Major League Baseball pitcher Shane Bieber entered his seventh season with the Cleveland Guardians with his eyes set on a bounce back season. After winning the American League Cy Young in 2020 with a 1.63 ERA, the 28-year-old right-hander has struggled, posting a 3.80 ERA in 128 innings last season. His redemption tour lasted just two starts however, after he ruptured a tendon in his elbow, causing him to have to undergo Tommy John surgery and miss the remainder of the 2024 season. Bieber joins a long list of players who have suffered the same fate.
Ever since Tommy John, a former MLB pitcher, got the surgery to reconstruct the ulnar collateral ligament (UCL) in his elbow on Sept. 25 1974, the surgery has become a more common practice, especially with pitchers. This is due to the constant strain on the arm, as kids are taught at a young age to throw year round so they can build up their velocity.
“The human body can only take so much stress, not to add the fact that the pitching motion is an unnatural motion,” Richard McLain, a retired administrative director at Brick Hospital said. “Kids start throwing at a young age and it starts the clock on their ligaments in the arm.”
A large part of the constant stress on the elbow is from the player’s throwing mechanics. Chris O’Leary, a pitching instructor and hitting coach for MLB clients, equates this “injury epidemic” to one thing - which he calls the Tommy John Twist.
“Tommy John Twist refers to the twist you see in the wrists of many baseball pitchers that is usually the result of having been taught to point the ball at second base or center field,” Leary said on his website. “The pitching arm fails to achieve sufficient external rotation by the time it starts to rotate and comes under load.”
After reviewing the data collected by Joe Roegele, it was apparent that there is a pitching epidemic in baseball, which may or may not be caused due to this "Tommy John Twist" theory.
Out of the 2,428 players that have received the surgery, just over 91 percent of them are pitchers. Outfielders are the second most common position at just under three percent, followed by catchers at 2.3 percent. Just a tick over one percent of shortstops receive Tommy John, while the remainder of the positions fall under one percent.
“I think we’re just seeing a more common trend of people wanting to throw hard but not accurately,” Joe Agnello, director of BlueClaws Baseball Academy said. “I coach a wide range of kids and everyone is always trying to throw their arm out to impress people. They don’t care about accuracy anymore, all that matters is the number on the radar gun.”
The average recovery for each player ranges due to the differences in each player’s body. Bryce Harper, the Philadelphia Phillies right fielder at the time, rejoined the lineup in just five months, although in the designated hitter role and didn’t return to the field until two months later, as a first baseman.
First baseman have the quickest return time out of any positions, taking just eight and a half months to rejoin their team. On the other hand, pitchers take the longest to get back on the mound, with the average recovery time taking roughly 18 months. Catchers and designated hitters are just behind, with roughly 13 months of recovery time on average.
Major League Baseball saw the highest number of players go down out of any of the professional levels. Even before they reach the professional level, players are opting to get the surgery because of the focus on velocity, as 414 college students and 195 high school students have been reported to get the surgery.
“I had a kid come in. And his parents said, ‘Hey, can you fix little Johnny’s arm?’ and I asked them ‘When did he hurt it?’ And they said, ‘Well, he didn’t hurt it. We just heard that Tommy John surgery can make them throw faster,’” Dr. Wiemi Douoguih told the Palm Beach Post.
The Texas Rangers (109) and Los Angeles Dodgers (105) are the only two teams who have had over 100 players within their organization (MLB to drafted players) undergo the surgery. The Colorado Rockies rank dead-last with just 55 players falling victim to the surgery, while the Arizona Diamondbacks are right above them with 57 players.
Sometimes, one Tommy John surgery isn’t enough to preserve a player’s arm throughout their career. Some players need to get the surgery twice. Guys like Cole Ragans, Spencer Strider, and Jacob deGrom have undergone some form of surgery twice, whether it be the main operation, an internal brace, or a platelet-rich plasma (PRP) shot. Just over 64 percent of players who get the surgery twice do get back to whatever level they were at before the second operation. On the other hand, just about 22 percent fail to reach that goal.