To baseball's best and brightest, the world's most precious resource isn't the gooey black stuff that oozes up from below. It's pitching, the good old-fashioned rear-back-and-fire of the cowhide, which can be found above ground and on several continents.

While there may be no limit to the planet's ability to sustain the flow of pitching talent, ballplayers are dropping like flies in recent years, and the sport's powers-that-be aren't too keen on taking chances. Millions of dollars — in some cases hundreds of millions of dollars — are invested in big-league pitchers today, and most ambitious baseball executives would like to know in advance if that money's going into training and salaries and the commissioning of World Series rings, or into scalpels and gauze and overnight hospital stays.
This spring alone, local relievers Sean Burnett of the Angels and the Dodgers' Chris Withrow have had their career paths altered by Tommy John surgery. Prominent pitchers to undergo the procedure in other cities include Brandon Beachy and Kris Medlen of the Atlanta Braves, Miami's Jose Fernandez, Jarrod Parker of the Oakland Athletics, the Yankees' Ivan Nova and the Rangers' Martin Perez. Dodgers Chad Billingsley and Scott Elbert had it done in 2013. Baltimore Orioles' catcher Matt Wieters just went under the knife yesterday.

It's not an “epidemic” in the true sense of the word, because the torn ulnar collateral ligament isn't contagious. The Center for Disease Control isn't sending out advisories. But with the baseball industry scared shitless, the American Sports Medicine Institute (ASMI) is, issuing a 1,200-word position statement. Teams such as the Dodgers, Yankees and Phillies are surveying the media to learn about their perceptions of Tommy John surgery.

There is increasing talk of innings limits, pitch counts and the wisdom of certain types of training regimens. Year-round pitching is now frowned upon in most circles. Sports Illustrated's Tom Verducci, as thoughtful a writer on the topic of pitcher health as you'll find anywhere, suggests lowering the mound, as MLB did to increase offense in 1968. While the same effect may occur if such a policy were instituted again, the idea of reducing stress on a pitcher's body is worthy of consideration.

The Dodgers' VP of medical services, Stan Conte, agrees that mound height is a risk factor associated with the need for Tommy John surgeries.

“There are scientific studies that show that a flat mound is better and others that say the opposite; that the mound is safer. I doubt seriously that MLB would ever lower the mound, but more research has to be done to look at this for youth baseball,” Conte tells the Weekly. “That is where a lot of MLB's efforts are headed right now, in looking at over-usage and other factors in Little League and high school pitchers.”

When asked via email what motivated him to conduct the survey, Conte says that in 2012, Yankees team physician “Dr. Chris Ahmad did a survey of about 300 people including parents, coaches, high school and college baseball players, asking them questions about their perception and knowledge of TJ surgery.” 

Conte said: “The results showed the following: 30 percent of coaches, 37 percent of parents, 51 percent of high school athletes and 26 percent of college athletes believed that TJ surgery should be performed on players without elbow injury to enhance performance. It was incredible to me that this many decision-makers would think it was OK to operate on a pitcher that did not have a problem, just to get him to throw harder or perform better. It made me wonder how those people got their perception.

“It occurred to me [that much, but not all] of the information they were getting was from the media, and I wondered if the media understood the facts about TJ surgery. So Nancy Patterson Flynn, Dodgers assistant athletic trainer, and I devised a new survey for the media. We enlisted the help of Dr. Ahmad as well since he had done the first survey. It took us about a year to put it together and we sent it out via teams' PR directors three weeks ago.

“To date, we have over 450 responses,” Conte said. “We are hoping to get over 500, since that would be a pretty big sample size of baseball media across the nation.”

The Dodgers' survey of the media is broken down into sections about the benefits, indications, recovery from, risks and details of Tommy John surgery, and concludes with a section on throwing injuries. 

Turn the page to see details from the survey.
Survey questions include the following:

Does Tommy John surgery improve PITCHING CONTROL compared to other pitchers without surgery?

Does Tommy John surgery IMPROVE PITCHING SPEED?

Does an athlete need to have an elbow injury to have Tommy John surgery?

Estimate what is typically used by surgeons for Tommy John surgery? Check all that apply – suture, tendon, plate, screws, ligament.

Estimate the risk of NOT BEING ABLE TO RETURN TO PLAYING BASEBALL after surgery.


Are throwing injuries preventable?

Throwing injuries are related to: Check all that apply – number of pitches, type of pitch, velocity, accuracy, overuse.

Tommy John, of course, is an actual person, a Dodger at the time of the injury that led to the groundbreaking 1974 surgery that bears his name, and at least in terms of wins, a more successful pitcher after the operation (164) than before (124). Most savvy baseball fans know that it was the Dodgers' team physician Dr. Frank Jobe who devised the procedure especially for John, and that it has been in common practice ever since.

What may not be appreciated today is just how important John was to the Dodgers' cause at the time of the injury. The left-hander came to Los Angeles along with Steve Huntz on December 2, 1971, in a trade that sent Dick (previously-known-as-Richie) Allen to the Chicago White Sox.

John went 11-5 with a 2.89 earned run average in 1972, and was one of four L.A. starters to finish the season with an ERA under 3.00. Don Sutton (2.08), 20-game winner Claude Osteen (2.64) and Al Downing (2.98) were the others. He was 16-7 with a 3.10 in 1973, and led the National League with a .676 winning percentage.

John shot out to a 13-3/2.59 start in 1974 and was lined up for a possible start in the July 23 All-Star Game, had he not been felled by the torn elbow ligament on July 17. The Dodgers were in first place in the NL West the night John went down, a seemingly comfortable 5 ½ games up on the Cincinnati Reds, who had beaten them out for the division the previous two seasons.

Losing a key starter was a big blow to the team's pennant chances, but the Dodgers still held their division lead, won the NL West by four games, and went on to defeat the Pittsburgh Pirates in the National League Championship Series, three games to one.

Though World Series losers to the three-peat Oakland Athletics that October, the 1974 Dodgers are considered one of the best teams in Los Angeles history, and the only club since the move from Brooklyn to win 100 games. L.A. finished the regular season at 102-60, with much of the heavy lifting accomplished without Tommy John.

John had pitched as part of a major league rotation for 10 1/2 years before the elbow gave way in 1974. After the surgery that August he sat out the rest of that season and all of the 1975 campaign, returning to the Dodgers in a 5-0 loss to the Braves in Atlanta on April 16, 1976. John pitched another 14 years in the majors, finally retiring in 1989 at the age of 46.

Not every ballplayer is as fortunate as Tommy John. Every patient is different. Some pitchers, such as L.A.'s Brian Wilson, re-injure the ligament and opt for a second operation. A few have three TJ surgeries, while others, like Billingsley, require surgery on another area of the same elbow. Some pitch another five or 10 years and are just fine.

Conte says, “A better-informed media can help form better opinions for their readers. That is really the goal of the survey. To get the media to see what some of the issues are and give them facts so they can write better articles and voice their opinions about the issue. Even if that opinion doesn't necessarily agree with me or other medical people. Sort of a win/win, I think.

“As far as the public, I think MLB and others like ASMI are going to be trying to put out more information to the public, but especially to parents and coaches on what increases risk to youth pitchers,” he says. “The better informed they are [the more likely they are to] make the right decisions for the kids and their players.”

And remember, glove conquers all.

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