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Reginald Washington

UNST110-23
Mr. Renfroe
11/11/09

Tommy John: Is it Worth It?

America’s pastime has evolved over the last twenty years. Baseball has witnessed an

increase in controversy surrounding the use of performance enhancing drugs. Even though

baseball has been darkened by the cloud of steroid controversy, it still remains vigorously

competitive. The competitive nature of baseball players causes serious injuries to young athletes

as well as professionals. High school athletes compete year round for exposure, seeking

opportunities to gain recruitment from colleges and Major League Baseball scouts. The lack of

time athletes have to rest and recuperate leads to an increase in arm injuries. The most common

injury is pain and discomfort to the elbow. Athletes are often faced with the difficult decision to

solve the problem either non-operatively or with a surgical procedure known as the Tommy

John. The Tommy John surgery is named after Los Angeles Dodger Tommy John who had the

first Ulnar Collateral Ligament (UCL) reconstruction surgery in 1974. The surgery causes

athletes to not participate for at least 8 months and rehabilitate for a year with a chance of

returning to optimal performance without pain. Statistics show that the surgical approach has a

success rate of over 80 percent. The surgery has become a career saving procedure. The Tommy

John surgery is highly recommended for anyone who wishes to continue their career.

Tommy John was born in Terre Haute, Indiana on May 22, 1943. He made his

professional baseball debut in 1963 with the Cleveland Indians. He struggled early in his career,

posting a record of 0-2 during his rookie season and posting an appalling 2-9 record during the

1964 season. John quickly improved his performance on the mound and became a left handed
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stalwart until his career came to halt in 1974. While he was playing for the Los Angeles

Dodgers, he permanently damaged the UCL in his pitching elbow. This injury usually ends the

career of a pitcher, but John received an extraordinary surgical operation by Dr. Frank Jobe on

September 24, 1974. The surgery replaces the torn tendon in the elbow with a tendon from the

knee or opposite elbow. In 1975, John received the Hutch Award for displaying courage,

dedication, and honor to baseball both on and off the field. John sat out the entire 1975 campaign

to recover and returned to the Dodgers’ rotation in 1976. He went on to pitch for over a decade

and earned over 50 percent of his 288 victories and also received the National League Comeback

Player of the Year Award in 1976. Although John remains the pitcher with the most wins not

inducted into the Major League Baseball Hall of Fame, he has provided thousands of athletes the

opportunity to continue their careers. John proved that devastating injuries to the throwing arm

do not have to end someone’s career. When asked what he was most proud of John replied “I

pitched 13 years after the procedure and I never missed a start. I had not one iota of trouble. I'd

like people to remember that about me," ("Official Site of Tommy John")

According to the American Orthopedic Society for Sports Medicine in Birmingham,

Alabama, UCL injuries have increased in high school baseball players due to the boost in year-

round competitive throwing. UCL injuries are also caused by throwing breaking pitches such as

curveballs and sliders, high fastball velocity, or inadequate warm ups. (H. Petty 1158-1163) The

Major League draft is also a reason UCL reconstruction surgeries have occurred more often

because of the rise in teenagers drafted right out of high school. In an effort to gain the attention

of scouts, high school pitchers are given inaccurate information on how to increase fastball

velocity, but some of their adolescence arms cannot take the pressure. Having an overly

competitive nature is also another reason there is an increase in Tommy John surgeries. High
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school and traveling baseball coaches often place the titles “Ace” or “Superstar” upon young

athletes to encourage these select players to throw more often than they should for their

respective teams benefit. They are pressured to win and take responsibility for their team’s

success. These elite high school pitchers take on that burden and do not want to disappoint their

coaches, teammates, parents, scouts, or fans so they ignore arm discomfort, therefore they often

pitch when they are in pain. Pitchers show signs of a problem when they experience reduced

velocity, loss of control, and obvious discomfort when throwing of 75 percent. (“Pub Med”)

Pitchers with UCL problems have two options: non-operative and operative. The

American Orthopedic Society for Sports Medicine conducted a study that tested the effectiveness

of the non-operative approach. The study was done from 1994 to 1997 and followed 31 baseball

players with UCL injuries. Phase one of non-operative treatment included a minimum of 3

months of rest with rehabilitation exercises testing range of motion, anti-inflammatory

medication to reduce swelling, and icing 40 minutes a day in ten minute intervals. Also, the

athletes’ arm is placed in a long-arm splint at night or a brace at a 90 degree angle when ever

needed to control pain during the day. If the athletes are pain free the splint is discontinued and

the strengthening program for the upper extremities of all muscle groups is monitored. Then he

or she can progressively return to throwing 3 months later. An elbow hyperextension brace may

be used for throwing and lifting. Once the study was completed and the results showed a 42

percent success rate of players returning to their previous level of performance after an average

time of 24.5 weeks. (ASJM 29.1)

While this rate of success causes one to consider the non-operative approach, UCL

reconstruction surgery is recommended for competitive athletes who failed at least 3-6 months of

non-operative management without seeing some signs of improvement. UCL reconstruction

surgery is done by taking a tendon from the opposite elbow or one of the knees and placed into

the injured elbow. The athlete is then faced with a difficult decision, to either retire from

competitive baseball or rehab for another year with no guarantee that he will return to his

previous level of performance. Medscape Orthopedics and Sports Medicine reported that UCL

reconstruction has demonstrated excellent results in athletes with competitive overhead throwing

injuries. Medscape reported that 72 percent of their patients returned to pre injury performance

level with a typical recovery time of one year. Patients who had previous elbow surgery tend to

have lower results. (“Medscape”) When asked what the hardest part about the surgery was John

says "The mental part was the hardest. The competitiveness in any athlete makes them want to be

out there helping the team. After I'd do my workouts, and my therapy and everything, I'd go into

the stands and watch the game. But at the All-Star break in 1975, I'd regained my fastball, and

that was some light at the end of the tunnel. That was the biggest thing."(Tommy John)

Numerous athletes seem to believe that the Tommy John surgery actually causes them to

come back throwing harder because the surgery replaced the damaged tendon. This belief is so

strong that early in some high school athletes’ careers they have the surgery to gain velocity so

they can be recruited by the MLB draft or elite colleges. Although the idea of the Tommy John

surgery helping pitchers compete at a higher level than they had before is not documented, many

pitchers have given testimonial proof that this theory is true. In an article written by Mike Dodd

in the May 2004 edition of Baseball Digest titled “Tommy John Surgery: A Career-Saving

Procedure for Many Pitchers”, it was discussed how Major League pitching careers’ are often

saved by the surgery and they even come back stronger than before. John comments in the article

that the surgery is pretty much a sure thing. The article gives several examples of how different

Major League superstars support the procedure and use their respective stats as evidence.
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Chicago Cubs All-Star pitcher Kerry Wood said "I hit my top speed (in pitch velocity) after the

surgery," Wood also stated that he threw harder and was more consistent. Billy Koch a Chicago

White Sox relief pitcher said “It felt so good when I came back; I recommend it to everybody

regardless what your ligament looks like”. Toronto Blue Jay Ace Pat Hentgen said “Tip your hat

to modern medicine,” Hentgen also said his arm feels like he never had the surgery. ("Baseball

Digest" 56-59)

The Tommy John surgery has had positive reviews and testimonials, but it has also had

its share of negative connotations. There are no medical journals that present a position that

opposes the procedure, but Dodd’s article does discuss the importance of rehabbing the correct

way. The article warns athletes against only rehabbing the elbow because it will affect their

shoulder when they are trying to throw. Hentgen says “A lot of guys come back and the

shoulder is blowing up (inflamed) because you go six months without exercising your shoulder.”

Another reason Tommy John is not successful is because athletes often push themselves back too

fast. The mental strain of not being able to compete for a year causes athletes to throw at their

maximum when medically they are not ready. ("Baseball Digest" 56-59) Throwing to early and

not rehabbing the shoulder properly can prolong full recovery as well as the possibility of

another surgery.

UCL reconstruction has become less of a risk due to the advances is modern medicine.

Dr Jobe and John caused a revolution with their innovation and success in 1974. Numerous

professional, collegiate and high school athletes have reaped the benefits of the surgery. Because

of the high success rate of the Tommy John surgery, it has become a common procedure in

baseball. UCL reconstruction surgery is allowing athletes to go though the rigors of surgery and
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rehab for a career not just a year. The Tommy John procedure has become a savior for baseball

players who tear the ligament.

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Works Cited

"Biography." The Official Site of Tommy John. 21 Jun 2005. CMG Organization, Web. 25 Oct
2009. <http://www.tommyjohn.net/bio.htm>.
H. Petty, Damon, James R.Andrews, Glenn S. Fleisig, and E. Lyle Cain. "Ulnar Collateral
Ligament Reconstruction in High School Baseball Players." American Orthopedic
Society for Sports Medicine 32.5 (2004): 1158-1163. Web. 25 Oct 2009.
H. Petty, Damon, James R.Andrews, Glenn S. Fleisig, E. Lyle Cain, and Paul Mieling.
"Nonoperative Treatment of Lunar Collateral Ligament Injuries in Throwing Athletes."
American Orthopedic Society for Sports Medicine 29.1 (2001): 15-17. Web. 25 Oct 2009.
"Medial collateral ligament reconstruction in the baseball Pitcher's elbow. Erne HC, Zouzias IC,
Rosenwasser MP...” Pub Med. 25 Aug 2009. U.S. National Library of Medicine, Web. 25
Oct 2009.
"Quotes." The Official Site of Tommy John. 21 Jun 2005. CMG Organization, Web. 25 Oct 2009.
<http://www.tommyjohn.net/quotes.htm>.
"Tommy John" surgery: a career-saving procedure for many pitchers." Baseball Digest May
2004: 56-59. Web. 22 Oct 2009.
"Ulnar Collateral Ligament." Medscape. 16 Aug 2002. Medscape Orthopedics & Sports
Medicine, Web. 25 Oct 2009. <http://www.medscape.com/viewarticle/439293>.