound. 

“You take away the game you love, the opportunity to play, that’s hard,” Berken said.

Luckily the surgery is very successful for most who have it.

“It's one of the most successful surgeries in all of orthopedics actually, with return to performance or play levels at 85-90%,” Dr. Shepet said. “It can be a long recovery – traditionally 12-18 months to be fully recovered."

According to injury analyst Jon Roegele, who tracks Tommy John surgeries in the MLB, the surgery has increased by 29% in pitchers who throw at the highest level since 2016. In 2023, 35% of all MLB pitchers have had the surgery.

“I don't want to say it’s inevitable but when you throw overhand, it’s an unnatural motion. I think you’re going to put yourself at risk for injury,” Berken said.

The need for Tommy John surgery has exploded at the youth level. According to Chicago's Rush University Medical Center, the biggest age group that needs the surgery in the country is from ages 15-19.

“Our youth athletes are under a lot of different pressures to throw harder and faster a lot more often,” said Dr. Shepet.

There are few reasons why doctors think this is happening. There was a long held belief that breaking balls were one of the main culprits.

“There are some theories that different pitch types, breaking balls or curveballs may put more stress on the elbow,” said Dr. Shepet.

Now, some think a big factor is the need: The need for speed.

“That's what kids are being asked,” said Berken. “How hard can we get you to throw, how fast can you spin a breaking ball, because the metrics now and all the data we have shows that the harder you can throw, the faster you can spin a ball the greater you become.”

Another factor according to the experts is overuse. 

“The more you put a high load on something whether it’s a rope or a ligament in the elbow, it’s going to fatigue over time and if it doesn’t have time to recover and rest, that ligament is ultimately going to fail,” Dr. Shepet said.

Doctors recommend avoiding single-sport specialization. 

“One should take (off) at least 2 months, some people advocate three or four months if you could,” Dr. Zellner said. “That doesn’t mean that a child or youth is sedentary during that time. They're able to do other sports, they’re able to cross-train lift weights and work on their conditioning. There are plenty of things that can be done outside of throwing with that arm.”

Berken now owns Impact Sports Academy in De Pere which trains baseball players year round. He tries to help parents understand what can be done to minimize the risk of a pitching injury.

“The biggest thing for me I think is, we try to let our coaches know that we gotta take it out of the kids hands,” Berken said. "The kids don’t know any better. Any competitive kid, if you ask them how do you feel, hey do you want to stay in the game, the answer is going to be yes.”

It’s not just taking the ball out of their hands. It’s building them up, giving a pitcher adequate rest, and having pitch counts. 

“The way we look at it, part of it is lifting weights, part of it is mechanics, on the mound work, you can make your body a more efficient mover,” Berken said. “It’s pre-and-post throwing routines making sure your arm is ready to go. It’s warm-ups. It’s rest in between outings, It’s rest in between games. It’s not playing shortstop the day after you pitch. It's all those things that are wrapped into it that allows you to stay healthier for longer.”

Berken doesn’t just train players, he also coaches his sons 9U team. Even with that young age group he makes sure to instill on them the need to take care of their arms.

“I'm trying to implement those small things into him even at 9 years old where he can understand I can't just grab a ball and just start chucking pitches, I have to get myself prepared,” Berken said.