Tommy John surgery becoming more common

After Miami Marlins young ace Jose Fernandez pitched for the last time this season May 9, it was not a surprise when the team learned he needed Tommy John surgery.

The surgery, which repairs the ligament that runs along the inside of the forearm from the elbow, has been everywhere you look this season. Since spring training, 20 Tommy John surgeries have been performed on major league pitchers, noted orthopedic surgeon Dr. James Andrews said, including 14 by the third week of April.

But what’s most alarming is the number of surgeries that promising young hurlers — including Fernandez and the Arizona Diamondbacks’ Patrick Corbin — have had to go through.

As one of the top left-handed prospects in pro baseball, Andrew Heaney has taken note of the trend. He was called up Monday by the Marlins after a short stint with the New Orleans Zephyrs.

“You think about it, but you can’t worry about it every day,” he said. “It’s sad. (In Fernandez), you got a guy coming off a great rookie year (12-6, 2.19 ERA) at 20 years old. And he was 21 looking to win a Cy Young. You don’t want to see that happen.”

Perhaps the only surprise regarding Fernandez’s injury was tied to the Marlins’ well-documented handling of him in an attempt to prevent arm injuries.

Andrews, an LSU graduate who has performed countless Tommy John surgeries, said MLB teams have sound policies regarding the health of pitchers and players in general. The problem, he said, begins much earlier.

“It’s one thing when you’re 38 years old and your ligament goes,” he said. “But when you’re 23, you can almost bet that they had problems when they were 14 or so. And that’s what’s happening relative to young professionals getting hurt early in their careers. The big problem is specialization. They’re playing year-round baseball at a competitive level, and their young bodies won’t take that type of a workload.”

Matt Montgomery, who has pitched for the Zephyrs and Double-A Jacksonville this year, said he put tremendous wear and tear on his arm as a high school prospect.

“I pitched all year round,” said Montgomery, 26. “There’s high school ball, travel ball, fall ball. I pitched a lot, and I’d say I didn’t have much of an offseason, either.”

Add to that showcase ball, Andrews said, where a top pitcher will come in for a few innings and perform before college and pro scouts, hoping to land a scholarship or more.

“They need at least two months off to let their bodies recover, and two months probably is not enough,” Andrews said. “We really recommend three or four months that they not throw or are not allowed to participate in an overhand throwing sport. A lot of them play in two leagues at one time. (Some) average one week off where they weren’t throwing at a high level, and that was the week after Christmas and New Year’s.”

When he was in high school, Zephyrs pitching coach Charlie Corbell said athletes played sports in season. Taking part in other sports allowed them a natural respite.

“That was our way of cross-training for our main sport,” he said. “If you played football, you ran track. You may play baseball and football or baseball and basketball. Now there’s so much money involved if you can have a major league career, it has changed things.”

The surgery’s namesake, former major leaguer Tommy John, called it an overuse injury.

Los Angeles Dodgers doctor Frank Jobe performed the surgery in 1974 after intense elbow pain cut short a season in which John was 13-3 with a 2.59 ERA. John returned in 1976 and in ’77 finished second in Cy Young voting.

It has given pitchers a second chance at continuing their careers.

But the game has changed quite a bit from when John pitched, and that compounds the problem. Throwing harder and harder has replaced finesse, Andrews and Corbell said. That has brought more traumatic injuries resulting from just one pitch, although overuse is related.

The 95-mph fastball is the name of the game, and that does not bode well for those trying to get to the major leagues.

“It puts too much pressure on the tendon,” Andrews said. “The average high school pitcher redlines — like the rpm on your car — at 80 miles per hour. That means, if he throws harder than 80, he’s getting beyond the mechanical properties that the ligament will withstand. But that’s how you get batters out, and the amount of money at stake is so much, the kids all want to match the radar gun.”

Throwing heat is not the only concern. Roger Craig helped popularize the split-finger fastball in the 1980s, a pitch that’s known to damage arms.

“It’s a difficult pitch for an arm,” Corbell said. “When you spread your fingers and you attempt to pitch, it creates tension in the forearm. … That leads to the mechanical breakdowns we talk about that create injuries.”

Andrews said a variation of an old pitch — the changeup — has been causing problems lately.

“They’re doing what we call a major league changeup,” he said. “They’re throwing it about 10 miles per hour slower than a fastball, and they’re pronating and rotating he arm and putting a mechanical stress on the elbow, and they’re tearing the ligament. I’ve had two or three major league pitchers this year tell me they’ve popped the ligament throwing a major league changeup.”

Tommy John surgery has become so prevalent so early that there has been an increase in players having it more than once, although Andrews said it remains a small percentage. Montgomery is one of those.

“The first one came in 2008 when I was in college, and it was a partial tear,” he said. “The second time, Dr. Andrews had to go in there and redo it because he said the ligament was too small and couldn’t withhold the strain the game puts on you. That was 13 months ago this past April.”

Montgomery said he thinks part of the recent spate of Tommy John surgeries is that medicine and technology have come a long way since the early years. Corbell said he remembers when a pitcher simply retired when his elbow gave out. Now, the road back just takes time.

“The first 10 days, you’re in a sling,” Montgomery said. “Then you’re kind of in a soft brace for six weeks. After that, it’s no-throw for four months. Then you throw on progression every two weeks — 60 feet, 75 feet, 90 feet.”

It takes about two years, Andrews said, for a pitcher to come all the way back.

“You have to retrain your arm how to pitch,” Montgomery said. “It feels weird. You have to find the right arm slot. But my fastball is back between 89 and 92 (mph), and I’m confident I’ll be able to get in my groove again.”

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