Tommy John surgery is often framed as a physical setback — a process of repair, rehab, and return. But for many athletes, the psychological scar may run deeper than the ligament tear itself.

This study, conducted on amateur and collegiate baseball players recovering from UCL injuries, investigated how the injury and recovery process affects mental health — specifically symptoms of post-traumatic stress disorder (PTSD). What it revealed was alarming: PTSD-like symptoms are not rare in this population — they’re the norm.

What the Study Found

• 68% of players demonstrated PTSD symptoms, with 28.8% meeting the threshold for probable PTSD diagnosis.
  
  
• 18.3% were classified as severe, while 21.2% reached clinical concern levels.
  
  
• 92.3% of athletes reported intrusive thoughts, such as flashbacks and mental replaying of the injury.
  
  
• 94.2% showed avoidance symptoms, including emotional suppression or detachment related to their injury.
  
  
• 88.5% had hyperarousal symptoms, including trouble focusing, sleep disturbances, or heightened stress.
  
  
• College athletes had significantly higher PTSD scores than high school players (p = 0.02).
  
  
• Pitchers showed greater symptom severity than two-way players (p = 0.04), likely due to performance identity and role specificity.
  
  

Why This Matters

UCL injuries have long been viewed through the lens of biomechanics and surgery, but this study makes it clear: injuries disrupt identity, confidence, and emotional regulation.

This is especially relevant in pitchers, whose success — and even self-worth — is often tethered to their throwing arm. When that arm is compromised, it’s not just pain and rest. It’s doubt, fear, and intrusive thoughts that can affect how athletes train, recover, and return to competition.

The PTSD symptoms observed — intrusion, avoidance, and hyperarousal — mirror what we typically associate with traumatic events. And in the context of high-stakes performance, an injury can become just that: a trauma. If left unaddressed, these symptoms may manifest as poor rehab adherence, movement hesitancy, overprotection, or even skill loss unrelated to the physical repair.

Perhaps most critically, college athletes showed significantly higher symptom load than high schoolers. This suggests that age, pressure, and context matter — the closer an athlete is to a draft year or scholarship timeline, the greater the psychological impact of a season-ending injury.

How We Apply This at VeloU

At VeloU, we’ve long recognized that rehab is a psychological process as much as it is a physical one. This study validates our emphasis on communication, reassurance, and mental performance training during recovery.

We don’t pretend to be clinical psychologists — but we train our staff to recognize signs of psychological distress and maladaptive recovery behavior. Whether it’s an athlete refusing to progress, reporting phantom pain, or isolating themselves from teammates — these can all be red flags.

Where necessary, we collaborate with licensed mental health professionals to support our athletes. We also educate families about the emotional strain of injury, not just the recovery timeline. Parents, coaches, and peers all play a role in creating an environment where mental health isn’t ignored or dismissed.

The bottom line: an elbow injury doesn’t just affect the elbow. And if we fail to address what’s happening between the ears, we risk sending athletes back to the field with more than just a repaired ligament — we send them back with an unresolved trauma.

This article is part of Applied Baseball Science by Dr. Nicholas Serio, where we break down the biomechanics, performance science, and injury research shaping the modern game. Powered by VeloU (Velo University) — where research meets real-world baseball.

Reference

Grinberg, D. R., Nealon, J. M., Nuelle, C. W., Magnussen, R. A., Saltzman, B. M., & Smith, M. V. (2024). Posttraumatic stress disorder symptoms in baseball players with ulnar collateral ligament injuries. Orthopaedic Journal of Sports Medicine, 12(4), 23259671241241730. https://doi.org/10.1177/23259671241241730