The Defensive Specialist has talked so much about aluminium bats over the past few weeks that he actually has a metallic taste in his mouth. That can’t be healthy right? Anyway, in an effort to move as far away from that debate as possible, the Defensive Specialist decided to delve into the world of baseball injury and rehabilitation. Graciously offering up his time (he has a whole bunch of it right now) and insight is Scott Mitchinson who began his professional baseball career with the Philadelphia Phillies before being traded to the Oakland A’s. Mitchinson has battled an assortment of injuries throughout his pro career (some baseball related, others freak accidents – shoulder dislocation while surfing) but the latest one may be the biggest. Mitchinson recently underwent an elbow reconstruction or as the procedure is commonly referred to – Tommy John surgery.
The Defensive Specialist asked the questions, Mitchinson provided the answers:
How did you first injure your elbow? Can you describe the pain or discomfort you felt?
I first started to feel pain midway through the 2009 season in the US; it was like a sharp pinch on the inside of my elbow when I started to bring my elbow forward to pitch. It was something that slowly got worse and worse over a couple outings, there was no one pitch that I can pin point it to.
Were there any warning signs leading up to the injury? Pitchers who’ve injured elbows before often describe elbow tightness.
No not really, the pain first started as something minor which I thought was just a little general soreness, but as a few days passed it got worse and worse to the point where I couldn’t lob the ball without pain.
You’ve previously had shoulder problems. In your opinion, do you think your arm problems are symptomatic of your throwing action or pitching motion?
I definitely think it is something I am going to have to look into now. In the past I have never really thought that my mechanics had anything to do with it, but I have had both shoulder and elbow surgery now so I guess there maybe something I’m doing that may be causing these problems.
Were you able to throw after the injury or was the pain too much?
At first I continued throwing when the pain wasn’t that severe, as I thought it might just be some general soreness that would go away on its own, but after a couple of outings the pain was too much.
Where were you diagnosed as requiring an elbow reconstruction?
The weird thing with my elbow is that none of the MRIs showed an actual tear in my ligament (I had 3 different ones) they all just showed some inflammation. The symptoms I was having were associated with possible ligament damage, but because the MRIs weren’t showing anything conclusive they first thought it may just be forearm tendonitis. Even when I went in for surgery they still weren’t 100% certain I needed a new ligament, so they went in with the idea of scoping it out and fixing what they saw. It turned out only once they were looking inside my elbow they could see the tear.
Well to be honest, I had already spent a lot of time trying to rehab this injury without success, so I just wanted it diagnosed and fixed. I really never knew for sure that I needed the reconstruction up until the point where I woke up after surgery. It’s obviously not something that any pitcher wants to go through, but I was just happy to have it fixed.
Can you explain why you had to return to the US for surgery?
I ended up choosing to go back to the US for surgery just based on advice from local doctors here in Australia. “Tommy John” surgery is a very baseball specific injury and there aren’t too many cases here in Australia. In the US, doctors see these on a daily basis, and as I was told, there are just some things about surgery you can only learn through experience. I was lucky enough that one of the top doctors in the US performing this surgery agreed to see me.
Can you step us through the surgery process?
I went in for surgery at the Kerlan Jobe orthopedic clinic in LA at 6am and probably got out of there at about lunchtime the same day. I didn’t have the correct tendon in my forearm which they would usually use as a first preference so they took the tendon graft from my gracilis muscle in my left leg. I think it’s about 50-50 as to whether you have the forearm tendon or not. So when I woke up I had a 90 degree cast on my right arm extending from my wrist to my shoulder and was in a sling. My left leg was also heavily bandaged around my knee. They gave me a cane to use as I walked to the car, but I needed it more for balance more than anything.
After I left the surgery center I went back to my hotel where I basically slept the rest of the afternoon, they gave me pain medication to take every 4 hours, but I only really took it for the first 2 days and then I was fine. My leg was sorer than my arm initially. The directions they gave me after leaving were basically not to do anything with my arm for 2 weeks until I came back and saw the doctor, but my leg was fine to do normal activity.
So for those first 2 weeks I basically did nothing that required using my right arm, just rested in front of the TV and did some touristy bits in California.
When I went back to see the doctor for my post-op appointment, they removed the cast and bandage from my leg. The stitches were all internal and didn’t need removing, so once I got the cast off all i was left with was a nice big scar on the inside of my elbow, around 10 cms long, as well as in incision on the inside of my left knee 3-4 cms long. They took a quick x-ray to make sure they were happy with everything and then I was sent on my way with a 10-12 month rehab protocol to follow.
For the next 2 weeks all I am supposed to be doing is trying to get full range of motion at my elbow. When I first got the cast off I could barely bend or straighten my elbow at all, but now I am at almost 4 weeks post-op and I am starting to get close to having full range. I have been seeing a therapist in Perth a few times per week as well as doing stuff on my own at home.
Don’t they usually take a ligament from a cadaver?
Not as far as I know
Can you give an overview of the rehabilitation process?
Basically the first 4-6 weeks is spent getting you full range of motion back at your elbow, and then you progress into the strengthening phases which include a lot of shoulder and scapular work as well. At around 5 months I can begin a throwing program, and at around 10-12 months they expect you back pitching in games
How has the pain been?
Pain has been pretty minimal so far. The only time it gets sore is when I’m doing my exercises which are aimed at trying to slowly stretch it out again. My leg was sorer than my arm straight out of surgery
How long until you can pick up a ball and throw again?
At 5 months post-op I can begin a throwing program
How long until you can get on a mound again?
Not sure exactly when I can start bullpens, a lot of that will depend on how my arm is feeling and progressing through the program. They say at around 10-12 months you should be able to be game ready.
Some pitchers have returned from Tommy John surgery throwing harder than before surgery. What can we expect from you?
I’ve got my fingers crossed; any extra miles per hours would be great. All I can do is do the rehab properly and give myself the best chance of coming back from this surgery, and getting back to the same level I was at. In the end I just want to be able to pitch again.
Ok, so that whole ordeal sounds fairly terrible! The work required to get back on the mound is significant AND tedious. Repetition after repetition required to build up the strength and range of motion that was once there in order to perform. Many thanks to Scott Mitchinson for sharing his experiences. The Defensive Specialist wishes you all the best in your quest to get back out on the field.
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