SoxProspects.com: Tales of Tommy John

At 24, Portland Sea Dogs pitcher Alex Wilson has not been in professional baseball long enough to be considered an elder statesman. But Wilson, who underwent Tommy John surgery in 2007, is more than willing to tell friends and teammates who need the same procedure exactly what they will be up against.

His words are not exactly encouraging, nor would they strike others who had the surgery as out of the ordinary. In fact, they are pretty simple.

“Hey, your life is going to stink for the next month,” Wilson tells them, without getting into the additional 11 months it typically takes to get back to game action. “It’s miserable.”

And to those who think the surgery is a magical cure-all that adds velocity to your fastball and automatically makes someone a better pitcher?

“You have it and see how fun it is,” he suggests.

Those who have undergone Tommy John surgery, an elbow procedure that involves drilling holes in the ulna (a bone in the forearm) and the humerus (the bone of the upper arm), and weaving a tendon through the holes to replace the damaged ulnar collateral ligament, will tell you it is no fun at all. The surgery itself, which Red Sox pitchers Daisuke Matsuzaka and Rich Hill underwent at the beginning of the month, takes about an hour.

But over the next year, Matsuzaka and Hill will join a list of members of the Sox organization that includes the man who replaced Hill in Boston, Tommy Hottovy, minor league pitchers Wilson, Drake Britton, Mathew Price, Caleb Clay, Miguel Gonzalez, Junichi Tazawa, Jennell Hudson, Tom Ebert, Seth Garrison, and Jordan Flasher, and even outfielder Zach Daeges and catcher Dan Butler. All endured the monotony and small, incremental improvements that make up the rehabilitation process following Tommy John surgery, a process that has become increasingly common but occurs without much fanfare.

“I just wanted to do it and move on”

Not everyone has the devastating moment experienced by Hill, who clutched his elbow following a pitch and told trainers that he felt a snap. For Wilson, the tear was gradual, and according to his doctor, the result of overuse in college.

After throwing 138 innings in his freshman year at Winthrop, Wilson went 6-4 with a 2.51 ERA in 111 1/3 innings during his sophomore campaign before joining the nation’s best college players in the Cape Cod League.

After two uncharacteristically poor outings for Falmouth, Wilson was shut down because a bone chip the size of a tooth found its way into the joint in his elbow, causing his elbow to lock up at a right angle. He had to straighten his arm with his other hand.

Wilson left the Cape on July 4, 2007, and drove to Cincinnati to have his elbow examined by Dr. Timothy Kremchek, the Reds’ medical director and chief orthopedic surgeon. Two days later, he had surgery.

“I didn’t have any part of [the ligament] left,” Wilson said during spring training. “My elbow was completely shredded.”

Kremcheck gave Wilson the option of rehabbing his elbow for six months to see how it responded, but Wilson was wary.

“Guys who rehab it, it’s like flipping a coin whether it’s going to help or hold you back,” Wilson said. “I just wanted to do it and move on.”

Had the Red Sox been making decisions for him, the team might have opted for rehab, as they did with former Virginia Tech left-hander Mathew Price, the team’s eighth-round pick in the 2010 draft. Price began to feel pain in his elbow in an ACC tournament game against Clemson.

“Every time I tried to throw after that, it was really painful,” he said. “I had to force myself through it.”

Price appeared in two NCAA Regional games after he felt something was wrong. He threw just 18 pitches in a rain-shortened outing on June 5 against Bucknell and came back the next day to face South Carolina. Price contained the Gamecocks for the first five innings, but was charged with six earned runs in the seventh inning. He went 6 2/3 innings, throwing 89 pitches. Two days later, Boston selected him in the draft.

“The Sox knew that I was injured,” Price said during spring training. “There was no harm in going the rehab route, so we went that way instead of surgery.”

Price spent the summer rehabbing the injury, and even got an injection of platelet-rich plasma that was meant to catalyze the healing process.

While trying to deal with his elbow, Price also had an important decision to make. As a draft-eligible sophomore, he could have returned to school and been eligible for the 2011 draft. He was in constant communication with the Red Sox about his injury, and ultimately signed for $415,000. The injury played a big role in his decision.

“If I had gone back to school, who knows?” Price said. “I could have had surgery and sat out all this year. I wouldn’t have been pitching until my senior year. That’s a huge setback as it is. It definitely gave a little incentive.”

All of Price’s MRIs over the summer showed no tears in his UCL, and the Red Sox invited him down to the Fall Instructional League in Fort Myers. He felt good, and eventually was asked to throw a bullpen session.

“The next day, I couldn’t move my arm,” Price said. “Two days later, I was getting an MRI and eventually, Tommy John.”

Despite the lengthy delay in a surgery that he may have needed anyway, Price does not believe the route he and the team took was harmful.

“I think it was the right thing with the steps that we took,” Price said. “We tried to make sure that we didn’t have to get the surgery if it wasn’t necessary. You never know what the outcome of surgery is going to be. We tried everything before that, so I feel like all the right steps were taken”

“I tried to make it fun”

While Price got a taste of rehab before his surgery, right-hander Jennell Hudson has gotten two full doses of it.

In the spring of 2009, an MRI revealed that the 6-foot-6 German had a strained UCL. Like Price, the scan showed no tear, so the team opted to try to let the injury heal without surgery.

The 2009 season was lost for Hudson, then 18. He spent the summer rehabbing in Fort Myers, and after an offseason back in Germany, returned to Florida for the 2010 season feeling better than ever.

He threw several bullpen sessions and was scheduled to throw batting practice one last time before returning to game action when the injury flared up. This time, an MRI revealed a tear. He had surgery last April and spent a second straight season in Fort Myers rehabbing his elbow.

According to most players, the first few weeks after surgery are the most difficult. The arm is kept in an immobilizing hard cast for the first week, then placed in a soft brace that allows limited movement. But once the hard cast is off, the process of breaking down the scar tissue that forms around the elbow begins. Hudson said that getting his arm straightened out was the worst part of the process, a sentiment Wilson echoed.

“It’s very slow, very tedious, and it’s painful,” Wilson said. “I hated it. Getting the arm straightened out was probably one of the most painful things I’ve done.”

The next few months consist of range-of-motion exercises and, most importantly, shoulder strengthening. After overuse, shoulder weakness is one of the leading causes of the injury that leads to Tommy John surgery. To rebuild shoulder strength and ultimately protect the elbow, pitchers do a number of shoulder exercises with light weights and dumbbells, as well as band-work.

“I tried to make it fun,” Hudson said of his rehab during spring training. “I had to try to make it work. It gets hard sometimes because you really want to go out there and play.”

For pitchers,whose livelihood stems from throwing a baseball, the four-month wait to simply play catch can be difficult. Though the reason for the layoff was that their elbow had betrayed them, there’s no apprehension when someone finally puts a baseball in their hands.

Hudson began spring training this year throwing bullpens, but after two years without throwing, he frequently felt uncomfortable on the mound and was having trouble with his mechanics. With the kinks worked out of his delivery, Hudson pitched in his first extended spring training game on April 22.

“I couldn’t wait,” he said last week of his first game action since throwing in the rookie-level Gulf Coast League in 2008. “It just feels good. It feels like I’m part of the team again.”

Hudson has progressed to a regular five-day throwing routine, and his fastball is peaking at 92 m.p.h., just as it did before the injury. Hudson pitched an inning-plus in the Gulf Coast League Red Sox’s season opener on Monday, closing the book on the most difficult portion of his comeback.

Back on the hill

While Hudson, who came to America at age 17 and is still learning the game, had few expectations to live up to following the surgery, others are not so lucky. Left-hander Drake Britton and right-hander Caleb Clay, both highly rated draft picks coming out of high school, underwent Tommy John surgery after impressive professional debuts with Lowell.

Clay, a supplemental first-round pick, 43rd overall, in the 2006 draft, made his debut for Lowell the following year. He went 1-0 with a 2.14 ERA in 21 innings, but left his fifth start with elbow pain. He had surgery a month later, and after rehabbing through the winter, returned to the mound in 2008 to make two appearances in the Gulf Coast League, just shy of a year after his surgery. Clay made his full-season debut in 2009 for Greenville, but did not perform like a first-round pick. He was 6-7 with a 4.01 ERA in 110 innings.

“I never really felt good when I was in Greenville,” Clay said in spring training. “Every pitch took a toll on my arm. There were games that I’d show up to the park and my arm would be hurting before I even pitched.”

Clay said he was close to full health in 2010 for Salem, but posted an unsightly 4-13 record with a 4.57 ERA in the Carolina League. This year, Clay has an ERA over seven out of the Portland bullpen. Though he said in spring training that he felt completely healthy, Clay still is not where he was before the surgery, which was three years ago this August.

“I still haven’t gotten my velocity back to what it was,” he said. “Before I had surgery, I was sitting low-90s. I was at 88-90 most outings this year. It varied. I don’t know if I’m ever going to get that velocity back.”

Increased velocity, a trait widely associated with Tommy John surgery, is no given.

“The biggest misconception is that everybody is going to come back throwing harder when they’re healthy,” Wilson said. “Really, the only reason people come back throwing harder is because they actually learn how to train their shoulder and strengthen it. I’d been doing that since high school, so when I finally blew out, I got right back to where I was.”

Britton, however, said he has seen “big-time upticks in velocity” with the added shoulder strength.

“I had a year to build my shoulder up,” he said. “I got in better shape and my shoulder and elbow felt phenomenal. My hard work shows out on the mound, especially with my velocity.”

Britton, a 23rd-round pick in the 2007 draft who received a $700,000 signing bonus, had a similar start to his career as Clay’s. He injured his elbow in a game at Lowell in August 2008 and had surgery a month later.

While it took Clay years to feel healthy again, Britton said his recovery went much faster.

“The first day at 90 feet, I just cut it loose,” Britton said. “You’re supposed to take it lightly, but my arm felt incredible. It popped every piece of scar tissue I had in my elbow, and I haven’t had another issue since.”

He returned to game action less than 11 months after surgery and appeared in seven games between the GCL and Lowell in 2009 before heading to Greenville for his first full season in 2010.

An unrelated triceps issue kept Britton out for a month early in the season, but the left-hander went on to post a 2.96 ERA with 78 strikeouts in 75 2/3 innings. Suddenly sitting in the low-90s and hitting 95 m.p.h., Britton found himself ranked as one of the top prospects in the Red Sox system.

“It was good to have a year and think about certain things that I could do without worrying about whether my elbow was OK,” Britton said. “Once my elbow was OK, I didn’t have any problems. Physically, there were no doubts.”

Perhaps the surest sign that the Tommy John chapter of Britton’s career is finished is that he has moved onto the next phase of struggles for a young, talented pitcher. The 22-year-old left-hander is dealing with failure for the first time. However, like many of his peers who have finished the journey back from Tommy John, he is prepared to deal with this next stage on his way to the majors.

“I feel great physically,” he said. “I finished last year really well, blew through spring training and was ready to go, but it changed once the season started. It’s just been mental. I’ve never struggled in my professional career, so I got worried and panicked. I have to continue to believe in myself and keep working. I’m not worried anymore.”