Tommy John Surgery: A New Approach to Reducing UCL Injuries

Tommy John Surgery: A New Approach to Reducing UCL Injuries

Tommy John surgery and UCL (ulnar collateral ligament) injuries have become major topics of discussion in the baseball world, especially with many of the game's most skilled pitchers, like Shohei Ohtani, Spencer Strider, Walker Buehler, and Shane Bieber, developing UCL injuries over the past year. The number of Tommy John surgeries has dramatically increased over the last 20 years, showing no signs of decline. From junior baseball to college, the minor leagues, and the MLB, pitchers are following the current guidelines to help avoid UCL injuries, yet the numbers continue to rise. It's time to ask if there might be a different approach to preventing UCL injuries.

What is Tommy John Surgery?

Tommy John surgery, named after the first baseball pitcher to undergo the procedure in 1974, is a surgical operation to repair a damaged UCL in the elbow. During the surgery, a ligament from elsewhere in the patient's body or from a donor is used to replace the injured UCL. This procedure is often necessary for athletes, particularly pitchers, who place a significant amount of stress on their elbows. Recovery from Tommy John surgery can take up to 18 months, and while many athletes return to their previous level of performance, the lengthy recovery period and the rigorous rehabilitation process make prevention of UCL injuries a high priority.

Current Guidelines and Rising Injury Rates

The current guidelines to help prevent UCL injuries include monitoring pitch counts, ensuring proper rest between games, and incorporating mobility and strength work for the forearm and scapula stability muscles. Additionally, pitchers are advised to use proper pitching mechanics. Despite these measures, pitchers at all levels continue to suffer from UCL injuries.

Over the past 10-15 years, we've seen a rise in average pitch velocity, with players achieving these higher velocities at younger ages. This increased stress on the UCL is likely contributing to the surge in injuries. Regular metrics such as grip strength and shoulder strength testing, like the ASH test, are essential to ensure pitchers aren't overexerting their arms when they are vulnerable. However, a more comprehensive biomechanical approach is needed to allow pitchers to generate more velocity while maintaining proper mechanics and limiting stress on the UCL.

The Importance of a Biomechanical Approach

Pitching is a full-body movement requiring proper biomechanical function of every joint from the feet to the fingers. Efficient pitching mechanics rely on a specific kinematic sequence that allows pitchers to create rotational velocity, transferring force from the ground, through the feet, hips, spine, and then into the shoulder, arm, and wrist. Through my work with hundreds of rotational athletes, from junior elite players to professionals, I've observed that almost all of them lack full thoracic and hip range of motion. This limitation hinders their ability to create an efficient kinematic sequence.

When pitchers can't achieve full thoracic rotation or lead hip external rotation, they put more force into the shoulder, elbow, and forearm to generate high pitch velocity. This leads to poor mechanics and overuse of the UCL. Unfortunately, the hip and thoracic spine are rarely assessed when discussing elbow injuries. One of the guidelines for avoiding UCL injuries is to follow proper pitching mechanics, but how can pitchers adhere to these mechanics if they lack rotation in the two major joints responsible for creating rotational velocity?

Assessing Posture and Biomechanical Alignment

Posture and biomechanical alignment significantly affect performance and need to be assessed to avoid injury and allow pitchers to throw harder with less stress on their shoulders, elbows, and UCL. By taking a holistic approach that includes assessing and improving thoracic and hip mobility, we can help pitchers achieve better mechanics and reduce the risk of UCL injuries.

A New Approach for Prevention

To truly address the rise in UCL injuries, we need to expand our focus beyond traditional guidelines and incorporate a more comprehensive biomechanical assessment. This approach should include:

  1. Regular Testing: Implement regular metrics such as grip strength and shoulder strength testing to monitor pitchers' readiness.
  2. Biomechanical Assessments: Conduct thorough biomechanical assessments to identify limitations in thoracic and hip mobility.
  3. Individualized Training Programs: Develop training programs tailored to each pitcher's specific needs, focusing on improving overall biomechanical function.
  4. Holistic Approach: Emphasize the importance of posture and alignment in maintaining proper pitching mechanics.

By adopting these strategies, we can help pitchers maintain optimal mechanics, reduce stress on their UCL, and potentially decrease the number of Tommy John surgeries in the future.

Let's work together to create a new approach to preventing UCL injuries in baseball. Email for more info!

Written by Daniel Hilborn, Osteopathic Manual Practitioner, Certified Athletic Therapist

Orthopedic Rehabilitation
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