Dear Toran

Tommy John Surgery, known in medical practice as ulnar collateral ligament (UCL) reconstruction, is a surgical graft procedure in which the ulnar collateral ligament in the medial elbow is replaced with a tendon (gracillis or palmaris longus) The procedure is common among collegiate and professional athletes in several sports, most notably baseball.

The procedure was first performed in 1974 by orthopedic surgeon Dr. Frank Jobe, then a Los Angeles Dodgers team physician who served as a special advisor to the team until his death in 2014. It is named after former major league pitcher Tommy John, the first baseball player to undergo the surgery, whose 288 career victories ranks seventh all time among left-handed pitchers.

Recommendations for professional pitchers and teams for reducing risk of Tommy John Injury (Andrews and Wilk)

After witnessing an increasing number of throwers seeking Tommy John surgery at progressively younger ages, Andrews and Wilk are trying to stem the tide of these devastating injuries at the youth level by teaming up to develop an iOS application designed to educate players, parents and coaches on how to prevent throwing injuries.

The app also includes a preseason preparation guide and pregame warm-up routine, including video instruction of various throwing exercises from Wilk. In addition to recommending specific exercises, Wilk offers tips to avoid common mistakes.

Based on the player's age, Throw Like a Pro creates specific guidelines with regards to numbers of pitches. The rest calculator outlines appropriate rest prior to resuming pitching.

Wilk said the goal of the app is to reduce shoulder and elbow injuries in youth baseball players while simultaneously improving performance.

"Hopefully this will help them to play at peak performance without injury," Wilk said, "so they can pursue their baseball aspirations in a healthy manner."

Andrews envisions the app as a means of broadly educating players along with their families and coaches to help prevent overuse injuries in young throwers.

"I'm really excited," Andrews said. "For the first time, kids and parents everywhere will have access to the information and routines that we hope will put an end to this epidemic."

This type of surgery is rarely performed in Brazil because this sport is little practiced, but the prevention of any traumatic injury will always be superior to any results of surgical treatment

Hey thanks @Nelson Elias,

Perhaps I should have been more clear with my question. I was wondering what this community thought about the recommendations posted by ASMI on prevention strategies specifically (as follows).

"RECOMMENDATIONS FOR PROFESSIONAL PITCHERS AND TEAMS FOR REDUCING RISK OF TOMMY JOHN INJURY

Optimize pitching mechanics to ensure using the whole body in a coordinated sequence (kinetic chain). A biomechanical analysis is recommended, as it provides objective data to the pitching coach, strength coach, and pitcher. A biomechanical analysis can also serve as a baseline for re-evaluation later in the pitcher’s career, after performance improvement or after return from injury.

Do not always pitch with 100% effort. The best professional pitchers pitch with a range of ball velocity, good ball movement, good control, and consistent mechanics among their pitches. The professional pitcher’s objectives are to prevent baserunners and runs, not to light up the radar gun.

Open communication between a pitcher and the professional coaching and medical staff is paramount. The pitcher’s elbow and body are living tissue. Pitching and training create small tears in the tissue; rest, nutrition, and hydration repair the tears. A pitcher and his team should have a plan, but that plan needs to be monitored and sometimes adjusted depending on how the pitcher feels. Specifically, the pitcher should keep his trainer or coach up to date about any soreness, stiffness, and pain. That way when there is an issue, the player and team can consider rest, modified activity, or examination from the team physician to allow the elbow to heal and avert serious injury.

The pitching coach needs to watch for signs of fatigue on the mound. This could be seen in-game as well as in bullpen sessions.

The team trainers, coaches, medical staff, and front office must share knowledge in a holistic approach to minimize the risk of injury.

Flat-ground throwing drills and bullpen sessions should not always be at maximum effort. Reduced effort will allow for physical fitness and technique without adding undue stress to the UCL.

Be wary of pitching in winter league baseball. The UCL and body need time to recover and build strength, so the concept of annual periodization should include adequate rest from full-effort pitching.

Exercise, rest, and nutrition are vital for a pitcher’s health. Performance-Enhancing Drugs (PEDs) may enable the athlete to achieve disproportionately strong muscles that overwhelm the UCL and lead to injury.

Pitchers with high ball velocity are at increased risk of injury. The higher the ball velocity, the more important to follow the guidelines above."

Dear Toran

Thank you

Regards

Age and pitch selection absolutely count, as well.  Pitchers should avoid breaking pitches until high school at the earliest, as far as I'm concerned.

Teaching a proper change up is the best thing- a good change up lessens the necessity for using other off-speed pitches.

Clinically, I believe strongly in measuring a pitcher's internal shoulder rotation, total arc of motion (IR+ER), as well as the carrying angle of the throwing elbow.  Therapeutic exercise can be prescribed accordingly to more effectively prevent injuries.

Another factor which gets strongly overlooked- pitchers should be training their lower body and core for endurance in addition to power.  Stronger legs lessen the need to overthrow from the arm.