Will the athlete in your house need Tommy John surgery?


Baseball fever is setting in for all of us who love the game. The pros are at spring training and school teams and clubs are ready to take to the field. There’s something about hearing the words, “play ball” that gives me a thrill. Spring training is the time to get back into baseball shape and get the mechanics straight, but from spring training throughout the season, the risk of injuries are there as in any sport.

We’ve talked about baseball injuries before, but I’m going to have you focus on a big issue because it is often misunderstood and the numbers of pro and amateur athletes being treated with this kind of procedure have jumped dramatically over the last few years. Tommy John surgery is a hot topic in baseball, but do you really understand what it treats, how it works and the many misconceptions there are about it? If the athlete in your house might be considering it now or could be looking at as an option someday, it helps to get a reality check.

Usually, college and pro baseball players are the ones who have the kinds of injuries that lead to Tommy John surgery, but younger people sometimes require this kind of surgical intervention, too. Pitchers are especially prone to the type of injury that can cause consideration of this surgery. But, it’s important for you to know is that it’s not just baseball players who may need this surgery. Sports involving repeated, demanding use of elbows can make a variety of athletes candidates for Tommy John surgery. While baseball tops the list by a big margin, softball, tennis, soccer, football, gymnastics, and even cheerleading are all sports where athletes can be at risk.

Tommy John surgery is a procedure that is done to repair the ulnar collateral ligament (UCL), which is located in the elbow. It’s a reconstructive surgery. During Tommy John surgery, the surgeon takes a tendon from somewhere else in the body like a wrist, a thigh, a knee, a hip or forearm and uses it to reconstruct the damaged ligament. It’s a big deal because before Tommy John surgery, was performed and proved to be so effective, players suffering this kind of UCL injury were done. It was the end of their playing days whether pro or amateur.

No surgery should be taken lightly and medical professionals are the last ones to do so. Before the surgery is performed, doctors carefully check the symptoms because it is tricky to diagnose a UCL injury. One of the more typical symptoms is pain on the inside of the elbow. There might be a feeling of numbness in the ring finger or the pinky, the small finger. This is usually caused by irritation to the ulnar nerve. There might also be a feeling of instability in the elbow. Some people will describe it as if their elbow feels loose. Very often, there’s a decreased ability to perform the sport related activities that require use of the impacted elbow. It’s important to know that it’s very unusual for UCL injuries to limit activities associated with daily living and activities like running. That said, it has been known to happen.

At the first sign of a problem, you know the drill. Get yourself or that athlete in your house suffering with a problem to a doctor. Write down the key facts. When did the problem start? What are the symptoms? Have you had a problem like this before? As I always tell you, write down any medications and supplements, as well, to give your doctor a complete picture.

Expect that your medical professional will want to perform a physical examination. There may be some tests that will be performed that can include X-rays and an MRI. The information gathered from a complete picture is critical to making a diagnosis.

Obviously, it would be great if surgery can be avoided. Typically, medical professionals try noninvasive treatment first. Treatments before surgery is selected can often include icing, anti-inflammatory medications and rest. It usually includes physical therapy as well because a physical therapist with the proper sports specialty training and experience in treating sports injuries becomes a partner with the doctor in trying to resolve the injury without surgery. Physical therapy typically focuses on building a program that will help strengthen surrounding muscles to offset the injured UCL. Those who don’t respond to non-surgical treatments and pro athletes or those looking to go pro who are going to have persistent, vigorous use of their elbow often wind up with Tommy John surgery.

When it comes to healing, I can’t emphasize enough the importance of listening to the doctor and the physical therapist. Whether it’s a noninvasive treatment approach or post-surgery, there’s a reason for the process. Healing can’t be rushed. The dangers of causing setbacks and further injury are huge. They are giving you the benefit of years of expertise and the knowledge the athlete in your house needs to recover.

There’s a big controversy around the issue of Tommy John surgery these days and you should understand it. A number of young pro and even amateur athletes who are taking many more risks than they should involving overuse and pushing the limits because they figure they can always have Tommy John surgery and it’s no big deal. Surgery is always a big deal. There are always risks and there are no guarantees that the surgery will work. This is not the attitude to have and that’s why listening to parents, advisors, and coaches should be job number one for any athlete.

Another important element is proper preparation and training. Warm-ups and cool downs are part of it. Proper training teaches proper mechanics and that is a key part of avoiding injury. Proper conditioning prepares the body for the strenuous activities that can cause injury and builds capacity. If you have questions about conditioning, you can talk to your doctor. Don’t be surprised if you are referred to a physical therapist with the know how and experience to evaluate your young athlete and create the kind of conditioning program that is appropriate to the specific needs of the athlete and the sport.

The other part of the equation is the need for your athlete to understand the importance of proper nutrition, hydration and rest as a part of their regular routine. Nutrition and hydration shouldn’t require further explanation. I put those in the no brainer category. The controversy that can be most frustrating for coaches, parents and medical professionals surrounds rest. Injury or no injury, every athlete wants to play and play as often as possible. The problem is that without the proper rest, the body is not able to heal properly. A good example of this is what happens to pitchers. Small tears in the tissue are a normal part of what happens with pitching. Those tears need to heal and they won’t heal without rest. I have these kinds of conversations with athletes all the time. They’re getting physical therapy because of an injury and they want to bargain over recovery time. My answer? It’s not going to happen.

I’ll leave you with the words of former pro pitcher Randy Johnson. He was the tallest player in big league history and was inducted into baseball’s Hall of Fame last year. Known as “The Big Unit,” he was a dominating left-hander who had his share of injuries. His philosophy on injuries was, “Work hard. And have patience. Because no matter who you are, you’re going to get hurt in your career and you have to be patient to get through the injuries.” Nothing earth shattering about those words except good old common sense. They remind us what we all should know and remember.

Bob Cairo is a licensed Physical Therapist at Tidewater Physical Therapy He can be-reached by calling (302)537-7260.