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Is youth baseball to blame for rash of MLB Tommy John surgeries?

TAMPA — What Scott Rutherford heard on that sweltering Florida afternoon took him aback.

Sitting in the stands of yet another travel baseball tournament, Rutherford caught wind of a conversation. The two mothers were speaking in hushed tones about a recent injury. Rutherford leaned in and inquired.

"She whispered to me that it looked bad, and he was most likely going to need Tommy John surgery," said Rutherford, the assistant director of Suncoast Travel Ball.

The kid was 12 years old.

Tommy John surgery has become a baseball buzzword over the past few years. In ulnar collateral ligament reconstruction, the ligament in the medial elbow is replaced with a tendon from elsewhere in the body. It is named after former major league pitcher Tommy John, the first baseball player to undergo the surgery.

Major League Baseball has never seen a season with such a rash of Tommy John injuries, causing a lot of folks to ask:

Is the problem starting on youth baseball fields?

• • •

At least 31 major league pitchers — including Alonso High product and Miami Marlin José Fernández — have undergone the surgery this year, a rate that already exceeds the average in any season this century.

The long list of names includes some of the game's top young arms: Kris Medlen, Patrick Corbin, Jarrod Parker, Matt Moore. That has MLB officials scurrying to pinpoint why this tiny ligament is not holding up at the rate it used to.

"Research has shown that the amount of competitive pitching and pitching while fatigued are strongly linked to (the UCL) injury," noted surgeon James Andrews recently wrote on his American Sports Medicine Institute website.

With big league teams losing millions of dollars in production this year to UCL injuries, the league is starting to look into the root of the issue. It recently commissioned a panel to investigate the cause of the dramatic increase in UCL injuries, and it will specifically consider the possible link with youth baseball.

"Everyone's trying to find an answer to this," Major League Baseball medical director Gary Green told USA Today. "My opinion is we're going to find multiple factors. It's not just going to be one thing."

There are as many theories as unanswered questions about possible causes, but Andrews said there is a hierarchy of risk factors. Andrews called the uptick in injuries "an epidemic" and says "we're beginning, through time, to see patterns emerge."

• • •

The youth baseball landscape has shifted dramatically over the past decade or so. Gone are the days of a short spring season, followed by a potential all-star tournament or two for the league's best.

These days, kids, especially in Sunbelt states like Florida, play baseball nearly year-round, thanks to the rise of travel ball tournaments. In the Sunshine State, there are multiple tournaments like these throughout most of the year.

"We usually have 30 to 40 teams in our tournaments but have had as many as 110," Rutherford said. "You can find a tournament somewhere just about every weekend."

Little League and Cal Ripken have enacted pitch counts for their league games, and some travel ball tournaments do the same.

"But not all of them," Rutherford said.

An even bigger problem occurs for players who participate in recreational and travel ball simultaneously.

"The overuse that occurs is when coaches start bouncing guys back for multiple appearances in the summer league tournaments or the fall league tournaments," FSU pitching coach Mike Bell said. "I firmly believe some of these guys are not getting enough recovery time between starts or appearances."

• • •

There is also no system to track pitchers throughout different leagues, so the onus falls on players and parents to communicate with multiple coaches about a pitcher's workload.

"The problem lies in, even though some of these parents have been around the game for a while now, it doesn't mean they are knowledgeable about the game," Rutherford said. "It's a problem for sure."

And even if parents are being cognizant of a pitcher's innings, the kids are being shuttled through different positions, throwing during the game and warming up in between innings. In modern youth baseball, it's not uncommon for a child to play upward of 80 or more games in a calendar year.

"The big risk factor is year-round baseball. These kids are not just throwing year-round, they are competing year-round and they don't have any time for recovery," Andrews recently told MLB Radio. "No. 2 is playing in more than one league at a time where rules don't count."

• • •

Brandon coach Matt Stallbaumer questioned the motives behind playing so much baseball at the youth level.

"The parents have unrealistic expectations in a lot of cases," he said. "You have to ask yourself: What are you trying to accomplish? What is the ultimate goal? I think a lot of these parents and kids feel pressure to play travel ball throughout the year."

Andrews also thinks young pitchers are throwing too hard, without the proper mechanics.

"Do not always pitch with 100 percent effort," Andrews said. "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."

Concerns about overuse also creep into the high school game. A Washington pitcher threw 194 pitches through 14 innings in a May game.

"I can tell you what, if that was my son," Stallbaumer said, "I would have walked out onto the field and taken the ball from him myself."

• • •

There is no magic elixir. Even though MLB teams are handling their superstar arms with kid gloves — Fernández threw a paltry 172.2 innings last year before blowing out his elbow in May — the innings limits at the big league level aren't fixing the problem. There were 36 pitchers who threw 200 or more innings last year compared to 49 in 1983. In 1973, seven pitchers tossed more than 300 innings, so the reduced workload hasn't been the answer.

Andrews thinks that's because by the time these players get to the big leagues, the undetected damage has been done.

"You can usually go back and find a minor injury in youth baseball that was not recognized that set them up for a major injury down the road," he said.

Is it the rise of year-round baseball? Is the increased velocity of modern-day pitchers too much for the current physiology? Is it something else?

The debate is sure to continue as long as the arms keep breaking down.

"Something's got to change," Stallbaumer said.

Brandon Wright can be reached at hillsnews@tampbay.com.

Is youth baseball to blame for rash of MLB Tommy John surgeries? 06/12/14 [Last modified: Thursday, June 12, 2014 9:59am]

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