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Ulnar Collateral Ligament Reconstruction In Baseball Pitchers
Chapter 6-UCL Replacement From Other Perspectives

Chapter 6

Player Point of View
     In-depth interviews with two college baseball players who have undergone this surgery gave me a new angle.  Doctors spend a small window of time operating on the athlete, and the majority of the responsibility to recover is placed on the player.  The process is time-consuming, and can be a daunting task for a young athlete.
     Player 1 and Player 2 both had not needed surgery for any injury prior to tearing their ulnar collateral ligament.  Player 1 knew he was hurt when he felt a pop during a game.  He went on to pitch one more inning that day, and then got his elbow examined.  At first Player 1 was told that he had tendonitis and took one week off.  After pitching two or three more games with pain, he was shut down and an MRI determined that he needed Tommy John surgery.  Approximately three months passed between the actual injury and date of surgery.  Player 2 believes he injured his elbow while throwing a change-up and pitched one more inning that day.  He was initially told he strained his elbow and was told to rest and then begin a throwing program.  When that plan was unsuccessful he was diagnosed with tendonitis.  Player 2s frustration with the situation brought him to seek an opinion from a different doctor.  He underwent one month of rehabilitation, and when that did not work he had surgery.  He estimated the time between injury and surgery as a little less than a year.  Both players noted that giving up was not an option.  They both feel there is a chance for them to play professional ball after college, and Player 2 said that no matter what his future would hold, he wanted to finish up his college career. 
     Player 1 affirmed that the pain was worse than he expected when he woke up from surgery, while Player 2 felt the post-operative pain was not bad.  Player 2, whose surgery was accomplished with the docking method, did note that his worst pain and some dizziness came in a follow-up appointment with the doctor when his sling was removed.
     The rehabilitation experience for the two pitchers was different.  Player 1 did not like therapy because it was repetitive and took up a significant amount of time.  He was completing the program during college and felt that it may be more difficult for a college player to get through rehabilitation than a professional player.  Whereas the sole responsibility of the major or minor league player is to get better, the college athlete is also balancing schoolwork with his recovery.  Player 1 was long tossing one year after surgery and threw off the mound at fourteen months.  Although he thought rehabilitation was hard, he said it was worth it.  Returning to the mound, Player 1 was a bit tentative with his pitches.  He did not want to throw the first curve ball he attempted hard, and had a fear of injuring his elbow again.  Even if it didnt hurt he would still take it easy, but now that he is a year and a half out of surgery, he says he is not tentative with his pitches anymore. 
     Player 2 was more satisfied with the rehabilitation.  He spent a couple hours a day, three days a week, with a major league trainer who had experience helping athletes recover from a UCL replacement.  One difference is that he was completing this program during the summer, when he did not have to worry about classes.  He was throwing off the mound after seven months and was throwing full speed at nine months.  Now two years removed from surgery he feels he is throwing 95-100 percent and is pleased with his results.  Player 2 claims he was not tentative with his throws after surgery but he knows players who were.  He believes that mental preparation is of the utmost importance for a return from surgery because pitching is all about confidence.
     Players returning my survey had this to say about their experience with ulnar collateral ligament replacement surgery:           

In the early months when you first start your throwing program, you think you can just get right up on the mound.  It takes time to heal and you have to take things slowly.

The toughest part was the mental aspect.  Rehab hurt like hell at times but it could never overshadow the question of whether or not I would ever pitch again.

My arm as a whole feels stronger than ever.  Although it often feels stiff when I wake up, it gets loose fairly quickly.  I often can not fully extend or flex it completely, but throwing is no problem now.

I believe that some key elements that are needed for this surgery to be successful are the rehab, and the right doctor.

I felt that the hardest part of coming back from the surgery was the mental part of it.  At first when you experience some pain you get kind of scared which you have to overcome or you will not make your arm stronger.  I felt surgery was well worth it.

It teaches patience, and results are seen if you rehab hard.

Surgery was amazing; I could not have imagined how effective it was in taking away the pain and giving me another opportunity to play.  I took the rehab slow and I think the was the key to how good I feel now.

Playing in the outfield and making hard throws while having cooled down hurt my elbow again.

After surgery or after you hurt your arm, your shoulder strength greatly reduces.  My strength is coming back but very slowly.

Im sixteen months out and I still dont feel one hundred percent.  With all the stories I hear about recovery at twelve months, I know I worked harder or as hard as anyone, why would I not feel normal yet?

The surgery and recovery process was very painless for me.  After ten months, I was pitching in games with no problems.  This was probably because I had surgery right after I hurt it initially.

Coach Point of View

     College baseball coaches are under pressure to win and often deal with injured players.  When asked if a player should have ulnar collateral ligament replacement if he is unlikely to play professional baseball, the coaches had varying responses.  Some felt that it depended on the athletes desire to play and if they would have the motivation to see it through.  On the other hand, a coach stated that he thought players without a future in baseball should get the surgery so he could continue to be active and one day be able to play catch with his son at full speed. 

     While one coach declared that a pitcher is not used differently after his return from surgery, other coaches did see a deviation.  First, the players mental state needs to be monitored after surgery.  Also, a coach thought it was important to build up the pitch count and not use the player as a starter in the initial stages of return to play.  A good example of altering use of a pitcher is John Smoltz.  After having his UCL replaced, Smoltz was moved from a starter to a closer for the Atlanta Braves and was very successful.

     Until recently, the issue of recruiting a player who has had Tommy John surgery had not been a major concern of college coaches because the surgery was not as common in younger athletes.  The surgery is now being offered to many high school athletes and this must be taken into consideration when scouting a player for the team.  The majority of the college coaches agreed that a player with this surgery would not be recruited differently as long as he had returned to one-hundred percent and was throwing up to their standards.  One coach, however, told me his coaching staff is definitely hesitant to recruit a player who has had Tommy John.  There is a large pool of players that we recruit from, so we would rather have a pitcher with a little less talent and a healthy arm.  He stated that there was high demand to win, so he wants to get the best healthy players that will give his team a chance to win everyday.  In the end, he stated that college baseball programs are limited with their amount of scholarship money by the NCAA, so any money given out, you like to see the results on the field. 

MLB Director of Scouting Point of View

      Although UCL replacement has been successful, the scouting directors for Major League Baseball still have a few reservations drafting someone who has had it.  After talking with six directors of scouting, I noticed that they shared somewhat similar views on this topic.  In the case of any athlete who has had prior surgery, the baseball club generally has the team doctors look at the players medical record before he is drafted.  One scout pointed out that since there is no professional baseball combine like football has, sometimes it may be necessary to build a clause into the players contract letting the team escape the deal if he is not healthy. 

      In general, the scouts commented that if they had to choose between two guys of equal ability, one who has undergone Tommy John and one who hasnt, they would pick the one who hasnt.  However, the also made it clear that they will not back away from a player who has had this surgery if hes throwing up to their standards.  Although these players will be under a microscope, the scouts are simply interested in how good the player was before surgery and if hes made a full recovery.  Once scout said his most common question is Hows he throwing now?  If the player is completely recovered, then the scouts dont see it as a big threat. If the player is still on the path back, there is a chance for them to be considered in the draft if they have superior pitching ability.  The scouts believe that selecting a player with a reconstructed UCL is not as big a risk as it used to be because of the current positive results.  Thus, a player who has undergone ulnar collateral ligament replacement is not at a large disadvantage entering the draft, and their pitching ability will be most important in determining their draftability.

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