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.


  1. Nick, I would like to pick your brain a bit and have a few questions, hope you have the time to answer them...?
    Much of what you have written has been used by myself and other coaches but you have named some things that I will print out and bring to the pitchers and infielders I work with a lot. I group infielders (catchers also) into the same mix...more or less.
    I like the idea of cross training, as a youngster in high school one sees most of the real good athletes play more than one sport...unless one is a pitcher, playing basketball and being a Quarterback would be a good cross training exercise, would it not?
    Most of the guys I grew up with played all three sports...many went on to college in one sport or another.
    What is your take on three sports players? Are there enough differences in each sport to give time for recovery as you pointed out? I know from experience, the body is working in many different ways for each sport!

    1. Great questions Ken. Here goes...
      Cross training with multiple sports is excellent for conditioning, coordination and skill development but if one is a baseball pitcher, playing quarterback is not going to give the active rest needed from maximal throwing. In this example I would recommend any other sport, position or activity that doesn't involve maximal throwing.

      As far as 3 sports are concerned, I would recommend at least two activities be dissimilar from one another. For example, competing in soccer and basketball stress similar tissues. Try wrestling, swimming or golf.

      Hope you find this helpful.

  2. Nick...
    Basketball is a very good sport to build endurance. We use to play basketball ...three on three and full court, even during the baseball, basketball and football season. Much better than running every day. What about it?

    1. Another great question that probably would be it's own post.
      Yes, basketball is one great way to build endurance. Running multiple times per week is another. What I think you're really asking me is which is better for enhancing your performance at baseball, basketball and football.

      I'll try to give you the short answer...
      This comes down to the type of muscle fibers you want to train. Type I or slow twitch muscle fibers are responsible for endurance... long distance running. Type II or fast twitch fibers are active during more explosive activities.... plyometric training, jumping, quick change of directions.

      If you're training to improve your condition specifically for the skills necessary to excel at baseball, basketball and football then endurance train with pick up basketball games.

      If your seeking active rest and still want to work on your endurance then mix in long distance running.

      It's more complicated than that but that's the jest of it.

    2. Nick, thank you very much, I wanted and needed your input because that is the way I did things back about 65 years ago. I also talked with the kids I coached in Football and Baseball to cross train in basketball...I hated running, too boring, and not enough action.
      I have no idea about weight training as I have never done any, I should think it would be specific to the sport.
      Again, thank you very much!


Sorry for the Capatcha... Blame the Russians :)