Pain, pressure and PTSD: Inside youth baseball’s UCL injury crisis

By Jamie Barton, CNN

(CNN) — Kade Durnin knew right away that something was badly wrong.

“It’s unlike any other feeling that you’ve probably ever had, in terms of arm pain,” the 19-year-old college pitcher says in an interview with CNN Sports. “It feels like you got hit in the funny bone – it’s just not very funny.”

Durnin was training his arm when he felt a pop. Before long, a doctor was delivering the news that no pitcher wants to hear: He had torn his ulnar collateral ligament (UCL).

It is an injury which has plagued Major League Baseball for the best part of the last century. The ligament in your elbow which connects the bone in your upper arm to the one in your forearm – and is only about as strong as “a piece of celery” – tears, leaving you unable to throw and facing a very length spell on the sidelines.

This season, the likes of Gerrit Cole, Corbin Burnes and Shane Bieber have all had Tommy John surgery – the most popular procedure to repair a torn UCL – while Japanese superstar Shohei Ohtani made his long-awaited return to the mound after almost 22 months away following the second elbow surgery of his career.

Dr. Christopher Ahmad, Tommy John expert and head team physician for the New York Yankees, has performed the surgery on some of the biggest names in baseball. But he has also been privy to the other side of the story.

“The alarms are going off on how devastating this problem is to the youngest players,” he says in an interview with CNN Sports.

“When I first started doing Tommy John surgery about 25 years ago, the population who I was operating on who needed the surgery were essentially very high-level players – they were college prospects destined to be professional, or professional players.

“Now, the population who needs the surgery most are kids.”

Of the 10-15 Tommy John surgeries that he performs every week, Ahmad estimates that between eight and 10 are on high school children, with some even still in middle school.

Such a high number of young players going under the knife is a relatively new phenomenon. In 2005, four players selected in the top 10 rounds of the amateur draft had already had Tommy John surgery earlier in their college or high school careers. By 2025, that figure had increased ninefold to 36.

But why?

Need for speed

One issue is that, simply, young pitchers are throwing faster than they ever have before.

“The big problem now is performance. It’s the desire and the hunt for velocity,” says Ahmad.

With thousands of aspiring college and professional players across the US, and an increased emphasis on pitch speed in the professional game, one surefire way to get noticed is to put the biggest number on the radar gun.

“The chase in velocity is really impacting these kids,” says Frank Alexander, the athletic trainer who works with Ahmad’s patients during their recovery phase, in an interview with CNN Sports. “Everybody’s chasing triple digits, and these kids just want to keep up with the Joneses.”

That chase has created a burgeoning industry of “velocity enhancement programs” and special techniques designed to get young players throwing fast.

In Durnin’s case, that technique was pulldowns, a drill where pitchers take a running start to try and throw as hard as they possibly can.

“It’s a training technique popularized by Driveline,” he explains. “There’s a lot of mixed feelings upon it because it does have a tendency to cause injuries.”

CNN has reached out to Driveline for comment.

“I was doing pulldowns, I was trying to break the facility record (of 101 mph). I did not break the record, and I got hurt doing so,” Durnin adds with a wry smile.

“It does seem a bit reckless. If you’re watching you’re like ‘Well, this seems like something wrong can happen.’ But obviously you can get injured doing many things. I don’t think pulldowns are bad. I don’t think pulldowns are going to injure you 100%. I think just with all training methods, you’re toeing the line between excellence and energy.”

Baseball is such big business nowadays that players are willing to put their own health on the line more than ever before if it means a shot at earning truly life-changing money.

The chance – however slim – of bringing in Ohtani or Juan Soto money ($700 million and $765 million, respectively), is one that many are happy to take the risk for.

“I had some draft interest. I had met with probably around half of the teams via Zoom or in-person meetings. And so that was a big gold mine. Along with every other baseball player, you want to get drafted and pursue a professional career,” Durnin explains.

“In order to get yourself in those conversations and be able to get drafted and get paid what we want to get paid, you have to be the top .001%. And in order to be that top .001%, you have to have a skillset – and that’s throwing hard, that’s throwing really good pitches. In order to do that, you have to train, and if you’re not willing to train really hard and push the limits, someone else is, and that person will take your spot.”

Alex Hoffman was even younger – just 15 – when he tore his UCL. Like many teenagers, he was playing two different positions.

“I was definitely overworked and I definitely wasn’t taking care of myself as much as I should,” Hoffman, now 17, says in an interview with CNN Sports.

“I was catching and pitching. So that was a lot of stress on the arm, constantly throwing the ball back or throwing the ball to the catcher. My arm never really had a break. So, ultimately, I believe that it was just that my arm couldn’t keep up and it broke down.”

No one asked Hoffman to play both positions. No one asked Durnin to try and break the facility’s velocity record. Both – understandably eager to play and impress – took it on themselves to stretch their bodies to the point where their elbows could not take any more.

But, in the 10 years he has worked with Ahmad, Alexander has seen plenty of instances when coaches and scouts have directly pushed their young athletes too far.

“One kid that we had was in high school when he had Tommy John surgery, and his pre-surgery velocity was in the low 90s,” he remembers.

“He was talking to the college that he was being recruited by, he had a verbal commitment with them, and it was going to the year that he could sign his National Letter of Intent. So he was rehabbing, he was 10 months post-op, and the coaches are like, ‘You need to be throwing low 90s.’

“And I remember vividly the conversation with him, mom and dad in the room, and I’m like ‘Whoa, this is a rehabbing elbow. This isn’t a healthy elbow. That’s an unrealistic goal for you at 10 months post-op.’”

Eventually, in his chase to keep hold of that non-binding verbal commitment, the young pitcher broke down again.

“He was chasing that velocity … he’s knocking on the door of being completely cleared, getting ready to be back and play. And he said his elbow started bothering him again,” Alexander says. “Later, we came to find out that the school actually pulled the scholarship.”

While not every case is that extreme, the mismanagement of young players is rampant in the US – one 2021 study found that 90% of youth teams it surveyed were violating Pitch Smart guidelines, which stipulate pitch counts and rest times for young pitchers.

“Coaches have to win at the college level, even at the high school level, so they’ll abuse players more often than we would like to see,” explains Ahmad. “We would like to see parents and coaches protecting kids. They actually need to win also for their job security.”

Mental scars

When, in 1974, Dr. Frank Jobe took a tendon from Los Angeles Dodgers pitcher Tommy John’s forearm and tied it through the bones in his elbow, Jobe estimated the chances his patient would pitch again at one in 100.

John, though, went on to pitch in three World Series and three more All-Star games. The surgery, frankly, was and is a miracle.

These days, there are success stories all across baseball. Ohtani sent the Dodgers to this year’s World Series with a win and 10 strikeouts – not to mention three home runs – against the Milwaukee Brewers in Game 4 of the NLCS.

Similarly, both Durnin and Hoffman are delighted they went under the knife, and both are now back on the diamond and making the next steps in their promising careers.

Such is the publicized success of the surgery, many players treat it as a foregone conclusion that they will have to take a year out of their careers at some point.

“There’s now a culture and an appreciation that Tommy John surgery is kind of part of the game. I often call it the Tommy John generation,” says Ahmad. “Everybody just has this feeling that it’s inevitable.”

On the other side of the World Series matchup, Bieber has returned to the elite level even quicker than Ohtani, starting two games and winning one as the Toronto Blue Jays’ snatched the ALCS from the Seattle Mariners despite only coming back to play in late August.

Game 4 of the World Series on October 28 – where the Blue Jays drew even with the Dodgers at two games apiece – even saw Bieber face off against Ohtani in an all-Tommy John pitching contest which simply would not have been possible without the incredible advancements the surgery has allowed.

Nowadays, many view a UCL injury as a significant bump in the road rather than a career-ending injury. But not everyone is as fortunate as John, Durnin and Hoffman.

“There’s a misperception about how good the operation is,” explains Ahmad. “With surgery, from a performance perspective, we’ll have a very high chance of getting back to baseball. But your performance may not be the same.”

On top of that, the general prevalence of UCL injuries appears to be making MLB teams think far more carefully about whether to select pitchers in the draft.

The percentage of all available pitchers selected in the first three rounds dropped from 73% in 2014 to 38% in 2025, which is perhaps unsurprising when you consider that a 2021 study found that 70% of pitchers entering the draft had abnormal findings on MRI scans of their elbow.

“I do have a role with the Yankees where I help identify risk factors for potential players: amateur players in the draft, professional players who are free agents, etc. And part of that evaluation is what their future potential for injury is,” says Ahmad.

“So many clubs now are being a little more cautious about how they use their draft picks when there’s injury potential and they’re going to lose that draft pick to surgery and time away from baseball.”

The risks of injury and subsequent surgery can extend beyond a sporting context. In 2021, college pitcher Sang Ho Baek died following complications from Tommy John surgery shortly after his freshman season.

While instances like Baek’s are thankfully extremely rare, the psychological impact of a UCL injury can often be devastating to young players. Alexander recalls giving the bad news to one prospect.

“We’re telling him: ‘Your UCL is torn,’” he remembers. “And this kid, he had such a visceral reaction, he actually started rocking back and forth on the examining table, and he’s like ‘No, it’s not. It’s not. It can’t be.’ And he was being talked about getting drafted even out of high school, so his world just came crashing down around him.”

For many players, the extended period spent away from the field can be just as difficult as the moment they find out about their injury.

“It’s a year-long recovery and, during that year-long recovery, it’s hard to be away from the game,” says Ahmad, who is in the process of setting up what he calls a “Tommy John support group” for recovering players. “They lose their identity. The fear of failure starts to creep in.”

“Every day is constant mental warfare,” Durnin reflects on his rehab. “You have two sides. One side is telling you that you’re never gonna get back, and that these guys are so far ahead of you that you’re always going to be chasing them. And the other side is like ‘Hey, you can do it, you know it, you’re fine.’”

The mental anguish experienced by these young men is often even more serious than what the likes of Durnin went through – a recent study conducted by Alexander and Ahmad, among others, concluded that nearly 30% of baseball players who sustained a UCL injury qualified for a probable diagnosis of post-traumatic stress disorder (PTSD).

“There were players that had symptoms that could lead to future immune system compromise,” Alexander comments. “So what they’re experiencing is real.”

In the past, MLB has been receptive to rule changes to protect the safety of its athletes – just ask anyone running from third base who no longer has to barrel through the catcher in order to touch home.

The problem with pitching, however, is any adjustment would result in a profound change to the sport.

“There may come a time when we design rules around baseball that say you can only throw so many pitches,” says Ahmad. “There may come a time when we say, if you throw too hard, that’s illegal – you can’t throw 102 miles an hour. I’m being a little silly because I don’t think that’s ever going to really happen.”

The Yankees physician points to the possibility of six-man rotations to aid rest and recovery.

But teams will always look for players who can throw hard and often. Fans like them. Teammates like them. Coaches and scouts like them.

“What we celebrate for performance is also exactly what puts you at risk for needing the surgery,” Ahmad explains.

“That’s the essential problem in baseball: what makes you better also makes you injured.”

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