|Friday, September 13
Interview with Dr. Frank Jobe
By Jonah Keri
Special to ESPN.com
In 1974, Los Angeles Dodgers pitcher Tommy John showed up in the office of orthopedic surgeon Dr. Frank Jobe and his partner Dr. Robert Kerlan to seek help with his sore elbow. Jobe found John had torn his ulnar collateral ligament, a condition that had previously meant the end of a pitcher's career. But after months of consultation, two surgeries and more than a year of grueling rehab later, John returned to the mound at Dodger Stadium. John would go on to win 164 more games in his career. The surgeon became one of the noted pioneers and leaders in sports medicine.
Jobe spoke to us recently in an interview at his clinic in Los Angeles.
Baseball Prospectus: Has Tommy John surgery improved since you first did it in '74? John needed 18 months or so to come back. Is the recovery time shorter now?
Dr. Frank Jobe: The reason (John's) recovery was longer was because the ulnar nerve hadn't come back. But I don't think pitchers should come back and pitch off a mound in a game for at least one year, with tossing at four months. You've seen some people that have tried to come back at seven or eight months. They got sore and inflamed, then you have to wait a couple of months before that goes away.
The techniques have improved though. It takes about an hour now. With Tommy, it took about four.
BP: When pitchers hear it's an elbow problem instead of a shoulder, there's almost become this sense of relief, given how tough it can be to repair a shoulder. What steps are being taken to fix the shoulder?
FJ: The elbow is almost a hinge, which is a simple joint. The shoulder has four joints involved and 21 muscles. They need to all be in good condition and functioning in a synchronous pattern. It's easier to get the shoulder out of whack and it's harder to get all the joints and muscles rehabbed and back in top shape. If you're lucky enough to have a pitcher with one diagnosis in the shoulder, that's easier. But there are often three or four problems. If you beat up more than one structure, it's very hard to fully repair.
BP: There have been buzzwords for scary pitching injuries. When people heard the words "rotator cuff" in the past, for example. Now more and more it's "torn labrum." Does that qualify as the worst shoulder injury you can get?
FJ: You can fix that if that's all that's torn. But if you've gone on to tear the labrum, you've probably torn the undersurface of the rotator cuff and stretched the capsule of ligaments. That would be three diagnoses. Can you fix all that? You can fix it. But can they get back to the same level of pitching they were before is the question.
BP: Speaking of getting back to where you were before and getting back to elbows, we've heard from quite a few pitchers, swearing they throw harder after Tommy John surgery than they did before. Is this possible?
FJ: When a pitcher comes in with elbow problems, you often see that their ligaments were already wearing out well before. Maybe four or five years ago they could throw a 95 mile an hour fastball, but they've had that ability diminished as the ligament's been stretched. What the surgery does is restore the ligament's stability to where it was four or five years ago. A pitcher might say the operation did it, but it's just more stability in the arm contributing to better mechanics.
BP: Would a pitcher ever consider getting elective Tommy John surgery, just hoping to get that fastball?
FJ: It wouldn't help if you didn't have it before. All the surgery does is get you back to your normal elbow. You either have the stuff or you don't. A player that reaches the majors, he's spent years in the minors improving, making his mechanics better, with his muscles getting stronger.
One thing we did see though, after we did this on Tommy. A person who's a pitcher might come in, someone who's not in the majors. And we'll ask him: Do you really want to be a pitcher? Is this your life's goal? Because it's going to take at least a year of your life to get back.
Tom Candiotti came in many years ago -- he was about an A-ball pitcher then. And I said to him: Are you really going to be a pitcher? Do you think you're a prospect? And he said to me, yes I'm a prospect. So every year since then I've gotten a Christmas card from him, and every year it says: "To Dr. Jobe, I'll always be your prospect."
BP: With teams having such a tough time building five-man pitching rotations, what do you think about going to four-man staffs?
FJ: I like the five-man rotation. Overuse and a breakdown in mechanics -- lots of volume creates problems.
BP: What if you limited pitch counts on pitchers? They could pitch every fourth day but have the coaches make sure each pitcher doesn't throw more than a certain number of pitches per game.
FJ: Well, it would take training to do it right. Right now you have starters trained to throw maybe 110 pitches, middle relievers trained to throw maybe 60 pitches, closers trained to throw 20 pitches or so. You'd have to get starters trained to pitch more often. The way things are going with salaries and the lack of good starting pitchers though, anything's possible. Maybe not in the next year or two but it would be interesting to see.
BP: Are teams using relief pitchers the right way?
FJ: I think they are, because overuse is the biggest problem you can get with a pitcher. A starting pitcher that goes 110 pitches or so, he begins to lose his mechanics. He might start to hurt himself and probably become more hittable too. Having a few guys in the bullpen to take his place keeps him and the other guys in the bullpen fresh for next time.
BP: What about high school pitchers or younger? Would you limit their pitch counts? Or have them not throw curves possibly?
FJ: I don't think throwing the curve puts that much more stress on the arm. I think learning how to throw it does. That's why Little League kids get in trouble. They want to throw a curve so they spend every afternoon throwing to their dads, trying as hard as they can to get it. Then if they're good, the coach wants to win. If it's the playoffs, the same kid might pitch three days in a row.
BP: Is there a magic age for pitch counts? Would an 18-year-old have a different limit than someone who's 23 or 24?
FJ: When they're 18, the bones are softer, the cartilage is softer, they should definitely be limited. Once they're 21 or so, they're more fully developed. When they're younger, they can't tolerate quite the same trauma.
An example of what I'm talking about is if you look at the baseball draft, there are a high percentage of kids at 18 who have already had Tommy John procedures. This has really been in the last 10 years. It wasn't nearly that bad before. When the Dodgers are looking at a pitcher, I see their medical records; there were about five or six that had had it. There was one we drafted, it turned out he needed (Tommy John surgery) and in the record it said he didn't need it.
BP: Is there less stress for sidearm or submarine pitchers?
FJ: It's a more natural motion for the arm. Remember when baseball first started, they pitched underhand. I've only seen a few (submarine pitchers) so I can't give you a scientific opinion, but it certainly appears that way.
BP: What kind of training regimens would you like to see? What do you think of the Braves' method of having their pitchers throw more than most other teams do?
FJ: Throwing is good. Throwing really hard can be bad. Doing some kind of throwing can definitely help build arm strength. We didn't know this before Tommy -- when he'd throw, he could toss OK, but once he got to 75 percent effort, that's when stress transfers from the muscle to the ligament. Throw a lot, just not in a game.
BP: What's the next breakthrough in medical technology that might help fix pitching injuries, especially shoulder injuries? Could it be something coming out of stem cell research?
FJ: It could be stem cell research. It could also be the regrowth of cartilage in joints. As fast as the research there has been going, it might not be long before you can regrow cartilage to treat arthritic knees, elbows, shoulders. This could really help degenerative conditions in a way that can't be done as well now.
You can check out more work from the team of writers of the Baseball Prospectus at baseballprospectus.com. Jonah Keri can be reached at firstname.lastname@example.org. Baseball Prospectus is a registered trademark of Prospectus Entertainment Ventures, LLC.