One of the biggest disappointments of the fantasy year has been the mediocre pitching of Minnesota's
Every year pitchers go under the knife to have their Ulnar Collateral Ligament (UCL) replaced, which starts the clock on the rehab process to regain velocity and form. The original rehab time to return to pre-surgery pitching efficiency after this procedure is 18 months. But in recent years a team's desire to get its multi-million dollar investment back on the mound combined with the athlete's natural need to compete have driven the rehab time down to 12 months. This shortened rehab schedule has produced mixed results.
This article will look at the results of certain pitchers who have come back from the surgery. Based on what is discussed below, here's the protocol you should follow when evaluating any pitcher that has the procedure done:
UCL surgery involves replacement of a damaged elbow ligament using one from another part of the body -- typically the hand, wrist, forearm or hamstring -- which is then wrapped in a figure-eight pattern through holes drilled in the arm's humerus and ulna bones. The procedure is more commonly known as Tommy
Prior to John's successful comeback, a torn UCL meant a pitcher's career path was headed towards coaching or broadcasting. However, after returning during the '76 season, John was able to add 2544.2 IP to the 2165.2 he had already thrown, and logged more than half of his 288 career wins after his surgery. Even by today's standards pitching an additional 14 post-surgery seasons was a remarkable feat, and John's results are the medical equivalent of Cy Young's 511 career wins: It's foolish to even discuss whether someone will come close to matching it.
Pitchers have reported a post-surgery increase in velocity. Former closer
Doctors postulate there are other reasons a pitcher might see increased velocity post-surgery. The pitcher likely pitched with a torn UCL prior to the surgery, so he had not been pitching at peak performance. Replacing the UCL allowed the pitcher to get back to where he would have been before the ligament damage, but not necessarily to a point of improvement. Also, the rehab process works to build up the shoulder and elbow, which means the pitcher is probably in the best shape of his life, concentrating on health, nutrition and fitness for a full year. And sometimes, the pitcher matures physically during the resting period. Any one of these reasons -- or any combination -- could lead to increased velocity.
Koch (yes, him again) once said, "[My arm] felt so good when I came back, I said I recommended it to everybody ... regardless what your ligament looks like." Sure he was being facetious, but since we're talking about potential multi-million dollar careers, many didn't take his comments that way. There has been talk of prophylactic TJS on healthy ligaments, but that would run south of anybody's interpretation of the Hippocratic Oath.
What is more disturbing is the increase in surgeries among younger pitchers. Dr. James Andrews estimates that 20% of his TJS patients are major leaguers, another 20-25% are minor leaguers, and the remaining 55-60% are college or high school athletes. The late
The initial rehabilitation time between Tommy John's UCL surgery and his return to the majors was 18 months, or basically the end of the '74 season to the beginning of the '76 season (technically, from 9/25/74 to 4/16/76). In his first season back John -- a sinker curveball pitcher -- made 31 starts (207.0 IP) with a 3.09 ERA and pitched six complete games. While his 10-10 record was mediocre by his standards, his underlying statistics were not far off his pre-surgery numbers and he was voted the NL's Comeback Player of the Year.
Since John's UCL surgery, post-TJS rehabilitation has become better defined. The arm is initially immobilized for a week then put in an adjustable brace. The patient is engaged in range-of-motion exercises working up toward swinging a golf club by the 12th week. By the 16th week the pitcher starts throwing on flat ground and then throws from a mound at six months. By the end of 12 months the pitcher has thrown breaking balls and can pitch batting practice. It is at this point the pitcher may return to competitive pitching. However, that's just from a muscular and joint point of view. The pitcher still has to mentally trust the arm (something some say Liriano is yet to do) and get back his mechanics, and it often takes another season before he can be considered back to full effectiveness.
Differences in physiology, surgery effectiveness, and environment can affect the length of the rehab. Also, the pitcher has to make sure to work on his shoulder while rehabbing his elbow, or risk a DL stint with shoulder problems because they allowed the muscles to weaken during times of limited arm movement.
With the established time to return to effectiveness being 18 months but the time that a pitcher can return to competition being 12 months, the more patient teams have used the compromise of having the starting pitcher return by way of the bullpen. The plusses are obvious as the pitcher, who may not still be back to physical and mental game shape by the end of the 12 months, need not be stretched back to pitch 100 pitches in an outing. Also, giving him one-inning outings allows him to get the feel of his pitches back with less damage to the team, and the manager can be more selective on when the pitcher enters a game.
Perhaps an argument in favor of going to the bullpen is the high-profile closers and relievers that have been able to perform well at the major-league level post-TJS.
Perhaps the highest-profile example of going the post-rehab bullpen route is future Hall of Famer
The blueprints for Smoltz's move to the bullpen in '01 may have been drawn by the Cardinals in the previous season. Starter
Let's look at some current starting pitchers and see what their post-surgery careers have been like. For each I'll note the player's current team, the date of their surgery, and their age at the time of the surgery. And keep in mind for each
Below are some notables that have had TJS within the past year and the date of their surgery. Note that most surgeries are done during spring training or the baseball season as that is when pitchers are working the hardest and most likely to have or notice an injury. That means the pitcher will likely return the next season and be more effective two seasons later.
The next pitcher to return will be
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