Is growing up in South bad for young pitchers?

Studies indicate that pitchers from the South are more likely to need Tommy John surgery. Staff/File

It’s no surprise to anyone who has lived in Charleston for even a short period of time why so many people want to move here. The great restaurants, the friendly people and the warm weather make it a desirable place to live and raise children. Can growing up here, or anywhere in the South, actually be detrimental to a young pitcher?

Recent studies suggest that pitching in warmer climates might actually increase a pitcher’s risk of suffering an ulnar collateral ligament (UCL) injury that will one day require Tommy John surgery.

Dr. Brandon J. Erickson and other researchers in Chicago identified the states in which every Major League Baseball player after 1974 played high school baseball. They determined the high school state for every MLB pitcher who had ever undergone Tommy John surgery as well. Then they separated the players into those who played high school baseball above or below the 33rd parallel. These states had average daily temperatures above freezing in January.

The areas considered to be warm-weather areas were South Carolina, Georgia, Florida, Alabama, Mississippi, Louisiana, Texas, New Mexico, Arizona, California as well as Puerto Rico, the Dominican Republic and other Central American countries.

While 64.5 percent of all the MLB players since 1974 played high school baseball in cold-weather areas, over 56 percent of the pitchers who had undergone Tommy John surgery grew up in warm-weather areas. Not only did a significantly higher proportion of the surgically reconstructed pitchers come from warm-weather areas, but also they underwent surgery at younger ages and fewer years into their major league careers than did the cold-weather players.

Researchers from the University of Florida will present a study this month at the American Medical Society for Sports Medicine’s annual meeting that shows a similar trend. They found that high school pitchers who play in Southern states are 6.2 percent more likely to tear the UCL in their elbows than Northern high school pitchers. College pitchers at schools in the South have a 5.5 percent higher risk than their Northern counterparts.

In fact, the Florida researchers found that of all the Tommy John surgeries performed on pitchers in the SEC and Big Ten conferences in recent years, 40 pitchers in the SEC had Tommy John surgery compared to only 18 in the Big Ten.

It might not just be a higher risk of blowing out an elbow, though. Pitchers from Northern states might be more likely to make it to the major leagues in general.

Glenn S. Fleisig and James R. Andrews studied all players on major league rosters at the end of the 2010 season. Sixty-three percent of the hitters originally came from warm-weather climates. Only 56 percent of the major league pitchers came from those warmer areas.

When asked by Grantland’s Jonah Keri about the risks for Tommy John injuries, Dr. Fleisig suggested that overuse from pitching for years in the South could play a role.

“So there’s an interesting study: More of the successful, Hall of Fame–type pitchers come from up North,” Fleisig told Keri. “And more of the hitters come from everywhere — a lot of them are from the South. And yes, if I’m a team, and I could draft a pitcher who pitched year-round, I’d be very hesitant.”

Obviously it isn’t the warmer weather itself that is harmful to a younger pitcher. It is what those warmer temperatures allow him to do that is risky.

We are finding more evidence that UCL injuries of the elbow result from wear and tear over a long period of time. The cumulative amount of pitching — not just over one game or one season but over many years — takes a toll on the pitcher’s elbow. Pitching year round from an early age increases that cumulative toll faster than only pitching seven or eight months a year, leading to more Tommy John surgeries at earlier ages.

The first group of pitchers who threw year-round is just now entering the major leagues, and they seem to be arriving with damage already done to their arms. Keri notes that more MLB pitchers underwent Tommy John surgery in 2014 than did pitchers in all of the 1990s.

Young pitchers need to take three to four consecutive months off from pitching every year. They can play other sports, but they need to give up pitching for another travel team for those months. They should definitely skip the showcase events held in the offseason too.

Just because they can pitch all year with our warmer weather doesn’t mean they should. More is not always better.

Dr. David Geier is an orthopaedic surgeon in Charleston. For more information about baseball injuries and other sports medicine topics, go to his blog at