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Throwing Heat? Tear UCL? We’ve Got A Patch for That

Updated: Oct 1, 2018

Some of us here at Anatomy in Clay® Learning System love baseball. And, of course, baseball gets us thinking human anatomy.

When was the last time you thought about what pitchers can do? More precisely, throwing a ball at speeds up to 100 miles per hour.

That is a very fast pitch. At that speed, a hitter has about .4 seconds to decide whether to swing and that includes the .15 seconds (or so) that the batter needs to get the bat around and into the hitting zone.

Hitting is hard. If you are a really, really good hitter you will FAIL seven times out of ten. If you fail only seven times out of ten, in other words, you might be Hall of Fame material.

Let’s go back to the pitcher. Think of that arm and what it’s going through. Much of the speed of the ball begins with the twist and torque of the abdomen, plus a strong push with one leg off the mound, but that arm is under a ton of stress, too. Thus the large ice bags at game’s end!

All that energy from the twisting torso and the hips and legs is transferred to the arm thanks to the shoulder, right? Think of all the motions your arm can make thanks to flexibility of that joint. If you’ve ever built the rotator cuff and the entire shoulder complex using the Anatomy in Clay® Learning System you know this a highly complex area of the body and that’s because the joint is so dynamic and has such a wide range of motion.

We’re here today to talk about the elbow, but wait! Before we get there, take a moment to appreciate the humerus. There’s a slight twist in the humerus bone and scientists say that twist in the humerus appeared for the first time about 1.8 million years ago. Fossil analysis told this story. The evolutionary change in the bone was about the time when there was evidence that humans were starting to throw spears to hunt. Much better to kill your food from a distance, right, rather than deal with all those angry claws and teeth? The humerus evolved, and incorporated that throwing motion.

Bottom line? No spear throwing back then, probably no baseball today. (Lucky us.)

Anyway, we’re thinking about the next joint down on the arm, the elbow.

Today, one out of every four pitchers on the mound has had their elbow repaired through Tommy John surgery, named after the first pitcher who had this specific surgical repair to fix a torn ulnar collateral ligament. Today, 25 percent of all pitchers in the major leagues have had this surgery.

One out of four!

The surgery involves harvesting a tendon from elsewhere in the body—the hamstring, the forearm, or a big toe. The tendon is then grafted into the elbow and asked to perform a new job.

And here’s where ligamentization comes in. In this process, the tendon cells called tenocytes modify their function and how they secrete regenerative protein collagen. It takes about two years for the tendon to change its entire form, but pitchers who have Tommy John surgery are often back competing in about 12 months, before that transformation is complete.

But, go figure—the tendon knows it’s being asked to take on a new function.

We learned a lot of this reading a great book called The Arm, Inside the Billion-Dollar Mystery of the Most Valuable Commodity in Sports by Jeff Passan.

Studies conflict a bit as to whether the athlete can perform as well as before the surgery, but many pitchers have returned to the mound and continued to pitch for years and years.

Whether it’s ethical to allow Tommy John surgeries and at the same time ban performance-enhancing drugs (a topic that Matthew Gladwell and many others have raised), we will stay out of that lively debate and just marvel at human anatomy and the doctors who know how to move the parts around.


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