07 September 2011

Shorter Recovery For Pitcher’s Elbow Surgery

Story first appeared in USA TODAY.
Stephen Strasburg was back on a major league mound right on schedule, a year and three days after having Tommy John elbow surgery.
That timetable, however, has narrowed significantly from years past.
Pitchers who have the operation are told to expect the rehab to last 12 to 18 months, but most are returning around the one-year mark, thanks to refinements in the surgical technique.
In a study conducted by the American Sports Medicine Institute and published in a trade journal last year, 83% of the 743 athletes (not all professional pitchers) who were contacted reported returning to their previous level of competition or higher within two years of having the surgery. The average return time was 11.6 months.
Research into the careers of active big-league pitchers who have had elbow-reconstruction surgery shows they return to the majors in an average of 394 days, or a year and 29 days, excluding those whose rehab bridged two offseasons because of the timing of the operation.
Recent examples include the Florida Marlins' Josh Johnson (342 days), the Cincinnati Reds' Edinson Volquez (348) and Strasburg's teammate on the Washington Nationals, Jordan Zimmermann (372).
Kevin Wilk, a physical therapist involved in the ASMI study who has worked for 23 years with noted orthopedic surgeon James Andrews of Birmingham, Ala said the rehab is not that complicated per se, the complicated factor is the throwing program and getting your mechanics back in line, getting your velocity back, and obviously the rehab allows you to do that, but what takes the majority of the rehab time is the fine-tuning of the pitching.
Medical experts say surgical adjustments developed in the last decade have helped speed up the recovery while minimizing the risk of complications.
The original procedure, performed in 1974 on John, then a Los Angeles Dodgers left-hander, by pioneering surgeon Frank Jobe, required transposing the ulnar nerve and cutting the elbow muscles off the bone.
Now some surgeons leave the nerve in place, and nearly all split the muscles, which allows for a quicker recovery. Brad Parsons, an orthopedic surgeon at Mount Sinai Medical Center in New York who has performed 30 to 40 elbow reconstructions said it's a little bit less invasive of an approach and the muscles are protected better, and the affixation of the graft into the bone is less invasive, so less trauma is incurred to the elbow.
Strasburg had a 5-3 record, 2.91 ERA and 92 strikeouts in 68 innings during his sensational, though truncated, rookie season, often baffling hitters with a devilish curveball as complement to his 100-mph heat.
He might not get the hook fully back until 2012.
Some pitchers who had Tommy John surgery say they were pleased to see their old fastballs return to their previous standards within a year, but they also point out other aspects of pitching — such as the snap in their breaking pitches and sometimes command — took longer.
Zimmermann said his breaking pitches were not quite as sharp at first, taking 10 months off from throwing, at first it feels like you've never thrown a curve before.
Some of that feeling probably stems from a psychological barrier. The rehab is full of ups and downs, often requiring the athletes to go back a couple of steps in the process, which takes a mental toll.
Lyle Cain, an orthopedic surgeon at ASMI said from a physical aspect, sometimes in eight or nine months they're actually pretty darn good, but having the confidence to really cut loose, to place the ball where they want to and to control all their pitches, it takes a lot longer.
Cain said at some point the rehab time might get further shortened.
But for now the general protocol is about a year, give or take individual variations.
San Francisco Giants right-hander Ryan Vogelsong, who had his elbow reconstructed in 2001, said Tommy John patients need to resist the urge to overdo the rehab on the days they feel good.

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