Tommy John Surgery: Myths, Stressors, Prevention

March 16, 2013 | Mo Skelton

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Tommy John surgery was once considered a pitchers' worst nightmare. The operation is the upper body  equivalent of an ACL reconstruction.

Previously considered a career-ender, the surgery gets its name from the triumphant return of National League pitcher Tommy John in the late seventies. In 1974, John and the Dodgers were en route to their first pennant in eight years—that is, until John damaged his ulnar collateral ligament. (See Tommy John Surgery and Baseball Pitchers.)

Located inside the elbow, the UCL's main service is to connect the humerus (upper arm bone) with the ulna (forearm bone). During Tommy John surgery, a surgeon replaces this ligament with a tendon, similar to what happens when repairing the ACL of the knee.

Before John, no pitcher had ever successfully returned to play after surgery. However after an eighteen-month rehab, John became famous, pitching for 14 more seasons and winning 164 games.

Many innovations to the surgical procedure have been made to streamline efficiency. However, despite improvement, there are still several misconceptions about Tommy John surgery. Here we will debunk the myths, explore the surgical details and explain how to avoid this unnecessary injury. (See also Avoid a UCL Injury and the Dreaded Tommy John Surgery.)

Tommy John Myths

  • If you have the surgery, you will automatically throw harder, so you should have the surgery before you need it
  • The injury is completely preventable
  • The procedure is 100% effective

In reality, the injury is cumulative. Many times a pitcher is throwing with a progressively worsening injury, pain and loss of function without realizing it for some time. Also, today's success rate is still only about 85%.

What Stresses the Elbow?

A: Throwing, throwing hard and throwing hard off a mound—in that order, which is why the Tommy John injury is more prevalent among pitchers than position players. During pitching, the ligament is stressed at two points in the throwing motion: maximal shoulder external rotation (or late cocking); and at ball release, when the elbow is fully straightened. Other stressors are poor mechanics and poorly-timed mechanics, when the front side opens too quickly and the elbow is stressed longer during the pitching motion.

How to Prevent the Injury

Protecting a pitcher from injury requires a multi-faceted approach and focused training. Leaving out any portion of the process can risk an injury that requires a lot of work to return from, but working to prevent injuries can make you a better pitcher before an injury occurs. (Check out Preventing Injury for Pitchers.)

Here are some prevention tips and exercises:

Improper breathing technique. This affects the shoulders by changing the shape of the rib cage and scapula, thereby inhibiting correct function of the shoulder muscles. A pitcher must work to correct breathing patterns to focus on the shoulder, the elbow and mechanics of throwing.

Restricted movement in the thoracic spine (mid back). This puts the muscles of the shoulder in a disadvantageous position and functionally weakens them. Increasing thoracic extension allows a pitcher to get more layback without forcing all the stress onto the shoulder and elbow. For enhanced mobility and extension of the thoracic spine, foam rolling is a great technique. (See Improve Flexibility With Four Foam Rolling Exercises.)

You can also try this simple way to begin any rotational exercise:

  • Bend straight down at the waist
  • Lock your hands behind your head
  • Begin rotating your upper body toward the ceiling

Shoulder Imbalances. If  the posterior capsule of the shoulder is tight, the arm bone slides forward, which can stress the elbow by changing the timing of the movements. These can be corrected by performing:

Functional strengthening for the rotator cuff. Rotator cuff function is the key to protecting the elbow during pitching. The rotator cuff's functions are to provide stability and to place the arm in the proper position to rotate. For the rotator cuff to do its job, the muscles around it need to be balanced in strength, timing and flexibility to function during the pitching motion.

Good exercises to perform include:

  • Manual resistance with PNF patterns
  • Dynamic isometric holds using a theraband, to strengthen the rotator cuff in the positions the arm is placed in during pitching
  • Sled-Pulls for lower-body strength
  • Plyometrics instead of Olympic lifts, as they stress the elbow ligaments and the shoulders
  • TRX Rip Trainer and medicine balls to improve rotational power

Maintain lower-body mobility throughout the season. Ensure bodyweight strength via Pull-Up and Push-Up variations. Build your single-leg strength to improve stability. For strength, perform Trap Bar or Sumo Deadlifts and safety squat bar Squats instead of Back Squats to reduce stress to the shoulder.

Other Tips

  • Strengthen the elbow flexors (the secondary stabilizers for the elbow) by doing heavy grip exercises
  • Ensure proper tissue quality of the forearms, shoulders and lower body
  • Manage your pitch count; move to the bullpen if necessary
  • Don't pitch through fatigue
  • Don't run long distances to stay in shape; sprint instead
  • Play something other than baseball at other times of the year
Mo Skelton
- Mo Skelton is a physical therapist at McCurtain Memorial Hospital (Idabel, Okla.) and is the founder of F.A.S.T. Sports Performance. He also serves as...
Mo Skelton
- Mo Skelton is a physical therapist at McCurtain Memorial Hospital (Idabel, Okla.) and is the founder of F.A.S.T. Sports Performance. He also serves as...

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