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Why Do Some Guys Come Back to Pitch Better after Tommy John Surgery?

Written on January 12, 2010 at 4:56 am, by Eric Cressey

Q: I was wondering the other day about why guys often come back from Tommy John surgery pitching better and harder than they did before.  My first thought was they can't do any upper-body strength training for months while they recover from the surgery, so they're forced to work on lower body, core, and mobility - and, in turn, come back as better conditioned athletes with more control and velocity.  Or, do you think their improved velocity and command is just an illusion made possible because we're comparing them to the way they pitched while they were hurt, but not yet "disabled?"  Or, is there another factor I'm missing altogether? I figure there's a sample-size issue -- we're just looking at the guys who make it all the way back, and ignoring the ones who don't.

A: It's an excellent question - and one I actually get quite a bit.   I'd say that it's a combination of all three.

In my eyes, an ulnar collateral ligament tear is usually an injury that speaks to YEARS of dysfunction and accumulated stress.  Guys usually have a history of elbow pain/soreness in their teenage years, some calcification on the UCL, and then it finally goes in their college/pro years.  They may have been managed conservatively (physical therapy) for a long time just because doctors don't like doing surgeries on 16-year-olds.  However, when they're 20, it becomes "acceptable" to do a Tommy John surgery.

scar

In the meantime, many of these injured pitchers will modify their deliveries to avoid the pain and end up with some crazy mechanics that leave the ball all over the place at erratic radar gun readings.  So, that can usually cover the velocity drop and control issues.  This is in stark contrast to what you'll see with serious injuries to the labrum (SLAP2 lesions), which generally give you the quick velocity drop, and eventually, loss of control - even in the absence of pain.  Elbow stuff doesn't usually directly influence velocity as quickly; a lot of guys can throw through it for years.

elbow

So, yes, we are comparing them to their pre-injury numbers.  However, there is - at least in my eyes - a better reason.

They are often lazy and inconsistent with their training and arm care before they get hurt.  Quite often, you'll see an ACL reconstruction leg coming back and being stronger than the uninjured side long-term.  The same thing can happen with a Tommy John.  The rehab is crazy long, so guys have time to learn arm care as religion and - as you noted - focus on athletic qualities that are often partially or entirely "squeezed out" by competing demands.

I remember talking with Curt Schilling along these lines - although it was with respect to his shoulder.  He had a shoulder surgery in 1995, and it made him "religious" about arm care.  His best years came years after that even though he'd gotten older.

curt-schilling1

So, usually, the guys who wind up throwing harder are just the ones who were lazy in the first place and were finally forced into actually taking care of their bodies.  The guys who DO take good care of their arms and wind up tearing UCLs rarely come back throwing harder, and to be frank, probably have a lower chance of returning to their former selves than their lazy counterparts.

Of course, this obviously excludes issues with the graft type (autograft or allograft), graft site (Palmaris longus, hamstrings, or another site), surgeon's abilities, physical therapy, athlete motivation, strength and conditioning, and return-to-throwing progression.

To learn more about assessment and management of the throwing elbow, check out my Everything Elbow In-Service video.

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  • BigJawnMize

    Eric-

    I had a TJ when I was 19 an then put the final nail in the coffin by blowing out my shoulder when I was 21. (The joys of having mediocre talent and trying to get/keep your scholarship.) In high school I didn’t really have too much elbow pain, but because I was so violent mechanicaclly I went from no pain to full tear in a couple of weeks.

    I think you last paragraph glazes over a lot of important points in the arguement. Having experience with this surgery I feel there is a psych aspect to it. I feel a lot of guys come back from the sugery with much better breaking stuff (I did) because the doctors tell you that they are putting so much material in that joint you will never tear it. You are encouraged once you heal to really take the performance of the joint to the limits.

    That said I do agree with most of your thoughts frankly because I doubt elbow strength has much to do with velocity. Velocity is more a result of shoulder mechanics (lay back) and the ability of the hips and spine to hold and release torque.

    Any of your guys had a TJ?

  • jerry weinstein

    Really good comments by BigJawnMize especially about the ability of the hips & spine to hold & release torque. This is a concept that few really understand.

    JW

  • http://www.38studios.com Curt Schilling

    Eric is 100% correct. Good Doctors will tell you the truth, they can make you 100% perfect, better than you ever were.
    However the surgery is a complete waste if you don’t get ‘religion’ about your arm, shoulder, elbow and the kinetic chain, and understand EXACTLY what does what, and why things do what they do in the effort it takes to throw a baseball.
    Understanding the chain starts at your toes, and ends at your fingertips, and that every part in between is part of a lever and pulley system that transfers power from bottom to top.
    Think about it like this. You have 100% of your throwing power when the chain begins to work, as you come out of your wind up into the throw, when the power begins to transfer up your body, from your foot, each part of your body in between is a conduit for that power, if you start at 100% and the result of the throw is you using only 70% of your power, where are you losing it in the chain? That’s the piece you need to strengthen, and it’s a constant, 12 month a year process.

  • BigJawnMize

    Curt-

    I don’t disagree at all. I didn’t have surgery after my rotar cuff tear…it took me almost 10 years (of basically rehab) to throw a ball with any velocity. I found my religion.

    I believe that the body is ineffecient at delevering the power developed in the lower body to the ball. People need to maximize the transfer of the power in the body more robust joints (hips and core) to minimize the amount of power needed in some of the more delicate joints (shoulder).

    Talking about the body being ineffecient. If the body was perfectly effiecent in transfering power from the lower body, then to increase pitch velocity we would work the quads. Obviously it is a more complecated answer. What I wonder about is if we should be teaching high schoolers the “Chain” thought which takes an incredible amount of mind muscle connection and athletic abilty to practice. Or as I have been doing the last couple years and focusing on the proper use of a limited number of very powerful muscles (quad, hips, core) because I don’t want to adversely affect a kids arm action be it perfect or flawed.

  • Clay T

    I had TJ surgery yesterday. My doc (Rangers Head Physician Keith Meister), said you get the boost in velo from all the hard work you put in with the rehab for the next year. I believe him, and when my arm is mobile again, i’m doing a shoulder conditioning program as well. wish i haad more input but i hate typing w/ my left hand

  • Bill Person

    Not a pitcher, but a grandfather of one. I think you should have a contract (thats with a small “c”) with all of your high school kids (and their parents) that they read your articles on the importance of proper strength training to avoid all of these problems!! For me it has been a great learning experience to read your articles.

  • Pitcher112

    Quick question… I know you talk about calcification of the ligament a lot.. But if i pitcher is currently pitching with it are they doomed to go under the knife?

  • http://www.ericcressy.com Chalo

    Eric, thanks for the info on TJ surgery I think more should be written about it. An article on surgens that are the best at doing TJ would be of great help. Our son suffered elbow injury during the summer and was diagnosed as a partial tear of the flexor tendon on his forearm. In six months he was not at 100%, we took him for a second opinion and the first thing the Dr. said was “you need TJ”, same old report from June. Not sure who to trust it’s a big decision and it has to be done right by a good Dr. and thats where the article would help who are the best across the country.

  • BJ Maack, ATC

    What about the simplicity of: “they are finally healthy and throwing with an uninjured ligament”?

  • Mike S

    @BigJawnMize. I think the basic core for teaching a young high school athlete on how to use his body correctly and work through the chain would be a solid strength and conditioning program that corrects any current constraints, improves mobility, improves tissue quality, works all planes, and gets you in that happy medium in between speed strength and strength speed. I.e. a program designed specifically for the athlete. Give him 4-6 months and you canoeoo

  • Will

    Coming from someone who has had two reconstructive (acl) surgeries… The doctor and your dedication afterwards is everything… You can have a great recovery or a bad one but its up to you and the dr. Who puts you back together

  • Robert

    Eric, do you belive that it alleviates stress on the elbow if a pitcher only throws max effort once or twice a week, ,period? Including mound sessions

    A lot of pitchers throw as hard as they can everyday and that seems pretty detrimental when the season goes from january to mid june

  • http://www.nesportpartners.com Tom Landry

    Injuries to adolescent pitchers pre puberty are potentially avoidable with education and awareness to the parents and coaches of these players.
    Often times the injured pitcher is taken to their pediatric physician and then to PT. The pitcher is put through a series of exercises for several weeks and then allowed to continue to pitch.
    The cause and effect of the injury is never addressed by the medical group so the mindset of the young pitcher is that they’re okay to maximize effort. There is a higher percentage of the injury recurring with a greater risk of more long term damage especially as the pitcher gets older and stronger believing they can ‘pitch through the pain’.
    One of your earlier posts with regard to pitching coaches needing to be educated in understanding kinetic movement is necessary to help with this education process. If you would like to set up a seminar to address these issues let me know.

  • Robert

    When long distance running is required by the baseball team, is it better to go above around 75 bpm heart rate? Or under?

    I know the studies you posted say it negatively affects you once you start going over, but would it be better when trying to hypertrophy fast twitch muscle fiber?

  • http://ericcressey.com Eric Cressey

    Robert,

    I keep it very low key. You aren’t going to hypertrophy fast twitch fibers running long distance.

  • http://ericcressey.com Eric Cressey

    Also a valid consideration, BJ!

  • http://ericcressey.com Eric Cressey

    Well said, Will.

  • http://ericcressey.com Eric Cressey

    Robert,

    Definitely silly to throw off the mound (or at max effort) every single day.

  • Mike

    TJ surgery fixes an internal issue, but in many cases the injury was a result of poor mechanics. Poor mechanics can be a result of never have been taught proper ones or as a result of limitations, dysfunctions, etc. Just because you were fixed, doesn’t mean you were fixed. I have watched too many young athletes get TJ surgery, go through mediocre rehab, come back “strong”, and repeat the injury.

  • http://ericcressey.com Eric Cressey

    Agree 100%, Mike. They usually come back as shoulder issues, though. That TJ repair holds for ~8 years (ask Soria, Brian Wilson, etc).

  • Hunter Palmer

    I am a 19 year old Junior college pitcher and I’m 2 1/2 months out of tommy john surgery right now. I’ve been doing rehab non stop trying to come back in better shape and throwing harder than I was before. Before my injury I was 87-89 on an average fastball, bump 90 every now and then on a good day, but after continuous throwing my velocity dropped off significantly. There was no one pitch where I felt a pop or anything like that. It was more of a gradual thing. By the end of the spring i was 82-84. Of course you could understand my frustration as to why I couldn’t light up the radar gun but was too prideful to blame it on my arm hurting. I was still effective with my off speed but it just wouldn’t cut it to go play division I baseball throwing 84. After the season is when I had my MRI and in fact was a torn UCL.

  • http://yours dave steere

    I looked at your archived articles and not sure,but I don’t see an article that addresses your approach/philosophy to TJ recovery,especially use of weighted balls and some of the Tom House approach,such as he used on Steve Delebar.I understand you’re busy.I’m 54 and had the surgery 3 weeks ago and I am in that category of hard worker and will do all I am allowed to strengthen and rehab.Any solid feedback or links would be appreciated!

  • http://ericcressey.com Eric Cressey

    Dave,

    Unfortunately, that’s because my approach is more like a book than an article! There is a ton of stuff to keep in mind, and each case is unique. I’d encourage you to find a physical therapist near you who has rehabbed TJ cases.


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