Tuesday, January 26, 2016

TOMMY JOHN SURGERY: Facts, Myths, Risk Factors and Prevention

During my 18 yrs as a Physical Therapist no topic has induced more discussions with my clients than Tommy John surgery (AKA ulnar collateral ligament reconstruction or UCL). Questions range from "What is it?", "Should I still draft Matt Harvey to my fantasy baseball team?", to "How can I prevent my Little Leaguer from hurting his elbow?". Here is my attempt to satisfy all.


This triangular ligament connects the humerus (upper arm bone) to the ulna (inside forearm bone) and provides stability to the elbow. Throwing athletes who sprain their UCL may experience sharp pain along the inside of their elbow or hear a "pop," after throwing. Sprains are defined as an overstretching or tearing of ligamentous tissue and are graded on a scale of I to III. Grade I sprains being the most mild, usually respond well to (RICE) rest, ice compression and elevation along with skilled physical therapy. A grade III sprain is complete tearing of the ligament resulting in elbow joint instability and usually requires "Tommy John surgery."

Tommy John surgery involves using a graft from either another tendon in the body such as Palmaris Longus (an unused forearm muscle) or a portion of hamstring to reconstruct the UCL. Sometimes tissue is harvested from a cadaver.


Myth: Pitchers who have had TJ surgery throw harder than they did prior to surgery.
Fact: Pitchers actually lose 2-3 mph from their fastball following surgery. They may gain velocity as a result of vigorous rehabilitation with emphasis on core strength, motion analysis, improved mechanics and a regimented throwing program.

Myth: TJ surgery is no big deal.
Fact: Typical recovery for a throwing athlete is 18 months for return to sport and almost 2 yrs before their performance level catches up. Only 75% of pitchers are able to return to the Major Leagues at all following TJ surgery.

Myth: UCL sprains occur primarily in professional throwing athletes.
Fact: UCL sprains have reached epidemic proportions in children as young as 6 over the past 15 yrs. The best way to combat this problem is to prevent it from occurring. This starts at an early age.


#1 Risk factor for UCL sprain is competitive year round baseball. I call this Tiger Woods Syndrome. Once a parent discovers their child has a gift in a particular area they isolate training to this one activity.

#2 Throwing with fatigue. Kids are throwing too many pitches and are not allowing themselves enough recovery time between bouts of hard throwing.

#3 Showcases. These are events where the child is required to throw as hard as they can for a short duration. Frequently the athlete is given insufficient time to warm-up and they overthrow to impress their audience or a radar gun.

#4 Participating in 2 leagues at once. Doing so may not leave the elbow enough recovery time resulting in repetitive micro-trauma and injury.


Active Rest: Participate in multiple sports to cross train. If your child is playing a throwing sport one season, have them compete in a lower body sport such as soccer, basketball or track the next.

Attempt 2-4 months off from competitive throwing after each baseball season. This does not mean they shouldn't play catch in the yard from time to time; just don't repetitively max out.

Pitch count: Coaches and parents should not allow their little leaguer to throw more than 80-85 pitches per game. They should monitor the child's pitch count and watch for signs of fatigue such as getting wild or a drop in velocity.

Young athletes should participate in activities that promote core strength, lower body conditioning, functional strength training vs. isolating particular muscle groups and encourage them to use sound throwing mechanics.

If you like this content please let us know in the comment section below. Also, please leave suggestions for future topics you would like us to break down.

The Boring Winter Ahead: Watch the 2003 World Series Game Three HERE

Game Three of the 2003 World Series between the New York Yankees and the Florida Marlins.

Yoenis Cespedes Didn't Take Less Money to Stay in New York

The New York Mets made their fans the happiest fans on the Earth this weekend when they signed 2015 rental Yoenis Cespedes on a three-year deal. The deal is a bit complicated, it contains a no-trade clause and an opt-out clause after the 2016 season. If Cespedes does not opt-out of his deal he will make $25 million annually for a total of $75 million while if he opts out the Mets give him an extra $2.5 million along with his walking papers. Either way the Mets organization did what they had to do to get Cespedes back in a Mets uniform for at least the 2016 season and either way the Mets feel like they got one of those hometown discount things that the team hasn't seen since David Wright's big contract. I hate to break it to you Mets fans and I hate to burst your bubble and all but Cespedes did not take less money to play for you.

Cespedes absolutely did not take less money to play for the Mets. Sure the Nationals reportedly offered the outfielder five years and $100 million and yes I realize $75 million for three seasons is less than $100 million, even if it is for five seasons but I also can use my mind and the common sense that my maker gave me. Cespedes is likely going to opt out of this deal, I'd put it at about 80% that he does, so he can take advantage of a very weak free agent market in 2017. Cespedes may be the top outfielder next year in a season where the Yankees lose Carlos Beltran and many teams that need an outfielder will have less options than they had this season. Cespedes basically took the one year pillow contract that I hoped Justin Upton took with the Yankees to take another run at things next season. If he has a down season or a serious injury he is still guaranteed $25 million per season for both 2017 and 2018. Not bad either way.

And also, this is worth mentioning in my opinion, if Cespedes gave the Mets this big discount and if he's so loyal to his fans and the team then why did his agent call the Yankees asking them to match the deal so he could sign with them? His loyalty went as far as his financial security went and if the Yankees gave him that he'd be wearing pinstripes today being introduced at Yankee Stadium, not Citi Field and not a Mets uniform. That's not loyalty, that's mercenary.

Could the Game Truly Go International?

Could Major League Baseball truly go international and have a team outside of the United States? This may be harder to answer than I make it out to be but truly I believe the game could with a little creativity and lots of security. Already Major League Baseball has a team in Canada and with the growing love for the game in South American countries such as Cuba, Venezuela and Mexico to name a few a team could end up there in the near future in my opinion.

Revenue in MLB rose to just under $9 billion during the 2014 season without tapping many potential markets outside of the United States and around the globe and it continued to soar sky high is 2015 as well. The move outside the United States would have to start slow and start small with a team right over the border in Mexico, Monterrey maybe or even Mexico City, and security would be a nightmare to begin with but if MLB could make this work then the sky is the limit for the league. With the popularity of baseball in countries like Japan, Korea, Cuba, Australia, Columbia, the Dominican Republic, Venezuela and even smaller countries like Curacao the game could explode internationally and truly set itself apart from the rest of the sports world.

It’s a dream now as we stand here in 2016 but this, in my opinion, is and should be the long term goal and vision for the game. Call me progressive and call me a dreamer but its coming ladies and gentleman so prepare yourselves for it.

2016 Yankees Statistical Predictions: The Lineup

Yesterday we discussed my predictions for the starting rotation as far as stats go and today I want to focus on the starting lineup. You and I both know that the offense can carry a pitcher and pick up a pitcher in tough times, ask Nathan Eovaldi, and the Yankees offense did just that in 2015 on their way to the second highest run scoring total in the Major Leagues. That’s the good news, the bad news is the Yankees offense is another year older, another year farther away from their primes and another year closer to retirement in some cases. Can this offense carry the team much like they did in 2015 or will Mother Nature and Father Time have the last laugh in the Bronx?

Jacoby Ellsbury is the guy that gets the Yankees lineup going day in and day out. When he struggles or when he’s injured it travels downhill and has a snowball effect through the Yankees lineup. If New York wants to have a productive season offensively in 2016 I believe it lives and dies with Ellsbury. Ellsbury is a sensitive guy I think, that’s what I gather from his interviews and his introductory press conference and such, and he can be his own worst enemy at times. In order to counteract that he needs to have a great start to the season in order to have a productive one and I truly think he will.

Jacoby Ellsbury
130 games, .280 average, 15 home runs, 76 RBI

Starlin Castro, what do you expect out of the newest Yankees second baseman? Is it the Castro that struggled during the first half of the 2015 season with the Cubs as a shortstop or is the second base version of Castro that took off hitting over .330 during the second half of the season? Honestly it’s probably somewhere right in the middle of the two, and that’s perfectly fine.

Starlin Castro
155 games, .265 average, 15 home runs, 76 RBI

What in the world can Alex Rodriguez do to follow up his amazing comeback story from 2015? Well he can’t get any younger, he turns 41-years old this season, and he doesn’t have the benefit (or curse) of having almost two full seasons off of rest and rehabilitation to push him through the dog days of the long MLB season. For these reasons alone I can see him taking a bit of a step back in 2016 but who could blame him or expect anything less from the Yankees slugger?

Alex Rodriguez
140 games, .245 average, 26 home runs, 82 RBI

Mark Teixeira cut gluten out of his diet before the 2015 season and either had a positive effect from it or was finally fully healed from his wrist injury from a couple years back. Either way Teixeira had one of his more productive seasons in 2015 and will need another productive season in 2016 if he wants a favorable free agent contract after the 2016 season.

Mark Teixeira
140 games, .253 average, 31 home runs, 114 RBI

Brian McCann has been overused in my opinion during his two year tenure in the Bronx. The Yankees have had suitable backups for McCann in John Ryan Murphy and Francisco Cervelli but have opted to get him and his big bat into as many games as his body would allow. Having Gary Sanchez on the team should help that going forward and allow the Yankees to keep him rested and fresh.

Brian McCann
125 games, .229 average, 25 home runs, 90 RBI

Not too many people know this but Carlos Beltran actually led the Yankees in batting average in 2015 despite what many thought to be another down season for the aging right fielder. With Gary Sanchez taking up at bats at DH to keep Alex Rodriguez fresh and Aaron Hicks needing regular at bats off the bench I can see Beltran sitting or playing DH a lot in 2016, this should help keep him fresh and healthy for the majority of the season. Beltran is not the Beltran we saw in Houston with the Astros or in Queens with the New York Mets but he can be solid before riding off on his white horse into the sunset that we have been known to call retirement.

Carlos Beltran
130 games, .260 average, 17 home runs, 72 RBI

Chase Headley reminds me a lot of Jacoby Ellsbury in the way that he can get inside his own head and become his own worst enemy. I believe his 30 home run hitting power years are long behind him but I do not believe that his days of being a quality defender at third base are. An offseason can do wonders for a guy that is struggling to make a consistent throw to first base and that pressure put on himself can affect him in the batter’s box in my opinion. Headley will enjoy a slight bounce-back in both departments next season in my opinion and become a solid player for the remainder of his Yankees tenure.

Chase Headley
150 games, .266 average, 13 home runs, 67 RBI

Brett Gardner, talk about a roller coaster of a calendar year. Last year Gardner went from being an All Star for the first time in his career to being labeled an injury prone player who cannot play in the second half. The latter led the Yankees to make him trade bait this winter with no takers willing to take on his salary or pay the price put forward by Yankees GM Brian Cashman. Gardner has gone from everyone wanting him to, use the term very loosely, no one wanting him via trade in less than six months. Does he let that get him down and does he beat himself up about it or does he use it as motivation to get better in 2016? Once again I’m going with the latter.

Brett Gardner
143 games, .275 average, 18 home runs, 70 RBI

Didi Gregorius quietly had one of the better seasons for the Yankees in 2015. Didi probably should have won the Gold Glove Award for American League shortstops in 2015 and is likely the player we saw offensively from June until the end of the season rather than the player we saw with the Derek Jeter themed monkey on his back the first two months of the season. I am a bit higher on Didi Gregorius than others, and I admit that 100%, but I have a sneaking suspicion my predictions won’t be that far off when the dust settles on 2016.

Didi Gregorius

154 games, .293 average, 10 home runs, 61 RBI

Fantasy Baseball: Who are the Los Angeles Angels of Anaheim?

The Los Angeles Angels of Anaheim are one of those confusing teams right now that you’re not quite sure if they are all-in in terms of making the postseason and winning a World Series or if the team is just wasting away Mike Trout’s best years and prime with mediocre ball clubs weighed down by large contracts. This LA of A team is paying Josh Hamilton to essentially play for their AL West rivals in the Texas Rangers and it’s keeping the team out of the deep end of the free agency water and away from potential bats like Yoenis Cespedes. Either the team is confident in what they have, they truly are more worried about going over the luxury tax than putting the best team out there on the field for 162 games or they believe in the young guys on the team that you are unlikely to have heard much of. Well until today when I explain how those same guys can help you win the later rounds of your fantasy baseball draft and win you your league. You’re welcome. 

If Trout is there first overall you should probably take him and he shouldn’t go any farther than 2nd, this much you should know, but the names of Andrelton Simmons, Kole Calhoun and Garrett Richards you may not. Rather than tell you that Albert Pujols is still one of the better first baseman in the league and to stay away from most, if not all, of the Angels pitching staff I would rather focus on the players that are going to win your draft. 

We’ll start with Simmons and your first warning of the day. Simmons is a glove-first type shortstop that will give you very little in terms of offensive prowess. He’ll likely hit low in the lineup and not get many chances to drive in runs or make a huge impact offensively. He’s there for defense and defense doesn’t win your league. If you just desperately need a shortstop then he will work in a pickle but I wouldn’t reach too high for him personally. 

Speaking of defensive only shortstops while the fantasy owners won’t appreciate Simmons much his pitching staff will, especially the staff ace Garrett Richards. Richards is a ground ball inducing pitcher that strikes out enough batters to survive. Richards K numbers should improve as he matures and grows into his body and he should only be helped by a potent offense behind him and a much improved middle infield defense. He may be worth taking in the middle rounds when most of your top notch aces are already off the boards. 

Kole Calhoun is an outfielder that a lot of people don’t talk about when they should. Calhoun is obviously overshadowed by Mike Trout in the Angels outfield and the fact that he plays on the west coast doesn’t help him much in terms of media but Calhoun quietly had a nice 2015 campaign. Last season Calhoun hit 26 home runs and knocked in 83 RBI at the top of the Angels order. Calhoun doesn’t steal bags and he may be destined for a platoon role sooner rather than later but if you need runs scored, RBI and home run then he may be a steal in the later rounds. 

Quick Hit: Gift Ideas for David Ortiz’s Farewell Tour

David Ortiz of the Boston Red Sox is retiring after the 2016 season and despite the “rivalry” that goes on between Boston and the New York Yankees the organization is planning on honoring Ortiz later this season. Now Ortiz has asked to not be honored and has said that he doesn’t want a farewell tour, although if you don’t want a farewell tour you don’t announce your retirement a year in advance but I digress, but apparently that has fallen on deaf ears in the Bronx. The Red Sox have showed much class and respect to former Yankees being honored along the way including Mariano Rivera and Derek Jeter so it’s only right that New York does the same for Ortiz. Hal Steinbrenner says he has no idea what the team is planning to do for Ortiz later on this season so me, being the helpful guy that I am, I have a few ideas for gifts for the old man.

First idea I had was a framed copy of the drug test he failed since so many people have conveniently forgotten about it or have chosen to ignore it. Maybe a framed copy of the Mitchell Report as well but only as a gag gift since he failed a test but wasn’t on the report that was conducted by a Boston senator.

Second idea I had was a substantial gift card to GNC. Remember his post in Derek Jeter’s Players Tribune where he wrote that he probably failed the test because of a substance “he got at GNC in the damn mall somewhere,” he’s got to be missing whatever that substance was. He has kids now and he is going to need all the energy he can get as he enters his 40’s and 50’s.

Third idea I had was a serious one, a substantial donation to an organization that helps young people and young players learn the game of baseball. Ortiz is well known for working with young people and young players not only on their life goals but their baseball goals as well. This is a fun post that is poking some fun at Ortiz but not enough is said about what he does off the field.

Enough of that praising Ortiz stuff though as we bring you the final idea for his farewell tour gift. You ever see those meme’s on Facebook and such that has the children dancing in the village saying that whichever team loses the Super Bowl, World Series or the 2004 ALCS that their championship shirts are shipped overseas and they should be there Monday? We’re going to give him the New York Yankees 2004 ALCS Champions shirt!

Full disclaimer. This is meant to be fun and it pokes at Oritz only in the name of the rivalry and in good-natured fun. I have a ton of respect for Ortiz and the Red Sox organization. Let’s leave it, and the hate, at that. 

This Day In New York Yankees History 1/26: Welcome Back Andy

On this day in 2009 the New York Yankees signed Andy Pettitte to a $5.5 million one year contract. The then 36 year old signed for half of the Yankees original $10 million offer but could earn the additional $4.5 million based on innings pitched incentives as well as an additional $2 million for staying healthy and on the active roster.