Baseball Elbow Injuries

Posted on July 8, 2014

If you’ve followed baseball news at all this Spring and Summer, you may have noticed many pitchers having their season cut short to undergo Tommy John Surgery. This surgery has been around since 1974 when Dr. Frank Jobe performed it first on Los Angeles Dodgers pitcher, Tommy John. The surgery allowed Tommy to return to baseball one and a half years later, where he continued to excel winning 164 more baseball games as a pitcher1. After Tommy, pitchers were not always able to return to their prior level and some were forced into early retirement. A study published just this year showed an 82% return rate to prior level of competition in just less than 1 year2. The real issue is that surgery should always be a last resort, and for many of these pitchers this year they’ve reached their last resort. They have torn their ulnar collateral ligament on the inside part of their elbow and without repairing it, they don’t have the stability to be able to through a 90 MPH fastball.

But why the sudden increase? We don’t know, but there are some good thoughts as to why.

  1. Throwing too much as a kid
    Many pitchers throwing before the year 2000 did not specialize in baseball as a kid. They played a lot of baseball in the spring and the summer, but would also play football in the fall and basketball in the winter to give their arms a rest. Today, the specialized youth athlete is becoming more and more popular. If your kid is good at baseball, by age 9, that’s all they play; kids are playing on teams throughout the whole year, and when they’re not they’re throwing the wiffle ball around with their friends or out practicing some more. Leagues have gotten better with pitch counts and limiting pitches thrown in games, but they don’t account for throwing in practice, outside of practice, nor in other leagues, therefore they’re not terribly effective. There has been a lot of concern about throwing a curve ball too young, but it appears that just throwing too much at a young age is the real issue. The thought is that this early throwing is resulting in possible rotational changes in the bone as the growth plates have yet to close resulting in excess stress on the inside elbow and the ulnar collateral ligament, predisposing it to tearing later on in the individual’s career.
  2. Poor core and hip strength
    This is an area often underlooked by athletes and their parents and coaches. You throw with your arm, so that’s the only thing that needs to be strong and flexible right? Totally wrong. In reality, the arm is just the end of the whip when it comes to throwing. Where the real power should come from is your hips and your core. Your hips should be what propels your momentum forward, and your core should be strong and stable enough to allow that momentum and force to reach your shoulder and enhance it’s force, and thus velocity on the ball. If you’re not using those big muscles to help you throw, and you’re still throwing hard, that’s a lot of stress on your shoulder, resulting in more stress on your elbow, and resulting in a higher risk for injury.
  3. Strengthening beyond a point that the UCL can tolerate
    This was recently mentioned by Dr. James Andrews in a piece addressing the recent increase in UCL injuries in the 2014 baseball season. He wonders if baseball pitchers have reached a point where they are able to strengthen their rotator cuff and supporting shoulder girdle musculature enough that they can produce too much torque for the UCL to handle. He states there is no evidence to support this thought, but that it is plausible.

In response to this, one could argue that increased strength in internal rotators to throw the ball could be counterbalanced by appropriate strength of external rotators to eccentrically control that force which would make the job of Physical Therapists all the more important to ensure that strength balance!

There is no current evidence to support the increase in UCL injuries, but there’s no arguing that they’ve been on the rise. Coincidence? Maybe. While there’s not evidence just yet to support it, it makes sense that one’s risk should be decreased by watching their pitch count when their young and having the appropriate hip and core (not just shoulder!) strength to decrease throwing stresses on the inside elbow – and Physical Therapy CAN help that!

– Dane Happeny, DPT


  1. Grantland staff (July 23, 2013). “30 for 30 Shorts: Tommy and Frank”. Grantland. Retrieved June 3, 2014.
  2. Osbahr DC, Cain EL, Raines BT, Fortenbaugh D, Dugas JR, Andrews JR. Long-term Outcomes After Ulnar Collateral Ligament Reconstruction in Competitive Baseball Players: Minimum 10-Year Follow-up. Am J Sports Med. 2014; 42(6):1333-1342.

*Photo courtesy of:

Comments are closed.