Elbow issues: Entering the majors too early

Major League Baseball may have a serious problem on its hands.

Teams that sign young pitchers to big bonuses often accelerate the process to the major leagues so they get an earlier return on their investment. That may actually be hurting the players they’ve drafted and increasing risk for an already common injury.

But let’s start with the news on elbow injuries in general.

Scanning the stats

A recent study from Henry Ford Hospital in Detroit encompassed 168 major leaguers who had undergone UCL reconstructive surgery (more commonly known as Tommy John surgery). The lead-up to the injury was indicated by a “statistically significant decline” in performance in the season before the surgery.

We’ve heard very little of this, and it’s somewhat alarming, partially because it hasn’t been noticed before. But the good news is this means it may be possible for trainers to use statistics as a red flag. When a UCL is undergoing stress that may lead to a fracture, a corresponding drop in statistics could be a good warning that prompts proper rest.

What’s not so great news, though, is that early entry to the major leagues appeared to increase risk for surgery.

That’s a huge problem, considering the money being poured into young pitchers who haven’t finished (or even attended) college but are expected to make it to major league rosters in only a few years.

The statistics in the study also seem to indicate that performance does decrease following UCL reconstruction. While 87 percent return to the same level of play (i.e. the MLB, not just minors), many are never quite the same dominant pitchers they were. Why risk a decline in performance, plus a year without a young pitcher, when gradual development and adding to the workload can make the most common pitching injury less likely in the first place?

Young UCL cases

Nationals starter Stephen Strasburg tore his UCL in his first major league season, about a month after turning 22. He took about 12 months to heal and rehabilitate. It would just be the first example in a string of young arms to turn to Tommy John surgery, though.

The Mets’ Matt Harvey, 25, is another young pitcher who had to go under the knife last year. Harvey was surprised when the surgery was recommended, since he didn’t feel the elbow pain typical of a torn UCL. He ultimately opted for the surgery for “peace of mind,” but not before plenty of thought, and an attempt at rehab. That peace of mind is one positive of a high success rate for a surgery for a common injury.

Marlins ace Jose Fernandez was not so patient in his decision. He took the mound though he wasn’t feeling 100 percent because his team was in first place. When his performance dropped significantly over the course of one inning on May 9, he was removed. The team announced he would need the surgery soon after. This surgery in particular caught the baseball world off guard because there had been so little warning. But perhaps there should have been — his old coach criticized his offseason workout, as well as the decision to turn to surgery. Fernandez made the choice promptly, and while the odds are with him returning, who knows how much he could have done if the UCL tear had been avoided.

In addition to quick entry to the major leagues, there is great reason to believe that youth baseball is largely to blame for this epidemic, as the competitiveness of the upper levels trickles down to younger and younger ages. The Atlantic outlines the youth baseball problem, which includes lengthened seasons and a focus on a single sport.

Conventional wisdom says you shouldn’t start throwing curveballs before you’re 15, with good reason — a reason we seem to have missed. It’s because pitching isn’t something young arms should do at high levels with high frequency. But the allure of making it big pushes young pitchers further. (Add this to my discussion of pitching injury rates, and it’s no wonder so many pitchers are getting injured.)

College baseball may actually be a necessary step to decrease risk of injury, if nothing else than to pace young pitchers’ increase in innings and the temptation to throw smoke.

There is certainly risk that injury during college can detract from a lucrative bonus, but the years at that level help build strength in a young arm that might otherwise do too much too fast.

At the very least, organizations should be cautious and move pitchers through the ranks slowly, emphasizing control and mastering the mental game. The shorter seasons in the low levels help pitchers work up to more innings. That way there’s no need for a Strasburg-type innings limit; it’s naturally included.

There isn’t a clear path to preventing injuries caused because of the shift in youth baseball. It may be a difficult road, but it’s one that must be discovered to help prevent undue stress, no matter how “treatable” a UCL tear may be. It would be irresponsible to allow this pervasive issue to go unchecked.

Final thoughts

There doesn’t seem to be such a problem with young position players; then again, the risks there aren’t so easy to quantify. A pitcher throws more than anything else, and the immediate stress added by multiplying innings is obvious. General fatigue and strength appear to be more forgiving for everyday players. The injuries that position players get are not so centered around one part of the body, so no matter how you figure, any potential risks won’t be easy to discover.

But that’s not the case for pitching. There is clear wisdom, anecdotal evidence and now some statistical proof that overuse early in a career can lead a pitcher directly to the surgeon’s table. It’s time to gain some patience, and make the prudent move for the health of young pitchers.

Dan Johnson is editor-in-chief of Three for Ten Sports and former managing editor of The Collegian at Grove City College.


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