After doing everything that they could possibly do to protect their franchise pitcher Stephen Strasburg, the Washington Nationals got the worst news that they could receive this season. Their rookie phenom, the young man whose pitching exploits has drawn thousands of baseball fans to home and visiting stadiums, has damaged his ulnar collateral ligament and will be forced to undergo what baseball fans and players call Tommy John surgery.
While this injury is scary for both the young pitcher and the Nationals franchise, if recent history is any indication, the surgery could very well result in lengthening, rather than shortening, Strasburg’s career. Players who have undergone this surgical procedure have often returned to the game stronger than when they were forced on the disabled list.
The Gory Details of UCL Repair
Ask any baseball player or fan, from the littlest Little Leaguer to the most experienced major league manager or baseball fan and they will be able to explain, in sometimes minute detail, what Tommy John surgery entails. In medical terms, this surgery is ulnar collateral ligament (UCL) reconstruction. It is a procedure whereby the ligament in the medial elbow is replaced with a tendon from some other part of the body – usually a forearm, hamstring, foot or knee.
The surgery is named after former Los Angeles Dodger left-handed pitcher, Tommy John, who was the first player to successfully undergo the procedure in 1974. This first UCL surgery was performed by famed orthopedic specialist, Dr. Frank Jobe.
In an articled entitled “The Gory Details of Tommy John Surgery,” online sports site The Good Point notes that Tommy John surgery involves a type of re-stringing of the damaged ulna collateral ligament. After the replacement tendon is harvested from some other part of the body, it is woven in a figure-eight pattern through tunnels that have been drilled in the ulna and humerous bone (aka "funny bone") that are a part of the elbow joint.
In the article, Dr. Michael Reinhold, physical therapist and rehabilitation coordinator for the Boston Red Sox notes that the success rate for elite (MLB) players who have the surgery ranges from 85 to 92 percent. However, for younger players such as high school pitchers, only 74 percent are able to return to play.
Can the Surgery Actually Improve a Pitcher’s Skill and Longevity?
In spite of the potential for nerve damage to the ulna collateral ligament and the end of a pitcher’s career, many baseball experts believe that having Tommy John surgery can improve the prospects for a young pitcher. Their proof? Six of the pitchers who played in the 2010 MLB All-Star game have had this surgery and are now on top of their game.
This group includes top Cy Young award candidate Josh Johnson of the Florida Marlins and the American League 2009 Rookie of the Year, Oakland’s Andrew Bailey.
Some other pitchers who are well-known for their skill and longevity who have undergone the procedure are New York Yankee pitcher Mariano Rivera and former player and perfect game pitcher, Kenny Rogers who pitched until he was 43 – ancient by professional sports standards.
Dr. James Andrews, who has performed this procedure more than 2,000 times including many major leaguers, was quoted in a recent Wall Street Journal article as saying that most athletes recover 100 percent and teams have full confidence in it. While recovery time varies, most professional baseball pitchers require a minimum of 18 month of intense rehabilitation in order to return to the mound. This rehab includes time to allow the ligament to heal, very slow resumption of throwing a baseball and highly specialized weight training for the arm and shoulder strength.
Since so many major league pitchers have successfully returned from the disabled list to pitch even better after this Tommy John surgery, the parents of many younger players – high school and even younger – have inquired about the potential of getting this procedure to further their baseball aspirations. Most reputable orthopedic specialists decline to perform this operation under this scenario.
Instead undergoing this surgical procedure, the young players are encouraged to put in the type of strength and conditioning work that players who are recovering from the procedure are forced to undergo. The coaches and managers of these younger players are also urged to limit the number of pitches in a given outing and to instruct them in the proper mechanics in throwing a baseball to build strength and reduce the chance of ulna collateral ligament damage.
What Caused Strasburg to Damage his UCL?
By all accounts, the Washington Nationals baseball organization did everything right when it came to protecting its star pitcher from physical injury. They allowed him time (albeit, not much) in the minors to build strength. They closely monitored his pitch count in order to preclude fatigue-based stress. They removed him from play at the slightest sign of physical stress. And yet, this highly trained athlete, with constant monitoring by the team’s management and with input from the best orthopedic specialists in professional sports, managed to destroy his UCL and will not be available to the franchise for at least one and maybe more seasons.
How did this happen? Some pitching analysts have offered a logical reason for this injury. They contend that Strasburg’s mechanics – his grip on the ball, the location of the ball before he releases it, placement of the landing leg off of the mound and even his lower body placement - are flawed.
As with everything associated with professional sports, especially something that could potentially destroy the career of a star player; there are differing opinions about this problem with Strasburg’s pitching mechanics. Scott Boras, Strasburg’s high profile agent, confidently noted that the injury is not related to his client’s pitching mechanics which he said are fine. However, it is important to remember that in spite of his success as a negotiator for many successful athletes, Mr. Boras’ training is not in orthopedic medicine.
Baseball Rehab is 90 Percent Mental and the Other Half is Physical
With apologies to former Yankee catcher Yogi Berra for the above headline, the mental aspects of coming back from a potential career ending injury can be very difficult indeed. Stephen Strasburg has natural talent and skill that are rare in professional sports. In many ways he has spent his young life getting ready to be a star on the baseball field. So what happens when this number one draft pick, someone who received a $15.1 million guaranteed rookie contract, is forced to spend hours in a decidedly less interesting environment – the rehabilitation weight room?
Many sports psychologists feel that the mental aspects of rehabilitation are more difficult to contend with than those that are physical. However, with the support from his friends and family, and, no doubt, the best medical treatment money can buy, Strasburg has every opportunity to join the hundreds of professional athletes who have undergone Tommy John surgery and came back to enjoy even more success.