July 23, 2016

More Young Pitchers Blow Out Arms, Get Tommy John Surgery


Daytona Beach News Journal

To read the full article by Zach Dean, click here.

DAYTONA BEACH — Spruce Creek pitcher Gage Hutchinson had looked forward to this game for a long time.

The Venice High School Indians were the top-ranked team in the state in 2013, and only lost three games en route to an eventual state title. They were the team nobody wanted to face.

But none of that fazed Hutchinson, who was 6-1 going into the matchup and coming off a stellar performance against Lake Brantley.

“That was a game I had circled on my calendar,” Hutchinson recalled. “I can remember throwing harder than I had all season that day.”

With two outs in the fourth inning, the Port Orange product reared back as he had done time and again, and threw his signature two-seam fastball.

In a split second, his world changed. He became another statistic in what some are calling an epidemic: teenage pitchers blowing out their arms — and sometimes shattering their dreams — from throwing too hard and too much.

“I felt a really intense burning sensation in my elbow, one that I’d never really felt before,” Hutchinson said. “I tried to keep throwing, but my fastball was gone. I’m usually 87 to 88 mph and it was down to 75-76.

That was the last time Hutchinson would play high school baseball.

A few weeks later, the then 17-year-old junior learned that his ulnar collateral ligament (UCL) was completely torn. He visited a specialist in Orlando, who gave Hutchinson the news that’s become commonplace for baseball players of all ages over the past few years.

“He said if I wanted to continue playing I would need to have Tommy John surgery,” Hutchinson said. “There was no other way around it.”

Hutchinson had the surgery in August 2013. He wouldn’t pitch again for nearly two years.

A growing problem

The operation, first performed in 1974 on ex-Los Angeles Dodger pitcher Tommy John, replaces a torn ligament in the elbow with a tendon from elsewhere in the body, usually the forearm, hamstring, or foot of the patient. For the first three decades, the surgery was a rarity, often a career-saving move for older pitchers. However, that's changed dramatically in recent years.

According to MLBreports.com, eight Major League players had Tommy John Surgery in 1995. To compare, a staggering 30 MLB players had the surgery last season.

While the numbers are troubling enough at the professional level, the cause for concern may lie at the sport's lower levels.

According to a report released by the American Sports Medicine Institute (ASMI) in 2014, the real damage is being done during the teen years. According to a study done within the report, the number of youth and high school patients who required Tommy John surgery rose 29 percent at Andrews Sports Medicine & Orthopedic Center between 1994-2010.

“During the past few years there has been an epidemic rise in the number of professional pitchers requiring ulnar collateral ligament reconstruction,” the report says. “In many cases, the injury leading to Tommy John surgery in today's young pro pitchers actually began while they were adolescent amateurs.”

John McFarland has plenty of experience with the surgery, at both the youth and professional level.

McFarland, who is the Director of Sports Medicine at the DeLand CORA Rehabilitation Clinic, spent time with the Baltimore Orioles training staff and served as Stetson’s Athletic Trainer from 1994 to 2005. He has spent the last 10 years working with local athletes at CORA.

“We haven’t had it as much as I know it’s been happening elsewhere,” McFarland said of the rise in elbow injuries. “With that being said, I have seen plenty of it, and there are a couple of different reasons for the spike.

“The more people play, the better the chance that they’re going to get hurt. Unlike 20 years ago, nowadays you have fall ball, spring ball, summer ball and winter ball. In some cases, you have kids playing baseball 12 months out of the year without restrictions.

“When you have pitchers going out and throwing as hard as they can for as long as they can, you start to run into problems.”

Another reason McFarland points to for the spike is the growing perception by some that having reconstructive surgery may actually be beneficial.

"People talk about coming back stronger, but isn’t there also something to the fact that they took time off? Take a kid who’s been pitching since he was six-years-old, because that’s how young they start now, and then he tears his elbow when he's 20. All of a sudden, he gets a year, sometimes two years off. Your body hasn’t had a break in 14 years and now it can finally recover.

"Of course you're going to come back stronger, but it has a lot to do with being able to take a year off."

‘Those days are gone’

For youth players, especially in a warm-weather state like Florida, the baseball season never ends.

“Any 13-year-old that you talk to nowadays has played on half a dozen travel teams already. Some are playing on two at a time,” University High School baseball coach Frank Martello said.

Travel baseball, showcase tournaments and year-round playing has been on the rise in youth baseball for the better part of the last decade. Gone are the days of a spring baseball season, followed by football in the fall and basketball in the winter.

“I played from January to January and never took a break,” Hutchinson recalled. “In-between sophomore and junior year I threw that summer, I threw that fall, I played for travel teams and then came into the spring and started all spring long.

“It was just too much stress on the elbow. Not having a break throughout the year is what really got me. I played for coaches who put me on strict pitch counts, but what I never did growing up was take time off.”

The 2014 ASMI report states that “year-round playing” and “playing on multiple teams” are some of the top risk factors associated with Tommy John surgery.

Despite the report, McFarland doesn’t see the trend changing any time soon.

“Those days are gone, and they’re never coming back,” McFarland said of playing multiple sports. “Ask any kid who the top travel ball team is in Central Florida. I bet they know.

“What most people just don’t understand is, when you change the forces on the body, such as basketball, swimming, whatever, you change how the body is reacting to those forces, which makes it more tolerant and resistant to injury.

“Should we get back to it? Absolutely, but in my opinion it’s not coming back.”

‘I used all of my ammo’

While many point to fatigue, others, such as former DeLand star Scott Moss, just chalk it up to fate.

Moss, the 2013 News-Journal Baseball Player of the Year, was dominate in his senior season.

He led the Bulldogs with a 0.52 ERA and 70 strikeouts and was drafted in the 38th round by the Colorado Rockies before opting to play at the University of Florida.

The plan was for Moss to pitch for the Gators, up his draft stock and eventually play professional baseball.

Those plans changed before his college career even began.

“I just felt something in my arm go," Moss recalled. "It was a week before the season in my freshman year and it just sort of went. There were no real warning signs."

Like Hutchinson, Moss had completely torn his UCL, and would miss the next two seasons. However, Moss, who was recently drafted by the Cincinnati Reds following a banner season at Florida, doesn’t think overuse had anything to do with the injury.

"I think pitchers nowadays have a certain amount of bullets that they can use and I honestly think I used all of my ammo up at that point," Moss said. "There are obviously measures that you can take to avoid it, but at the same time I think it’s just one of those things that happen in sports."

McFarland acknowledges Moss’ theory, but says it's happening sooner than ever now.

“You had kids tearing their arms up during the other decades, but it took them a lot longer to get to those numbers because they weren't throwing as much," McFarland said. "There are guys out there now who are constantly on these kids to throw at maximum velocity all the time."

Hutchinson points to the pitching motion as another factor.

“You can’t make an unnatural motion over and over again and expect it to be fine the rest of your life,” he said. “You’re going to hurt something sooner or later.

“I think you need at least three months, if not more, out of the year where you’re working out, building strength and giving that arm a break.”

‘His arm was wasted’

Throwing year-round is one contributing factor. Throwing too much at one time is another.

Three decades ago, pitch counts in baseball were unheard of.

“When I first started coaching you never even thought about pitch counts,” said Martello, who's been coaching for over 30 years. “We're constantly on top of it now. We look at how often guys throw and what our pitchers are doing throughout the week."

Instead of employing a set pitch count, high school baseball instead follows an innings limit that varies for each state — in Florida a pitcher may not throw more than 14 innings in a week.

However, elbow problems have continued to rise, and stricter pitch count rules are now being enforced at the high school level.

Recently, the National Federation of State High School Associations announced that each state association will now be required to develop its own pitch count restrictions for the 2017 season.

In August 2006, President of Little League Baseball and Softball Stephen D. Keener announced a major shakeup to the decades-old pitching rules, saying that a strict pitch count would be enforced based on a player's age.

“If there wasn’t a speed limit, would people drive safely? We’re talking about human nature,” said McFarland, who's also coached in DeLand Little League since coming to CORA in 2006. "They had to understand that these kids are probably going to do something else with their life instead of this.”

Since that announcement, pitch counts for all youth baseball leagues have continued to be a priority. However, the problems persist.

“Even with the pitch count, when I was coaching little league here locally, there was another coach in the league who had a pretty good thrower and he pitched him max pitches, minimum days of rest, all year,” McFarland recalled.

“That young man did not play baseball for two years after that because he had nothing left in his arm. Even with the restrictions, I watched a 12-year-old boy just be physically destroyed. Did he have a Tommy John injury? No. But his arm was wasted.”

Knowledge is everything

Some subscribe to the theory that an elbow injury, for a serious baseball player, is inevitable.

Others say that time off and strict pitch counts at a young age will do the trick.

However, the medical consensus says that, first and foremost, knowledge is everything.

"If you don’t understand throwing amount, throwing intensity and throwing recovery then you’re not going to prevent this injury," McFarland said. "From my standpoint, the prevention starts with having a sound basis."

High School and college programs around the country have started to take action.

Strict stretching and workout routines are now strongly enforced for pitchers. Athletic trainers are now receiving additional training on Tommy John prevention. Locally, McFarland and the CORA clinic have provided additional athletic trainers to all Orange County public schools while also working closely with several high school programs to raise awareness on the issue.

"If you think doing dumbbell exercises will prevent arm injuries then you’re in for a long road," McFarland said. "It’s one of those things where it takes a good flexibility program, it takes a good arm program, it takes a good running program, it takes a good core program, and it takes the knowledge that you can’t play year-round.

While this will be new at the high school level this season, it started in youth baseball a decade ago.

"There’s so much that goes into preventing these injuries and it’s a process that the average adult and the average person doesn’t understand."

Like most, Moss was a part of that generation.

"When I was younger you didn’t really care about weightlifting and stretching and all that stuff," Moss recalled. "After the surgery it’s definitely something I pay attention to now."

‘It was heartbreaking’

While Hutchinson now plays at Daytona State College, the former Spruce Creek Hawk, at one time, had bigger aspirations.

“My sophomore year I got an offer from Florida Atlantic," Hutchinson recalled. "I had other Division 1 schools looking at me, too.”

With kids playing year-round baseball now more than ever, it’s become routine for college scouts to see a player more often and at a younger age.

However, that's not always a benefit.

“You put these players at 12, 13 and 14 out there, plus high school guys, playing 12 months and doing things in November, December and January at full speed for scouts and you’re going to have a problem,” Martello said.

“That used to be a time for rest and conditioning and recovery. Now you’re making them throw max effort in a bullpen in January that you never did before.”

After the surgery, Hutchinson lost contact with most of the schools previously interested in him, including FAU.

“They all just kind of stopped reaching out to me,” Hutchinson said. “Jason Jackson, the pitching coach at FAU, was kind enough to call me and tell me if I ever need anything to let him know, but unfortunately the scholarship had to go. He said they had to give it to someone else that for sure could come in and be able to pitch.

“It’s very emotional, hard to hear. But I understood. There’s nothing he can do. His job is to win baseball games, not put some hope in a guy who may or may not be able to pitch again.

"It was definitely a little heartbreaking, though, to know that because of the surgery I was no longer a wanted item."