VOL. 129 | NO. 134 | Friday, July 11, 2014
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Tommy John Surgery Growing More Common
By Don Wade
Envision a baseball board game with dice and a spinner in which players try to go from Little League to pitching and winning Game 7 of the World Series.
St. Louis Cardinals relief pitcher Sam Freeman in a recent game against the Philadelphia Phillies. Freeman had Tommy John surgery in 2009 before making his big-league debut three years later.
(AP Photo/Scott Kane)
Let’s call our fictional game “Bringing the Heat.” One can imagine positive squares where players learn “you just struck out 12 in a game, move ahead two spaces” or “you just had your fastball clocked at 94 MPH as a junior in high school, move ahead three spaces.”
But every so often, there is that dreaded square with the picture of a knife and two large initials: TJ. “You have to have Tommy John surgery, go back five spaces.”
Forty years ago, Los Angeles Dodgers pitcher Tommy John was the first to undergo the elbow ligament replacement surgery that today in professional baseball seems about as common as a flat-bill cap or a cough-drop box beard.
At any given time, from a fourth to a third of the pitchers on major-league rosters have had the procedure at least once; a handful, such as Texas Rangers closer Joakim Soria and Dodgers reliever Brian Wilson, have had it twice. Now retired, former St. Louis Cardinals reliever Jason Isringhausen, who pitched professionally for 20 years, had the surgery three times, according to Baseball America.
Cardinals reliever Sam Freeman, 27, had the surgery in 2009 when he was in the minors. He made his big-league debut three years later and this season had a tidy 1.50 earned run average through his first 19 appearances.
“You’re never gonna be the same as pre-surgery,” Freeman said. “So you just have to realize you’re going to be different and accept that.”
But what Freeman means isn’t necessarily what you think he means. The slim lefty is again consistently in the low- to mid-90s with his fastball. In fact, he believes he maxes out around 94-95 more often now than he did pre-surgery. It’s more that nothing feels quite like it did pre-surgery.
David Aardsma, 32, who has saved 11 games for the Memphis Redbirds this season, had Tommy John surgery in 2011; at his best, he saved 38 games with a 2.52 ERA in 2009 for Seattle.
“You have to learn how your body feels and adjust,” Aardsma said. “It doesn’t have to feel perfect. Just accept you have a new normal.”
Which doesn’t have to mean accepting mediocrity. Exhibit A: Cardinals ace Adam Wainwright, a Tommy John survivor who has been dominating this season and was 11-4 with a 1.79 ERA and two complete-game shutouts through his first 131 innings. He also missed a couple of starts when his elbow got sore but came back without incident.
In an attempt to answer whether pitchers get better or worse after the surgery – the urban myth is that the procedure is so good it’ll make any pitcher better whether he needs the surgery or not – there have been several studies. Typically, these studies have looked at pitchers who have had Tommy John in the two to three years before their surgery and then the first two to three years post-surgery.
Inside Science examined the various studies and found that the one statistical certainty is that 80 percent of MLB pitchers who have had the surgery have returned to the big leagues. Aardsma is in that group but, statistically, was not as effective in 2013 when he had a 4.31 ERA with the Mets.
The popular narrative for cause and effect leading to TJ surgery goes like this: young pitchers, all the way down to Little League, throwing too much, too soon and too hard.
“I go to my son’s game – he’s 10 years old – and guys (on the other team) are throwing curveballs already,” Redbirds manager Pop Warner said, shaking his head.
“Pitching is not really good for your body,” said Redbirds pitcher John Gast, who had the surgery in 2007 when he was in high school. “It’s not what we were designed to do.”
Which is why former Nolan Ryan teammate Steve Buechele, who now manages the Rangers’ Triple-A Round Rock club, is still awed by the Hall-of-Famer who threw seven no-hitters but, almost more amazingly given the fragility of pitchers today, also threw an estimated 240 pitches in a 13-inning game and threw more than 300 innings in a season at the age of 42.
“He was a freak, basically,” Buechele said. “No one does that.”
Nor does anyone aspire to try. But like Ryan did, today’s young pitchers want to throw hard. And organizations, whether they admit it or not, put a premium on velocity and like to see sliders and cutters with bite. Elbow ligaments will continue to be tested.
St. Louis lefthander Tyler Lyons, to this point, has not had any significant arm problems. But the specter of Tommy John surgery is always out there when there seems to be a revolving door connecting the clubhouse to the operating room.
“You see people having it year in and year out,” Lyons said. “It doesn’t seem like you can avoid it to some extent.
“It’s just a matter of who and when.”