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Feature on college closer undergoing Tommy John; feedback appreciated

Discussion in 'Writers' Workshop' started by Hustle, Apr 11, 2008.

  1. Hustle

    Hustle Guest

    A kid from our county is pitching at George Mason; in 2007, he set a school record for saves and tied for fifth in Division I. He was on scouts' radar; BA had listed him as a prospect in its preview. He tore his UCL during his first outing of the season and is now about three weeks post-surgery.

    I thought this turned out fairly well; I wish I would have had another night to sleep on it and go through it again, but oh well. I tried to give his perspective of what happened and then used other folks - doctors, players who had TJ - to describe what lay ahead.

    I included a sidebar that focused on the TJ itself; so if you feel like something specific is missing about the procedure, check the sidebar. I probably included it there.

    Feedback, as always, is welcome.


    Jordan Flasher’s windup was innocuous, just as the game had been: The final game of the season’s first series against a non-conference opponent two states away. By itself, the 7-6 loss to Charleston wasn’t going to break George Mason’s season; by mid-April, the game would be just another memory in a 54-game regular season.

    But this pitch, a curveball on the second pitch in the ninth inning, wasn’t right. Something in Flasher’s elbow tweaked. He came back with a fastball; that same something snapped.

    The Patriots’ junior closer felt no pain, so he kept throwing. His next two pitches, both fastballs, were exceedingly slow. There was still no pain, only numbness. The respite was brief; after Flasher summoned his coaches and training staff, he was lifted from the game. In the dugout, his arm stiffened. The pain set in.

    In Flasher’s elbow, the ulnar collateral ligament was gone, split in two. If his baseball career was to continue, the only option was surgery — the Tommy John procedure.

    The injury seemed odd for someone whose mechanics weren’t wild and who had never had arm troubles before. In 2007, Flasher set a school record with 14 saves, which tied him for fifth in Division I. His spot at the back of the bullpen was safe; there was no reason to overthrow to impress anyone.

    “There were zero [indications of problems]. Zero, I mean, across the board,” Patriots coach Bill Brown said. “Like Jordan said, that was the last thing he would have ever thought would have happened to him.

    “It’s a crazy thing with Jordan because his mechanics are very sound, he delivers the ball really clean. It’s not a lot of herky jerky. Sometimes, it just happens.”

    That’s how Flasher, an Osbourn Park graduate, found himself in an operating room in Birmingham, Ala. on March 13. He said he found comfort in the wall of autographed jerseys in the office of Dr. James Andrews, who has done surgeries on John Smoltz, Roger Clemens and Andy Pettitte, three of the many athletes in pro baseball, football, basketball and golf that have sought Andrews’ services.

    The surgery moved quickly. The procedure lasted less than an hour, and Flasher was able to return home once the anesthesia wore off. Less than a week later, he regained the mobility he’d lost in Charleston, though his arm remained tender.

    “I took about two pills — I still have my whole bottle left. No pain,” Flasher said. “It was real surprising how quickly I recovered.”

    The more arduous task of full recovery, however, is a long way off. The process of rehab work is already underway; Flasher appeared just in time for the introduction of the starting lineup for Wednesday’s non-conference game against Richmond, coming straight from the school’s training facilities.

    At best, he’ll be fully healthy in time for the 2009 season. The typical recovery time is a year to 18 months, about half of which is spent waiting for the body to adjust to the new tendon.

    “[It takes time] for the patient’s body to fully incorporate that piece of tissue — about four to six months,” said Dr. Tal S. David, a San Diego-based orthopedic surgeon who works as a consultant with the Los Angeles Dodgers.

    Pat O’Brien said he only needed nine months for a full recovery. The George Washington University assistant coach tried to push through a sluggish spring training with the Houston Astros in 2004. One day before a game, he was playing catch with a teammate.

    “I felt something really give,” he said. “At that point in time, I kind of knew. Something wasn’t right.”

    His rehab began in earnest: three days a week of work with Jim Mehalik, the director of rehabilitation with the Cleveland Indians, strengthening the elbow while taking care not ignore other parts of the body that risked becoming weaker.

    “It’s not easy,” O’Brien said. “We got after it every rehab session ... Just like anything else, the more you put into it, the faster you’re going to be, the better you’re going to be.”

    The rehab won’t be limited to the elbow or the shoulder. Dr. Robert Nirschl, the founder of the Nirschl Orthopaedic Center for Sports Medicine in Arlington, said that the lower body must be in shape as well. Since pitchers gain velocity by pushing with their legs, any weakness there might cause the patient to compensate with the arm and shoulder, putting that area at further risk for injury.

    As difficult as the physical rehab will be for Flasher, the mental recovery could prove just as great a challenge. When biology has integrated the tendon and the arm returns to what it once was, Flasher will head back to the mound to do what his team needs him to do: Get batters out in crucial situations.

    Getting over the mental hurdle was particularly challenging for Chris Vines, a relief pitcher for the Class-A Myrtle Beach Pelicans. Vines underwent Tommy John surgery in July 2006 after waking up one morning in Savannah, Ga., to find he couldn’t straighten his arm.

    “There’s no real pain,” Vines said before Wednesday’s game against the Potomac Nationals, “it’s just a matter of trusting your body that you can let it go with everything you’ve got again. Because that ligament’s stronger now than it was before.”

    That’s the best outcome of the Tommy John procedure: Replacing a ligament, which attaches bones to other bones, with a tendon, which typically connects muscles to a bone, makes the joint stronger.

    Flasher is still a long way from figuring out just how the surgery will ultimately affect him. These days he watches out for foul balls when the rest of the Patriots’ relievers are warming up.

    A month ago, Flasher was the one warming up there, coming out to pitch in front of 20 scouts — his estimate — in Charleston. A few have e-mailed encouragement since then.
    In the snap of a finger, or an elbow ligament, Flasher is reduced to watching games.

    “I get to spend a summer at home,” Flasher said with a smile, trying to find a positive aspect to his injury. “At first when it happened, it was a real shocker, like I don’t know what to do. Everything happens for a reason, I believe that God did this for a reason. It gives me another reason to mature, to get stronger. I’m excited about it, actually, right now.”

    ----- Sidebar follows -----

    Dr. Tal S. David, an orthopedic surgeon in San Diego, recalled a study that showed that the force exerted on the ulnar collateral ligament on the average fastball was greater than the force it took to break that same ligament in lab tests. The ligament doesn’t break during pitching because some of the force is absorbed by the surrounding bone and muscle structure.

    But when it does break, Tommy John surgery is the best way to fix it.

    David compared the UCL to a fan belt. If you drive across the country twice, he said, the wear on the fan belt builds. It may fail on the third trip across the country or on a simple drive to the grocery store. The repetitive stress on the ligament is what leads to the break, not necessarily a single catastrophic event, he said.

    The procedure is specific to athletes who throw. In most cases that’s a baseball player, but David said javelin throwers may also benefit from the surgery.

    The operation was first performed on its namesake, then-Dodgers pitcher Tommy John, in 1974. The procedure uses a tendon somewhere else in the body — or perhaps even from a cadaver — to replace the injured ligament.

    Dr. Robert Nirschl, an orthopedic surgeon in Arlington, said his preferred method for the procedure was to drill holes in the bones and thread the new tendon through the holes. Screws can also be used, he said; staples are riskier because of the chance they can become loose.

    As the new tendon becomes incorporated, new blood vessels will reinvigorate the tendon, giving it life again. Nirschl likened it to a Christmas tree, which can survive without a water source. But if the tree is kept from water for too long, the needles will fall off and it will die.

    The rehabilitation process can last as long as 18 months; Nirschl said in the early days of the Tommy John procedure, pitchers could be forced to sit out at least 18 months because there were no guidelines on how long recovery would take.

    Nirschl divided the recovery process into three stages: rehabilitation, fitness and performance exercise. Rehabilitation, he said, gets the affected area back to normal. Fitness makes it better than normal. And performance exercise fine-tunes the area to perform specific tasks, whether it’s in baseball or occupational therapy.

    Overcoming the mental hurdle is mostly an individual exercise. Nirschl said a doctor can help in that regard by hooking the patient up to a machine that measures workload, showing the patient that his or her elbow is as good as new.
  2. BYH

    BYH Active Member

    Really good stuff, Hustle. Good anedotes from the subjects and you were able to get the docs to explain the wounded elbow in easily understandable terms.

    you even got me rooting for this kid from Mason to succeed. :D :D :D
  3. deviljets7

    deviljets7 Member

    I really enjoyed the article. It was quite informative with a lot of good anecdotes.

    I don't know if anyone feels the same way, but the only possible concern I'd have is that there are so many anecdotes, you have a pretty long stretch where there are no reference(s) at all to the pitcher.

    Besides for that (and I'll admit it may be a nit pick), it is a very good story with great visual details.
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