In the recent past I had a parent of a talented youth baseball player I know state, “These guys end up having Tommy John and come back throwing harder.” That sounded like nails on a chalkboard to me.
If anyone ever tells you Tommy John will make you throw harder, turn the other way and run. No, the surgery will not make your kid throw harder.
What is elbow Ulnar Collateral Ligament reconstruction aka “Tommy John”?
UCL reconstruction is an orthopedic operation of the elbow joint where a doctor harvests a tendon from the patients own body (autograft) or from a donor (allograft) and reconstructs the ligament (UCL) that gives the inner (medial) side of the elbow it’s stability. Note that doctors use a tendon to replace a ligament.
An overview of how UCL reconstruction is done.
A 4”-5” incision is made on the inside of the elbow to expose the ligament and the bones it attaches to. The UCL is attached to the ulna bone and the humerus bone of the elbow. Small holes are drilled through each bone. Then the doctor will take the grafted tendon and weave it through the drilled holes, replacing the ligament that was torn or stretched. Anchors are used to hold the new graft in place. The bone then grows back, closing the two drilled holes, and now the throwing athlete has a “new ligament” in place.
An autograft (tendon harvested from the patient’s own body) is typically taken from one of the patient’s forearms (palmaris longus tendon) or the patient’s hamstring (gracilis tendon).
Other details of the surgery.
Different doctors use different techniques when putting the grafted tendon in place and anchoring it to the bones. Some doctors remove the old ligament from the patient’s elbow and some doctors leave the remains of the natural ligament in place. Another part of the surgery is whether to transpose (reposition) the ulnar nerve aka “the funny bone”. If you have ever hit the inside of your elbow against something hard and felt shock and tingle run down your forearm into your fingers, that’s the ulnar nerve! Some doctors reposition the nerve during the surgery and some leave it in it’s place. The technique behind repositioning the nerve exists because there’s not a lot of room in the joint space—there have been many post-operation patients that feel tingling in their forearm, pinky and ring fingers due to the swelling caused from the surgery. Moving the nerve is a way to mitigate this nerve compression from happening.
Notice that some doctors are doing certain things while other are not. There has been a plethora of research done on these techniques to see which way is best but research hasn’t been conclusive in showing one way being better than the other.
The typical pitcher is not game ready until 11-13 months post-op, and it typically takes up to 18 months to feel completely normal.
Does Tommy John make a player throw harder?
This is a myth. No. The surgery will not make a player throw harder. A quick read of one of the many articles with input from world renowned orthopedic Dr. James Andrews will tell you just how disturbed he is by the amount of youth patients he’s operating on. Here is an excellent read from the best in the business, Dr. Andrews.
The reason this myth started is there have been players that come back throwing harder after having the surgery. This is due to two reasons:
- The player had a slow deterioration of the ligament and slowly lost velocity and control over time before having symptoms of pain or instability. Post surgery, the player gets a strong, robust, stable ligament and is then able to throw to his full capability.
- If you have never been through TJ surgery and the 12-16 month rehab process that goes along with it then you just don’t understand what kind of a mountain this is to climb. A proper TJ rehab program will consist of intense strength and conditioning from head to toe. This includes intense core work, hip mobility, weight training for the lower and upper body, and tons of shoulder exercises and stability measures. The intense rehab process is the other reason some players come back throwing harder—they’re in the best physical shape they have ever been in after completing the rehab process.
What is the success rate of Tommy John?
Surgery should be a last resort. There are never any guarantees when going under the knife. Several credible medical studies of pro baseball players have put the success rate at around 80%. Success in this instance is defined as the pitchers making it back to the level they were at before surgery, and making significant contributions upon returning. A quick look at this March 2015 article in Baseball America shows all major league pitchers that had TJ surgery in 2012 (27 pitchers). When this article was written in March of 2015, only five of the 27 major league pitchers that had TJ in 2012 returned to throw more than 100 innings. 11 of the 27 big leaguers had thrown zero innings at the major league level when this article was written in 2015.
Big leaguers like Jonny Venters, Joel Hanrahan, Kris Medlen, Brandon Beachy, Peter Moylan, and Joey Devine have all needed additional TJ surgeries, with Venters, Hanrahan, and Devine unable to return to a big league mound at all.
Final Thoughts
As a former major league pitcher that has had three elbow surgeries, including Tommy John, I wouldn’t wish the surgery upon anyone. The comeback is a battle, both mentally and physically. You can lessen your kid’s chances of ever having to go under the knife by getting him on a structured and proper throwing program, and by monitoring the amount of throws he makes. Baseball pitchers —especially youth baseball players— need three to four months without any throwing, every year. Play another sport. However, during the season it can be highly beneficial to throw every day (with a correctly structured program and proper mechanics). After the age of eight, it’s smart to explore and start scapula and rotator cuff exercises for your youngster—nothing too intense. Be smart now and set your kid up for healthy success in the future.
The best thing you can do is find a mentor that can provide insight and guidance on a proper throwing program. Make sure your kid has structure, a plan and someone with credible experience monitoring his throwing program.
If your kid is throwing only twice per week with no structure in place, he will struggle to develop arm strength and stability.
Does your kid play baseball in Orlando, Tampa, Miami, West Palm or Fort Myers? We have an excellent network of pro baseball players, from first round draft picks to big leaguers, that will help your kid excel on the baseball field by implementing a throwing program that will set your kid up for success.
Pro4mer makes it easy to find, book and train with pro baseball players in your community—book online, and train in-person with a local pro athlete.
To smart, healthy baseball,
James Parr
Founder of Pro4mer, former MLB pitcher
