Latest high school rage: Tommy John surgery?

In what should not be a terribly big surprise, Tommy John Surgery (TJS), also known as Ulnar Collateral Ligament (UCL) replacement surgeryhas spiked in the last decade or so.

Thanks to Buster Olney for pointing this one out.

I'm a bit slow, I guess, but some things I find confusing:

1. Generations ago, kids played ball all the time (fewer other distractions)
2. Generations ago, pro pitchers pitched every fourth day, not every fifth like today
3. Generations ago, pitchers routinely went the distance in games, or at least approached each start as if they planned on finishing the game.
4. Generations ago, medicine, training, education about arm health were rudimentary, at best.
5. Today, fewer kids play baseball (more options)
6. Today, fewer kids play baseball all the time (again more choices)
7. Today, kids as young as 8 are on pitch counts (I know this first hand)
8. Today, pro pitchers take the hill every 5th day, at best.
9. Today, pitchers rarely go the distance, expecting to last six, maybe seven, innings before handing the ball off to a middle reliever or two, for an inning or so each, before handing the ball off to a closer.
10. Today, medical knowledges and advancements are saving arms and careers.
11. Today, we're doing more career-saving elbow surgeries than just 10 years ago despite everything we now know.

How come? How come we are seeing high school aged (and even younger) needing TJS? It can't be simply "over-use", can it? Is it poor coaching, allowing younger and younger arms to try to snap off curves and sliders?

The conventional wisdom, which I am willing to admit might be flat-out wrong, is that use built up arm strength. The Japanese are legendary with regards to this (see also: Dice-K's history). And now, the prevailing wisdom is not to pitch your way to arm strength, but to limit your arm to protect it.

Doesn't this limiting of pitches thrown become a self-fulfilling prophesy at some point? Don't kids grow up now not with the mindset of "finishing what you started" but rather "let me throw as hard as I want for a limited period then someone else can finish"? And can't that lead to injury? This is not a rant on "kids of today", rather it's the teaching of today. Maybe it's kids not doing enough variable distance throwing between starts, or as warm-ups. Throwing from 60, 90, 120 feet to get loose and stretching the arm out. Build strength in the shoulder.

A pitcher needs to learn how to pitch, mix speeds, conserve effort. Check out Greg Maddux, for example. He's never a max-effort guy and he's never hurt. Not that the guys without the radar gun arms don't get hurt; they do. But learning how to pitch takes time and effort and limiting the time and forcing the effort would seem detrimental to a pitcher's physical development, not to mention their mental development. Again, to me, a simple knucklehead, it comes down to training and preparation. Training and throwing in non-game situations are lower stress situations for an arm/body and better suited for building strength for in-game situations. The problem is, I think, that not enough time, effort and focus is spent on training for those in-game situations.

Lest I be misunderstood: I think some kids CAN be overused, particularly the most talented ones. Coaches want to win. Teams want to win. These kids with the prized arms feel the pressure to help their peers. But, I think there's a middle ground that's being avoided.

Dr. James Andrews, one of the nation's most respected orthopedic surgeons, has also seen a spike in the number ofhigh school pitchers he has performed the procedure on.
In a three-year span from 1996-99, Andrews performed Tommy John surgery on 164 pitchers, 19 of whom were high school aged or younger. From 2004-07, that number had jumped to 588 pitchers, 146 of whom were high school or youth league players — a seven-fold increase.

"Without a doubt, it's an issue," said Glenn Fleisig, the Smith and Nephew Chair of Research at the American Sports Medicine Institute, which was founded by Andrews. "The numbers are staggering in adolescents. More and more high-school-aged kids are having the surgery."

"Without a doubt, the No. 1 statistical cause (of UCL injuries) is overuse," Fleisig said. "In our studies, when a pitcher regularly threw with arm fatigue, he was 36 times more likely to be in the surgery group as opposed to the non-surgery group. That's the strongest statistical correlation in any study we've ever done."

High school coaches agree pitchers are throwing too much these days — and it starts before their high school careers. With the warm weather in Houston, the high school season is just one part of an elite pitcher's year. Such pitchers often play with select or travel teams in the summer and sometimes in the fall, leaving little time for rest.

Again, to be clear, I think there is a fine line between overuse (use in game situations) and training (use in non-game situations). I think we can do a better job, as parents and coaches, in training these kids to throw better, properly.

The final paragraph in the article sums it up quite nicely, too:

But parents and coaches at all levels also have to take responsibility.

"Dads thinking (their sons) have to win at all costs at 9, 10, 11 and 12 years old to win those championship games (at tournaments) — all that means nothing in the big picture. They are fun years, but they all mean nothing compared to (the high school) level. It's not worth risking your son's arm to win a tournament at all costs."