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With one name, the fortunes of pitchers’ health changed forever. For baseball pitchers, their throwing arm is the most vital part of the body and without a healthy arm, a pitcher is nothing. The shoulder and elbow are the most important part of the throwing arm for pitchers, because they are used with the most violent motions in repeatedly throwing a baseball over time. Between the two, the elbow is what needs more care as a more fragile part of the arm. Tommy John, pitcher for the Los Angeles Dodgers at the time, was dealing with “dead arm” which was the most common term for a pitcher that had a torn ligament during most of the 20th century. John had the first surgery to repair his ulna collateral ligament (UCL) in his throwing arm’s elbow, by Dr. Frank Jobe in 1974. The surgery is now simply called, Tommy John surgery, and it has completely revolutionized the health and longevity of pitchers.
The UCL is like a strong rubber band, as it is a thick band of tissue. If you overuse or stress a rubber band, it will stretch too much and snap. The same goes for a UCL, it and can be injured by stretching, tearing or dislocation. Stress is easily accumulated over time on the UCL, as it is located on the inside of the elbow and connects from your upper arm (humerus) to a bone in your forearm (ulna). Though baseball pitchers are the most common people to injure their UCL, anyone who is giving repetitive stress on their elbow is able to hurt their UCL. Athletes who use a throwing motion a lot are most likely to need Tommy John surgery. These sports besides baseball include softball, football, javelin throwing and even tennis for its repeated use of the elbow.
Tommy John surgery is performed by an orthopedic surgeon. A small incision is made on the inside of the elbow to remove the damaged ligament and the surgery usually takes an hour to two hours long. Dr. Douglas Andrews has overseen many Tommy John surgeries in his time working with athletes and physical therapy. Andrews earned his BS in Athletic Training and Health Science from Armstrong Atlantic State University in 1997, and went on to earn his BS in Education and Exercise Science at the University of Georgia in 2000. Most recently, he was the Doctor of Physical Therapy at Emory University in 2003 and worked at Duke University as a physical therapist until 2011. Now, he is the Director of Sports Medicine at Optim Healthcare. Dr. Andrews explained Tommy John surgery:
The surgeon is basically trying to replace the Ulnar Collateral Ligament (UCL) in the elbow. They take a tendon graft from either the Palmaris Longus muscle in your forearm, hamstring tendon in your thigh, or from a cadaver. This decision is based on whether or not you have a palmaris longus tendon (not everyone does) and if it is large enough to use effectively as the replacement for the UCL. The torn UCL is completely removed as it no longer has any function or purpose. There are different surgical techniques depending on the surgeon’s training and preference, but for a pretty standard procedure the surgeon will drill a hole or tunnel in the ulna bone and the humerus in an attempt to re-create the anatomical position of the native UCL. One end of the graft will then be inserted into each tunnel and secured with a screw and/or various sutures to hold it in proper position and with appropriate tension sufficient to stabilize the elbow. The graft is often doubled over to provide extra support and can be wrapped across the joint in a figure-eight fashion if it is long enough.
Caleb Woods, sophomore at Armstrong Atlantic, relies on his arm for success as a pitcher for the Pirates baseball team. As a freshman, Woods was a key contributor to the pitching staff, appearing in 19 games and starting six of them. He finished the season with a 6-2 record, with a 4.15 earned run average and added four saves. Woods was second on the team with 56.1 innings pitched in his first season of collegiate baseball.
Over the summer, Woods was simply playing long toss with teammate Corey Crunk, when he knew something was wrong. “I felt a pull and a tingle in my elbow, but there was no pain until the next day,” Woods said. “The next day I couldn’t really bend my arm and my elbow was really swollen.”
Woods rested, but threw on and off for about a month with his injured arm. The pain was still there and swelling would show up, so he finally saw the doctor. After examining his elbow, the doctor immediately knew an MRI — a medical technique to view internal structures of the body in detail — was needed, and the results were devastating.
“The MRI showed that my elbow was so bad, that my UCL was completely severed and it popped off the bone,” Woods said. On July 29th, 2013, Woods had Tommy John surgery and 10 days later he began doing rehab. Woods also had to wear an arm brace that kept his arm and elbow in place and the movements progressed over time. He started with his elbow at a 90 degree angle and had to move from zero to 135 degrees during rehab.
“I do rehab five days a week for an average of two hours every time, and have to do it for a total of 32 weeks,” Woods said. “I can begin throwing a baseball 16 weeks after surgery and I’m projected to be ready to go again in nine to 12 months.”
(Woods’ scar healing weeks after surgery. Photo courtesy of Caleb Woods)
Ken Tessier, head athletic trainer at Armstrong, oversees the rehab that Woods must do strengthen his elbow. Tessier is in his third year as Armstrong’s head athletic trainer, and worked at Savannah State as their head athletic trainer and USC Aiken as an assistant athletic trainer, prior to Armstrong. In 2002, he earned his bachelor’s degree in physical education with a concentration in sports medicine from Endicott College.
“Rehab really depends on the patient and pain tolerance,” Tessier said. “You have to start right away or as soon as you can though.”
Just like any other procedure, rehab for Tommy John surgery is a progression. Going too hard with rehab right away will put an excessive amount of stress on the elbow, but babying the injury is not smart either.
“It’s a progression, that needs to get gradually tougher as you go and you have to go hard and be committed,” Tessier said.
Right now, Woods is 13 weeks out of surgery and hitting rehab hard. He does elastic band work rigorously, is throwing a weighted ball off a miniature trampoline in front of him and catching it with his injured arm, and is working on getting his throwing motion back, so when he throws a ball in three weeks, he still has a grasp on what he’s excelled at his whole life.
The goal is to return to full strength as a pitcher after the surgery and continue a baseball career, as did Tommy John and many other prominent big league players. Before reconstructive elbow surgery, John threw in 12 seasons, had a season-high win total of 14 and compiled 124 wins for an average of just over 10 wins per season. He was also a one-time All-Star selection. After surgery, John missed the whole 1975 season and returned in 1976 to play 14 more seasons until he was 46 years old. His career after surgery was a miracle. John won over 20 games three times, including 22 at 37 years old in 1980, made three more All-Star teams, was runner-up in Cy Young voting twice and finished in the top 10 four times. In 14 seasons after surgery, John won 164 games, averaging just under 12 wins per season. He finished his career with a 288-231 record, a 3.34 ERA and 2,245 strikeouts over 26 seasons. Baseball Reference compares him to rank higher than Hall of Fame pitchers, Dizzy Dean, Gaylord Perry and Robin Roberts, though John has not been inducted into Cooperstown.
Over the years, Dr. Frank Jobe has done over 1,000 Tommy John surgeries. In recent history, the number of major league pitchers has spiked to an astounding rate. A July report done by Bleacher Report’s sports injuries lead writer, Will Carroll, showed that 124 pitchers — now 125 with Brian Wilson signing to the Los Angeles Dodgers in August — on an MLB roster, had undergone Tommy John surgery. That results to about one-third of all the current pitchers in the MLB. Of the 125 pitchers, Adam Wainwright, Anibal Sanchez, C.J. Wilson, Joe Nathan, Jordan Zimmerman and Stephen Strasburg have all had successful careers since the surgery, and went on to make the All-Star team for their respective league.
This season, many pitchers that underwent Tommy John surgery in the past, had successful seasons. Wainwright threw a career-high 241.2 innings after missing the 2011 season due to surgery, and he won 19 games, made the National League All-Star team and is pitching in the World Series. Sanchez won 14 games, had a career-low 2.57 ERA and signed a five-year $88 million contract before the season started. Wilson won a career-high 17 games and signed a five-year $77 million contract after the 2011 season. Nathan won six games and saved 43 games as a closer. Zimmerman won 19 games and was a first-time All-Star, and his teammate is Strasburg had a down-season, but only had 3.00 ERA.
Brian Wilson, closer for the Dodgers, is one of the unfortunate pitchers to undergo the surgery twice. He had it first done in college at Louisiana State University, and then again last season after only pitching in two games for the San Francisco Giants. In August, Wilson signed with the Dodgers as a free agent for a one-year, $1 million. Wilson has been a huge success with the Dodgers, going 2-1 with an astounding 0.66 ERA in 13.2 innings pitched. In the postseason this year, he has not given up a single earned run in six innings pitched.
A big question with pitchers after Tommy John surgery is if their velocity will diminish. There have been mixed results with these players, but none are drastically negative. In fact, many pitchers find an increase in velocity after the surgery. Wilson threw a harder fastball a year after surgery. FanGraphs has his fastball going from 90.7 miles per hour to 92.6 miles per hour. Strasburg’s biggest question is velocity as he is known for his blazing fastball and is a young superstar in the making. When he first came to the big leagues, Strasburg thew 97.6 miles per hour. After surgery, he threw 95.8 miles per hour in 2012 and 95.2 this season. Matt Harvey, 24, is another young superstar like Strasburg who is a flamethrower and had to have Tommy John surgery in September. Leading up to his surgery, Harvey was 9-5 with a minuscule 2.27 ERA and was the starting pitcher at the All-Star game. His average fastball was 95.4 miles per hour. He will miss all of the 2014 season with the hopes the surgery will make him as dominating or better after.
Currently, there are no pitchers who have received Tommy John surgery in the Hall of Fame, but there are some who have career numbers that have came close and one that is a surefire future inductee into Cooperstown. Kenny Rogers and David Wells both had the surgery as minor league players and had a successful careers after. Rogers had the surgery in 1987 and finished his career with 219 wins over 20 seasons, while Wells won 239 games over 21 years, including a perfect game with the New York Yankees. The ideal situation for anybody getting Tommy John, is former Atlanta Braves great, John Smoltz.
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Before surgery, Smoltz was one of the most dominant starting pitchers of the 1990’s. He was a four-time All-Star and won the 1996 Cy Young award. After, he brought his arm into the bullpen and transformed into a closer. His career ended with 213 wins, a 3.33 ERA and 154 saves. Smoltz is expected to be enshrined into the Hall of Fame in 2015, his first ballot-eligible year. With the success of pitchers like Wainwright and youngsters on the rise like Harvey and Strasburg, pitchers who have undergone Tommy John surgery are a lock to be in the Hall of Fame in the future.
Thanks to one experimental surgery, the fate of pitchers completely changed and their careers were rejuvenated. “Dead arm” killed the careers of pitchers until a brave doctor decided to try a new surgery on Tommy John. When Dr. Jobe gave John surgery on his UCL, he put his chances of a full recovery at 1 out of 100. He defied the odds, and had 14 more successful seasons. Nearly 40 years later, doctors have patients getting back to full health and previous performance level or better, 85 to 95 percent of the time. Not only has Tommy John surgery changed the careers of pitchers, but it changed, and may have saved baseball forever.
Sidebar: Though pitchers are the primary players to get Tommy John surgery, position players need it at times too. The time needed for rehab is much shorter, since position players use less stress on their arm as opposed to pitchers. Position players usually need six to nine months to recover, but the timetable can fluctuate.
Notable position players to undergo the surgery that are currently playing in the MLB include Shin-Soo Choo, Carl Crawford and Rafael Furcal. Choo had arguably his best season in 2013, as he hit .285 with 21 home runs and 20 stolen bases. Crawford appeared in 116 games after having the surgery in the beginning of last season and hit .283. Furcal on the other hand, missed all of the 2013 season after making his third All-Star team in 2012.