Tommy John surgeries on the rise in high school baseball as the need for speed grows
Luke Dellentash remembers the moment it happened.
He was pitching in a game with his club team in July 2022 when he felt a strange sensation in his right throwing arm after firing a routine slider a few pitches into the third inning. A few pitches later, the pain intensified and he noticed his velocity dropped from the mid to upper 80-mile-per-hour range to about 75.
Soon after, Dellentash, then a 16-year old rising junior at Bergen Catholic High School, scheduled an MRI, which confirmed his worst fear: a complete tear to his right elbow’s ulnar collateral ligament, requiring the reconstructive surgery known in baseball circles as Tommy John surgery.
“It was tough to hear, but I had suspected something wasn’t right and wasn’t all that surprised when I got the results,” said Dellentash, now a senior. “Before the MRI appointment, I went to a nearby field with a ball and threw it as hard as I could. I wanted to test my velocity and see if the pain I experienced was just temporary, a one-time thing. I couldn’t break 73 miles per hour. I went through a wave of emotions and kept thinking ‘what’s next?' ”
He's not alone. Coaches and pitching specialists around high school baseball say they're seeing more UCL tears and young athletes needing Tommy John surgery. It's on the rise in the major leagues, too.
“We’re definitely seeing a rise in arm injuries over the years, everywhere from the youth and high school level all the way up to the pro level. It’s an issue,” said Niko Leontarakis, Director of Pitching and certified strength and conditioning coach at Rockland Peak Performance in Paramus. “There’s a number of reasons why it’s happening. It’s not one specific reason or pitch selection. There’s several contributing factors.”
Among those factors are overuse due to specialization and year-round play, excessive throwing of curveballs and breaking pitches, and a lack of strength and range-of-motion deficits.
But the biggest factor is believed to be the need for speed. As pitchers aim to increase their velocity, they put more torque and stress on their elbow.
Leontarakis, who has worked with Dellentash the last two years as well as other athletes that have had Tommy John surgery, believes focus on the fastball is one of the reasons for the rising rate of arm injuries.
“Throwing on a mound from a down slope is going to increase the torque on the elbow,” said Leontarakis, a former Division I college pitcher and MLB Draft pick. “More than ever, there’s a demand for velocity. Athletes are throwing their hardest to catch the attention of college recruiters and for other reasons. It’s important that athletes and pitchers have a plan in place and that they’re training properly year round.”
How we got here
It’s that time of the season when high school coaches and pitchers are paying close attention to pitch counts and the number of innings pitched.
With the state tournament underway, coaching staffs are carefully forecasting their rotations and confirming which arms are available to make a playoff run.
But despite all the monitoring and extensive oversight of pitchers, arm injuries are on the rise. Many are calling it an epidemic and seeking answers on how we got here and what can be done going forward.
Dr. Christopher Ahmad, a renowned orthopedic and sports medicine surgeon at Columbia University Medical Center and leading expert in Tommy John surgery who regularly works with the Yankees, performed the surgery for Dellentash and other high school pitchers in the area.
On a recent podcast titled “Tales of the Tape: Tommy John Series,” Ahmad talked about increased velocity and its correlation to arm injuries.
“Velocity, high intensity throwing, is something we can’t keep up with from an injury perspective," he said. "There’s so much emphasis on hard throwing. It used to be that year-round baseball was the issue and players would not take a break. Now, it’s the hunt for velocity with velocity-enhanced programs. During games, high intensity throwing with every throw. There’s no easy pitch anymore. These breaking pitches and off-speed pitches are being thrown with incredible intensity. And the metrics that we have available instantly to players, they’re analyzing just velocity, spin rate and ball movement. They’re optimizing their pitching in such a way and there’s so much incentive to be the best pitcher you can be that the stress on the elbow can't keep up with it.”
In order to reconstruct the UCL, the procedure takes a tendon from somewhere else in the patient's body to use as the new UCL. The procedure is named for former major leaguer Tommy John, who spent parts of eight seasons with the Yankees. The surgery was first introduced and performed by Dodgers team physician Frank Jobe in 1974, aiming to stabilize the elbow, reduce or eliminate pain and restore stability and range of motion. This fall marks the 50th anniversary of that achievement.
What's next
Dellentash underwent surgery on Aug. 30, 2022. Intense rehab followed for three months before he was able to lightly throw for the first time on Dec. 5, 2022.
“I’m so grateful for Doctor Ahmad. He guided me through the entire procedure and post-surgery. I really didn't have any worries or concerns under his care. He was so comforting and reassuring,” said Dellentash, a Westwood resident. “I never had any doubts I’d make it back.”
After missing most of his junior season, Dellentash returned to the mound on April 26, 2023, eight months following surgery. Now, two years later, he’s the Crusaders' leading pitcher this spring, having thrown 42⅓ innings with 50 strikeouts to a tune of a 2.31 ERA. He's added 20 pounds to his frame and gained four miles per hour to his fastball. He's committed to Stonehill College.
Dellentash believes his injury could be attributed to a lack of in-season weightlifting and a poor training regimen. A baseball player since an early age, he admits he would stop weight training when the season started and didn’t implement a proper arm-care routine along the way.
“Pitching and throwing is a very explosive movement and the body is not built for overhead movement like that,” Dellentash said. "I really believe if I had a lifting and weight training plan, and a guided approach going into high school, I would have been able to avoid the injury or at least cut down on the chances of it happening.
“Now I go to the gym regularly, especially after a start. Sometimes it’s the same night as I pitched, but either way, I’ll do a complete workout. It’s helped tremendously and I can feel the difference. I’m energized and feel strong the next day.”
Mike Lembo, pitching coordinator at Total Arm Care in Wharton and a Kinnelon High School assistant baseball coach, says athletes need to invest more time in the gym and invest in themselves.
“Everyone is throwing harder than ever. Instruction has changed as the emphasis is on velocity and it promotes kids to throw harder,” Lembo said. “There needs to be more individual monitoring, especially with pitchers, and a greater focus on weight training, nutrition and rest. Those who are physically bigger and conditioned don’t usually suffer arm injuries.”
This article originally appeared on NorthJersey.com: Tommy John surgeries on the rise in high school baseball
