A day with Dr. James Andrews

ASMI and Dr. James Andrews: A must read for all parents who want the best for their son

By: David List-February 4, 2008 

This article is written as a summary of a recent youth injury seminar, which boasted the biggest name in all of sports medicine, Dr. James Andrews of Birmingham, Alabama. Please understand that the information in this article is to the best knowledge of the doctors that spoke, some of which has scientific data to prove it and some are opinions on things they have yet to study.   

I attended the Youth Injury Seminar this past Saturday in hopes of being able to pass on information to all you athletes and parents out there. At times I am very skeptical of others opinions about baseball and injuries but I have had a surgery (Tommy John) by Dr. Andrews and I haven’t met a better doctor (intelligence and bed-side manner) than he either. First, to those of you who don’t know of Dr. Andrews, I will try to give him some credibility right now.   

Dr. Andrews and Dr. Frank Jobe were the first doctors in the country to perform the “Tommy John” surgery and they both pioneered many different procedures that have allowed professional players and the general population, to be able to function after an injury. I couldn’t even begin to tell you how many different professional athletes have had surgery done by Dr. Andrews, but I do know that his hospital is littered with posters and pictures of many famous professional athletes thanking him for getting them back into their sport. 

The main focus of the youth injury seminar was to inform as many parents/coaches about the vast increase of injuries among youth baseball players and to give scientific advice about why this is happening. Below I will list some things that they were able to prove about why injuries occur and what leads to injury most often. 


  1. Fatigue- Research shows that the greatest factor involved in injury is fatigue.  The study they did showed that fatigue raises risk by 3,600 percent or 36 times greater. Advice was not to play on two teams at one time.
  2. Greater than eight months of competitive throwing per year raised injury rates by more than 500 percent or five times.
  3. Throwing more than 80 pitches in a game raised injury rates by 380 percent or 3.8 times greater risk.
  4. The study also showed that players that threw harder than 80 MPH were more than twice as likely to develop injuries verses those who don’t. Two factors were involved with this: overuse and higher stress on the elbow and shoulder.
  5. 76 percent of “Tommy John” surgeries were successful in that the patient was able to go back to competitive throwing within 11 to 15 months. 
  6. 50 percent of high school age pitchers who had “Tommy John” surgery went on to play baseball in college.

The most interesting piece of the seminar was the latest research on the curveball and when is the right time (age-wise) for it to be thrown. From 1988 to 2005 it was advised that a pitcher should wait until they were shaving before they started throwing curveballs. The latest technology has allowed for extensive testing of college and little league pitchers. The findings contradicted what was thought before. The “Tommy John” ligament in the elbow, called the Ulnar Collateral ligament, was found to have less stress on it when a curveball was thrown than when a fastball was thrown. They also survey hundreds of healthy pitchers verses unhealthy pitchers about when they started throwing the curveball and the data showed that they all started throwing it at nearly the same time. So age and the curveball were not considered factors in the reason for injury. What they did find was a direct correlation between injury cause by fatigue, overuse and poor mechanics. Dr. Andrews still recommends that all pitchers wait to throw the curveball until they shave and was very adamant about it. 

One of the most interesting things that Dr. Andrews showed us was that when an injury to the ulnar ligament occurs, it usually occurred between four and five years previous to the actual tear.  

He showed an MRI and X-ray of a 15-year old arm who had a tear. He pointed out that probably when he was 10 years old, a bone chipped in his arm from overuse and lodged in the ulnar ligament. Over the next five years it didn’t cause pain, but made the ligament weak where the bone chip was lodged. Eventually, as the boy grew and threw harder, it weakened enough and tore or caused other problems in the elbow area. Although I was skeptical of this, I thought  back to the time I spent with Dr. Andrews. On the day after my surgery, he came in and told me that I had torn the ligament earlier in life. He asked me specifically if I remembered doing it. My response was “yes”. It actually had happened four years earlier and scare tissue had healed me.   

The panel didn’t claim to have all the answers, nor have they studied even 10 percent of what they would like to. ASMI guidelines for number of pitches and days rest were adopted by Little League Baseball last year. To view those recommendations you can visit –http://www.littleleague.org/media/pitch_count_08-25-06.asp 

Those pitching recommendations produced a reduction of teams with injured arms by 46% from the year previous. They have also added a pitch count category for 7-8 year olds for the 2008 season. Click here to see some of the same presentations that I saw in Columbia this past weekend.     http://www.littleleague.org/pitchcount/pitchpresentation.htm