The Hidden Pitch Count That's Causing Tommy John Surgeries

Hall of Fame pitcher John Smoltz and Dr. Lyle Cain explain the true cause of the increase in Tommy John surgeries among young baseball players.

The possibility of needing Tommy John surgery is a dark cloud that hangs over baseball players, especially pitchers and catchers. Some wonder when, not whether, they will have to undergo the surgery.

If you're not familiar with Tommy John surgery, read more here.


The possibility of needing Tommy John surgery is a dark cloud that hangs over baseball players, especially pitchers and catchers. Some wonder when, not whether, they will have to undergo the surgery.

If you're not familiar with Tommy John surgery, read more here.

For high school baseball players, the rate of Tommy John injuries goes up 9 percent every year despite our awareness of the injury and efforts to prevent it. Mandatory pitch count limits and rest days required by baseball's governing bodies simply aren't working.

And even the best training and arm care programs aren't doing the job for many athletes.

Why? There's a cultural problem in baseball that can't be fixed by a single strategy.

To learn more, we talked to Hall of Fame pitcher John Smoltz and Dr. E. Lyle Cain, renown orthopaedic surgeon at the Andrews Sports Medicine and Orthopaedic Center.

There's More to it Than Pitch Counts

"There's this general philosophy that only the strong survive or only elite athletes get to the next level," says Smoltz.

This mindset leads baseball players and their parents to believe that playing more is always better. You might play on several teams during the same season, have skill instruction on your off-days and throw bullpen sessions.

Although you might not throw over a certain number of pitches in a single game, there's a good chance you are throwing throughout the week.

"Everybody looks at game pitch counts, but the reality is any kind of maximum effort pitching, which includes pitching instruction, bullpen to some degree—part of the bullpen includes throwing in live batting situations—and off-season throwing practice and instruction are all part of the same process," explains Dr. Cain.

Bottom line: Young pitchers are probably throwing far more than they realize.

The more you throw, the less time you give your arm to recover. The result is increased fatigue, inflammation and stress on your arm structures—in this case, the UCL ligament—which gradually leads to an injury.

For pitchers, the issue is even worse because of the emphasis on velocity.

"When you focus just on velocity, high-velocity pitchers by nature put more stress on the joints," says Cain. "So it doesn't matter whether you do it in an effective manner or an ineffective manner, power and velocity means more stress, and the guys that are doing that are throwing more innings, more pitches and longer throughout the year. It's a recipe for disaster really."

To make matters worse, baseball is often played all year long to some extent—even in cold weather states. There are teams for almost every season, along with showcases where you are told you have to attend or run the risk of being overlooked by coaches and scouts. Or you work diligently with a throwing coach in the weeks or months you have off from baseball.

Put simply, this is a huge problem, because you don't give yourself an off-season.

"Pitches are accumulative so you never give the elbow or shoulder the ability to rest," Cain says. "Overuse doesn't mean you have to play in a competitive game 12 months out of a year. It just means that you use the same muscles and joints over and over again without a period of rest."

"We've got to start listening to these statistics. We've gotta stop this madness of year-round baseball," adds Smoltz. "It's not healthy. It's not healthy for a big leaguer, let alone for a youngster who is trying to get to that level and trying to play baseball as long as he can."

So how do we fix this problem? Cain and Smoltz have a few practical recommendations:

1. Schedule an Off-Season

"I think that specifically in baseball we feel that it's important for baseball players, especially pitchers and catchers who do a lot of overhead throwing, to have at least three or four months of rest from throwing each year," says Dr. Cain. "You have to have an off-season. You can still condition. You can still stay in shape. You can still play other sports. But to throw a baseball more than eight months out of the year is probably not good for your arm. We think that's a lot of the reason kids are developing overuse injuries at a younger and younger age."

2. Play Multiple Sports

As Cain alludes to, playing multiple sports is a great way to protect your arm by giving it a break from the repetitiveness of baseball that leads to injury.

"I grew up in Michigan. I had seasons. I played basketball when it was basketball season, football and baseball. The only thing I didn't do was put ice skates on," Smoltz says.

As an added benefit, multi-sport athletes are generally superior athletes, because playing several sports develops a more complete athletic skillset. Yes, there may come a time when you need to specialize, but it's a smart decision to play more than one sport as long as you can—even if this is counter to the culture of baseball.

Tony Gentilcore, a Boston-based strength coach who has extensive experience working with baseball players, explains the dangers of specializing in one sport too soon in this article.

3. Focus on Location and Precision

The importance placed on velocity from a young age is so dangerous that Smoltz suggests banning radar guns.

"If [baseball] was played just purely in its season and we didn't have overuse, then there would still be a problem with high velocity," Smoltz adds.

It's better to develop sound fundamentals and precise pitches than to glorify velocity, especially at a young age. As your strength develops, your velocity will gradually improve and you will ultimately pitch at a speed that your body can handle.

4. Prepare Your Arm Before Your Season

One of the worst mistakes you can make is failing to prepare your arm for your season, or even a tournament. If your muscles and structures aren't prepared, they are even more susceptible to injury.

The solution is simple: Start a throwing program before your season.

"In youth baseball, it's important that kids build their arm strength up before the season actually starts and they're in competition," says Cain. "We recommend at most ages a 4- to 6-week throwing program to get their arms in shape before they start the season."

Try this pre-season throwing program.

5. Limit Pressure on Young Baseball Players

Parents want their kids to get involved in everything available to have the greatest chance of succeeding. And they emphasize quick results instead of thinking about the long-term consequences.

Smoltz frequently experiences this situation. Parents brag about their son's ERA, and he's not even a teenager. He says, "That means absolutely nothing, and you're talking to the most competitive guy in the world. We're allowing our kids to become rockstars in some cases, and they go all the way to the Little League World Series and we're allowing our kids to experience a risk that is not worth that risk."

If a young baseball player is a stud and shows promise, he will not be at a disadvantage if he doesn't participate in every baseball-related activity. In fact, he will likely be better off when it matters, later in his career.

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