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Want to prevent UCL tears? Maybe we should be looking at grip strength.

Updated: May 5, 2022

Ulnar collateral ligament (UCL) reconstruction or repair, also known as Tommy John surgery, is a rising issue in baseball at all levels. I wrote about UCL reconstruction and repair here, but I want to discuss some staggering statistics. In Major League Baseball, 10% of professional players had undergone UCL reconstruction surgery in 2012. That number jumped to 13% in 2018 per Leland, et al. Another study by Rothermich, et al. showed that 2.5% of Division 1 college baseball players underwent UCL reconstruction in the prior year. That equates to 0.86 surgeries per program. So, a vast majority of programs had at least one Tommy John surgery in the prior year at the Division 1 college level. These are large numbers.

Baseball has come a long way over the last few years, but these studies looked at the 2017 and 2018 seasons. All of our information on training, workload, and other metrics should be limiting injuries. Instead, we are seeing an increase in injuries. Part of that can be due to players simply getting better. Players are throwing harder at younger ages which puts stress on the arm in ways we never saw before. However, it is irresponsible to ask players to throw with less velocity, as throwing harder is a surefire way to advance your career.

We have actually seen an overall decrease in shoulder injuries over the years, but elbow injuries continue to increase. Shoulder strengthening has come a long way, and most pitchers are doing some form of shoulder exercise, but few focus on their elbow. The elbow is supported by the biceps, triceps, and other muscles from above and the forearm muscles from below. It may be time to look more in-depth at strengthening protocols for those muscles, as they seem to play a role in elbow stability.

UCL anatomy

Before we dive too far into the rationale behind training the forearm musculature, it is important to understand the anatomy of the region. Here is an excellent image of the muscles surrounding the UCL courtesy of