Over the past few years, athletes, baseball pitchers in particular, have achieved a new historical mark, but it may not be one to brag about.  The number of Tommy John surgeries, also known as Ulnar Collateral Ligament (UCL) reconstruction, has risen exponentially.  The surgery, named for the first athlete to have it done, was created and first performed by Los Angeles Dodgers’ team physician and orthopedic surgeon, Dr. Frank Jobe. 

Having gone in for the procedure myself and done the rehabilitation, I have firsthand experience to the full process: from the pain to the diagnosis to the recovery.  The recent propensity for baseball players to have this surgery is making it seem like a quick fix for pain to the average fan.  Make no mistake about it, this is a surgical procedure and should be taken seriously.

To be specific about the increase in occurrences, there have been 31 total surgeries completed in 2014 alone, 17 major leaguers, with two more pitchers expected to have the procedure completed shortly.  That accounts for 4.6% of all the completed procedures since its inception in 1974.  Since the beginning of 2012 there have been 146 surgeries equaling 22% of the total 673 total surgeries completed.  This shows how common this procedure has become.  Here is a complete list of baseball players that have had the surgery.

But why?  Are there more pitchers and athletes having arm pain and damaged UCLs?  No.  There have been many advancements in medicine to make the surgery more successful and full recovery percentages rise, from 1% in 1974 to 92% today.  The surgery and rehabilitation is predictable and repeatable at this point.

So what is the procedure and recovery?  A very quick overview of the surgery follows: An incision on the inside of the elbow is made to access the elbow joint and the UCL.  Two holes are drilled through the Ulna and Humorous bones, one each.  A tendon that has been removed from elsewhere in the body (or now more typically from a cadaver), usually the forearm, Palmaris tendon, or behind the knee, patellar tendon is woven in a figure eight through the holes and secured.  The Ulnar nerve, which is the part of the body most consider the “funny bone”, is relocated to avoid future unnecessary pain and loss of feeling as the nerve becomes loose during the surgery. 

Rehabilitation starts in week two after the surgery because during week one the patient’s arm is in a brace that restricts movement.  Week two, the brace is replaced with a new one that limits range of motion to not disturb the new tendon and inflamed joint.  Range of motion exercises commence in this stage and is as simple as normal eating.  Weeks three thru eight will see the patient doing actual stretches, range of motion exercises and light, three pound maximum, dumbbell exercises.  This is a very gradual stage.  During week ten, the athlete can start the throwing motion without any weight or a ball up until week 16.  All time tables are subject to set backs and how the patient is feeling.  Assuming the rehabilitation is on schedule, the following throwing program is implemented.  Each step progresses as the athlete’s arm can support the progression with zero pain.  The following program takes anywhere from three to nine months.

Suggested Throwing Program for Baseball Pitchers Returning from UCL Reconstruction

Step

Distance

Throwing Schedule

Min./Session

Special Instructions

1

30-50 feet

2-3 days/week

10-15

Easy tossing, no wind-up

2

50-60 feet

2-3 days/week

10-15

Easy tossing, no wind-up

3

30 feet

alternate days

10-15

Lob ball

4

40-50 feet

2-3 days/week

15-20

Lob ball with easy wind-up

5

60 feet

2-3 days/week

20-25

Lob ball with occasional straight throw at 1/2 speed

6

100 feet

2-3 days/week

20-25

Lob ball with occasional straight throw at 1/2 speed

7

150 feet

12-day cycle

20-25

Throw 150 feet on 5-6 bounces

 

 

 

 

12-day cycle: Throw 2 days, rest one (repeat 4 times)

8

150 feet

12-day cycle

30-35

Gradually increase to 150 feet and then decrease

9

60.5 feet

12-day cycle

30-35

Mixed with some long throws, 3/4 speed-full speed

10

60.5 feet

12-day cycle

30

Throw batting practice, 3/4 speed-full speed

11

60.5 feet

12-day cycle

25-30

Emphasize technique & accuracy, 3/4 speed-full speed

12

60.5 feet

12-day cycle

30-35

Gradually increase throwing time, 7/8 speed-full speed

13

60.5 feet

2 days/week

60-120

Game simulation including breaks between innings

 

A common misconception with the surgery is that a player’s velocity increases post-surgery.  There are quite a few instances where a pitcher throws at a higher velocity when he returns to competition; however, his increase is not due to the surgery but, instead, it is due to the focus on conditioning and overall strength the player has attained through the rehabilitation.  I can personally vouch that the core and stability exercises that are completed in the rehabilitation prior to even throwing are as intense and thorough for your small, stabilizing muscle groups as cross fit is for your large muscles.  This focus on stabilizing, conditioning, and core strength is the utmost importance to high velocity and a repeatable and successful pitching motion.  Once the body is ready, the throwing program builds up the arm strength starting at only 20 feet and working its way back.  If players would complete a throwing program like this each year as opposed to just start throwing like normal, they would rarely need any type of surgery or rehab ever. 

There is also an ongoing process of taking care of the new tendon that helps maintain its health and strength.  There are many small and important steps that most pitchers do not complete on a regular basis until after they have the surgery; a focused running program that helps blood circulate through the arm, icing and stretching, and small stabilizing and conditioning exercises with simple sand-filled tennis ball cans are all part of this ongoing process.  If pitchers took care of their arms to this extent all the time, they would be throwing harder and pain free.  This is not to say the potential for a ruptured or partially torn UCL cannot happen with proper care, but it would be dramatically reduced.

Tommy John surgery has become as common with baseball as the national anthem.  I hope that ball players and parents of future players do some research on the matter and realize how easy it can be to prevent the surgery.  But in the case it is needed, one should no longer fear the surgery, just respect its process.

Written by Nic Amanno.  Follow Nic on Twitter @ChicoAlum

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