The most famous left arm in baseball- Tommy John
Photo Cred: Matt Wood
In the second installment of the Tommy John series, I bring you the perspective of an individual who has worked very closely with a doctor who has performed the surgery. The individual I interviewed was Frank Alexander. His perspective is key to understanding what goes into Tommy John rehab and why so many pitchers and players are having this surgery.
Frank Alexander is the partner of Dr. Christopher Ahmad. Dr. Ahmad and Frank Alexander together are part of the physician team for the Yankees, as well as contributors to the Baseball Health Network. Dr. Ahmad is the one who performs the surgeries and Frank is the Athletic Trainer who specializes in the rehab and conditioning of the athlete after the surgery. Alexander' s official title is that of a physician extender to Dr. Ahmad at the Center for Shoulder, Elbow and Sports Medicine. Their office specializes in shoulder instability and labral tears, rotator cuff pathology, ACL injuries, and Tommy John surgeries. Their office is located at Columbia University Medical Center.
The first question I asked was how long Frank had been working with Tommy John patients? He has been working with Tommy John patients his entire medical career. It made sense for him to work with these types of injuries, as he played baseball in high school and college. His exposure is not just that of a doctor, but of a former player and friend. Lots of his childhood friends and ex teammates have needed the Tommy John surgery to prolong their career.
Alexander has done a lot of research through his practice and the Baseball Health Network on this injury. The next question had to do with his findings. Does Tommy John research show that certain arm slots could be a pre-cursor to Tommy John? He offered up the following response, “There is no research that speaks directly to arm slot, but the research does discuss the biomechanical process of the throwing motion as a whole. When we talk about mechanics, we have to look at the body as a single unit and understand the kinetic chain. There is a lot of attention paid to the elbow and shoulder, but the throwing motion starts in our legs and moves up through our core. As the ball is released, the arm decelerates, and the kinetic chain is completed in the shoulder, elbow and hand. If you are looking at the pre-cursors to Tommy John, we can look at the throwing motion as a whole as well as paying attention to mechanics when they become flawed due to fatigue. “
I wanted to get Frank Alexander’s take on the common myth that some players are less reluctant to have the Tommy John surgery because they believe they will throw harder. I did ask this exact same question to Steve Hayward last week. The responses differ a little. Alexander said, “ Throwing harder simply because of Tommy John is one of the biggest misconceptions about the surgery. Many athletes believe they will throw harder as a result of the new ligament and this is incorrect. Dr. Ahmad found that 51% of high school athletes and 37% of parents think that Tommy John surgery is necessary to improve the performance without an injury being present. This is alarming in the sense that the surgery isn’t needed and while most players can return to pre-surgery playing levels it does not guarantee they will be throwing harder. The reason you see the increased velocity is because the pitcher has allowed their body to rest from throwing and focused their workouts on their whole body. They have 4 months of rest before they can begin throwing again. Rest coupled with a good workout regimen is what helps the player get back to high levels of competition. The full recovery process takes about 12-14 months for pitchers and requires a lot of hard work. Having surgery just because you think it will help you throw harder or improve performance is not something that anyone would recommend.”
This was a lead in to the next question, which had to deal with varying rehab times for pitchers and position players, and if the rehab for pitchers and position players is different. Frank responded, “Rehab from Tommy John is position specific and we have protocols for every position. The therapy and the throwing programs themselves are similar but may vary on an individual and positional basis.” The access each athlete has to their trainers is what is different. With the professionals having the widest variety and the best in the business. “The most important thing to understand with the throwing programs is that throwing has a therapeutic effect.” Much like Steve Hayward mentioned last week, Alexander views this step as overcoming a mental hurdle for the player. He wants them to exercise the ligament and slowly build back up the strength, not go out the first time and try to throw as hard as they can. That leads to potential reinjury. The one difference between pitchers and position players is that position players need to throw before grabbing a bat and hitting again. Alexander and his team make sure the throwing program is going well before a bat is picked up. Hitting is not as therapeutic as throwing is for an injury of this magnitude.
Christian Vazquez recently recovered from Tommy John Surgery
Photo Cred: Jeff Pini
The last question asked of Frank Alexander was if he believed every pitcher will eventually get hurt and need to have the surgery. He offered, “25% of major league players have had Tommy John surgery, so it is possible to make it through your career without needing it. However, the numbers continue to rise. Avoiding Tommy John surgery starts with the young athletes. We’re seeing them specialize in sports at an increasingly younger age. The more young athletes engage in multiple sports, the more likely they are to avoid overuse injuries. Putting repetitive stress on their young body can lead to injury and burnout if they participate in one single sport. At the higher levels of play, giving yourself a “true” offseason where you allow your body to rest and recover from a long competitive season is imperative. While in season, it is important to keep physical fitness up and perform your arm-care exercises on a regular basis. The pitch that puts the ligament most as risk for injury is the fastball. That doesn’t get off-speed and breaking pitches off the hook; these pitches can also put a pitcher at increased risk for injury if the player has poor mechanics.”
I enjoyed interviewing Frank Alexander. I thank him for taking time out of his busy schedule to help me out. Frank Alexander and Dr. Ahmad do great work and they are very innovative and cutting edge. Next week, I will deliver an interview with a personal trainer to Rick Porcello, who has yet another experience with Tommy John.