Extra Baggs: Alarming trend of Tommy John surgeries

Extra Baggs: Alarming trend of Tommy John surgeries
May 19, 2014, 11:00 am
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So many arms have given out this season around Major League Baseball. The list is stunning in its breadth as well as its star power.
Andrew Baggarly


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Other than Brian Wilson in 2012, the Giants haven’t lost a big league arm to Tommy John surgery this decade. (AP IMAGES)

Programming note: Giants-Rockies coverage starts Tuesday night at 5:00p.m. with Giants Pregame Live on Comcast SportsNet Bay Area (Channel Locations)

SAN FRANCISCO – You really can’t call it an epidemic.

A torn ulnar collateral ligament in the elbow does not come from a communicable disease. No amount of hand washing can prevent it. There isn’t a virus or bacteria to blame, no antibiotic that can knock it out.

The CDC can’t help you here.

Plain and simple, a torn elbow ligament is an overuse injury. And it is a reminder that the human arm wasn’t designed to hurtle a 5 ¼-ounce sphere 60 feet, 6 inches from a steep downward plane.

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No, it is not an epidemic. Just a very, very, very alarming trend. So many arms have given out this season around Major League Baseball. The list is stunning in its breadth as well as its star power.

The Marlins’ Jose Fernandez, last season’s NL Rookie of the Year, was a charismatic drawing card whose pure stuff was the filthiest since Kerry Wood. He had his UCL reconstructed on Friday. The Rangers’ Martin Perez was 4-0 with a 1.42 ERA through five starts before his elbow began to stiffen up. He’ll become the 35th pitcher this season to undergo the procedure, which requires 12 months of rehab and recovery.

Patrick Corbin, Jarrod Parker, A.J. Griffin, Brandon Beachy, Kris Medlen, Josh Johnson, Bobby Parnell, Ivan Nova, Luke Hochevar … the list goes on and on. It gets longer if you include minor leaguers, including heralded Pirates prospect Jameson Taillon.

It is inescapable: sometime soon, perhaps in a matter of days, another arm will give out. That pitcher will be the 36th this year – matching the record set in 2012, according to Stephania Bell of ESPN -- to require the surgery that Dr. Frank Jobe pioneered 40 years ago when he resuscitated Tommy John’s career.

Everyone is looking for answers. Every team is searching for a protocol they can use. Kid gloves are not protecting against right crosses to the jaw.

Maybe to understand how to prevent all these Tommy John surgeries, we should listen to … Tommy John.

[RELATED: Baseball wonders why pitchers' elbows keep tearing]

"Throwing pitches in the big leagues will not hurt your arm," John told the Watertown (N.Y.) Daily Times. “ "It's what you did down the road when you were younger ... In essence, the injury itself is a buildup of overuse. And not overuse as an adult, but overuse as a kid.

"What I would like to see these guys do, these surgeons and all, is ask all the guys who have had the surgery -- 'How much did you pitch as a kid and how often, and did you pitch year-round?' And nowadays, probably 70 to 80 percent of the pitchers today have been pitching 12 months a year since they were seven, eight or nine years old. And your arm is not made for that."

There is no one-size-fits-all explanation. Every pitcher has a different physiology, different mechanics, different genetic predispositions and different training regimens. But we are seeing the first full matriculation of the “youth travel ball” era baseball player. Add that to the specialization of the game, when every teams seems to have six guys blowing 95 mph and up from the bullpen, and it all starts to make sense.

It’s a case of too much, too fast, too hard – and too soon.

Tom Verducci of Sports Illustrated laid out the most thorough and well researched case linking UCL ligament failures and year-round youth baseball, including showcase circuits where high school pitchers are exploding off the mound to light up draft boards in the hopes of a bigger slot bonus.

[RELATED: A's Parker to undergo second Tommy John surgery of career]

I would add one more contributing factor: This is the age of data, and there is no data point for pitchers more objective than mph. A pitcher’s size, durability and athleticism used to get them drafted in the first rounds. But now teams rely less on projection and more on the here-and-now. After all, pitchers can move more briskly through the system because teams can always use a sixth-inning guy throwing 98.

This is where we come to the Giants, who have been as successful as any major league club at avoiding consultations with Dr. James Andrews and Co. Other than Brian Wilson in 2012, they haven’t lost a big league arm to Tommy John surgery this decade. (Minor leaguers Eric Surkamp and Hunter Strickland were minor leaguers who had their elbows reconstructed.)

The Giants don’t have a great secret or something special in the Gatorade jug. They limit their minor leaguers to specific pitch counts per game and per inning, they cap innings limits and they’re selective in whom they choose to send to the Arizona Fall League or ask to pitch winter ball – the same precautions that every other team is taking.

Perhaps the Giants are just lucky. Or perhaps we’re dealing with a selection bias here – specifically whom the Giants select in the amateur draft.

Their current top prospect, right-hander Kyle Crick, has an upper-90s fastball and an athletic delivery. But it wasn’t just his stuff that made him stand out as a supplemental first-round pick. He was, in scouting parlance, a “low-mileage arm.” He was a first baseman who came late to pitching. He didn’t participate in every showcase. His senior year at Sherman High in Texas, when Crick knew he would be drafted in a spot where he could receive a bonus of $1 million or more, he made a decision that was not odd except in its increasing rarity:

He decided to play varsity football his senior year. He gave his arm a break, other than using it to tackle from the linebacker position.

Crick was a high school kid first, a big-time baseball prospect second. That’s the way it should be, right?

That’s the way Tim Lincecum grew up, too.

“Quarterback, running back, corner and safety,” said Lincecum, who played youth football through his freshman year of high school. “I was a pretty good quarterback. We just ran the balls, did counter plays, stuff like that.”

He played basketball through his sophomore year of high school. And on a whim, he tried out for the golf team. He ended up playing two seasons. Going into his junior year, he started to “condense my after-school activities, you could say.” But he never stopped playing other sports.

“I loved playing sports. That’s about it, really,” he said. “Usually you’re doing what your best friends are doing, and that’s how we stayed together and hung out. And we’ve always been a competitive family. My brother played three sports, and I played three sports.”

But didn’t he know his future was on the mound?

“Well, I was hoping, anyway,” he said. “I was sub-5-foot-10. That’s not knowing. That’s praying.”

Lincecum’s size and delivery scared off scouts when he came out of Liberty High near Seattle. It took three record-setting seasons at the University of Washington to make him a first-round pick. The Giants saw a pliable body and an arm that was along for the ride in an athletic delivery.

Every major league arm has a finite number of bullets. Lincecum’s balloon didn’t pop like so many scouts predicted. But the air escapes for everyone, eventually, and his fastball isn’t close to what it once was. Still, the Giants have gotten two Cy Young Awards and two World Series titles out of him. That’s a dividend to make any club jealous.

Giants closer Sergio Romo stands eye to eye with Lincecum. Along with his size, he throws so many sliders that his elbow is a constant concern. Yet he came through his first season as a full-time closer with All-Star numbers, and he’s 15 for 16 in save chances thus far this year.

Perhaps it’s no coincidence: He did not play travel ball year-round as a kid, either.

“Baseball, football, basketball and for a short time I boxed,” said Romo, who grew up in Brawley near the Salton Sea in Imperial County. “I played football till my sophomore year. I was the third-string quarterback, linebacker and tight end. Placekick holder, too. I was kind of a chubby kid: 5-foot-8, 170 pounds as a freshman.”

His basketball skills involved “standing at the three-point line and either shoot or pass. Then I’d try to play defense. I wasn’t very good. I just liked to run around and be active. That’s what it was more about for me. Just try to stay active and have fun with my friends.”

Could the answer be as simple as that? Pitch counts and physiology aside, maybe having fun as a kid – and taking a break from baseball to play other sports -- is more powerful in the long run than any anti-inflammatory.

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