Rehab after Tommy John surgery grueling process
Third in a series of four articles.
Jameson Taillon was expected to be a mid-season call up to help the Pirates’ push for a second-consecutive playoff run. Instead, Taillon is in the midst of a year-long rehabilitation after Tommy John surgery in April and likely will not be available until midway through the 2015 season.
Geibel Catholic graduate Anthony Speeney went through the grueling year-long rehab after surgery in February of his junior year in high school, but always kept his sights on the return to the pitching mound for his senior year in high school.
“I was in a cast for 10 days and then in a brace,” explained Speeney. “I had three months of nothing and three months of rehab.”
Physical therapist Mark King worked with Speeney after his surgery. King said he and his staff, including sons Jarrod and Matt, use one of two protocols for the rehabilitation after Tommy John surgery. The Massachusetts General Hospital/Harvard Medical School protocol is set for 32 weeks, while Galland/Kirby UCL Reconstruction Post-Surgical Rehabilitation Protocol is spread across 10 to 12 months.
“Most surgeons recommend the longer rehab,” said King.
Dr. Lance Brunton, an orthopedic surgeon upper extremity specialist with Excela Health Orthopedics and Sports Medicine, agreed.
“A year (of rehab) is more practical and safer,” said Brunton, a 1994 Laurel Highlands graduate.
Speeney had his arm in the brace for three months with the angle of motion increased over time. He began his rehabilitation with King after the time in the brace.
The Galland/Kirby protocol calls for “total body conditioning” a couple weeks after surgery, as long as the incision has healed properly to avoid any infection.
After the first month of healing, the athlete can begin resistive elbow and forearm exercises (with either light weights or elastic bands). Exercises for the entire upper extremity, including the rotator cuff, along with lower body/trunk conditioning program, continues through months 2-3.
If all goes well with no swelling and full, pain-free range of motion in the elbow, the athlete is permitted soft tossing in months 3-4. The protocol calls for initially 25-30 throws, building up to 70 while gradually increasing the throwing distance.
“We work the muscles around the ligament (and elbow) to strengthen and give more flexibility,” explained Jarrod King. “We work on shoulder strength, scapular strength, and use plyometrics.”
In months 4-5 after the surgery, the Galland/Kirby protocol allows for a throwing program to begin. The workout starts with a 10-throw warm-up from 20 feet, stepping out 10-20 feet for the next 10 throws, 30-40 throws from 50 feet, and cooling down with 10 throws from 20-30 feet.
Months 5-6 allow the athlete to eventually step out to 60 feet and throw at no more than half speed. Starting with 10 warm-up throws from 30 feet, the athlete steps out 10-15 feet for the next 10 throws, reaches max distance for 30-40 throws, and closes with a cool down of 10 throws from 30 feet.
The next two months push the athlete to up to 150 feet (about 25 feet longer than the throw from home plate to second base) over four phases. As with the previous months, the athlete warms up and cools down. The maximum amount of throws at any distance is 30 with about 70 total throws in each session.
The pitcher is permitted to throw off the mound at ½-¾ speed in months 7-8. Emphasis is placed on using proper body mechanics, notably when throwing off the mound, by staying on top of the ball, keeping the elbow properly positioned, coming over the top and following through with the arm and the trunk of the body. The number of throws from 60 feet through the four phases increases from 10 to 40 or 50 by the end of the eighth month.
If the athlete progresses through the first eight months with no pain or discomfort and has approached ¾-speed on his throws, the athlete, under the supervision of the manager/pitching coach and training staff, is permitted to begin bullpen sessions and throw a “simulated game” with a rest after a series of pitches.
Bullpen sessions on Day 1 begin with 10 warm-up soft tosses from 120-150 feet, 10 more from off the mound, 40 pitches at ½-¾ speed off the mound, a 10-minute rest, and then 20 more pitches off the mound. After a day off, Day 3 has the same warm-up throws before a 30-pitch session, 10-minute rest, 10 warm-up throws, 20 pitches, another 10-minute rest, 10 more warm-up throws, and closing with 20 pitches.
After taking the fourth day off, the final day of the cycle starts with the same warm-up process, 30 pitches, 8-minute break, 20 pitches, 8-minute rest, 20 more pitches, a final 8-minute break, and 20 final pitches.
If the pitcher satisfactorily meets the demands of the first nine months, he is then allowed to begin a normal routine from throwing batting practice to bullpen sessions.
Both Kings agreed Tommy John surgery does not create a “bionic man,” stressing it’s the rehabilitation process that gives the joint strength and flexibility.
“It’s the angle of the arm. There’s less chance of injury throwing over the top. It’s more mechanics and preparation,” said Mark King. “Kids don’t work on simple strengthening.”
Mark King threw out a personal observation.
“Maybe if an athlete has a small ligament, he shouldn’t be a pitcher. Maybe we should be like the Soviets were and test (to see which sports to slot athletes),” said King.
Speeney worked through the program and was able to run cross country and earn all-county honors as a senior.
“(The rehabilitation and conditioning) was easy for me. I started running right away,” explained Speeney. “The hardest thing was not being able to throw. I couldn’t work on my mechanics.
“It was the excitement of starting out all over again.”