Almost all of us who talk about Tommy John surgery are not doctors and are not versed in biomechanics. So that should give you pretty fair warning that, for the most part, we’re just spittin’ into the wind when it comes to the “what should be done?” part of this conversation.
Personally I’ll defer to Dr. Andrews and people like him and take them for their word that most of the ligament damage in young pitchers happens well before they’ve hit the big leagues and likely happened well before they made it to pro ball. The development of kids’ muscles are outpacing the development of their ligaments, Andrews says, allowing them to put more stress on a UCL than it was designed to handle. That plus kids simply being overworked and pitching year-round in multiple leagues means that the TJ cake is already baked by the time we know who these dudes are.
Tom Verducci is in lock step with Andrews with all of that, so I’ll go along with his ideas on the topic to a certain degree. Against that backdrop he suggests doing something to limit the amount of strain on those still-developing UCLs: lower the mound:
What can be done? It’s time for Major League Baseball to lower the mound — and for the entire amateur market to follow its lead. When I took part in an MLB Network roundtable discussion last week on the epidemic of Tommy John surgeries, what struck me as most profound was the statement of fact by both Mets team physician Dr. David Altchek and biomechanics expert and former pitcher Tom House that the greater the slope of the mound the greater the forces that are applied to the arm. Reduce the height of the mound and you reduce the forces upon the arm.
Of course, given that he and Dr. Andrews both say that the problem really occurs before the guys get to the bigs, I don’t know that lowering the mound at the MLB level would do much to solve the problem and the byproducts of that — most likely dramatically increased offense — will end up putting the same sort of pressure to develop pitching that we saw in the 1990s and 2000s, the fruit of which is being harvested today. That in turn would place even more of a premium on hard-throwers and would incentivize kids and their parents to churn out even more impressive pitching phenoms, no matter the cost. So many unintended consequences. Like, say, kids throwing even gnarlier pitches their arms aren’t ready for. Leagues not really lowering the mounds because, hey, who’s gonna measure them?
I don’t know that you can crack that nut without Major League Baseball actually becoming a hands-on authority over youth baseball to one degree or another. The incentives are just too detached right now to ensure change. Youth coaches and parents are aimed at winning now and/or having their kids get drafted and paid at 18-21, and they don’t give much of a toss to what happens at 25. MLB has little if any interest in ensuring the well-being of their own minor leaguers, so how in the hell do we expect them to take any kind of ownership or exert any kind of authority over youth baseball?
I don’t think there are any solutions here. At least those that MLB can just impose via a rules change. This is a medical and a societal issue and those sorts of things aren’t amenable to quick fixes.