If you are a baseball fan, you’ve certainly heard the name Dr. Christopher Ahmad – head team physician for the New York Yankees since 2009.
Dr. Ahmad is one of the top surgeons in the world in terms of UCL repair and his résumé speaks for itself. He’s treated 2600 college commits, performed 1033 college TJs – including 139 big league pitchers, with five of those being World Series champions.
He knows the industry as well as anyone and he sees the trends occurring before they become mainstream.
From a personal standpoint, I wish I had the opportunity to speak with him when I was younger. Looking back, just about everything I did during my pitching career flew in the face of what modern data tells us about injury prevention. Much of that was because my father was a professional bodybuilder, not a doctor or physical therapist, and didn’t have the knowledge at his disposal the way parents do now.
- I started throwing curveballs regularly by the time I was 10
- I would routinely throw over 100 pitches in a game by the age of 12.
- I would pitch in relief days after throwing a complete game.
- I threw 150 innings in 2007 as a 10th grader.
- I exclusively played baseball from the time I was in 8th grade.
Simply put, if coaches and parents paid attention to people like him speak, UCL injuries wouldn’t be so prevalent in youth baseball. While we can’t go back in time and undo any damage, perhaps the following information can help a young player avoid missing out on crucial development to an injury.
Special thanks to Dr. Ahmad for being generous with his time and the valuable information. We hope you enjoy…
What do professional organizations do to protect pitchers that youth program could realistically adopt?
Professional baseball has made enormous advances in how it monitors pitchers. Organizations now have access to biomechanics, motion analysis, strength testing, workload data, medical imaging and dedicated teams of athletic trainers, physical therapists, strength coaches and physicians.
But here’s what I think is important: you don’t need a Major League nugget to adopt some of the most valuable principles.
The first is monitoring total workload. Professional teams look beyond how many pitches a player throws during a game. They consider bullpen sessions, warm-ups, throwing intensity, recovery between appearances and changes in workload over time.
Youth organizations can do the same with something as simple asa shared throwing log.
Second, respect recovery. Young pitchers need appropriate rest between outings, gradual progression in their throwing programs, and genuine periods away from competitive pitching. MLB and USA Baseball’s Pitch Smart guidelines provide an excellent framework.
Third, develop the entire athlete. Strength, coordination, mobility, lower-body development and endurance are essential. A pitch begins with the ground, moves through the legs and trunk, and ultimately transfers tremendous force through the shoulder and elbow. We cannot focus exclusively on the arm.
And finally, create a culture where players feel comfortable reporting discomfort. A young athlete should never feel that admitting pain will cost him his position, disappoint his coach or make him appear weak.
If I could bring one professional-level practice to every youth baseball program, it would be communication.
Coaches, parents, trainers and players should understand how much an athlete is throwing, how he is recovering and whether anything has changed. Protecting a young pitcher shouldn’t require sophisticated technology. It requires informed adults working together.
When can a UCL injury be treated without surgery, and when is surgery appropriate? How does reconstruction differ from repair with an internal brace?
One of the most important messages I give young athletes and their families that a UCL injury does not automatically mean Tommy John surgery.
The treatment decision depends on several factors: the severity and location of the injury, the quality of the remaining ligament tissue, the athlete’s age, skeletal maturity, symptoms, level of competition and future goals.
Some partial UCL injuries can be successfully managed without surgery. That generally involves stopping painful throwing, addressing strength and movement deficiencies and following a structured rehabilitation and progressive return-to-throwing program.
In selected cases, additional treatments may be considered, but no injection or biological therapy should be presented as a guaranteed solution.
Surgery indications and treatment depend on position, seasonal timing, career timing, as well as prior history of injury.
Surgery becomes more appropriate when the ligament cannot provide the stability required for throwing, when an injury is structurally unlikely to heal adequately, or when a well-supervised nonsurgical program fails to restore pain-free function.
There are also important differences between the surgical procedures.
Tommy John reconstruction replaces the damaged ligament with a tendon graft, typically obtained from the patient’s own body. Most common graft is from the forearm called palmaris longus. Second most common is the hamstring from the leg.
UCL repair with internal brace augmentation is different. Instead of replacing the entire ligament, we preserve and repair suitable native ligament tissue and reinforce the replace with a strong suture-based construct.
Repair may be an excellent option for certain injuries, particularly a tear where the ligament has pulled away from its attachment and the remaining tissue is healthy. It is generally less appropriate for extensively degenerated or poor-quality ligament tissue.
For appropriately selected athletes, repair can allow a faster rehabilitation and return-to-play timeline than reconstruction. But faster is not automatically better, and the internal brace does not make the ligament indestructible.
In younger teenagers, we also have to consider injuries involving the growth plate, which may require a different treatment approach entirely.
The objective is not to select the newest procedure. It is to select the right procedure for the individual athlete.
What does the evidence say about weighted balls, maximum-effort training and breaking pitches? Where is the research still uncertain?
This is one of the most important and frequently misunderstood areas of modern baseball development.
We are living in an era where velocity is enormously valuable. Players understand that throwing harder can create opportunities. That has fueled the growth of weighted-ball programs, high-intensity training and increasingly sophisticated pitch-design systems.
There are legitimate performance benefits to some of these methods. But we have to distinguish between improving performance and improving durability. They are not necessarily the same thing.
Research has demonstrated that weighted-ball programs can increase throwing velocity. However, a 2018 study found increased velocity alongside concerning physical changes and injuries in the training group.
That doesn’t establish that every weighted-ball program is dangerous. Different programs use different ball wrights, throwing volumes, intensities and progressions. We still need stronger long-term evidence identifying which approaches are safest, particularly for developing athletes.
My concern is when these programs are introduced too aggressively, without adequate physical preparation or layered on top of an already demanding throwing schedule.
Maxiumum-effort training presents a similar challenge. Throwing at a high intensity is an important part of competitive baseball, but repeatedly asking an underprepared athlete to reach maximum velocity can increase the stress placed on the elbow.
The body needs time to adapt to the performance we’re asking it to produce.
Breaking pitches are another area where longstanding belief don’t always match the research.
Biomechanics studies have shown that curveballs do not necessarily create greater elbow torque than fastballs. In some studies, fastballs actually generated greater joint loading.
But that doesn’t mean every breaking pitch is harmless, particularly when thrown at maximum intensity or with poor mechanics.
Modern sliders, cutters and other designer pitches are increasingly thrown with exceptional velocity and intent. The relationship between pitch design, movement characteristics, individual mechanics, and long-term ligament health remains an active area of research.
For younger pitchers, I favor developing sound mechanics, fastball command and an effective changeup before aggressively pursuing sophisticated breaking pitches.
My message is not that velocity development is bad.
It’s that velocity must be earned, not rushed.
How can players distinguish ordinary muscle soreness from pain that needs evaluation?
Some muscle soreness is a normal part of training, particularly when athletes increase activity or introduce new exercises.
But throwing-related elbow pain deserves special attention.
General muscular soreness is typically diffuse, associated with muscles that have been working, and improves with appropriate recovery. It should not produce a progressive loss of throwing ability.
I’m much more concerned when an athlete experiences pain alone the inside of the elbow, sharp or localized discomfort during throwing, persistent pain after throwing, swelling, loss of motion or a noticeable change in velocity or command.
A sudden pop, significant pain or inability to continue throwing is an obvious reason to stop immediately and seek medical evaluation.
Numbness or tingling into the ring and small fingers can also indicate irritation of the ulnar nerve and should not be ignored.
But there’s another warning sign that is easy to miss: a pitcher who keeps changing how he throws because something doesn’t feel right.
Sometimes the athlete isn’t describing significant pain. He simply says his arm feels heavy, his mechanics feel different, or he cannot locate the baseball the way he normally does.
Those changes deserve attention.
For parents, the most important distinction is that soreness should improve with recovery. Pain that persists, returns when throwing resumes, or changes the way an athlete performs requires evaluation.
And I strongly discourage using pain medication simply to get a young pitcher through an outing.
A teenage should never have to prove his toughness by pitching through elbow pain.
Pain is information. Our responsibility is to listen before it becomes an injury that changes a young athlete’s future.
Are game pitch counts enough? How should families account for bullpens, warm-ups, lessons, showcases and high-intensity training?
No. Game pitch counts are essential, but they only tell part of the story.
This is a major theme in my book, Getting Cut.
There’s an entire world of throwing that never appears in a box score.
A pitcher might throw 80 pitches during a game, but he has also played catch before the game, warmed up in the bullpen, thrown between innings and potentially completed additionally throwing earlier in the week.
A reliever might earn up several times without ever entering the game.
The official pitch count may say zero. The elbow has still experienced stress.
In Getting Cut, I describe this as hidden pitching volume.
For example, a pitcher credited with 82 game pitches may actually have thrown 150 to 180 times when preparation and between-inning throwing are included. That is an illustrative workload scenario, not a universal conversion factor. The intensity of those throws also matter.
Families should maintain a simple weekly throwing record that includes games, bullpens, private lessons, showcases, high-intensity throwing sessions and rest days.
It doesn’t have to be complicated.
What matters is understanding the total pattern.
I also want parents to pay attention to sudden increases. An athlete who has been throwing relatively little should not abruptly begin pitching multiple games, attending showcasesant completion high-intensity velocity sessions in the same week.
The elbow responds to cumulative stress, not the Caterogies we use to organize a baseball schedule.
And we should distinguish between routine catch from maximum-effort throwing. Not every throw places the same demand on the ligament.
Pitch smart guidelines should remain the foundation for game limits and required rest, but additional throwing must be considered when planning training and recovery.
The ligament keeps it own ledger.
It doesn’t know which pitches counted in the game. It only experiences the forces placed upon it.
When a teenager needs Tommy John surgery, is the injury usually one sudden event or damage that developed over time?
Many familiar remember the exact pitch when the injury happened.
Sometimes the athlete feels a pop. Sometimes there is immediate pain and he cannot continue.
But in many cases, that final pitch is only the last chapter of a much longer story.
The UCL is exposed to tremendous reparative stress during pitching. Over time, that can produce microscopic tissue damage, changes in ligament structure and a reduction in the ligament’s ability to tolerate additional force.
Workload, velocity, fatigue, recovery, mechanics, physical preparation and individual anatomy can all influence that process
Then one pitch becomes the moment when the ligament can no longer tolerate the load.
That doesn’t mean every UCL tear develops gradually. Acute injuries can occur, including in athletes with previously healthy ligaments. But repetitive overload is an important mechanism in throwing-related UCL injuries.
In younger athletes, it’s also critical to recognize that the growth plate may be injured instead of the ligament itself.
One of the central messages of Getting Cut is that we should stop viewing these injuries exclusively through the lens of the final pitch.
We need to examine the months and sometimes years that preceded it.
Was there a sudden increase in throwing volume. Was the player chasing velocity? Was he pitching while fatigued? Did he have recurring soreness? Was recovery being sacrificed for another game or showcase?
Often, those questions reveal opportunities where the risk might have been reduced.
The pitch that ends the season is not necessarily the pitch that started the problem.