Tommy John Surg, Rehab & Return

I am helping to rehabilitate two regionally high-profile prep pitchers who had elbow surgery (one had TJ, other had avulsion fracture due to trauma). It's frustrating for sure. One has his big D-I offer in the bag and the other does not while both are 2015 grads. Mostly rough psychologically, not physically.

 

I feel for your son. Best of luck in rehab!

2015 LHP had TJ end of August by Tim kremchek in cincy.   Will begin throwing program March 1.  NLI to Big 10 school and working hard on rehab and getting stronger.   Optimistic about future and staying healthy.  Although on Spring HS Team, will not be playing at all...not worth the risk.   He was both pitcher and CF prior to injury.   

Kremchek did my son's TJS as well. His timing will allow him to fully participate positionally during his HS season. He doesn't want him to begin mound work till 11-12 months, which is a more conservative approach.  

 

My son's buddy who also signed with the same ACC school had Andrews do his TJS. It's interesting to see how different the 2 surgeons rehab timeline is. Andrew's seems to stick more closely to the normal 12 months, while Kremchek is fine taking longer if the player doesn't have a very significant reason to return at 12 months. 

BK you say your sons buddy.Is it a buddy thru having the injury or a H.S. or travel fellow player?

Yes and we are fine with the timeline.   Son was scheduled to throw starting next week but surgeon suggested focusing on the future and begin throwing in March and look to be "100" for fall ball.   Could have been a DH this spring, but made decision it isn't worth risk of injury...doctor strongly discouraged any competitive play in Spring   

 

We have been so impressed with college coaches and support they have provided.   

It's another recruit in his college baseball class that he'll be a freshman with.

2016 RHP/1B had his done in October 2013.  He returned to throw one inning in September 2014 and threw two innings in early then late October respectively. Andrews was his surgeon.  I think many misconstrue Dr. Andrews time-frames.  It had always been clear that a player must follow the protocols at his own pace. 

 

There's a certain point in which you are healed physically in terms of the repair itself.  Getting them to trust the repair is the challenge.  There's a fine line between encouraging them to ease into it and instilling fear.  We are fortunate that his pitching coach is an MLB rehab coach.  His advice to my son is to trust he is healed and get after it.  If you feel fine, do the work at your best level.  The unsuccessful rehabs from his experience are those who baby it long after the physical healing.   

How long did it take to return to 1B? 

He was playing 1st Base in Mid-Late April.  He was hitting in mid March.  Although he was playing 1st, he wasn't gunning it.

7 to 7.5 months seems to be a pretty normal for 1st & 2nd Base. All other position guys around 9 months. Short-Stops return to 2nd before moving back to Short. Although, I was surprised to hear my son's Dr say a 2nd Baseman could return at 5 months if required.

My son had Tommy John Surgery following his Frosh year of college in late July of 2012 at Kerlan/Jobe in Los Angeles.  247-son came into the Fall this past season 13 months post-op feeling good.  However, after experiencing some soreness/swelling, he was shut down for a few weeks at the end of the Fall.  His arm was ready for the 2014 season and when he finally got his opportunity, he pitched pretty good.  After ten appearances his arm was tender and he was forced to miss 6 weeks as league play was commencing.  He pitched one more game towards the end of the regular season.  Probably should have taken some time to rest, but when you only pitch 19 2/3 innings you play summer ball.  He spent six weeks in Alaska last summer, and pitched a decent amount of innings.  He honestly never felt 100% last season.  The good news is that he's felt very good through this Fall...knock on wood that he doesn't have any setbacks in the 2015 season.

BTW Razorback, my son was recruited as a 2-way player as well.  After his TJS, he decided to focus on pitching only.  It takes a lot of time and energy to be a two-way player in D1, and very few kids get a legitimate opportunity.  Best of luck to your son through the process.

 

I'm not sure how the 2-way plays out but as of now, he's prepping for both.  I'm inclined to say it's easier to just focus on position play after TJ. Time will tell and like most, I'm sure he will settle in at one or the other.

 

Is there anything that you believe made his return a little difficult? Was his rehab smooth Or did he have set backs? Any issues with the actual surgery? 

Not really, he did everything by the book.  Rehab was smooth, and I had him follow up 1-2 times a week for a month beyond the subscribed rehabilitation.  The surgery was a success.  The surgeon moved his ulnar nerve as well, and we were told that could slow things down a bit.  

Honestly, my son has been dealing with elbow issues since age 13, and probably should have had TJS his Sophomore year of HS.  I'm just hoping that his arm stays strong the next couple of years...my kid deserves a little good karma. 

I wish him the best with it. It's such a difficult process mentally.

 

Oddly enough my son is in the best shape ever from this & feels comfortable saying he THINKS he'll be better after this. He was 193lbs when he got hurt & he's still not a huge guy but he's a solid 6'2, 210lbs. His return to weight training has been very successful with his strength in his elbow nearing normal now & he was able to put on some solid muscle for the 1st time. Not playing travel ball all summer/fall allowed regular workouts & improved eating. With that said, he does watch benching very closely to avoid valgus stress & hasnt returned to any explosive Olympic lifts yet. Lots of alterations to how he lifts now. 

 

The one area of difficulty has actually been the hamstring used for the graft. He struggled with it more than the elbow, which I found odd. But, Doc says this sometimes happens & can take time. He reads a good amount on TJS & convinced himself that the hamstring is a better option than the patellar tendon due to its strength & girth. I'm sure that's highly debateable but you tell yourself whatever it takes to get back I suppose! 

bsbl247 - wishing your son the best of success...and the good karma to be flowing his way.  It's been very difficult to watch son go through TJS and now have to miss senior season...although we are keeping our eye on the prize for what's to come after high school.  Anxious for March 1st when he can begin throwing program...excited and nervous for him.

 

 

Thanks HawkeyeNation1.....best of luck to your son during his comeback!  Feel free to send me a Dialog/PM with any questions as he goes through the process.

Razorback,

A good friend of my son (position player) had TJS exactly two weeks prior to his surgery.  They used his hamstring as well, and I recall him having some pain and rehab issues with his leg.  He's now 100% healthy and playing ball at a strong D2 here in So Cal.

Amen. A young man who shows such perseverance deserves a chance to show or find out how good he can be.  

Here's a question... What kind of shelf life do you put on TJ? Some guys never need it again but many are now into round 2. I'm inclined to say that a player is more in the clear if he makes it over the 4-6 year mark without an issue. Do you approach post TJ as a limited window to pitch or as a long term solution?

My hope would be a long term solution...that would mean he'd be playing beyond college at the next level. 

My 2016 has been catching a kid, 24, who is a year out of TJ. Looks pretty good so far, touching 86 after a few months of work. Was drafted by Cubs and is hoping to get some scout interest in a few months. Certainly has positive attitude and high spirits. Exciting to watch him give it another go.

There are some pitchers that struggle to get back and some that decide that another surgery isnt feasable unless you have a big ML contract.  Strasburg is a good example of a slow bounce back, he really hasnt been the same since he returned, but they have a huge investment in him so they will do everything in their power to have him return to post TJS self.

Many pitchers with TJS develop secondary issues, shoulder as an example.  Jaime Garcia is a good example, he has not been able to return to the mound since his TJS.

Chris Carpenter told son in rehab once that after his TJS he was never the same but he is a beast, so I am not sure how many actually are still pitching 4-6 years after the surgery.

The odds are good of a 97% recovery but I am not sure what that translates into how many are still pitching 4-6 years afterwards. Age has a lot to do with it as well.

 

JMO

This is a good thread with some good information.  One thing that hasn't been discussed with regard to the post surgery rehab is the mental aspect of the recovery.  Trusting your arm again and not freaking out thinking that you've retorn it or rinjured everytime you get a pain or a sore arm is a big hurdle to get over.  Having the confidence that you can throw hard without reinjuring it was tough for my son.  He is eighteen months out from his TJ surgery and I think he has finally gotten to the point where he trusts everything and isn't afraid to let it rip with max effort. The pre elbow injury(s) velocity has fnially returned and I really think that, for him anyway, it was more mental than anything with the rehab or surgery.  Either that or my prayers have finally gotten answered .         

My son's PT has to be tired of hearing me ask about how the shoulder is looking. I harp on it constantly.