Athletic Training Blog Series #2
So Chris Sale is Having Tommy John Surgery? What does that mean?
Chris Sale announced last week during the postponement of the beginning of baseball season that he is going to have season ending Tommy John Surgery after months of mixed reports of the seriousness of his injury and many trips to a variety of physicians including the world renowned Dr. Andrews. So what does that mean? Why has this become a major issue at all levels of baseball? And what does the recovery look like?
Tommy John Surgery is a surgery that repairs the Ulnar Collateral Ligament(UCL) in the elbow. If you are looking at your elbow with your palm up- it is the ligament on the inside (body side) or medial side of your elbow. This ligament helps stabilize the elbow. The surgical repair requires using a tendon (Hamstring, Great Toe Extensor, Palmaris Longus) from your body or a cadaver tendon and attaching it as a new UCL. Tommy John was the first person to undergo this surgery (thus it is named after him). He was a professional baseball player. His surgery was completed by Dr. Frank Jobe in 1974.
UCL injuries are occurring at markedly high rates in overhead throwing athletes-particularly baseball and softball players. It is an overuse injury that has led to lots of changes in baseball and softball over the years. This is why the new MIAA pitch count rules have been put in place. It is also why many recommend not teaching student-athletes the true curve ball technique until they are more fully grown/developed. At my previous school, I had a pitching coach who taught a different off speed pitch to all our pitches that created much less stress on the medial elbow.
So once you’ve had the surgery-whats next? Lots of rehabilitation. An athlete will be sent home in a hinged brace similar to those you see for ACLs right after surgery that will limit motion.1-2 weeks after surgery you will begin to be able to move your arm to increase gradually your range of motion. You will be locked in the brace when not exercising, and may wear a sling as well for comfort. Hopefully by the end of the first month you will be able to fully extend (Straighten) your arm-which will mean you no longer have to wear the brace. Most athletes regain full motion in 2-4 months. After this point regaining strength will be the next goal.Aggressive stretching and strengthening will be important. Like ACL surgery it typically takes 9 months or more for an athlete to be able to return to competition. It will be very important to work on throwing form in the late stages of this progression. Long toss will happen well before throwing off a mound.
So why did Chris Sale wait so long? Professional sports teams are notorious for not releasing lots of information-but here are my educated thoughts on his injury. He has most likely been battling a partial tear of his UCL for over a year that they were treating in the AT facility with the Red Sox team of PTs, ATs, and MDs. Sale had probably gotten to a point where any throwing activity was causing such pain and inflammation they had to re-evaluate the plan for his long term ability to pitch. Thus, especially with the current shut down of sports) and what will most likely be a shortened season, it was the prudent decision to get the reconstruction done and focus on getting healthy for 2021.
Takeaways for our athletes-
- If and when your elbow hurts- SPEAK UP DO NOT WAIT
- Start throwing progressions now while we are in social distancing with a sibling or parent
- Building arm strength is important
- Develop other pitches. Do not live in one place all the time.
- Rest between throwing sessions
Some informational links:
Hope you are all practicing social distancing and staying healthy. Can’t wait to get back on the fields soon I hope.
Kristen
