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The name you never want to hear
Tommy John surgery can be tough to battle back from, despite a high success rate
01/28/2012 2:52 PM ET
The scar on the inside of Sean Jarrett's elbow is a constant reminder
The scar on the inside of Sean Jarrett's elbow is a constant reminder (Ryan Schembri / SMP Images)
Tommy John.

Two words that any pitcher would dread hearing any day of the week, at any point in his career. It's more than just a name, for the combination of those two words can signify the end of a lifetime in baseball, or, in the very least, a minimum of one year away from the mound.

Tommy John is the name of a surgical procedure that reconstructs the ulnar collateral ligament (UCL) in the elbow. Though other athletes are affected all the same, it happens most often with pitchers in their throwing arms. The injured ligament is replaced with a tendon from somewhere else in the body.

The surgery is named after the major league pitcher who had the experimental operation in 1974. Tommy John had 288 career wins, ranking him seventh all-time among left-handed pitchers, with the majority of those victories coming after his UCL was replaced with a tendon from his right forearm.

Success is often the result after undergoing this procedure, as it was with its original recipient. The most painstaking part of the process however, is the rehabilitation. Tommy John spent 18 months rehabbing before returning to pitch in the majors.

Jon Durket of the Brisbane Bandits had the surgery in 2009 and found out firsthand just how difficult coming back from it was.

"The rehab was miserable," Durket said. "It's such a long, slow process. My whole life I'd thrown a baseball and to cope with the fact that I wouldn't be able to do that competitively for nearly a year was just as hard mentally as it was physically.

"After surgery I wasn't allowed to move my arm for a month and then slowly I began to work on my range of motion and strengthening all the muscles that deteriorated. A lot of the exercises are super tedious and you're basically lifting 2-3 lb. weights to try and recondition the muscles you need for pitching. It took me 11 months to throw again competitively but I wasn't mentally and physically 100 per cent until about 15 months."

Not only is coming back from any injury difficult, but accepting what's happened and trying to understand how it might affect the future can be a more daunting task. For the American left-hander, playing Division-I baseball at Wright State University at the time that he was injured, Durket wasn't sure where it might leave him.

"When it first happened I was pretty shocked," the 25-year-old said. "I'd never had any arm problems so it took me awhile to realize the significance of the injury. Initially I tried to pitch through it and when I realized I couldn't do that, then I started to think my baseball career might be over."

Durket first tore his UCL during a scrimmage over the winter, and believes that his arm succumbed to the pressure of throwing as hard as possible while coping with freezing temperatures. Sean Jarrett, his Bandits teammate, can pinpoint the exact moment in May of 2007 when he tore his ligament.

"I was the closer my first full year in pro ball and I was doing well," Jarrett said. "I was 5-for-5 in save opportunities with a 1.15 ERA. My arm felt really good that day. I got the first two guys out and then the third hitter came up and I threw a fastball for strike one at 94 mph. When I threw the pitch though, my elbow popped.

"So I decided to throw a curveball the next pitch because I thought maybe it wouldn't pop on a curveball. It did again though, worse this time, and I had to come out of the game with two outs and two strikes on the last batter of the game. The next pitcher came in, threw one pitch, and got my save and strikeout."

While Durket didn't feel a significant tear on just one pitch, or two, as Jarrett did, he did have some pain and then noticed a significant drop in velocity during subsequent outings. Jarrett wasn't able to even follow up with another outing on the mound because of the pain he endured.

"The first pop hurt pretty good," Jarrett said. "It was maybe a six on the pain scale. So I took a few moments and stretched out my forearm, thinking that maybe the nerve just moved around on me or something. Then on the next pitch it popped in the same spot but the feeling was 10 times more painful. It was a shooting pain down my arm to the hand. It felt like my hand was on fire. When I tried to bend my elbow, I just started sweating like crazy and got upset to my stomach."

The 28-year-old righty from Colorado knew immediately how seriously he had injured himself and had the feeling that his season was over, though he was hopeful that it might not be true. Amidst moments of panic in which he would worry that his baseball career might be finished, he figured it would all work out.

When Jarrett was told that he needed Tommy John, a sense of relief came over him because he realized his problem was fixable and all he would need to deal with it was time.

"Good," Jarrett said of his original thoughts on when he was informed he needed the surgery. "Because I can't even throw a dart right now, or swing a golf club.

"It was disappointing to hear but relieving that they knew exactly what to do and the recovery rate for surgery is so high."

The Brisbane Bandits are hopeful that two more of their pitchers can come back and have as much success post-surgery and through their rehabilitation processes as Jarrett and Durket have. Both James Albury and Drew Naylor threw for the Bandits in the Australian Baseball League's inaugural season, but missed out on this year because of Tommy John.

Though Albury's injury occurred prior to the season, he pitched through the pain and continued to take the mound for Brisbane all year long.

"I actually did it in an A-grade game, a local club game," Albury said. "It happened before the start of the season last year but I pitched through the whole ABL season. I kind of just felt a little pop in the elbow and I knew it was hurt but I wanted to pitch because it was the first ABL season.

"It didn't really bother me in that first game but afterwards it would hurt every time I pitched basically. And my arm would swell up after every game."

It's been almost 11 months since Albury's surgery and at this point he is beginning to throw bullpen sessions, a good sign for Bandits fans. While it was hard to watch the most recent season from the sidelines, Albury, along with Naylor, will be looking forward to recovering and getting back to work next year.

"They say 90 per cent of guys come back throwing harder so I'm doing a lot of gym work and everything," Albury said. "I expect to come back throwing the ball harder."

While there is a certain likelihood that pitchers will be even better when they come back from the surgery, the reason isn't because of the replacement of the UCL, but instead due to the work put in during the rehab process.

"Some come back stronger from it, only because of all the rehab that has to be done," Jarrett said. "The months of strengthening shoulders is why they come back throwing harder, not just because of the new ligament. I was pitching at 91-94 mph before the surgery and since then I have only gotten back to 92."

Having been through what Albury and Naylor are going through right now, Jarrett and Durket would both caution them and anyone else having Tommy John to take rehabbing seriously. And with such a long process to endure, patience is key.

"I'd tell them not to rush and to listen to their arms," Durket said. "When you start throwing post-surgery it's really hard to resist just letting one fly. Because your arm feels great and you want to know if you still have it, but if you push it too much you can end up tearing it again. Also to be patient mentally because it takes a whole year before you get the control and velocity back that you're used to having."

This story was not subject to the approval of the Australian Baseball League or its clubs.