What If?

Mentioned in a previous post were the seemingly inevitable "what if" factors. Through the past seven months, almost every possible question has popped into my head at one point or another.

What if I tear it again somehow?
What if this activity is putting too much stress on the ligament?
What if it doesn't fully heal?
What if I don't return to normal?
What if I didn't complete part of the recovery correctly?

I have never handled "gray areas" well because I would much rather have definitive answers. But with this particular injury and recovery, nothing is certain. Everyone's body is different, meaning every body will respond to the reconstruction differently. At first, it was hard for me to understand that. I was constantly on Google researching others who have went through the TJ process and comparing myself to how they felt. I would feel on and around the incision site searching for tenderness or soreness. Looking back, all this did was provide unneeded stress. The solution to ending the mental "games" was very simple.

Any time I have a question, I ask it. Any time I feel something unusual in my elbow, I make sure I am honest about it. Talking to my physical therapist has been my biggest sense of stress relief. Openness and honesty help me understand the recovery, such as what to be concerned with and not to be concerned with. For example, in the beginning, whenever I felt a small pain or soreness in my elbow, my mind immediately turned to the thought of tearing the ligament again. In the back of my mind, I knew it was not a logical thought, but it seemed realistic having just come off the surgery. Through conversation with my PT, I am now able to distinguish the irregularities. 99% of the time, these naturally come about due to the extensiveness of different exercises.

Just as importantly, I have stayed off of the internet. My recovery, like all others, is unique to me and my body. I may not run into issues that others come across. Above all, I am healthy! I am over seven months into the rehab without encountering a single major setback. It took me up until recently to wrap my mind around it, but once I did, I have not looked back.

Bottom line, the "what if" questions are never going to become anything more than questions. I've found ways to alter my thinking, allowing only positivity.

Throwing (Week 3)

Week three consisted of Step 7 and Step 8 (repeated for two days). No issues came about and my elbow feels 100%!

Step 7
10 throws @ 45 feet
25 throws @ 60 feet
Rest 10 minutes
10 throws @ 45 feet
10 throws @ 60 feet
25 throws @ 75 feet
A few throws were across my body, but it was the first time stretching out to 75 feet and it was easily corrected.

Step 8 (Day One)
10 throws @ 45 feet
10 throws @ 60 feet
25 throws @ 75 feet
Rest 10 minutes
10 throws @ 45 feet
10 throws @ 60 feet
25 throws @ 75 feet
No issues!

Step 8 (Day Two)
10 throws @ 45 feet
10 throws @ 60 feet
25 throws @ 75 feet
Rest 10 minutes
10 throws @ 45 feet
10 throws @ 60 feet
25 throws @ 75 feet
Slightly increased effort with each throw, elbow responded nicely.

This week will cover Steps 9, 10, and 11.

Throwing (Weeks 1 & 2)

The varsity team spent spring break on a beach in Alabama competing in a tournament. I spent my spring break rehabbing...thirteen hours away with snow on the ground. Not that I have any complaints about therapy, but who wouldn't want to be in 80 degree weather with their teammates! This was the first time in my high school career that I had a true spring break. I came to find that I had not missed out on much during the previous years. I was able to see just about every March Madness game and watch a fair share of movies.

The best part, by far, was throwing! I have successfully completed my first two weeks of the throwing program without any pain, discomfort, or tenderness. After each session, I briefly document what was completed, how I felt, and how my elbow responded.

STEP 1:
10 throws @ 30 feet
25 throws @ 45 feet
Elbow responded very well, but throwing for the first time since July felt a bit awkward!

STEP 2:
10 throws @ 30 feet
10 throws @ 45 feet
Rest 5-10 minutes
10 throws @ 30 feet
25 throws @ 45 feet
Beginning to get a better feel for my natural arm slot, no elbow issues.

STEP 3:
10 throws @ 30 feet
25 throws @ 45 feet
Rest 5-10 minutes
10 throws @ 30 feet
25 throws @ 45 feet
Rest 5-10 minutes
10 throws @ 30 feet
25 throws @ 45 feet
Continue to become more and more comfortable and my elbow is feeling great!

STEP 4:
10 throws @ 30 feet
25 throws @ 45 feet
Rest 10 minutes
10 throws @ 30 feet
15 throws @ 45 feet
25 throws @ 60 feet
Throwing 60 feet without any issues is something I haven't done in months, kind of a crazy feeling! Even with increased distance, there have been no issues.

STEP 5:
10 throws @ 45 feet
25 throws @ 60 feet
Rest 10 minutes
10 throws @ 45 feet
25 throws @ 60 feet
Everything continues to go without a problem!

STEP 6:
10 throws @ 45 feet
25 throws @ 60 feet
Rest 10 minutes
10 throws @ 45 feet
25 throws @ 60 feet
Rest 10 minutes
10 throws @ 45 feet
25 throws @ 60 feet
Elbow and body feel very, very strong!

I will continue to post the throwing program after each week (or two) is completed along with the notes. Next week moves back to 75 feet!

The Path to Throwing

The first few weeks following the surgery were uneventful. With one arm locked at 90 degrees, there is not much to do. No driving, no physical activity, and even showering was a struggle. My main focus was searching for a physical therapist who was familiar with the UCL rehabilitation. Through recommendation of coaches and doctors, I eventually found one an hour away from my home. Personally, distance did not factor into my decision as long as I was receiving the best possible treatment.

My physical therapist (PT) had successfully rehabbed several Tommy John surgeries prior to this and I instantly knew I was in the right hands. Three days a week were recommended, so immediately following school on Mondays, Wednesdays, and Fridays, I went through therapy. It was relatively simple, as I expected. It consisted of more of the finger touches, squeezing putty, fist clenching, etc. I was given at-home exercises to do as well, like a shoulder isometric routine and lower body mobility routines to maintain flexibility. The only time I was able to remove the brace was when my PT performed flexion and extension exercises, which were necessary to retain full range of motion. I rarely had discomfort and my range of motion came back surprisingly quick. Sure, it was sore and very tender from the surgery, but there was never any real concern with pain or loss of feeling in my hand.

Setting up small goals is what carried me through the process. The first "milestone" I reached came when the stitches were removed two weeks after surgery. It revealed a nasty, dark scar. Following that came the elbow brace adjustments. After being locked at 90 degrees for several weeks, it was gradually set to allow more leniency depending on the progress made with natural flexion and extension. The sixth week after surgery finally, finally arrived and the brace was removed. The range of motion was still slightly limited accompanied with minor pain, but that subsided with time. The highly-restrictive therapy continued three days a week. Throughout this period of time, I was focused on the day I could start throwing, which was scheduled to be the first week in January. That was my motivation.

The three-month mark rolled around (December 1), which meant another visit to Dr. K in Cincinnati. It was surprisingly a short-lived appointment, lasting no more than 40 minutes. There was an ultrasound performed on the elbow as well as a routine stress test on the ligament, both of which were successful. I was happy to hear everything looked great. However, I was not complacent with sitting around the house and I was not happy with the weight I had lost, so I wanted to know my limits and restrictions. "Six months" seemed to be the common answer I received. At six months post-op, he would allow clearance for weightlifting and returning to most activities (within reason). I was at 188 pounds, so I had lost around 12 pounds between basketball and surgery. We discussed possible options for the spring, like designated hitting (which is how I spent my junior season). Ultimately, that idea was put to rest for the simple fact that it posed unnecessary risks. Since it was decided that I would not play, Dr. K pushed back the throwing program to begin in March. This would allow me two more months of strengthening and rehabbing, so I was not discouraged by any means.

With my strength coach, I set up a body weight strength and conditioning program as well as a 3500 daily calorie diet to help me build up what I had lost over the past couple of months (image below). Not playing basketball for the first time in 10 years was hard to accept, so this gave me something to focus on and I took it very seriously. Physical therapy was starting to become more intense and I was able to start using dumbbells, body blades, kettle bells, etc. Seeing and feeling results made me buy in that much more.

Fast forward to today- March 16 (6 1/2 months). Three weeks ago, I was cleared to begin lifting. I now have a completely new lifting program to attack (image below). I am 195 pounds, which is still not where I would like to be, but it has been steadily increasing. Physical therapy is exhausting and strenuous and I love it! The five-month throwing program begins tomorrow (FINALLY!) and I am anxious, excited, and nervous. The negative, inevitable "what if" thoughts loom in the back of my mind, but I am too excited to give into those thoughts. The ligament is healthy and strong. My body is even stronger. Previously, I had never worked my scaps, my lats, or my upper back. I did not target areas specific to pitching. But after six months of doing so, the difference is incredible. During this throwing program, I will document the details after each session (3x a week) and enter them into this blog at the end of the week.

Surgery

Dr. Kremchek (Cincinnati, OH) and his staff were unbelievably professional. It actually may have been the only time in my life that I had not complained about a long car ride (five hours or so). My visit was set up not even a week after my initial phone call. I arrived in Cincinnati on Friday August 29, prepped for the surgery, and went under the knife the very next morning. Dr. K. informed my mom and I the surgery would take no more than an hour and a half. It only took an hour before I was back in the room with a brand new ligament.

The craziest part of it all was that I had no idea that it was the Tommy John procedure that was done until I woke up from the anesthetics. I had a partial tear, but the MRI did not reveal how severe it was. The day before the operation, I was told there were two possible solutions- the UCL reconstruction or a Platelet-Rich Plasma (PRP) injection, which is relatively new to medicine. The PRP injection would require around half of the recovery time as the reconstruction as it helps to naturally repair the ligament damage. I'm sure the way it was explained was a highly simplified version, but Dr. K. said if fluid was present in the elbow, he would go ahead with the Tommy John procedure. If not, he would do the PRP injection.  Unfortunately,  there was a significant amount of fluid.

If there were any positives that came out of it, the fact that I had a partial (and not complete) tear was one. The palmaris longus muscle was removed from my left forearm as a replacement ligament to be inserted into the elbow. I was informed by the doctor that partial tears that have been repaired and rehabbed tend to be stronger than those with full tears. Reason being, the partially torn ligament is not removed, so the "new" ligament (in this case, the palmaris longus muscle) is inserted to fuse with the original ligament.

Sunday morning, around 24 hours post-op, I received my first therapy treatment with Dr. Kremchek's staff. It was agonizingly simple, consisting of hand squeezes, finger touches, and wrist movement. Iodine still coated my elbow from the operation and Sharpie marks were everywhere. The bandages were replaced and wrapped before my arm was set in a full-arm brace that was locked at 90 degrees. With nothing to further complete, I was soon on my way home with little feeling in my elbow (mostly due to the heavy medication) and a repaired UCL. The twelve month journey had begun.

Pain, But No Gain

I did not feel the "pop". I did not experience unbearable pain. Looking back, I almost wish I would have. For just over 10 months, I battled through elbow soreness, elbow tightness, and several rounds of therapy. Needless to say, I was not shocked when I was told I needed Tommy John surgery. Over that period of time, as therapy failed and soreness did not subside, I realized the possibility of my elbow improving without a procedure was becoming less and less.

My life has revolved around the game for as long as I can remember. I quickly fell in love with pitching and the competitive nature it brings. At the age of ten, I received pitching instruction from a former big-leaguer, who I still work with now at 18 years old. Through this, I developed clean mechanics at an early age and began to learn the art of pitching. I was fortunate to have my dad as a coach throughout all of travel ball. I know this is often times frowned upon, especially today, as an alarming amount of parents push their kids over the edge. However, this was not the case for me. "Overthrowing" was never a concern and neither were curveballs (for the sake of improper mechanics). I was always on a pitch count (rarely above 45/50) and did not pitch consecutive days during tournaments, throw three times a week, etc.

By the time I reached my freshman baseball season, I was a 6'3" LHP with an advanced feel for the game. I was able to earn a spot on the sophomore team and established myself in the rotation early on. Through the spring, I threw consistently both in the outfield and on the mound. Mix that with the unfavorable spring Midwest weather and it can take a toll on the body, especially the arm. Towards the end of that year, my velocity significantly dropped and I was told I was simply going through "dead arm". So I shut it down for a few weeks and got ready for summer and fall ball, where I drew interest from a few division one schools. It was at this point when I first realized I, with a strong worth ethic, would have the opportunity to play beyond high school.

With no problems after that, I was called up to varsity my sophomore year, where I felt strong and I felt healthy. I had a solid sophomore campaign on the mound and gained significant experience, which carried over to the summer where I saw continued success. I found myself on the roster of a Prep Baseball Report Midwest Future Games team as well as a fall team that entered in the PG Tournaments in Cedar Rapids, Iowa and Fort Myers, Florida. I had heard all about these tournaments, but this is the first chance I had at actually playing in them. I was ecstatic.  Between physically maturing, as I was now 6'6" 200 pounds, and hitting the weight room, I added velocity and felt better than I ever had. From the fall of my sophomore year to the fall of my junior year, I went from 81-83mph to 85-87mph. With my physical stature certainly helping me, I began accumulating serious interest from major division one schools. The recruiting process exploded and I set up several visits, eventually committing to a division one program. But the last tournament of the fall, my velocity dropped to 81-84mph and I felt some unusual soreness in my elbow. I never had elbow soreness in all my years of pitching. But since it was the last tournament of the year, I moved on to basketball and shut my arm down for the winter. I thought nothing of it.

Back on the bump in February of my junior year, I attended a regional showcase where I let loose on 12-15 pitches. My velocity was at 86-87mph, where it had been the previous fall, and I did not feel the elbow soreness to the extent of that fall. Over the next few weeks of high school ball, I developed further elbow issues. The ball coming out of my hand didn't feel as comfortable as it should, my body didn't seem to work together, and the worst part was my level of frustration. I started looking for a mechanical flaw, I tried resting it, and I tried to throw through it. I was told "it's early" and that it is "going to get stronger." I trusted those words even if I knew my body was off. I wanted to compete. I had two outings at the beginning of the season, experiencing a burning down my forearm and tightness after the outing. It didn't hurt while I was throwing and I didn't lose velocity or control. So I tried throwing through it. After my second outing, I erred on the side of caution and decided to have it checked out. Long toss was no longer "long" and the burning feeling was overwhelming.

I ended up throwing seven innings over two outings during my junior year of high school. After the first week of the high school season, when I decided to have my elbow looked at, I was told I had a "strained flexor tendon" (after an MRI) which would require two weeks of therapy before return. Two weeks quickly passed and no improvement was evident. I was then stopped from all throwing, both in center field and pitching, and spent the next six weeks doing more therapy. I wanted to get back to competing, so I completed my therapy rep by rep, and was able to return to the outfield with three weeks remaining in the high school season and I logged one inning on the mound in the last game of the season. But something still felt off. It wasn't as bad as it was before the therapy, but it was still off. Regardless, I kept faith in the throwing program and in the words of positive encouragement I received.

That summer, my elbow was inconsistently irritated. One day it would hurt, one day it would be tight, and the next it would feel great. But once again, I was told to "give it time." I pitched throughout the summer with a high level of success against talented competition. The last week in July, I set up an appointment with a second doctor. The elbow wasn't improving and I still had the gut feeling that something was not right. That visit resulted in another MRI and another five week round of therapy for a "minor Ulnar Collateral Ligament (UCL) strain." This round of therapy was similar to the last and completed by the book. The doctor had said to make an appointment after therapy to contemplate the next action. Since I did not show improvement, the follow-up visit ended with the suggestion of a procedure. I was slightly confused because I had not been diagnosed with a tear and the MRI did not show an obvious tear. Taking the doctor's advice, my parents and I organized yet another appointment with a third doctor to discuss surgery. Different from the last two, this doctor is a nationally-recognized surgeon who specializes in Tommy John surgery. It was here when I finally, finally received a clear-cut answer. Following my third MRI (this time with a dye injection) in six months, it was a confirmed tearing of the UCL, which meant surgery. Surprisingly, I was relieved.