Tommy John & Pitch Counts

This year, eighteen pitchers have undergone Tommy John surgery in the MLB (last I checked) and we are not even half way though the season. There is tons of speculation about why we are seeing such a rise in ulnar collateral ligament (UCL) injuries and I don’t think it is ever easy to boil any injury down to one single factor. Even when you think you have everything figured out and have crossed your “T’s” and dotted your “I’s” injuries can creep up because of factors that you might not be aware of or factors that are outside of your control.

That being said, one of my good friends works in major league baseball as a manual therapist and strength coach and during a conversation one day he mentioned that it would be interesting to know how many pitches Jose Fernandez (the second year phenom pitcher for the Florida Marlins who pitched in 8 games this year before undergoing Tommy John Surgery and will miss the remainder of the season) threw in those eight games. Again, hard to pin-point injury to one single factor and just having something like pitch count doesn’t provide you with enough information to really understand the whole situation (although famed orthopedic surgeon, Dr. James Andrews, does feel that throwing too much and overuse may be one potential factor in UCL injury). However, I thought it would be interesting to look at so here are some of the things I quickly found after looking at a few websites and getting pitching statistics.

During Jose’s 2013 season (his rookie year) he:

  • Threw 2604 total pitches over 28 starts
  • Averaged 93 pitches per game

During the first 8 games of the 2013 season he:

  • Threw 665 total pitches
  • Averaged 83 pitches per game

During Jose’s 8 games in 2014 he:

  • Threw 770 total pitches (105 more during the first 8 games of this season than the 2013 season)
  • Averaged 96.25 pitches per game (averaged 13 more pitches per game over the first 8 games than the 2013 season)

Graphically, this is what Jose’s 2013 season looked like:

Screen Shot 2014-06-02 at 7.08.44 AM

You can see that over the first 11 games the teamed seemed to take it a bit easier on the rookie and ease him into the swing of things (there may be reasons for this – again, tough to know with just pitch count information) – before really pushing it the rest of the way.

In comparison, here is what the first eight games of the 2013 and 2014 seasons looked like together:

Screen Shot 2014-06-02 at 7.12.59 AM

I don’t know that there is a big take away here other than it is interesting to look at the way Jose was managed from his rookie year to his second year in terms of pitch count. There was a considerable jump in the first 8 games of the 2014 season compared to the 2013 season and the second half of the 2013 season. It would be great to have more information – daily readiness information, fitness information, how much throwing he does/did between starts, how much he did in spring training, etc, on-and-on.

Perhaps one factor (of many) that plays a role in UCL injury is the management of pitchers in terms of how much they throw or how it is determined that they are fit enough to go out and throw a certain amount or tolerate greater volumes of throwing? I’m sure the picture is much larger than this though.


4 thoughts on “Tommy John & Pitch Counts

  1. Shane Hayes - Sports Physiotherapist

    Are we sure it’s actually increased injuries?

    In Australia we had almost NO FAI’s, now that surgeons discovered such, there is so many in our pro footballers, and so many are having surgery. Now ok if they had groin and hip pain, or not, but no one seemed to have issues with them before. Is it just surgeons can now diagnosis and make money off operating on it? How many have FAI but thats just a genetic difference, or non-symptomatic issues? The same with spines, and after the invention of MRI’s that discovered everyone had these so-called ‘degenerative’ discs, but never had any issues or pain from this, but now apparently they do. It’s often just a “overdiagnosis”, or clinican’s ‘searching’ for issues that need fixing. But often there is no issue, it’s normal to have changes, especially with sport. Doesn’t mean that it’s bad or that it’s some issue. Just my opinions.

    1. Patrick Post author


      I agree. I don’t think that it actually increased injuries. I think we don’t know enough to truly say that (as I mentioned in the article). Mainly I was using the article as a way to begin the discussion around how we manage athletes.

      I agree with you about doctors increased diagnosis. I believe that many of these injuries (tommy john, FAI, etc) are a bigger story because of how much diagnosis and medical intervention there now is.


  2. Thomas Lam

    Hey Patrick,
    Interesting analysis. As you mentioned, there are certainly more metrics / items to consider that ultimately led to the UCL to become symptomatic, followed by the subsequent Tommy John Surgery. I’d be interested to learn, what biomechanics considerations you would find valuable to investigate. There has been some work from A.Robb and Sue Falsone regarding the impact of lead leg hip ROM (although how they measure HIP IR/ER passively in the supine position (“log roll method”) is controversial. Thoughts??? I certainly have my ideas that I would love to share….but i figure it’s best to ask first :)…

    Chat soon and thanks for the analysis and the continued great work.


    1. Patrick Post author


      I wasn’t specifically thinking just biomechanics, although I do think lead hip IR ROM, t-spine rotation, etc, might be a good start. It is hard to say what is “right” pitching biomechanics and what is “wrong” given each person seems to have a unique throwing style. I was thinking more along the lines of understanding basic things such as the initial fitness of the athlete coming into training camp and then measures of training/competition load through out the season to understand how the athlete is tolerating the stress of the game.



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