Is baseball battling a Tommy John epidemic?

By DANIEL BROWN

Tribune News Service

Joe DeMers was just 10 years old when he started using the most powerful word in a young pitcher’s vocabulary — no.

No, he wouldn’t pitch on short rest. No, he wouldn’t go beyond his pitch count. No, he wouldn’t play for multiple teams.

Now a high school senior, DeMers has a fastball in the mid-90s, a scholarship commitment to Washington and first-round buzz in advance of the Major League Baseball draft.

Is he glad he took the prudent route?

Yes.

“I’ve pretty much gone my whole career without injuries,” said DeMers, a student at College Park High in Pleasant Hill, Calif.

DeMers is among the lucky ones to emerge unscathed from the increasingly demanding world of youth baseball. The landscape is so dotted with red flags that two governing bodies, Major League Baseball and USA Baseball, teamed up to create new guidelines to help young arms stay in tact.

The creation of Pitchsmart.org comes at a time when major league elbows are wearing out at record rates, with Tommy John surgeries nearly doubling over the past three seasons. This spring had hardly gotten underway before top pitchers Yu Darvish of the Rangers and Zack Wheeler of the Mets had to make the Tommy John decision.

“There is a real sense of urgency to understand the entire TJ surgery now,” said Stan Conte, the Dodgers’ vice president of medical services and a member of the Pitchsmart.org advisory board.

In July, the American Sports Medicine Institute went so far as to describe it as an epidemic. In a position statement that seemed aimed squarely at youth league coaches, the institute wrote: “In many cases, the injury leading to Tommy John surgery … began while they were adolescent amateurs.”

From 2000-2011, there were an average of 15.4 Tommy John surgeries per year in the majors. But over the past three years, the average has almost doubled to 28.3.

Perversely, though, the upward trend leads not to fear but acceptance in some cases. It’s as if reconstructing a damaged ulnar collateral ligament is as inevitable as rotating the tires.

Fueled by the misperception that most pitchers come back throwing harder — “an urban myth,” one major league trainer called it — some teenage prospects are electing for Tommy John surgeries, even though they don’t need it.

The trend amazes early pioneers such as Tom Candiotti, who was the second player — and the first not named Tommy John — to reach the majors after undergoing Dr. Frank Jobe’s revolutionary procedure. Candiotti had the elbow ligament surgery in 1981, seven years after John made history, but only after Jobe made sure it was worth his while.

“He said, ‘You need to tell me: Are you a prospect?’ ” Candiotti recalled.

Jobe, who died March 6, 2014, at age 88, pioneered the operation in 1974, when he transplanted an unneeded tendon from John’s right wrist into his left elbow. John pitched on that elbow until he was 46, winning 164 games post-surgery.

John once told the Orange County Register: “I think there should be a medical wing in the Hall of Fame, starting with him.”

Candiotti later became the first patient to square off against the man himself, starting opposite John on Aug. 25, 1983 in what was billed as “the battle of the reconstructed arms.” Candiotti delivered a complete game 7-0 victory and arrived at the ballpark the next day to find John waiting for him in the dugout.

“He sat down and we talked about my surgery, his surgery and what it felt like to get better,” Candiotti, now 57, recalled. “He was the most gracious man in the world. He said, ‘You’re not done yet. You’ve still got a long way to go.’ “

Back then, they were the only two men on an unpopulated island — like Neil Armstrong talking to Buzz Aldrin about what it’s like to walk on the moon.

Now, the Tommy John community is a burgeoning metropolis, and the population is trending younger.

In 2000, Dr. James Andrews and colleague Glenn Fleisig reported performing Tommy John surgery on 17 youth and high school players, making up 18 percent of all elbow reconstructions they did that year. In 2010, the last time Andrews and Flesig collected data in a similar fashion, there were 41 surgeries on kids making up 31 percent of the procedures. And Andrews told USA Today Sports this past summer that the stats were getting worse.

“The largest number of all those different groups, believe it or not, is high school kids,” he told the paper. “They outnumber the professionals. There was a tenfold increase in Tommy John at the high school/youth level in my practice since 2000. I’m doing way more of these procedures than I want to.”

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Little League Baseball has established pitch limits (backed by Pitchsmart.org) that vary depending on age. At ages 7 to 8, a player tops out at 50 pitches, for example, while ages 17 to 18 can go as many as 105.

But a survey led by Dr. Joseph J. Fazalare confirmed what parents know: Some coaches lie. In that 2012 study, only 73 percent of coaches reported that they followed the pitching rules, and only half (53 percent) felt that other coaches generally followed the rules.

In the South Bay alone, there are plenty of examples of fudging the workload. Cases include a 12-year-old throwing 110 pitches over five innings last month; a 10-year-old pitcher throwing an estimated 130 pitches in a no-hitter in 2012; a 10-year-old in 2014 throwing three days in a row and totaling 156 pitches.

Ross Nakaji, a specialist at Los Gatos Orthopedic Sports Therapy, can gauge the trend just by walking around his office. His older patients have asked him, in essence: What are all these little kids doing here?

Nakaji laments that most of the injuries are preventable because they stem from overuse. He’s always taken aback by parents who push too hard too early, prompting him to recall one of his favorite quotes: “There’s really no Hall of Fame for youth coaches.”

“I always find it strange when a dad comes in and says, ‘We have this tournament this weekend, and the team really needs him. Is he going to be ready?’ ” Nakaji said. “It’s really not a smart move to push a youth athlete the way you would a professional athlete. But I think sometimes the mindset of the parents is to think of it that way.”

DeMers is an increasingly rare example of restraint. The 6-foot-2, 215-pound right-hander is the ace for the College Park team ranked No. 1 in the nation by Baseball America.

DeMers credits his caretaking to longtime personal pitching coach, Angel Borrelli, a Pleasant Hill, Calif., kinesiologist who has little patience for conventional baseball wisdom.

Borrelli first made her way as an Olympic weightlifting coach before transferring her knowledge of body mechanics to the throwing motion. Like others interviewed for this story, she recoiled at the sloppy mechanics and heavy workload common in youth leagues.

“Kids are injuring themselves, and they don’t know it,” she said. “The take-home message is that the body is pretty resilient, so it can put up with doing things wrong for a while. But there is a breaking point.”

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Arms are already ailing this spring, with some of the game’s brightest major league stars and prospects expected to be sidelined the 12 to 18 months it takes for recovery. Aces such as Yu Darvish and Zach Wheeler surrendered to Tommy John surgery right out of the gate.

In the college ranks, promising Stanford right-hander Cal Quantrill had Tommy John surgery earlier this month. The son of longtime big leaguer Paul Quantrill will be out for this season and perhaps beyond, clouding his status as a potential No. 1 overall pick in the 2016 draft.

Conte, the Dodgers head trainer and a leading voice on baseball injuries, prefers the word “uptrend” over epidemic. He noted that part of the reason for the statistical jump in Tommy John surgeries can be traced to a relatively recent breakthrough: do-overs.

More and more pitchers are having the procedure for a second time, and these so-called “revisions” account for much of the spike.

From 1996-2011 there were a total of 22 Tommy John revisions, an average of 1.3 a year.

Last year, there were 10.

“That’s a little bit of a shocker, to be honest with you,” said Steve Ontiveros, the first player to pitch in the majors after two Tommy John surgeries. “That’s a big deal.”

Ontiveros led the American League with a 2.65 ERA while with the A’s in 1994 and made the All-Star team with Oakland the next season. These days, he runs the Spin Doctor pitching academy in Scottsdale, Arizona. Predictably, his focus is on long-term health — and proper rest — for his young players.

“To me, that’s the biggest common denominator when it comes to injuries,” he said. “I’ve been running the academy for 12 years now. And the biggest thing that I’m seeing is overuse. By far the No. 1 reason for injury.”

At the major league level, however, some stars from a bygone era wonder if baseball isn’t looking at the problem upside down. Former A’s ace Vida Blue said the problem isn’t that pitchers throw too much. He threw 312 innings and 24 complete games as a 21-year-old in 1971.

“Well, they didn’t have a lot of money invested in me, so they allowed me to,” said Blue, now 65. “They didn’t care. Had I hurt myself, it would have been, ‘Oh, that’s just Vida. Roll his butt out of there and bring in so-and-so.’

“Today, obviously, you’ve got to protect your investment. I understand that part. But I think they’ve gone too far. You have to let them throw. Now, they’re watching them like bird dogs. ‘Oh, it’s 100 pitches! Get him out!’ Come on, man.”

Dave Stewart, 58, another former A’s ironman, recalled coming up through the Dodgers organization when racking up innings was the ticket to the majors. Stewart pitched 856 innings in the minors, including 37 complete games, before sticking in the bigs.

“Coming through the Dodgers organization as a young guy, it was: 800 innings before you got to the big leagues,” said Stewart, now a rookie general manager with the Diamondbacks. “That theory is gone now. I think that guys aren’t throwing enough. Too much attention paid to weightlifting, not enough to throwing a baseball.”

Bert Blyleven, like Stewart, brought up weightlifting as a concern. The Hall of Fame right-hander threw 325 innings in 1973 (at age 22!) and later led the league in innings pitched in 1985 (293.2) and 1986 (271.2).

” ‘Elasticity.’ That was very important to my pitching. I wanted to be loose,” Blyleven, now 63, said. “And when you lift weights, you’re muscles contract. And when you throw a baseball, it’s the complete opposite. That rubber band is breaking a lot more often.”

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Then again, radar guns suggest that baseball arms are stronger and better than ever. Improved training methods help explain how the average major league fastball reached a new high last year, at 91.4 mph. Writer Ross Newhan, in a piece for Lindy’s Baseball Preview, noted that there were 15,969 pitches of at least 97 mph in 2014.

Tommy John success stories are helping fuel the heat. New York Mets ace Matt Harvey appears to be the latest back on the fast track, hitting 99 mph this spring in his first game since Aug. 24, 2013. “Things felt so good that the fact that I did have surgery is completely out of my mind,” he said.

Harvey would follow in the recovery footsteps of pitchers such as John Smoltz, a patient in 2000 who will be inducted into the Hall of Fame this summer; Chris Carpenter, who finished second in Cy Young Award balloting two years after elbow surgery; Stephen Strasburg, who led the National League in strikeouts last year after undergoing the operation in 2011.

But it’s not always such a smooth ride, according to a study by Eric C. Makhni, published last spring in the American Journal of Sports Medicine. Of the 147 major league pitchers examined in that study, 80 percent returned to pitch in at least one game. But only 67 percent of established pitchers returned to the same level of competition postoperatively, and 57 percent returned to the disabled list because of injuries to the throwing arm.

Candiotti counts himself among the lucky ones. After his pioneering Tommy John surgery, he had to reinvent himself as a knuckleball pitcher, but he lasted 16 years in the major leagues.

After all of them, he got a Christmas card from Jobe. Candiotti recalled with a laugh that the cards were always addressed the same way:

“To my prospect.”