Saving Careers

“Tommy John” surgery has put Tech baseball standouts Andrew McDonald and Nic Enright – and others – in a position to continue their careers, and Tech’s sports medicine staff is playing a role in the rehabbing of and prevention of elbow ligament tears

By Nathan Loprete
​Special to Inside Hokie Sports

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On March 5, 2014, Virginia Tech was trailing William & Mary 6-0 at English Field when Hokie head coach Patrick Mason made the move. He decided to bring in Andrew McDonald, a 6-foot-6-inch freshman from Cincinnati, Ohio, to throw the final two innings. The freshman walked the first batter, but then got a strikeout and a double play to end the inning. In the ninth, he walked a batter and gave up a run-scoring triple before getting out of the frame.

McDonald’s collegiate career was officially underway. Just as most college athletes do, he remembered his debut.

“I was a little nervous,” he said. “I got hit that time, too. I took a one-hopper right off the leg. It was a funny way to release some tension.”

McDonald earned three varsity letters while in high school, winning the Ohio High School Division 1 Player of the Year honor prior to arriving in Blacksburg. His freshman year at Tech featured ups and downs, but the future looked bright.

That all changed in 2015 when he found his career in jeopardy. During a bullpen session in the fall, he felt something wrong in his arm and didn’t pitch for the remainder of the fall. He tried to come back during the offseason, but the discomfort came in waves.

Eventually, he went to a doctor, and the news was every pitcher’s worst nightmare. The ulnar collateral ligament [UCL] in McDonald’s elbow had ruptured, leaving holes in the ligament. That required him to miss the season and undergo what many know today as “Tommy John” surgery. He became a statistic in the rising epidemic of UCL injuries sweeping across all levels of baseball.

“Everywhere around my arm, I had some kind of pain,” he said. “There were times that it was a constant ache. I would throw some pitches, and as soon as I would release the ball, it would hurt.”

The surgery usually requires taking a ligament from the wrist to replace the torn ligament, but McDonald was born without the ligament in both wrists. So the surgeons took a hamstring graft from his left hamstring to replace his UCL.

“They drill a hole through one of your bones, tie a knot in the ligament and put it through and wrap it around everywhere else it needs to go,” McDonald said.

Anyone around the game knows that Tommy John surgery serves as the main way to repair such injuries. Doctors continue to perfect the procedure to get athletes back on the field faster. They also look for new ways to decrease the recovery time without putting the athlete in danger. Pitchers like McDonald are sharing their experience and providing valuable insight into the issue.

After strenuous rehab and conditioning, McDonald made his return Feb. 23, 2016 – about 12 months after the surgery. He started against East Tennessee State, threw four shutout innings and earned the win. After the game, Mason talked about McDonald’s road back.

“He’s come a long way, worked really hard to put himself in a position to even be ready to throw now,” Mason said.

McDonald completed the season in good health. He made eight appearances, starting four games.

Nic Enright, another Tech pitcher who actually was drafted out of high school by the New York Mets and chose to go to college over the big leagues, shared a similar experience, undergoing Tommy John surgery in May of 2016. In high school, he was a four-year varsity player and named the Gatorade Player of the Year in Virginia. The right-handed ace from Richmond featured a fastball that topped out in the lower 90s. He made 12 appearances in 2016 and encountered some early struggles, but seemed to settle in as the season went along.

In late April in a game against Duke, Enright tried to pitch through discomfort in his arm. On May 1, he threw five innings and gave up four unearned runs against Boston College. The next day, he couldn’t pick up his backpack.

Yet Enright never felt the “pop” that some guys feel.

“For me, it was more of a gradual thing,” he said. “It makes me wonder if it could have started months before, and finally, over the course of a 55-game season, it took its last blow. It started off as a dull pull in my elbow and eventually progressed into the sharp stabbing pain.”

He ultimately underwent Tommy John surgery. Four months later, he started throwing a baseball and expects to pitch this upcoming season. Tech pitching coach Jamie Pinzino is optimistic.

“He’s in the training room a couple hours a day,” Pinzino said. “We’re certainly hoping to have him back for the spring.”

Advances made in the medical field over the past 25 years now make the recovery process faster. In the early stages following Tommy John surgery, players more likely faded out of the league than recovered and prospered. But Dr. Frank Jobe turned the tables in 1974 when he performed surgery on Tommy John, a major league pitcher at the time and for whom the surgery is named.

Using a healthy tendon from John’s forearm, Jobe replaced the torn ligament. The tendon serves as stability for the elbow joint. Surgeons drill holes in the humerus and weave a tendon through by using a figure-eight pattern. With that procedure, Jobe sparked a movement that has saved the careers of countless pitchers. John went on to win 164 more games over the course of 14 years. Other notable pitchers to thrive following the surgery include John Smoltz, Tim Hudson and Adam Wainwright.

Today, doctors perform Tommy John surgery almost every day. Dr. Timothy Kremchek, the Cincinnati Reds team doctor, performed the surgery on McDonald and Enright. On the day of McDonald’s surgery, he performed four or five Tommy John surgeries, according to McDonald. Kremchek told McDonald that the surgery used to last four hours, but now only takes a shade more than an hour.

The stance on Tommy John surgery has changed drastically over the years. In fact, some parents think their kids need to get Tommy John surgery early to increase arm strength. According to the American Sports Medicine Institute, 25-50 percent of amateur players, coaches, and parents believe this theory.

Brett Griesemer, the athletic trainer for the Tech baseball team, said some parents think the surgery guarantees their kids come back stronger – a common misconception.

“It’s become quite a hysteria,” he said. “You have these teenage kids, and they’re having some elbow pain, and they [parents] want to just get the Tommy John surgery over with.”

According to the institute, 10-20 percent of pitchers never make it back to their previous level after having the surgery. Major League Baseball and the institute conducted a study that examined professional pitchers who underwent Tommy John surgery. It showed no differences in pitching biomechanics.

The institute called the rise in injuries an epidemic. There has been a sharp increase in the amount of UCL tears since the start of the century, and the institute attributed these changes to young pitchers doing more with their arms before they reach their 20s than a pitcher who played 12 years ago.

Some players overuse their arms on the mound, and others play multiple positions instead of giving their arms a break. Poor mechanics and conditioning are other possible reasons for the rise in UCL injuries.

“I think the biggest reason is because guys are training more,” Griesemer said. “They’re able to throw harder. They’re throwing 90 mph in high school. Over time, that puts a lot of stress on the elbow.”

Athletes specializing in one sport also give cause for concern. With scholarships increasing in value and sports becoming more competitive, high school athletes believe they should focus on one sport to receive a scholarship.

“I think it’s the specialization of sports that has led to more injuries,” Griesemer said. “Guys that play baseball year-round are probably more at risk than back in the day when everyone played every sport. Now college scholarships are a big deal, so if you want to specialize in baseball, then you throw year-round.”

Coaches try to do their part to make sure their pitchers aren’t dealing with a lot of stress on the mound. Inning limits and pitch counts have been implemented, though there is no magic number. Pinzino said that he takes into account other factors in addition to pitch count.

“The No. 1 indicator is leaving balls up in the zone,” he said. “If I’m getting tired, it’s not just my arm, but my whole body getting tired. Typically, the mechanics can slow down a tad bit. Most pitching coaches want pitchers to work quickly. Sometimes you see the pace slow down quite a bit. That’s a fairly common indicator.”

“I do believe pitching them less is safer,” Mason said. “I don’t have a number, and neither does anybody else because, if somebody had that perfect number, they would be extremely rich. You have to have a good relationship with your pitcher. You have to have an honest dialogue with your pitcher.”

Other ways to decrease an athlete’s odds of injuring the arm include the forbidding of throwing a curveball at a young age, as many young pitchers still lack the ability to throw a curveball with the proper mechanics. Also, young pitchers need to limit the amount of “full-effort pitching.” This means playing different positions or different sports.

Tech’s sports medicine staff always tries to be proactive in dealing with injuries. This group, led by Griesemer, implemented a system hoping to decrease the chances for injury.

“We have all of our pitchers come in, and we measure them,” Griesemer said. “We look for different ranges of motion in the wrist, shoulder and elbow. We look at grip strength. We put those all in a spreadsheet and compare their numbers to see if guys gave deficits in the internal rotation of their shoulder, extension of the elbow, or extension of the wrist, which may put increased risk on their shoulder or elbow. We have a designed program for them to come in here and do some corrective exercises.”

Schools throughout the ACC compare notes and hold conferences throughout the year. This creates an open discussion, and ideas get shared. Protecting the next generation of pitchers remains a top priority, and it starts with creating a dialogue between the athletes and doctors.

There may never be a universal answer as to why the UCL tears. So many variables make it difficult to pinpoint a single reason. It can happen on one pitch or over time. In the cases of McDonald and Enright, neither had dealt with previous arm issues. Doctors and scientists continue to flood the field with studies and ideas in search of an answer because they know that athletes will continue to develop and throw harder.

The rehab following the injury remains the hard part. Athletes must work to get back on the mound. McDonald and Enright put in that work.

“Both guys are pretty militant when it comes to doing their rehab,” Griesemer said. “They’re in here every day. They do their extra work, and they don’t try to push past what we recommend to them. Both are extremely hard-working kids.”

McDonald and Enright didn’t let Tommy John surgery end their careers. Now, they have their eyes set on the future.

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