Baseball and Tommy John Surgery

tommy john surgeryIt seems that Major League Baseball elbows are wearing out more frequently nowadays. And more athletes are experiencing the need for Ulnar Collateral Ligament Reconstruction (UCLR aka Tommy John) surgery. The procedure, named after the LA Dodgers pitcher who first had the surgery in 1974, while still relatively rare, is experiencing a resurgence.

According to, Tommy John surgeries have nearly doubled over the past three seasons. It’s not just the pros, either. Elbow injuries to youth league players are increasing as well. The American Sports Medicine Institutes suggested that “In many cases, injury leading to Tommy John surgery … began while they were adolescent amateurs.”


To help curb repetitive stress and other arm injuries, Little League Baseball has established pitch limits that vary depending on age. At 8 years old, a player maxes at at 50 pitches per game, for example, while ages 17 or 18 can go up to 105.

But a 2012 survey led by Dr. Joseph J. Fazalare confirmed what parents know–the guidelines aren’t followed. In the study, 73 percent of coaches reported that they followed the pitching rules, and 53 percent felt that other coaches generally followed these rules.

Prevention is all about watching body mechanics like a hawk and being obsessive about sticking to the guidelines there to protect a player’s arm.


TJ surgery treats symptoms that come from overuse. Pushing athletes, especially at a young age, is often not without a cost. It’s as if reconstructing a damaged ulnar collateral ligament is as inevitable as having to change your car’s oil. And there’s a dangerous misconception that pitchers throw harder after surgery. That’s a myth. Some teen prospects are even electing TJ surgery when they don’t really need it.

Conventional wisdom says that you should know all your options before committing to any type of surgery. There are other factors, too, such as healing time, psychological impact, and misguided expectations for post-surgery performance.

Recovery from TJ surgery

As with any surgery, TJ surgery requires time to heal properly. This is NOT a quick fix. In the first 4-6 weeks after surgery, the focus is on reducing swelling, restoring range of motion, reducing pain and beginning basic exercises. A physical therapist traditionally takes the role of “coach” here.

For the next couple of months, it’s all about returning strength, mobility, flexibility and stability to the bones and muscles. Lots of shoulder and arm exercises, building intensity and weight over time. Under the watchful eye of a physical therapist, and frequent visit to a qualified sports massage therapist, can get you through this part much more quickly.

Finally, returning focus to skill building in pitching, catching and other necessary moves for the sport of baseball. Most can return to active play after 90-120 days, but only after the physician and physical therapist releases them.