The Dangers of Tommy John Surgery According to One of Baseball’s Greats

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Last Sunday, on a Cooperstown stage adorned in stars and stripes, the newly inducted John Smoltz took a moment to speak about Tommy John surgery. He'd spent 25 minutes offering his sincerest thanks to the baseball world, calling attention to the many friends, family, and coaches who contributed to his life, even providing humorous tidbits about teammates Tom Glavine and Greg Maddux. But now, his tone changed – he became urgent, beseeching.

"Before I hand it over to next inductee, I'd be remiss if I did not talk about Tommy John," he said to the audience stretched out on picnic blankets. "I've been given an opportunity as one of the only players, the only one right now, to be inducted into the Hall of Fame with Tommy John Surgery. It's an epidemic. It's something that is affecting our game." The Atlanta Braves legend went on to discuss his firsthand observations about the surgery. Specifically, how it's now needed for pitchers at an alarmingly high rate – and at alarmingly young ages.


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"Tommy John" is now a common term in sports vernacular, an easy pairing of two first names that's burrowed itself deep in the baseball consciousness of players and fans. But tossed around so carelessly by broadcasters and sportswriters alike, even the most educated fans often forget the bare bones anatomy of the surgery.

On a Wednesday night over forty years ago, 31-year-old Thomas Edward John was pitching a game for the Los Angeles Dodgers against the Montreal Expos. The Dodgers's ace at the time, John possessed a record of 13-3, an ERA of 2.50 – and a time-bomb in his elbow. As told in ESPN's 30 for 30 documentary Tommy and Frank, John had a perennial penchant for pitching through pain. "Back then, you never told anybody, 'Oh, my arm's sore,'" John said. "You just kept pitching." 

But finally, that little pain at the tip of his elbow became too much to handle. In the second inning, the bomb went off. John fired one pitch, only to feel an explosion of pain, and then threw another, which limped in a weak arc to the dirt in front of the plate.

Sitting in the stands that day was Dr. Frank Jobe, the Dodgers physician. He witnessed John's breakdown, both as the team doctor, and as a friend. The next year of their lives, with John's stubbornness to play again and Dr. Jobe's creativity to repair the elbow, the first ever ulnar collateral ligament reconstruction surgery was performed.

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Exactly a year and a day after John went under the knife, the Dodgers pitcher was again on the field, firing strikes and pitching scoreless innings. Still, what exactly did Dr. Jobe do? What does it mean to undergo ulnar collateral ligament reconstruction?

According to David Reavy, a Chicago-based physical therapist and Men's Journal columnist who has extensive experience with professional athlete injuries, the repetition of a throwing or hitting motion is sports is extremely punishing for an elbow. "Though the elbow is a non-weight bearing structure, a lot of force is translated through it," Reavy says. "If you are not stabilizing properly in your shoulder and core, your elbow will take excessive force."

Essentially, improper mechanics, particularly relating to the shoulder, result in excessive tightness for the elbow. A merry-go-round of velocity dips, rest, and returning tightness often yields a torn ulnar collateral ligament. And when this happens, as Dr. Jobe first attempted all those years ago, a tendon is taken from elsewhere in the body and fashioned into the irritated elbow joint. In some cases, a tendon is even taken from a cadaver.

Reavy largely finds this process inexcusable. "Nowhere in the rehab and rest process will the inefficiencies in core rotational power or the misalignments in the glenohumeral joint be addressed," he says. "The body is not working efficiently as a whole, and the elbow will bear the brunt of this disconnection."

More pitchers underwent the surgery in 2014 than in the entire 1990s. Stephen Strasburg, Jose Fernandez, Yu Darvish, and Matt Harvey, to name a few. Harvey, who had the surgery last season, is now 26 and pitching well, but one could argue his best days are behind him. He has doubled the amount of home runs served up, walked batters at a higher rate, and just doesn't seem to be the same lights-out pitcher he once was.


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Sometimes struggles in the year immediately after the surgery can be chalked up to a Tommy John hangover. With time to fully recover, pitchers can be enormously successful. As in the case of John Smoltz, who was encouraged by Tommy John himself to pursue the surgery, sometimes the process just needs time.

In 2000, Smoltz underwent the surgery at the age of 34. Afterwards, he found a niche as a successful relief pitcher. But a successful recovery can sometimes can be misleading, even damaging, to those who blindly trust its efficacy and now solidified place in the game.

"They've perfected the ability to come back from it," he told Men's Journal, just ahead of his recent induction. "They've not perfected the ability to prevent it, or to prevent another one."

The idea that a pitcher, particularly a young one, has a surefire recovery from overwork is dangerous so long as it allows young pitchers to continue to overwork. The problem, Smoltz believes, lies with the culture of baseball today. It's an era where pressure to specialize is paramount.

"That's the problem – nobody just goes out and plays catch and throws. We played catch and threw a baseball; we didn't pitch like all these kids are doing at seven, eight, nine, ten, eleven, twelve. They're just, they're over the top," Smoltz says. "It's the max effort, it's the social networking, guru carnival baseball, 'look at me, I threw the baseball 90 miles an hour.'"


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During his speech Sunday, Smoltz spoke about the need to pursue passions – all passions. The logic make sense. Athletes are better served working their entire bodies. Not just one arm, and certainly not just one elbow. Many parents might balk at the thought of allowing their prized children free reign in other sports, but that just may be what it takes to stay safe from injury.

So what can be done to cull the rising tide of Tommy John-requiring maladies? An improvement in coaching is a good start. Coaches at instructional levels need to be forward-thinking in their understanding of young arms. "We've fallen in love with is the ability to max out everything," Smoltz says. "The 'stuff,' the sexiness. 'This is the ninth-rated kid' – how do you know who the ninth-, tenth-rated ten-year-old is?"

Smoltz preaches patience in a baseball world with many looking for shortcuts. Hopefully, the Hall of Famer's words, which were applauded heavily by the Cooperstown crowd, will continue to resonate across the country. Perhaps little kids on one coast won't quit soccer, and coaches on the other will set pitch limits. And after all, maybe we should just forget that the operation exists. Like balancing high up on a beam without a net, perhaps we'll toe more carefully moving forward. Especially when we're carrying our kids.

Additional reporting by Aaron Stern.

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