San Diego Union-Tribune (Sunday)
PADRES AWAITING VINTAGE REBOUND
Richards, Paddack, Lamet all have had Tommy John surgery
The three pitchers expected to be at the top of the Padres rotation all had Tommy John surgery in the past 31⁄2 years. Two will be embarking on their first full seasons pitching after the operation.
The procedure involves a surgeon replacing the damaged ulnar collateral ligament in a patient’s elbow with a tendon from elsewhere in the body or from a cadaver. During the 60 to 90 minutes the operation takes, the ligament is tightened into place. Over the next several months, the body remolds the new tendon into a living ligament.
This Padres’ TJ trio — Dinelson Lamet, Chris Paddack and Garrett Richards — is being counted on to provide substantial quality innings. Even one of them being less effective than anticipated would be detrimental to what are considered tenuous playoff hopes for an organization that has not been to the postseason since 2006.
This might seem fore
boding for the Padres. It really isn’t.
The hardest work was done during those pitchers’ long, lonely months away letting their elbow heal and then strengthening it back to (and beyond) what it had been. All three have demonstrated the tenacity required to attack the arduous recovery process. And the trio has pitched enough since returning to the mound that their performance, as well as the history of other Tommy John patients, suggests no medical reason they won’t be outstanding in 2020.
“The results and track record of Tommy John at this level has become much more predictable than some of the other things that athletes get operated on,” said Dr. Neal Elattrache, an orthopedic surgeon at Cedarssinai Kerlan-jobe Institute and the head team physician for the Los Angeles Dodgers and Rams. “While not 100 percent of guys will come back to their previous level of performance … 75 or 80 percent come back to their previous objective measures of performance — velocity, WHIP, innings pitched, the other measurable things.”
Tommy John surgery for pitchers is a big deal, but then it also is not.
The generally accepted industry estimate is that 25 percent of all major league pitchers will have Tommy John surgery in their career. Of the 159 pitchers who started at least 12 games in 2019, 48 had come back from Tommy John surgery.
Through this week, a reported 490 major leaguers have had the surgery since Dr. Frank Jobe performed the first one in 1974 on Dodgers pitcher Tommy John. That number includes only players who were in the majors at the time of their surgery.
Paddack was pitching in low Single-a Fort Wayne when he felt the often-telltale twinge after throwing a change-up. Since his surgery on Aug. 15, 2016, 296 more major and minor league pitchers have had Tommy John.
Hardly one in 10 games played in the majors in recent years does not feature at least one pitcher who has not had his UCL replaced.
Two major league teams in 2019 had four pitchers with Tommy John surgery in their past who made at least 12 starts. Another seven had three such starters, including the World Series champion Washington Nationals. (Patrick Corbin underwent Tommy John surgery in 2014, World Series MVP Stephen Strasburg had the procedure in 2011 after his second MLB season and Anibal Sanchez had it in 2004 as a high schooler.)
None of those teams had three recoverees who all had the surgery as recently as Lamet, Paddack and Richards.
But, really, that doesn’t seem as if it will matter, at least not adversely for the Padres.
“This is an exciting year,” said Ben Fritz, the Padres’ bullpen coach and before that their rehab pitching coordinator. “We’ve seen from past surgeries and all the surgeries that most of these guys, after their first full offseason is when they really come back to the level they were before surgery.”
That might be short of exact science, but it isn’t inaccurate. There is plenty of anecdotal support for optimism.
Strasburg made 28 starts and posted a 3.16 ERA in his second season (first full) back. He has never had an ERA higher than 3.74 since.
Jose Fernandez, who missed much of the 2014 season and half of ’15 after surgery, returned to post better statistics in the final 40 starts of his career than he had in the first 36. (Fernandez died in a 2016 boat accident.)
Walker Buehler had Tommy John surgery in August 2015 while at Vanderbilt. He was in the major leagues at the end of 2017 and in ’18 posted a 2.31 ERA and 0.92 WHIP (walks and hits per inning pitched) for the Dodgers.
That is, of course, a selective sampling of top-tier pitchers. It goes without saying that a number of pitchers have hardly been heard from again following Tommy John surgery.
But, as Elattrache stated, the evidence shows the vast majority of pitchers return to their previous level of performance.
Before they even return, though, there is a 14- to 24month rehabilitation process.
The Padres trio got back on the mound in a bullpen only after essentially resting their surgically repaired arms for about six months, during which time they worked to regain range of motion and focus their strength training on their lower body. Then they began throwing softly up to three times a week at a distance of about 45 feet with gradual increases. Generally, it takes a couple more months to work up to throwing off a mound, during which time there is a return to carefully throwing breaking pitches.
The timeline throughout the process varies, in part, dependent on the pitcher’s age and experience level. Lamet and, particularly, Richards had pitched more than Paddack at the time of their injuries. They had built up strength and developed mechanics. Paddack’s return from injury had to coincide much more with his development as a pitcher.
“When you have a young guy come in that has this injury they are typically at a lower point on their developmental curve with regard to their craft,” Elattrache said. “… You’re going to do that operation and going to get them back onto that developmental curve. You’re not going to turn them into Nolan Ryan. They’re still learning how to pitch. You take a veteran who has been there and he’s had success and he knows how to pitch — where his release point is, what his body mechanics need to be — he’s gone through that and he has figured it out on that developmental curve. He’s going to go back to the things that have worked for him.”
If a rehab process is attacked correctly, which Elattrache and other observers said it seemed the Padres pitchers did, there can be benefits to having gone through the surgery and build back to health. Pitchers often throw harder and even have more movement on their pitches.
“For the first time in a long time — maybe the first time ever — they’ve been able to focus on things like mechanics,” Elattrache said. “A lot of them never really maximized the parts of their body that are really responsible for generating power. … During the rehab process there is a hyper-concentration on strengthening and conditioning.”
The three Padres pitchers have something in common that bodes well for a successful return. All three have an intensity that stands out even among highachieving peers.
“One of the most important things as far as the recovery goes is to have an engaged, interested, motivated player,” Elattrache said.
During recovery, after what has been described as an inevitable period of depression, all three pitchers described a shift toward attacking their rehab with vengeance.
“You go through that phase at the beginning,” Richards said. “Your arm feels not normal at all. But once you go into that defining period, if you decide you want to use this time off to completely better yourself physically, mentally mechanically, if you go about it that way you have no choice but to come out better on the other end. I made a choice to look at it like I’m never going to have another time in my career to have 15 months off to hit the gym as hard as I can, condition myself as hard as I can, put myself in the best physical condition to be successful.”
The other two expressed a similar sentiment. Paddack also used that time to develop many of the workout and preparation regimens on which he now relies. Lamet studied opposing hitters in ways he never had before.
Their final steps to this point, where the Padres are confident they can carry a bulk of their innings, varied but also had similarities.
Lamet had just one inconsistent major league season before undergoing Tommy John surgery in April 2018. In ’17, he had a 4.57 ERA but was throwing in the mid- to high-90s with a wicked slider that helped him to 10.9 strikeouts per nine innings. He returned July 4, 141⁄2 months after surgery and two weeks shy of his 27th birthday, and over 14 starts struck out 105 batters in 73 innings (12.9 per nine).
Richards was the emerging ace of the Angels staff when he began experiencing elbow problems in 2016. He opted for treatment over surgery and even pitching in what he described as nearly constant discomfort in ’17 and ’18 posted a 3.29 ERA over 104 innings. He finally had surgery in July 2018. The 31-year-old right-hander returned last September for the Padres, making three starts mostly to be better prepared for a full ’20 campaign.
Paddack, who was just 20 at the time of his TJ surgery, pitched 90 dominant innings in the minor leagues in 2018 before making 26 starts under a strict workload limitation placed on him by the team. His 0.98 WHIP was fifth lowest in the majors last season.
And now …
“It’s that next season,” Elattrache said of the typical progress he sees, “where they make the jump in performance.”