Specialization, focus on velocity lead to surge in Tommy John surgeries
As the Pirates medical staff vetted pitching prospects for the June draft, general manager Neal Huntington was astonished by the findings.
“They were blown away by the number of significant injuries high school and college pitchers had this year compared to three years ago, five years ago. The level of injuries is growing exponentially,” Huntington said. “We are just starting to get to the front edge of this (Tommy John surgery) wave. We might not even be through the worst of this yet.”
There have been 47 Tommy John surgeries performed on professional pitchers this year as of Saturday. That's on pace to shatter the record 69 in 2012, according to baseball analyst Jon Roegele's Tommy John database. And this wave of ulnar collateral ligament reconstruction might just represent the outer bands of the storm.
The Tommy John epidemic arrives when major league clubs are taking more care than ever in managing young arms. Because of that, experts trace the epidemic's roots elsewhere, to the first generation of arms arriving to the major leagues raised in a sport-specialization culture.
Jameson Taillon and Gerrit Cole are part of that generation. They are two of the highest draft picks of the Huntington Era. As the industry looks for answers, having spent more than $1 billion on disabled pitchers over the past five years, perhaps the stories of Taillon and Cole can be instructive.
Taillon is a statistic in the Tommy John surge.
Cole still is pitching.
Taillon was roused from his sleep by searing pain in his right elbow the morning of March 20 in Bradenton, Fla. He threw four innings the previous afternoon. He had pitched with mild elbow discomfort throughout the spring. He thought there was a difference between pain and injury. This was different. Said Taillon: “My elbow was screaming at me.”
Taillon had Tommy John surgery April 9.
“I've kind of accepted it now, but early on I was trying to think what maybe could have caused it,” he said. “I've definitely put a lot of thought into it.”
Taillon was handled carefully. He threw 92 innings in his first professional season. Wrote then-Baseball Prospectus analyst Kevin Goldstein in spring 2012: “While I'm for being cautious with young arms, the Pirates went a bit overboard with Taillon.”
Moreover, Taillon said he was not overworked as an amateur. Nothing like Rochester (Wash.) High pitcher Dylan Fosnacht, who threw 194 pitches in a 14-inning game last month. Or Dylan Bundy, the No. 4 pick of the 2011 draft who, as a high school senior, threw 293 pitches in four days.
Taillon, however, played baseball year-round.
“Even if you're not pitching, you're playing games all year,” said Taillon, who grew up in The Woodlands, Texas. “If you're playing infield, you're making throws. I could definitely see how that played a factor.”
Taillon's injury, and dozens of others, might be traced to sports specialization, said baseball executives and medical professionals.
“We are getting to the first wave when travel teams and year-round (baseball) became the thing to do,” Huntington said. “(They) are pitching too much. … Specialization is the worst thing to happen to every sport.”
Former major league pitcher John Smoltz played three sports and threw only in the spring during his amateur days. He had Tommy John surgery after pitching 2,400 major league innings.
“I can tell you the damage is being done,” Smoltz said. “We are going to see in the next five years (the damage) from the overspecialization.”
Zak Doan is on the front lines.
Doan is part of the specialization boom in Southern California. A former pitcher in the Miami Marlins' system, Doan began ProBall, a private instruction facility south of Los Angeles, 10 years ago. Six years ago, he moved his operation to a larger facility to satisfy a growing client base.
“The guys who are playing multiple sports are feeling like they are being left behind,” Doan said.
Doan said specialization has its benefits: Taking more reps means building more advanced players. But Doan said there is a distinction: Hitters can swing until they blister, while orthopedic surgeons believe ulnar collateral ligament tears are most often the product of wear and tear, like a rope fraying.
“Parents come to my facility, and they'll say, ‘He's only thrown 120 innings this year. He's taken a few weeks off.' I'm thinking, ‘Holy cow,' ” Doan said. “Throwing year-round is No. 1 by a landslide as far as why there is a breakdown eventually.”
Ten years ago, one curious client came to Doan's facility. Mark Cole wanted his son to learn proper mechanics, but he also wanted him to throw less.
There is a geographical component to Tommy John surgery.
No place has produced more professional pitchers who have had the surgery than the Los Angeles area. Since 2005, 25 professional pitchers who played high school baseball in that region required Tommy John surgery. Los Angeles-bred pitchers have had more such surgeries than those from Canada, Mexico or Japan.
Southern California is an ideal environment for elbow injury. The average January high is 68 degrees. The average household income in Gerrit Cole's native Orange County is $85,000. It's a perfect storm to fuel specialization.
“I remember growing up and being in a climate that allows you to do that,” said Cole of pitching year-round. “It's a trap you can fall into, especially in Southern California where guys are trying to make money and you can get a lot of good instruction.”
In this climate, Mark Cole wondered how best to manage injury risk with his son. Mark Cole's background gave him a particularly sharp interest. He had a doctorate in pathology from California-Irvine, where he studied the cause and effect of disease and the underlying mechanisms of the disease process.
Gerrit Cole began with pitch counts in Little League. Mark wanted the limits to continue into high school. During Gerrit's freshman year, Orange Lutheran High coaches had him throw a 60-pitch bullpen the day after he started a game. Mark protested.
“High school was tough,” Mark said. “You are supposed to be at arm's length as a parent and frankly not say much. There were few times I had to step in, and I did.
“In the end you have to defend your son.”
Mark Cole took interest in Sports Illustrated writer Tom Verducci's theory that young major league pitchers subjected to substantial workload increases were at a greater risk of injury.
“For me, it was all about progressive workload,” Mark said. “You are not fully grown until 25. These young kids at 11, 12, 13, their growth plates aren't even complete.”
Mark developed a system in which he asked Gerrit about his soreness after every session, using a 1-10 scale, and tracked it. There also were two, two-month breaks from throwing.
“I just believe completely in rest,” Mark said. “I know some people can appreciate that, but I think by and large it's not really done.”
Did it work?
Gerrit never has had an elbow injury.
“I just played (regular season), while other guys were playing fall ball, winter ball, multiple travel teams,” Gerrit said. “There's a reason grown men have an offseason. Why would you not think a 12-year-old needed that?”
Demand for velocity
The ulnar collateral ligament is about 2 cm long and 1 cm wide. It never has been under more stress.
The American Sports Medicine Institute released a position paper on the Tommy John epidemic in May. ASMI research director Glenn Fleisig found there are two salient factors at play: overuse and an increase in velocity.
“If you look at the fastest throwers today, the (velocity) ceiling is not that much different than 20 years ago,” Fleisig said, “but more people are getting toward that ceiling.”
There never has been more incentive to throw harder.
From 1989-99, the average first-round bonus increased from $176,000 to $1.81 million, according to the Society of American Baseball Research.
In 1994, the nation's premier showcase circuit, Perfect Game, was created because of the cooler spring weather in Iowa. It had humble beginnings.
“Iowa is one of the few states that plays high school baseball in the summer months,” Perfect Game president Jerry Ford said. “What was happening was the talented kids from Iowa were a year behind. So we opened up a building for the real serious kids to work out, and we started a spring league.
“One thing led to another, and we started having events where there were 50 to 100 scouts.”
Perfect Game is now a nationwide circuit offering events year-round. From 2003-14, 150 alumni became first-round picks, Ford said. Perfect Game will host 48 showcases in 2014, with 12 from November through February.
Taillon threw in six Perfect Game showcases during a 13-month period as a 16- and 17-year old, touching 97 mph. “There's no doubt whenever you have scouts behind you, you are definitely throwing for them,” Taillon said.
Baltimore Orioles pitching coordinator Rick Peterson works with Fleisig on injury prevention at ASMI.
“There's a dollar figure attached to high-end velocity,” Peterson said. “You're going out there trying to win stuffed animals (at showcases), trying to throw as hard as you possibly can.”
Gerrit Cole said he was offered to participate in “1,500 showcases.” He participated in one. “You can stretch a rubber band as many times as you want to 50 percent capacity,” Cole said. “You stretch it to 100 percent, and all of the sudden it breaks.”
Ford counters by noting Perfect Game alumni have accounted for 61 Tommy John surgeries, but he said it is a lower rate compared to the industry average. Ford said the blame should be shared by all levels of the sport.
“There are times they could show up at a showcase after pitching seven innings somewhere, but if that's the case, he shouldn't be at the showcase,” Ford said. “But it's not like there is no reward involved (in throwing at showcases). Were you unlucky that you were throwing 96, 97 mph?”
Arms with no Carfax
Major league teams have little data on players prior to their junior years in high school. Because of the rash of injuries, former major league GM John Hart said he “absolutely” would rethink allocating premium picks on arms when weighing a similarly talented position player.
Peterson's side venture is 3P Sports, a service that identifies flaws in pitching deliveries and guidelines for injury prevention. Peterson said “a massive education” is needed.
“Parents must understand there is not a direct correlation between being a good big league pitcher and a really advanced amateur pitcher at 11, 12, 13 years old,” he said. “It's like buying a used car with no Carfax. The tread on these tires is already worn out. … There is no question this (injury wave) is just the beginning.”
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