Gerrit Cole, Shane Bieber, Corbin Burnes, Clarke Schmidt, Walker Buehler, Tony Gonsolin. What do all of these notable pitchers have in common? They have all undergone Tommy John surgery in recent years, along with many other pitchers across baseball. The game has undergone drastic evolution over the past few decades, and one of the most noticeable changes is the significant rise in the number of pitchers requiring Tommy John surgery.

What Is Tommy John Surgery?

Tommy John surgery is a procedure that repairs a torn ulnar collateral ligament (UCL) in the elbow. This injury is most commonly seen in baseball pitchers due to the extreme stress placed on the arm when throwing at high velocities. The UCL plays a crucial role in stabilizing the elbow during the pitching motion. When it is damaged, pitchers may experience a loss of velocity, diminished control, or pain and instability in the elbow.

During the surgery, doctors replace the damaged ligament with a tendon taken from another part of the player’s body or from a donor, creating a new, stable ligament. Recovery typically takes 12 to 18 months for pitchers and involves extensive rehabilitation before returning to competitive throwing. The procedure is named after former MLB pitcher Tommy John, who was the first player to successfully undergo the surgery and return to a long professional career.

Why Is Tommy John Surgery So Common in Pitchers Today?

Pitchers today are throwing harder than ever before. Modern baseball places a heavy emphasis on velocity and movement, with many pitchers routinely reaching the upper 90s or even triple digits. While increased velocity can provide a competitive advantage, it also places extreme stress on the UCL. The human arm has physical limits, and repeatedly pushing those limits significantly increases the likelihood of injury over time.

In addition to velocity, pitchers are trained to maximize spin rate, late movement, and sharp breaking pitches, all of which place additional strain on the elbow. As teams prioritize strikeouts and swing-and-miss results, pitchers are often pushed closer to their physical breaking point.

Player development at younger ages is another major factor. Many pitchers now begin intensive training at very early ages through travel ball and private coaching programs, often with little rest throughout the year. This constant workload can cause strain to accumulate long before players reach the professional level. By the time these pitchers make it to MLB, their elbows may already have years of wear, making them more vulnerable to serious injuries such as UCL tears.

Changes in pitching strategy have also contributed to the rise in Tommy John surgeries. Today’s teams rely more heavily on bullpens, frequently asking pitchers to throw at maximum effort for shorter outings rather than pacing themselves over longer starts. Relievers, in particular, are expected to enter games throwing as hard as possible for brief stretches, sometimes on consecutive days. While this approach can be effective in terms of performance, it places repeated stress on the arm with limited recovery time. Even with pitch counts, rest days, and advanced medical monitoring, the cumulative strain of high-intensity pitching can overwhelm the body’s natural ability to recover.

How Can the Number of Tommy John Surgeries Be Reduced?

One potential solution is improved workload management, especially for young pitchers. Limiting high-intensity innings and ensuring adequate rest can help prevent overuse injuries. Refining mechanics and improving arm conditioning are also critical, as proper throwing techniques and strength training can reduce stress on the elbow.

Changing the culture around velocity and early specialization could also make a difference. Placing a greater emphasis on overall skill development rather than pure speed may help build healthier arms. Preventative monitoring, such as biomechanical assessments and early injury detection, can also identify warning signs before they develop into serious injuries. A combination of these strategies may allow pitchers to remain healthy while still performing at a high level.

The rise in Tommy John surgeries reflects how modern baseball has pushed the limits of the human arm. While the game now rewards maximum effort and elite velocity, those gains often come with long-term physical consequences for pitchers. Until baseball finds a better balance between performance and preservation, Tommy John surgery will likely remain a common part of the modern MLB landscape.