“Forearm tightness” — two of the scariest words that a pitcher can utter to an athletic trainer. Often, when a trainer hears a pitcher complain of tightness in his forearm, the trainer goes straight to the elbow. After confirmation from an MRI, the next two words could very well be “Tommy John“.
Unfortunately, there has been an outbreak of pitchers, throughout the league, that have needed Tommy John surgery, including: Kris Medlen and Brandon Beachy (both of the Braves), Jarrod Parker (Athletics), Luke Hochevar (Royals) and now Bruce Rondon (Tigers). Patrick Corbin of the Diamondbacks is likely to follow, as he is planning on going for a second opinion before going under the knife.
Astros hopeful Peter Moylan has also been diagnosed with a torn UCL. Like Corbin, he will be seeking a second opinion. I’m sure that if you’ve followed baseball for any length of time, you’ve probably heard of the procedure, but unless you’re an athletic trainer/physical therapist or have been through the process, you may not know all it entails.
About ten years ago I was playing baseball at a small Division III college in Arkansas. It was my sophomore year and I had been secretly dealing with elbow pain since my senior year in high school. I had managed to mask the pain using a variety of anti-inflammatories and a certain product I picked up at a farm supply store (that I later found out was banned by the NCAA). Finally, the pain became too much for me to handle and I had to let my coach and trainer in on my little secret. Often times, a pitcher will say they felt a snap in their elbow or sudden tingling in their ring and pinky finger on their throwing hand. That wasn’t the case for me, so when the orthopedic surgeon told me that I would need Tommy John Surgery to continue to pitch, it came as quite the surprise. Apparently I had bone chips in my elbow that had frayed the ligament over time.
Tommy John Surgery is the nickname for Ulnar Collateral Ligament Reconstruction. Let’s refresh your anatomy: Your UCL is the ligament that connects your humerus (upper arm) to your ulna (one of the two bones in your forearm). Basically, the only way you can tear this ligament is by making a throwing motion. In fact, the surgeon gave me the choice of just rehabbing my arm and ending my baseball career. Of course I decided to have the surgery and I’m glad I did! My church league softball career would have been over before it even started!
The surgery consists of replacing the UCL with a tendon from somewhere else in your body. The most common tendon taken is the Palmaris tendon, which you can find on the underside of your wrist. Some people don’t have this tendon or the surgeon may determine that the tendon would not be strong enough, so he may choose to use a hamstring tendon (which is what my surgeon used) or a tendon from your toe or groin area. This procedure usually takes somewhere between 60 and 90 minutes. Once the surgery is done, the real fun begins. The patient can expect a year of hardcore rehab before ever pitching in a game again.
The first five weeks post-op are the worst. The patient must wear this bulky, Craig Biggio-looking elbow brace that keeps his elbow from extending past a certain point. It starts off at 90° and gradually extends over the five week period. This is a great opportunity for the patient to work on doing everyday tasks with their opposite hand. Thanks to Tommy John Surgery, I’m now an ambidextrous wiper (TMI?).
It is ten weeks post-op before a player can even simulate a throwing motion. In the meantime, the patient will spend about an hour and a half a day, five to six days a week with a physical therapist or athletic trainer. This time is filled with colorful Thera-Bands, light weights, buckets of rice and stretching. The days are extremely monotonous, and with no end in sight it’s difficult to stay motivated.
At around 16 weeks I finally got to start tossing a baseball with my right hand. I tried to pull a Billy Wagner and convert to a lefty but apparently I’m only coordinated enough to wipe with that hand (still TMI?). Most throwing programs start with light tossing at 45 feet, every-other day, with the distance gradually increasing each week until you’re long-tossing at 150 feet.
After six long months of shoulder and forearm workouts, it’s finally time to climb that ten inch hump. Pitchers are allowed to throw only fastballs off the mound at 50% effort, increasing effort every week. During this time a pitcher focuses on his mechanics, being sure to not rush his delivery and to keep his elbow above 90° throughout the throwing motion.
One month later, a rehabbing pitcher gets to overcome his fear and start throwing breaking pitches. I remember being so afraid of throwing my breaking stuff due to the fear of blowing out my elbow again. The first few weeks of throwing breaking balls, the pitcher will be throwing on flat ground, again, being sure to mind his mechanics.
Once you hit nine months, it’s all downhill from there! You start with throwing batting practice to hitters and progress to simulated games and intersquad scrimmages. If you’ll recall, last April, Astros starting pitcher Alex White had to undergo Tommy John Surgery. According to a recent Houston Chronicle post, Alex is getting close to returning and is currently throwing all of his pitches in live batting practice, every fifth day.
After 11-12 months of anticipation, it’s time to finally pitch competitively again. Of course, one of the most discouraging parts of a pitcher’s return from Tommy John is that after he’s given the green light to return to games, it usually takes a half season for his velocity to return completely. This is why it’s important to work on your command while going through rehab.
Now that you know what all goes into returning from Tommy John Surgery, think about this: Brandon Beachy, Kris Medlen and Jarrod Parker will all be going through this for the SECOND time. I would rather watch a series of bikini, baby oil wrestling matches between Kirstey Alley and Rosie O’ Donnell than go through that process again. I understand that some of these guys are getting paid millions of dollars to play, so their situation is quite different than mine. I will tell you that baseball was my life before my surgery, but something was different once I returned. After spending a full year rehabbing, I managed to pitch for about a month of my Junior season. Despite taking the summer off from baseball, once it was time to get revved back up in the fall, I had no desire whatsoever. Somewhere along the way, baseball had become more work than fun for me. I hope that these guys never lose the desire and determination that makes them the special players that they are.