Introduction
Baseball injuries, particularly UCL (Ulnar Collateral Ligament) tears requiring Tommy John surgery, have reached epidemic proportions in youth and professional baseball. In this comprehensive guide, we dive deep into the insights shared by Dr. Joshua Dines, a renowned orthopedic surgeon at Hospital for Special Surgery (HSS), who has worked with elite athletes including the New York Mets, Rangers, and US Davis Cup tennis team.
Meet Dr. Joshua Dines
Dr. Joshua Dines is an orthopedic surgeon at Hospital for Special Surgery, where he completed his residency before pursuing a fellowship in Los Angeles focusing on sports medicine. His impressive career includes:
- Former team physician for the New York Mets (decade-long tenure)
- Medical work with the LA Dodgers and Lakers
- Current medical director for Major League Pickleball
- Team physician for the New York Rangers
- Doctor for the US Davis Cup tennis team
Following in his father’s footsteps (also an orthopedic surgeon and former Mets physician), Dr. Dines brings both legacy expertise and cutting-edge knowledge to sports injury treatment.
The Tommy John Surgery Epidemic: Alarming Statistics in Professional Baseball
One of the most striking revelations from my conversation with Dr. Dines is that 25% of professional pitchers have undergone Tommy John surgery. While this might sound like an exaggeration, the statistics are sobering and reflect a growing crisis in baseball.
Why Are UCL Injuries So Common?
Dr. Dines identifies several key factors contributing to the UCL injury epidemic:
1. Year-Round Playing
Modern athletes, unlike previous generations, play baseball 12 months a year. Dr. Dines uses the analogy of tire treads: “The more you drive, the faster you drive, they’re going to wear out. So we see that with the ligament.”
2. Velocity Obsession
The emphasis on radar gun readings has dramatically increased. Where 86 mph was once acceptable, today’s pitchers need to throw 93-95 mph to get noticed. This represents a significant increase in stress on the UCL.
3. Early Specialization
Unlike previous generations who played multiple sports seasonally, today’s young athletes specialize early, missing the protective benefits of varied athletic development.
Prevention Strategies: What Can Be Done?
Dr. Dines acknowledges the difficulty in reversing current trends, noting the financial incentives and competitive pressures that drive year-round specialization. However, he offers several prevention strategies:
Technology and Monitoring
- Wearable technology to monitor throwing stress
- Pitch count limitations and better monitoring systems
- Early identification of at-risk players
Proper Training Focus
- Core strength development
- Shoulder range of motion maintenance
- Lower extremity strengthening
- Proper throwing mechanics
Dr. Dines emphasizes that throwing is a full-body activity, not just an arm motion, making comprehensive strength and mobility crucial.
Treatment Options: Beyond Traditional Tommy John Surgery
UCL Reconstruction (Traditional Tommy John Surgery)
- Recovery time: 12+ months for high school and college athletes
- Success rate: Approximately 85%
- Process: Uses a tendon graft to create a new ligament
UCL Repair: A Promising Alternative
Dr. Dines is particularly excited about UCL repair, which offers several advantages:
- Faster recovery: 6-8 months vs. 12+ months
- Better for younger athletes with acute tears
- Preserves original tissue when possible
- Enhanced with internal brace technology
The key is proper patient selection. Younger athletes with acute tears and good ligament quality are often ideal candidates for repair rather than reconstruction.
The Growth Factor Challenge
Why Recovery Can’t Be Rushed
Dr. Dines explains the biological reality that many parents and athletes struggle to accept: “We can’t speed up what’s happening on the inside, that ligamentization process where your body’s turning that [graft] into a new ligament.”
The Adrian Peterson Myth
When patients reference NFL star Adrian Peterson’s rapid ACL recovery, Dr. Dines provides perspective: “Are you really comparing yourself to one of the freak athletes of all time?”
The data shows that even professional athletes don’t return to pre-injury performance levels until year two post-surgery.
Red Flags: When Parents Go Too Far
The Elective Surgery Myth
Perhaps the most concerning trend Dr. Dines encounters is parents requesting elective Tommy John surgery for their children, believing it will make them throw harder. This dangerous misconception stems from misunderstanding why some athletes throw harder post-surgery.
The reality: Post-surgery velocity improvements come from:
- Improved mechanics developed during recovery
- Enhanced core and shoulder strength
- Better overall conditioning
- Return to pre-injury velocity (many athletes gradually lose velocity before the tear)
The Showcase Pressure
Dr. Dines frequently encounters parents who resist rest recommendations because of upcoming showcases, even for 13-year-old athletes. His response: “They’re 13 years old, let’s land the plane. It’s not that important.”
ACL Injuries: Parallels in Prevention and Treatment
Similar Patterns, Different Sport
Dr. Dines notes striking parallels between UCL injuries in baseball and ACL injuries in sports like soccer and basketball:
- Early specialization increases risk
- Proper training programs can significantly reduce injury rates
- Rushing return increases re-injury risk
- Comprehensive rehabilitation is crucial for success
The 10-Month Rule
For ACL injuries, returning before 10 months increases re-injury risk seven-fold. This emphasizes the importance of patience in recovery timelines.
Insurance Challenges in Sports Medicine
The Coverage Gap
Both Dr. Dines and physical therapists face ongoing challenges with insurance companies that fail to recognize the extended rehabilitation needs of young athletes. Insurance companies often:
- Authorize limited visits (6 at a time)
- Cut coverage prematurely (after 3 months)
- Apply adult standards to pediatric athletes
This creates financial burdens for families and potentially compromises recovery outcomes.
Finding the Right Healthcare Team
Choosing a Physical Therapist
Dr. Dines emphasizes that “a bad therapist could ruin a good surgery.” Key factors to consider:
- Specialization in sports medicine
- Experience with similar athletes
- Good communication with surgeons
- Appropriate athlete-focused environment
- Individualized attention vs. “factory” approach
The HSS Advantage
Hospital for Special Surgery’s reputation spans 150 years as a global leader in orthopedic care. Dr. Dines notes that HSS has expanded access through satellite locations:
- Paramus, New Jersey
- Stamford, Connecticut
- White Plains, New York
- Uniondale, Long Island
Technology and Future Directions
Emerging Technologies
- Internal brace systems for enhanced repairs
- Advanced imaging for better diagnosis
- Biomechanical analysis for injury prevention
- Wearable sensors for real-time monitoring
The BEAR Technique
For ACL injuries, the Bridge-Enhanced ACL Repair (BEAR) technique represents another potential advancement, though Dr. Dines emphasizes the need for more research to prove superiority over current methods.
Key Takeaways for Parents and Athletes
When asked what message he’d put on a billboard for everyone to see, Dr. Dines emphasized: “Listen to your body” and “Don’t play through pain.” He also stressed the importance of perspective: “There’s no such thing as an elite eight-year-old baseball player.”
Essential Prevention Principles
- Avoid year-round specialization in young athletes
- Prioritize proper mechanics over velocity
- Develop total-body strength and mobility
- Listen to pain signals and rest when needed
- Focus on fun rather than elite performance at young ages
The Role of Physical Therapy in Recovery
Beyond Basic Rehabilitation
Successful UCL and ACL recovery requires comprehensive physical therapy that addresses:
- Kinetic chain dysfunction
- Sport-specific movement patterns
- Psychological readiness for return
- Injury prevention strategies
- Performance optimization
The Chef and Waiter Analogy
The arm is merely the “waiter” delivering the ball, while the core, hips, and lower body are the “chef” generating the power. Effective rehabilitation must address the entire kinetic chain.
Conclusion: A Balanced Approach to Youth Sports
Dr. Dines’ insights reveal a sports medicine landscape challenged by cultural shifts toward early specialization and velocity obsession. However, with proper education, prevention strategies, and when necessary, advanced surgical techniques, we can help young athletes enjoy longer, healthier careers.
The key is finding balance between competitive excellence and long-term health, always prioritizing the athlete’s well-being over short-term performance gains.
Listen to the Full Podcast
Want to hear the complete conversation with Dr. Joshua Dines? Listen to the full episode of the Myokinetix Podcast for additional insights on sports medicine, injury prevention, and recovery strategies.
Not Injured Yet? Let’s Keep It That Way.
If you’re a pitcher or overhead athlete worried about elbow strain or shoulder tightness, now is the time to act. Our team can identify small movement imbalances before they turn into major injuries—and keep you strong and pain-free all season long.
Ready to Take the Next Step in Your Recovery or Injury Prevention?
Whether you’re recovering from Tommy John surgery, dealing with elbow pain, or looking to prevent a serious UCL injury, we at Myokinetix Physical Therapy & Performance is here to help.
We specialize in helping baseball athletes—from youth players to college stars to professionals—recover fully and return to peak performance. We work directly with top orthopedic surgeons like Dr. Joshua Dines of Hospital for Special Surgery (HSS) to build results-driven rehab and performance programs tailored to your specific needs.
Why Choose Myokinetix?
- ✅ 1-on-1 expert sports physical therapy sessions—no crowded clinics or cookie-cutter programs
- ✅ UCL-specific return-to-throw protocols designed to restore full function, confidence, and velocity
- ✅ Cutting-edge treatments: Blood Flow Restriction (BFR), manual therapy, biomechanics analysis
- ✅ Clear communication with your surgeon and coaching staff
- ✅ Focused on both short-term recovery and long-term injury prevention
Book a free 15-minute discovery call with our team now to ask questions, get clarity, and start building your personalized plan.
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(No pressure. Just honest answers from experts who care.)