Tommy John surgery prevalent among high school pitchers

[Guest Toby For OC]

Tommy John surgery prevalent among high school pitchers

Nathan Eovaldi knew something was wrong. For all the pitches he had thrown in his young life, his arm never felt like it did after this one on March 13, 2007.

"I threw a slider, and something didn't feel right," said the Alvin High School senior righthander. "It wasn't a horrible pain, but when I threw it, I felt a tingling in my arm, and I could just tell something was wrong."

Two months later, the Texas A&M signee underwent surgery to reconstruct the ulnar collateral ligament in his right elbow, otherwise known as Tommy John surgery.

It may sound drastic, but what was once a last-ditch procedure to save a professional player's arm is now becoming more commonplace at all levels — including high school.

Eleven months after the procedure, Eovaldi is back on the mound competing with his Yellow Jackets teammates. He is both a picture of a successful recovery and a sign of how the procedure has been mastered.

But he is also a symbol of a larger concern.

While rates on UCL surgery are not tracked nationally, some of the area's and country's top surgeons said they've seen a significant increase in the number of high-school-aged players having the procedure.

"I would say over the last five to seven years, (the rate) has doubled," said David Lintner, an orthopedic sports medicine specialist who is Eovaldi's doctor and also serves as the Astros' team medical director. "And it goes up steadily every year."

Dr. James Andrews, one of the nation's most respected orthopedic surgeons, has also seen a spike in the number of

high school pitchers he has performed the procedure on.

In a three-year span from 1996-99, Andrews performed Tommy John surgery on 164 pitchers, 19 of whom were high school aged or younger. From 2004-07, that number had jumped to 588 pitchers, 146 of whom were high school or youth league players — a seven-fold increase.

"Without a doubt, it's an issue," said Glenn Fleisig, the Smith and Nephew Chair of Research at the American Sports Medicine Institute, which was founded by Andrews. "The numbers are staggering in adolescents. More and more high-school-aged kids are having the surgery."

The big question: Why is a procedure once used mostly on college and professional players becoming more prevalent in kids who can't legally vote?

There are many factors, including how much a pitcher throws, what type of pitches he throws and whether he has good mechanics. But one factor stands out as the main culprit.

"Without a doubt, the No. 1 statistical cause (of UCL injuries) is overuse," Fleisig said. "In our studies, when a pitcher regularly threw with arm fatigue, he was 36 times more likely to be in the surgery group as opposed to the non-surgery group. That's the strongest statistical correlation in any study we've ever done."

High school coaches agree pitchers are throwing too much these days — and it starts before their high school careers. With the warm weather in Houston, the high school season is just one part of an elite pitcher's year. Such pitchers often play with select or travel teams in the summer and sometimes in the fall, leaving little time for rest.

'Crazy' year-round play

"(Year-round play) has gone off the charts," Alvin coach Mike Rogers said. "Years ago, it used to be that you played Little League, and then you went to basketball and football. Now you have 8- and 9-year-olds playing winter league and summer league. It's crazy."

Fleisig said year-round play is one reason high school pitchers may eventually require the surgery.

"Kids get more specialized, playing all year round, but that's what got them here," Fleisig said. "With so many pitches thrown, their total pitch count is now what a 25-year-old man used to have."

Eovaldi said he began pitching at a young age.

"I started pitching when I was 8 or 9," he said. "It was just fastballs, though. I've been a pitcher ever since then, for about nine or 10 years."

He said he rarely experienced pain — aside from customary postgame soreness — until that March game against Brazoswood. Once the UCL tears were discovered and the decision to have the surgery was made, Eovaldi wasn't nervous. In fact, he was somewhat excited about the procedure, which was performed by Lintner.

"I was ready to get it, recover and get back into it," Eovaldi said. "I read up on it. Doctors have really mastered the surgery. All the pros recover. It's just about being patient for that full recovery before you get back out there."

Timeline for a full recovery is normally about 12 months or longer, though pitchers can often throw again before then. Eovaldi, for instance, has been competing with the Yellow Jackets for much of this season, but he has been on a strict pitch count and hasn't fully regained his original velocity.

Lighting up the gun

"Before surgery, the highest I hit on the radar gun was 96 (mph), and I was consistent with 90-94 (on my fastball)," he said. "Now, the highest I've hit is 94, and I've been pretty consistent from 88-92."

Eovaldi is one of a handful of players in the area to have recently had Tommy John surgery. Mo Wiley, a senior at Mayde Creek, underwent the procedure in late March. The 18-year-old righthander, who is a University of Houston signee, had the procedure in hopes he could return in time to play as a freshman with the Cougars in the spring of 2009. His procedure was also done by Lintner.

"Luckily, most of the players understand that it can take a year to get back to pitching," Lintner said. "But every teenager thinks they'll heal quicker than everyone else ever did."

While the number of surgeries has increased over the years, so has the rate of full recovery. It's a much more reliable procedure now, and Fleisig said a recent study he conducted shows athletes who have UCL reconstruction come back to the same or a higher level 80-85 percent of the time.

"Yes, more kids are getting hurt, but now that we have a reliable surgery, people will have it because the recovery rates are good," Lintner said. "Ten years ago, it was almost a coin flip whether a pitcher would get back. It was just a salvage operation out of desperation. Now we expect upward of 85 percent getting back to being able to pitch."

Still, athletes can take preventative measures to help them avoid the injury. It starts with monitoring how much they throw — weekly and annually.

"The older they are, the more they can throw," Lintner said. "A teenage pitcher should not be going over 100 pitches once a week, generally speaking."

Rest is another important preventative measure. Most doctors agree pitchers should take a minimum of two to three months off from throwing.

Back off on the curves

Also, doctors recommend pitchers not throw breaking pitches (curveballs or sliders) until they are ready — normally after they've reached puberty.

But parents and coaches at all levels also have to take responsibility.

"Dads thinking (their sons) have to win at all costs at 9, 10, 11 and 12 years old to win those championship games (at tournaments) — all that means nothing in the big picture," said Mark Wiley, Mo Wiley's father. "They are fun years, but they all mean nothing compared to (the high school) level. It's not worth risking your son's arm to win a tournament at all costs."

[TradinUp BH]

I hope alot of youth coaches/parents read this post and understand the importance of pitch counts. I've heard alot of gripping about the little league pitch count, but I think it's a good thing.  Keep your kids arm strong and come high school ball they'll be ready to throw more pitches. Over throw them while they're young and your son probably won't last until high school pitching.

[elhector1]

Don't you know though, that there is going to be someone on here that is going to try to justify a pitcher's overuse as "leaving it all on the field", and "the kid knows if he's feeling bad".  To me, leaving it all on the field is a whole team effort, a team working hard, making next to impossible catches, stretching that extra inch, giving that extra effort...it does not mean relying on one guy so much that you take the chance of physically damaging him because he carries the whole team.

I was a local Little League official, and a Junior League coach.  I realized early on that relying on one good pitcher was not enough, and damaging to the kids, both the pitcher physically, and the others that wanted to give it a shot mentally.  As an official, I saw so many coaches try to figure out days off to get their hoss to pitch again as soon as possible.  Little League recently went to the maximum pitch count method versus the innings pitched method.  That is an improvement.  As a coach, I tried to find kids who would pitch and play other posistions, that way, I wasn't putting only one kid on the mound constantly.  A good cach develops kids, doesn't just rely on the raw talent of one to bring him glory.   

[2throwrundown]

Ban the curveball and other breaking balls until the kids reach 13-14.  Let their bodies develop enough to stand up the the strain of throwing such pitches.  If you want an off-speed pitch a simple palm ball change up at the younger levels is just as effective if not more effective.  That and proper rest can help with these injury rates.

[NHS83LU87]

Ban the curveball and other breaking balls until the kids reach 13-14.  Let their bodies develop enough to stand up the the strain of throwing such pitches.  If you want an off-speed pitch a simple palm ball change up at the younger levels is just as effective if not more effective.  That and proper rest can help with these injury rates.

Amen!

[elhector1]

And a frontal lobotomy for all those parents who ride their under 13 year old kid, saying..."that's a bunch of bull! It can't happen to my kid".

[77]

someone once said you shouldnt throw curve balls until your shaving.

[643]

TJ ended my sons career, not the surgery it was due to massive 'scar tissue' buildup that is related to genics. Being twice drafted by the Yankees, they highly recommended Dr Andrews do the surgery, he was opperated on 1 week after John Smoltz. The Dr did relate the cause on younger players to a cpl of reasons including the ones listed above with mechanics being #1. I can say with my son it was not curve balls at a younger age that led to his elbow being torn up it was due to a Hernia which led to him to trying to pitch thru this and altering his mechanics. Many players from HS down can get by with bad mechanics but at higher levels when you thro in the low to mid 90s it don't take much to tear something up in the elbow or shoulder. I have sat and watched kids in the summer leagues thro curve after curve with some being 12-13, if you will watch the team just play catch (warm up) and notice 'arm action' you will be surprised at the boys trying to thro a breaking ball, this was something I watched closely with mine. A book that was a very helpful to both my son and I was "A pitchers Bible" by Nolan Ryan and Tom House as it speaks on staying away from curve balls. What gets me is the parents of young pitchers that risk arm injury to win a game which meens absolutley nothing, I have went and talked with dads but it seemed as if they know it all, I will say although I came from a BB family I knew enough about BB to know I didn't know anything when it came down to it and I GOT help for him starting at 13. I thank Coach Gilligan and Kyle Green for helping my son reach a goal and stay focused on something he wanted. BTW C Gilligan told my son >>@ 13 if he stayed away from curve balls among other things he would be a Lamar pitcher and one day play Pro ball, both came true as he was a early signee with Lamar but went the JUCO route and did play 2 yrs with the Rangers untill the scar tissue got to much to overcome.