Although they are prone to a variety of injuries, there is one particular injury that pitchers desperately try to avoid. It involves three words that strike fear in the heart of any hurler: Tommy John surgery. The infamous procedure is considered to be very serious as it involves a long period of recovery. However, it is also a remarkable operation that has prolonged many careers.
"Dr. Frank Jobe's development of the Tommy John procedure had a significant impact on sports medicine," says Dr. Michael Reinold, physical therapist, medical blogger and rehabilitation coordinator for the Boston Red Sox. "His creativity and intuition helped spur a group of other surgeons such as Dr. James Andrews, Dr. David Altchek, and many more, to focus their energies on treating athletes and advancing surgical skills to help individuals return to sport."
The official medial term for Tommy John surgery is ulnar collateral ligament reconstruction or UCL reconstruction. The ulnar collateral ligament is located in the elbow. It connects the humerus (the bone that runs from the shoulder to the elbow) with the ulna (the bone that runs on the medial side of the forearm). Pitchers put intense pressure on the elbow when throwing. Too much pressure can cause this ligament to tear, affecting the pitcher's velocity and accuracy.
The actual procedure is literally similar to putting new laces on a shoe. The damaged ligament is replaced by a tendon taken from another area in the body. Using a figure-eight pattern, the tendon is then inserted through holes drilled in the humerus and ulna.
In 1974, Tommy John, a 31-year-old left-hander with the Los Angeles Dodgers, became the first professional athlete to successfully undergo the operation. At the time, a torn UCL usually meant the end of a pitcher's career and many thought John would suffer the same unjust fate. However, he miraculously returned in 1976 and continued playing until 1989. John's ground breaking surgery was performed by Dr. Jobe, a former team physician with the Dodgers.
It's important to remember that a ligament connects bones, whereas a tendon attaches a muscle to a bone. Therefore, lengthy rehabilitation is required in order for the tendon to get used to its new role.
Following the operation, the pitcher must wear an elbow brace for a week. He then begins exercising in the second week to regain a range of motion. Every recovery program is different. But typically, the pitcher starts a throwing program four months after the procedure.
According to a 2003 USA Today article by Mike Dodd, the pitcher will start on flat ground and toss softly from 45 feet. There will be one set of 25 tosses, which is followed by a rest and then another set of 25. The practice is conducted every other day, with the distance slowly increasing after a few sessions. At the six-month mark, the pitcher will then start throwing off the mound, using just 50% of his ability. Gradually, he will increase the intensity and begin to include specialty pitches. By the eighth month, the pitcher will start throwing in "game conditions." This involves throwing during batting practice, taking part in simulated action and pitching in low-level minor league matches. Although most pitchers can return to regular competition around the one-year mark, it sometimes takes an additional year for the pitcher to return to his proper form.
As noted by Dodd, most pitchers who undergo the procedure and have a successful recovery stress two important factors. First, it is vital to be patient. It takes a while for the converted ligament to gain enough strength to withstand normal throwing. Second, it is also vital to exercise the shoulder - in addition to the elbow - to ensure proper strength throughout the arm.
Dr. Reinold also points out that due to the success of the procedure, there is almost a false sense of confidence that all pitchers will return from UCL reconstruction.
"I have even heard some people state that they want to get the surgery so that they can return stronger than preoperatively," exclaims Reinold. "It is almost as if there is a misconception that not only is it easy to return to pitching after surgery, but that it is likely that you will come back better than before."
Reinold states that a return to sport requires a significant amount of work during rehabilitation.
"Although our success rates are close to 85-92% in elite pitchers, other studies have shown only 74% of high school pitchers return to play," he says. "Bottom line, if you have this procedure, there is going to be a lot of hard work for an entire year or more."
Aside from pitchers, fielders may require Tommy John surgery. Boston outfielder Rocco Baldelli is one such example. However, this type of occurrence is rare.
"You do see UCL reconstruction in other position players within baseball, but at a far less common frequency," says Reinold. "Two factors come into the play: First, the force that is developed while pitching is much higher than throwing while fielding. Second, the quantity of pitches is significantly higher with pitchers. Because of this, an injury to a fielder's UCL is less common and more likely to respond to non-operative treatment."
Other athletes such as javelin throwers, tennis players, and football quarterbacks are also prone to UCL tears. But Reinold says the force and repetition that causes their injuries is less when compared to pitchers.
The notion of Tommy John surgery is a scary thought to any pitcher. This is due to the long journey one must take when they are required to have the operation. However, the end result tends to have many benefits. Of course, the procedure does not necessarily mean a pitcher will return and perform better than he did previously. But it is certainly more attractive than the alternative.
Current Comments
17 comments so far (post your own)How long is the rehab for catchers
Posted by KOD20 on Wednesday, September 23, 2009 @ 4:23pm
Catchers are a little different since they don't throw as hard and consistent as pitchers. They are prone to the injury and I would suspect their rehab would be the same length. A UCL tear is very serious. You're basically making one thing (a tendon) do something that it's not custom to do (become a ligament). It takes time.
Posted by Eric Rosenhek on Thursday, September 24, 2009 @ 8:03pm
My son is a college pitcher and had "tommy John" surgery almost a year ago. His elbow is rehabbing nicely, but he is having tremendous pain in his groin where they removed the ligament to do the repair in his elbow. He has had an MRI done on his leg at school and they said that they didn't see anything. The doctor that did the surgery says that it just takes a long time to rehab. It really seems like there must be something else wrong with the amount of pain he is in. Do you have any suggestions? Thanks.
Posted by Debbie on Wednesday, December 23, 2009 @ 3:32pm
You could seek out a second opinion. See if you can get an appointment with a local sports physician or physical therapist. I would also visit Mike Reinold's blog. He might have some useful tips.
All the best to you and your son, Debbie.
Posted by Eric Rosenhek on Wednesday, December 23, 2009 @ 8:00pm
I tore my UCL in March of 2009 and rehabbed it. I began throwing it again in October and everything was feeling great. I was throwing harder than ever before. It's now January, and all the symptoms I felt right after the tear have returned. I have incredible pain in the elbow and my ulnar nerve feels swollen. It looks like another missed college season for me. I'm trying to find a list of doctors experienced with Tommy John Surgery on the west coast. Any suggestions? I obviously want the best doctor possible.
Posted by Ryan Hood-Taylor on Friday, January 15, 2010 @ 7:59pm
Ryan, your family doctor would be the best person to talk to. They can refer you to someone.
Posted by Eric Rosenhek on Sunday, January 17, 2010 @ 8:26pm
My college son had Tommy John Surgery, performed by Dr. James Andrews. His rehab has been on going for 19 1/2 months. His velocity is at 92 % of the last registered speed over 3 seasons ago. He has no pain after 100 pitch bull pen at 100 % effort. He has returned healthier and stronger than before the injury. Is velocity something that comes back over a longer period. He has started competing again with control but no velocity yet?
Posted by Coach on Monday, February 22, 2010 @ 7:16pm
I partially tore my UCL during a weightlifting competition (In the snatch lift)
1. Will my elbow ever heal on its own?
2. Any research about lifters with the surgery??
Posted by Robyn on Wednesday, February 24, 2010 @ 2:19pm
Coach, every patient responds differently.
Robyn, your doctor would be a better person to speak to.
Posted by Eric on Wednesday, February 24, 2010 @ 7:46pm
Hi, my son had tommy john surgery in aug 2008. He completed his rehab, pitched in fall ball pain free. He's started the season 2-0 but now is feeling some numbess in his two fingers, he wrapped his arm in an extended position while sleeping as instructed by his surgeon. Now he's feeling pain in the elbow still despite taking over a week off. He's considering a cortizone shot near the nerve. Any thoughts? He's also been doing muscle stem, massage and rest.
Posted by tim south on Monday, March 8, 2010 @ 2:39pm
Tim, the best person to ask is your family doctor. They'll point you in the right direction
Posted by Eric on Monday, March 8, 2010 @ 9:18pm
my boyfriend is having this surgery and theyre taking a tendon from his wrist/forearm, hes 16 any idea what the length of recovery time will be before he can pitch again? he wants to play college ball and hes really good so this is important to him
Posted by michelle on Thursday, April 1, 2010 @ 10:08pm
I have a 14 year old son that is may have to get this procedure. If he has the procedure in April and follows all the recovery procedures would it be possible for him to play football in the fall (3-4 months later, July/August). He is not a quarterback and will not use his throwing arm.
Posted by Chuck on Monday, April 5, 2010 @ 9:36am
I am a 21 year old college RHP. I had Tommy John performed by Dr. James Andrews on February 3, 2010. I have since regained all mobility in the arm and have started being able to lift almost the weight I was before the surgery. I have stayed about a month ahead of schedule in rehab and am due to start the interval throwing program in the next few weeks. Dr. Andrews said that the ligament he took out of my wrist was the size he usually sees in legs for knee surgeries. Does that sound like a good thing? What are some suggestions you have for more strength throughout the recovery. I am 6'6", 228 lbs. and threw 87-89 topping out 90-91 before surgery. So I believe with the proper strengthening exercises I could really benefit from the surgery if everything goes right. Any help would be appreciated.
Posted by Justin Ferrell on Wednesday, April 21, 2010 @ 5:27pm
9 months ago I had successful TJ surgery. Because of other committments (school) and nasty Canadian winter weather, my rehab is a bit behind schedule. I am almost ready to begin working off of the mound but a little hesitant because of a sharp, but not intense pain when I move my arm in certain positions. However, I dont experience this discomfort when I am throwing?? As with most athletes in rehab, I am very paranoid about re-injury. The "pain area" is "pain free" to touch. I guess my question would be; is this part of the healing process?...and is it something I should be working through or something I should rest? I dont see the surgeon for another 10 weeks.
Posted by Jesse owen on Sunday, May 30, 2010 @ 2:19pm
Speak to your Doctor or GP. They know best.
Posted by Eric on Sunday, May 30, 2010 @ 9:00pm
My 20 year old son had tommy john surgery in April 2008 at MGH and went through a successful rehab, pitching again one year to the day. The following fall, his college freshman year, he pitched and felt tingling and numbness in his elbow and fingers. Following rest, he worked out during that winter and returned to pitching the spring of his freshman year, only to suffer the same fate. Three MRI's later, it has been determined that the first surgery failed, this with a alograft, not his own ligament. He will undergo his second surgery this month at a different hospital and different surgeon. For those of you out there that feel the same symptoms, don't ignore them. Perhaps if we had pressed the issue, he would have had the second surgery much sooner rather than wasting more than a year. Good luck!
Posted by Donna on Sunday, June 20, 2010 @ 2:13pm