The competition is grueling, and the tendency to try to gain a competitive edge through specializing has become increasingly popular. Not surprisingly, year-long training in a single sport with few breaks equates to an amplified risk of injury. In fact, a recent ten-year study of adolescent players found that pitchers who threw over 100 innings in a year were three times more likely to be injured – and those who played for at least eight consecutive months were five times more likely to be injured.

Introducing Tommy John – Baseball Surgery de Jour

Ulnar collateral ligament reconstructive surgery, also known as “Tommy John” surgery, replaces the torn UCL inside the elbow to allow the athlete to regain his or her ability to throw. Tommy John has earned a sexy reputation – the zipper-like scar left on the player’s elbow has been known to not only return throwing capability, but create a “bionic” arm, increasing velocity post-surgery.

“Ulnar collateral ligament reconstructive surgery, also known as “Tommy John” surgery, replaces the torn UCL inside the elbow to allow the athlete to regain his or her ability to throw.”

But that benefit is the exception, not the rule. It is critical that young pitchers, parents, and coaches educate themselves on the consequences of electing Tommy John and understand just what the rehabilitation process entails.

Tommy John’s Misleading Success

Tommy John success stories filled with star-power names dominate ESPN, and the number of players going under the knife has spiked in the past three years. While it’s not entirely clear what is causing the surgical epidemic, the number of young players electing to have Tommy John pre-injury is a good indicator that it is thought of as a performance enhancing procedure. When you take a closer look at the data, a different picture emerges.

According to the American Sports Medicine Institute (ASMI) the procedure touts an 80% success rate. However, the term “surgical success” in this context can be misleading, and certainly does not equate to increased velocity or a lower ERA.² In a 2014 study, published in the American Journal of Sports Medicine, only 67% of pitchers returned to an “established” status post-surgery, playing at least ten games in a season, while more than 50% of players returned to the disabled list due to an injury to their throwing arm post-surgery.³

Still think TJ will give you a performance boost? According to the renowned Dr. James Andrew, the likelihood of reaching collegiate level play decreases three-fold when surgery is administered to a youth baseball player.⁴

Unfortunately, these are not the stats that parents, coaches, and players are hearing when they watch stars like Matt Harvey of the New York Mets, twenty months post-op face the Washington Nationals’ Stephen Strasburg, who did his rehab back in 2010. For those young pitchers able to return to the game, their arm has been permanently altered and many throw at a lower velocity than pre-surgery.

“Tommy John has earned a sexy reputation – the zipper-like scar left on the player’s elbow has been known to not only return throwing capability, but create a “bionic” arm, increasing velocity post-surgery.”

If not exceeding or even meeting pre-surgical performance isn’t enough to battle, players must often undergo a revision, or repeat surgery. In fact, eleven of the 31 procedures done in 2014 on players in the Major Leagues were repeats.⁵

Now if baseball were purely a physical game, Tommy John may still be a gamble worth taking. Unfortunately, the buck doesn’t stop there. A successful post-op career, meaning the player will return to A-game, is only possible with a successful rehabilitation.

It’s Not All Fun and Games

According to Glenn Fleisig of ASMI, when things go well, like for 80% of pitchers, you could be back to playing pro baseball in twelve months, but it takes about eighteen months to be as good as you were pre-surgery.⁶ During my own rehab from Tommy John surgery I witnessed several colleagues rehab for upwards of two years before returning to the mound, and some did not return at all.

Through no fault of their own, many players are not mature enough to handle the grueling rehabilitation process. Months of painful physical therapy, monotonous days, and relearning mechanics can take an emotional toll. Pitchers who were previously throwing over ninety miles per hour must summon the will power to show up day after day to perform simple exercises, regain lost range of motion throughout the shoulder and elbow, and have a therapist manually break up their scar tissue. Trust me when I say this is not for the faint of heart. The road back to the mound is nothing if not long, and it can be filled with setbacks that test a player’s mental and emotional strength.

“During my own rehab from Tommy John surgery I witnessed several colleagues rehab for upwards of two years before returning to the mound, and some did not return at all.”

An example of one of these mental setbacks is commonly referred to as the “yips.” A simple game of catch can yield massive amounts of anxiety. During my recovery, going to the field became something I dreaded. It was hard to believe twenty years of baseball and twelve months of rehabilitation could lead me to such a dark, insecure place. More than a few cars were hit, and spiking fastballs fifteen feet from the mound became commonplace. Don’t get me wrong, rehabilitation is different for every player, but the possibility of returning to the mound with both an altered arm and mind, is a possibility not to be ignored.

Do Your Research

It is commonly understood that “knowledge is power,” and with the increased popularity of Tommy John surgery comes a vast supply of resources on the subject. I encourage all athletes, parents, and coaches to utilize them. Surgery may not provide the competitive edge that some players might hope for, but making informed decisions regarding the athlete’s health so he or she can continue to develop just might.

If nothing else, remember:

• Invest in the development process. Do not play all year round. Let your body get the rest it needs.
• Strength exercises every day keeps the doctor away. Do not skimp on strength exercises between outings and after games.
• Find a throwing program that works for you. Every arm is different, and how much off-season throwing should be done should vary by pitcher. Finding a program that allows the pitcher to maintain throwing mechanics creates a more consistent arm slot, which is critical to staying healthy.
• Give your body a chance to repair the tear naturally. With nine to eighteen months of rehab and at least three to four months without throwing a baseball, it’s worth adding another six weeks to see if your tear will heal. Yes, it’s hard. Do it anyway.
• Get a second and third opinion. Do not be afraid to get as many opinions as you need to make an educated decision on how to proceed with an injury.

More on injury and recovery:

• Common Elbow Injuries and What to Do About Them
• Standing Wall Clock: Address Elbow Pain Before It Continues
• 3 Steps to Addressing Pain: Are You Hurt or Are You Injured?
• What’s New on Breaking Muscle Today

References:

1. “Probability of Playing College and Professional Baseball”, High School Baseball Web. 

2 “Tommy John 2015 – Madson Saga shows surgery not perfect” 03/02/2015. 

3. Makhni E, Lee R, Morrow Z, et al,“Performance, Return to Competition and Reinjury after Tommy John Surgery in Major League

Baseball Pitchers: A Review of 147 Cases,” American Journal of Sports Medicine” 42 (2014):6.

4. “Tommy John FAQ”, Pitch Smart Resources, USA Baseball.

5.“ What we’ve missed about Tommy John Surgery” Last Modified 4/9/2015. 

6. “ASMI’s Glenn Fleisig talks about Tommy John Surgeries, Wearable Sensors at Sloan Conference” 03/05/2015. 

Photos courtesy of Shutterstock.

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Tendonitis is basically inflammation of the tendons as they insert on the related bone. The tendons connect the muscles to the bones. The suffix “–itis” means inflammation and is usually paired with the associated body part, as in epicondylitis or Achilles tendonitis.

Acute inflammation is a natural, normal process in our bodies. Our bodies innately know what to do to heal themselves. Pain, swelling, redness, and warmth are all part of the acute inflammation response. This inflammation response is supposed to be fast and direct, not extended. It is when this inflammation response becomes chronic or even systemic that it is difficult to manage.

When a patient comes to me with elbow pain and points to either condyle area (a condyle is the knobby part at the end of a bone), as in tennis elbow or golfer’s elbow, the first thing I find out is how long he or she has had the pain. Generally, if the symptoms have been around less than four weeks, the quicker it will go away. If someone has experienced elbow pain for more than four weeks, then serious intervention is needed.

For acute lateral epicondylitis (tennis elbow) or medial epicondylitis (golfer’s elbow), I recommend icing with an ice cup 7-9 minutes at a time, multiple times a day, with an hour between icings. I advise all the same things I recommended in my shoulder article because shoulder mobility and thoracic mobility definitely affect the elbow flexibility. I recommend treatment two to three times per week for the first three to four weeks. And, with out a doubt, no “grippy workouts.” That means no pull-ups, farmer’s carries, kettlebell swings, etc. When it calms down to pain less than 2 out of 10, you can ease back into workouts.

Chronic epicondylitis requires serious intervention. By this point there is inflammation everywhere in your body. Your body does not know how to regulate the mess you have going on. My tips are the same as above with a few added bonuses. Ice with ice cup 7-9 minutes at least three times a day. Get yourself chiropractic plus soft tissue treatment three times a week. If you have a chiropractor and a massage therapist, use them both. Perform shoulder mobility and thoracic mobility regularly. Clean up your diet – no grains, dairy, or sugar for thirty days. You have got to decrease the overall inflammation in your body or that nagging injury will not disappear. And finally, examine your life. I find that chronic, lingering injuries in our life are usually our bodies’ way of trying to tell us something. The elbow joint is flexible in all ways except backwards, so there could be something in your life hindering your progression forward professionally, athletically, emotionally, or spiritually.

Once you do get the okay to start back with your normal fitness routine, you must ease into it and continue regular maintenance on your body. Kelly Starrett has a great video on elbow mobility and Donnie Thompson has a video with his tips for dealing with elbow pain, too. Be sure the shoulders are firing properly to take that pressure off the elbow. Find a mobility routine that works for you that you can do before and after workouts. Keep your elbows, and yourself, healthy.

Photos courtesy of Shutterstock.

The post How to Heal Tennis Elbow and Golfer’s Elbow appeared first on Breaking Muscle.