On July 17th, 1974, a southpaw for the Los Angeles Dodgers took the mound to compete against the Montreal Expos and made it to the third inning before an excruciating pain struck his elbow. Despite the high-level of discomfort, Tommy John managed to hurl the ball across the plate once more before he called time and eventually exited the mound.
A moment like this was devastating, as John was on pace to have an exceptional season. He was leading the National League with 13 victories while the team was first in the National League West. John thought his career was potentially over until Dr. Frank Jobe, the Dodgers’ team physician, offered to perform Ulnar Collateral Ligament (UCL) reconstruction surgery.
On September 25, 1974 he officially became the first athlete to receive the operation, which is now famously known as Tommy John surgery. After, John went on to pitch for more than a decade in the majors.
Luckily that moment did not plague the talented young pitcher's career, but instead led to a medical breakthrough for the sport of baseball.
Only a few major league pitchers had Tommy John surgery in the 1970s and 1980s. The number of surgeries increased in the 1990s, yet still remained somewhat rare. In 2012 a record 69 MLB pitchers had Tommy John surgery, and in 202, more pitchers had the surgery than in the entire 1990s combined.
In general, the sport of baseball has evolved significantly since that operation was first performed in the 1970s. Pitchers are throwing harder and the pitch clock has forced them to throw quicker.
I have always wondered how the sport would look today, had this surgery not completely changed the longevity of athletes careers. Would fans see a lot of pitchers' careers end like Sandy Koufax, who was shut down at the age of thirty due to chronic elbow pain?
To gain a better understanding into the mental and physical sides of the healing process, I interviewed Red Sox minor leaguer, Tyler Uberstine, who returned to pitching full-time in August of 2024 after about 728 days away from competing. Additionally, I spoke to Dr. Joseph B Kahan, who specializes in this surgery and is dedicated to getting athletes back to their sport safely.
What Even is Tommy John Surgery?
The surgery has served as a thread that has connected some of baseball's biggest stars including Shohei Ohtani, Justin Verlander, Jacob Degrom and Bryce Harper. In the most basic explanation, it is an operation used to repair the torn ulnar collateral ligament inside the elbow by replacing it with a tendon from elsewhere in the body.
Originally, Jobe removed the palmaris longus tendon from John’s right arm and drilled four holes in his left elbow to replace the torn ligament. Today, doctors have built on Jobe’s surgery technique to help avoid excessive scarring and create the proper tension to throw at a higher velocity.
Quick Facts:
Tears are sprouted from overuse, not a one-time accident.
A big misconception is that it only occurs for pitchers, but it can realistically happen to anyone.
The surgery takes about 90 -120 minutes to complete, and athletes are home within the same day.
Tendons used to fix the ligament are usually taken from palmaris longus tendon in the forearm or a hamstring tendon in the back of the knee.
Recovery time varies depending on the severity of the injury, the athlete's position and sport. But it takes most big leaguers about a year before returning to the mound.
No Stranger to a Comeback.
Two years ago I had the privilege of sitting down with a right-handed pitcher, Tyler Uberstine, to discuss his Anything but Ordinary Journey to Professional Baseball. To cut to the chase, Uberstine is no stranger to perseverance. I figured that his path to getting back on the mound would be no different, and serve as a great resource to find out more details of the healing process.
Uberstine was a 19th round draft pick by the Red Sox in 2021. That next season marked his first full year in the pros, where he suited up for Boston’s Low-A affiliate in Virginia. That July, he was one of the first hurlers to earn a promotion to the High-A level, where he achieved a 2.43 ERA and 35 strikeouts to close out the year.
From the end of 2022 through a successful spring training, everything seemed to be on track for the 2023 season…Until his elbow snapped.
“It happened during the last game before wrapping up spring training, ” Uberstine said. “I had pitched three or four innings at that point, but threw a change up and felt a yank in my elbow.”
What was originally thought to be a sprain ended up being diagnosed as a full tear, after Uberstine had an MRI about two weeks later.
After consulting with his parents, his agent and gathering advice from other athletes, he underwent Tommy John surgery that June in Arlington, Texas. Uberstine returned to Fort Myers a few days after to begin the lengthy healing process.
“It was really devastating because I had just come off a big year and made so many strides in Spring Training,” Uberstine said. “But I know life throws you curveballs and I've dealt with them before, so I saw it a s just a bump in the road.”
The total process of being able to throw at full strength took about 14-16 months with the first two being more underwhelming due to Uberstine’s leg taking time to heal as well, since he used the tendon from his hamstring in the operation. A rough timeline included starting to throw a baseball at around five months and progressing to throwing live at bats by month 12.
Finally at the 14-month mark, Uberstine was cleared to be back in uniform and rejoined his teammates in Greenville.
“Being on the mound under the lights again was so surreal since I returned almost two years after the injury happened,” Uberstine said. “Especially since this process was not easy, there were times where I thought I was never going to throw hard ever again.”
It is no secret that the physical part of the process can be grueling and painful, but there is also a mental health side paired with the process that should not be ignored.
“The Red Sox have mental health support staff that would check on us and be there if we needed them,” Uberstine said. “But it was nice going through it with teammates so you have each other to lean on and relate to.”
One of those teammates was Wyatt Mills, who joined Uberstine in Fort Myers to also rehab from Tommy John. But, there were several athletes rehabbing from various injuries that were able to keep each other company.
“Mills really took me under his wing since he is a big leaguer who has a lot of experience,” Uberstine said. “But there was a close group of us that would have mini golf tournaments on Wednesday nights, go bowling and do dinners out in Naples together.”
Obviously Uberstine is not one of the first, and will certainly not be one of the last pitchers to go through this. The way the statistics are trending, more and more baseball players will fall victim to an elbow injury every year.
His advice to athletes who are going through something similar is to trust the process.
“There are going to be hard days where you don't want to throw or do anything and you’re frustrated,” Uberstine said. “But if you stick to the plan and listen to people like your trainers and physical therapists, you will get through it.”
The Doctor Is In
Once the unfortunate news breaks of an athlete needing a season ending surgery, it is pretty common to see them and their coaches addressing it with the media. This time I thought it would be interesting to gather answers to most asked questions from a doctor who regularly performs the surgery on patients of all ages, and previously worked with minor league baseball players. Dr. Joseph B Kahan is dedicated to helping patients with acute and chronic injuries, with a special interest in sports-related injuries to the shoulder and elbow.
A Vermont native, he played collegiate soccer for Wesleyan in Connecticut before relocating to Boston to attend medical school at Tufts University. His medical background includes working in Charlotte, North Carolina, with the city’s professional soccer team (Charlotte FC), football team (Panthers), and minor league baseball team (Knights).
I have read many articles stating that Tommy John surgery is occuring in much younger pitchers not just the professionals, is there a reason for that trend?
“A few factors contributing to this is that kids are now playing baseball year round and throwing more innings, along with the fact that they are chasing high velocity at such a young age. They are not resting as much as players used to before the travel ball scene started. High school players can also be different because their ligaments are sometimes stronger than the bone it is attached to.”
Do you see a difference with the injury in starters vs. relievers?
“No, it does not matter if the pitcher starts the game or comes out of the bullpen, it can happen to anyone.
Is there any way injury to the elbow can be prevented?
“Not really. I describe it to patients like driving a car. You are always at risk for an accident when you get behind the wheel, you just never know. But I recommend resting, icing your elbow if it hurts and do not ignore the pain.”
Can pitchers have the procedure done more than once?
“Yes, they can have the surgery again. It is called revision surgery and it is a similar rehab process. However, it is not great if the athlete has it a second time, because it means the first execution of the surgery was not successful as it should have been. A second Tommy John procedure is relatively rare.”
Do you have any advice for athletes going through the rehab process?
“It is most important to not skip any steps in the process or power through to get ahead. If you skip steps you will most likely end up injuring it again and start all over. Listen to your body, your doctors and all involved in the process.”
Comments