Why Are Some Pitchers Able To Avoid Tommy John Surgery Longer?

With what seems like an increase in Tommy John surgeries the past few years, I've had people ask me why it seems that some pitchers are able to avoid the surgery longer into their pitching career. There are a multitude of things that can decrease the risk/odds of tearing the UCL in the pitching arm. I will try to hit on a few of the major ones in this post.

1. The absolute number one way to decrease your risk for an Ulnar Collateral Ligament tear is education. Knowledge of how the body works and what movements/actions create greater stresses on certain body parts. I'm not saying all pitchers need to go out and change their mechanics to mirror Greg Maddux or Nolan Ryan. Everybody is an individual. What works for you may not work for your teammate, cousin, or brother. When I say "education," I mean pitch selection, how much you throw, your workout routine, how you perform these exercises, whether or not you can recruit the correct musculature when your body needs it to stay healthy, etc. etc. "Knowledge is power."
2. The rest of these can go in any order. Timing is very important to any thrower. By timing, I mean "Where is your arm when your lead foot makes contact with the ground?" There are positions that place your elbow/shoulder under greater stresses than others. Good timing can decrease the stress on the UCL and/or rotator cuff.
3. How efficient is your body? This can go for any athletic movement. Efficiency is key. I often speak about how the body is a "kinetic chain," meaning that what one section of your body is doing can have an affect (either positive or negative) on another section of the body. This goes for throwing a ball, swinging a bat, sprinting, swimming, doing a cartwheel, ANYTHING. Being efficient will allow your body to conserve energy when and where it can in order to utilize it when it is required most.
4. Believe it or not, velocity can effect your odds of needing Tommy John surgery. Guys who throw harder place a greater degree of stress on their elbows. This is due to the incredible range of motion the shoulder/elbow go through in such an extremely short amount of time. The harder you throw, the greater the degrees per second your arm must travel in order to release the ball. So why don't so many flame-throwing relievers need Tommy John? Read on...
5. Fastball percentage. Yes, throwing fastballs is easier on your elbow than curveballs. Shocked? Didn't think so. This is one of the most well known facts about elbow injuries. We've all heard it: "You shouldn't throw a curveball (or slider, or whatever) until you are X years old." In this equation, X varies depending on who you talk to (13,14, 15, 78, never...). In reality, the correct answer may not be until your body is fully matured. However, another reason fewer hard-throwing relievers require elbow surgery, which I alluded to earlier, is that they just don't throw as much. Let's say that the average MLB starter throws approximately 200 pitches (not including warm-ups before/between innings during games) per week (2 starts/week, 100 pitches per start). A reliever may throw 3-4 times per week, at roughly 20 pitches per inning. This comes to 60-80 pitches a week vs. 200/week. Let's assume both pitchers stay healthy for a season. A starter will make around 32 starts. If they throw 100 pitches per start (again, not including warm-ups), that's 3,200 pitches trying to get Major League hitters out. A good, reliable reliever can make 50+ appearances. In this scenario, let's say the reliever pitches in 70 games at 20 pitches/inning. That's 1,400 pitches a season. It can take a reliever 2 1/2 seasons(!) to equal that of one season for a starter.

 I'll stop at just those five, but there are many more. My first reason (above) can be broken down into several more reasons itself. Just something to think about for those curious as to why it appears some pitchers can prevent/prolong the need for Tommy John more so than others.