February 25, 2011

Adam Wainwright

It was the Minnesota Twins' Joe Nathan whose season ended before it even got started. This year it's St. Louis Cardinals ace Adam Wainwright.

Wainwright like Nathan before him, has a torn ulnar collateral ligament in his throwing elbow and is expected to undergo reconstructive surgery, commonly referred to as Tommy John surgery, followed by a lengthy rehabilitation.

They (Cardinals and Wainwright) are no doubt devastated by this news, no one can say they were entirely surprised. Wainwright's stellar 2010 season ended in unceremonious fashion when he was shut down in September because of inflammation in his right elbow. He had a history of injuries to the elbow dating to 1998, including a partial tear of the same ligament in 2004, which caused him to miss significant time in the Cardinals' minor league system that year. Nonetheless, preseason examinations had Wainwright confident that his elbow was a non-issue coming into spring training.

To be fair, from an athlete's perspective, that is precisely how Wainwright should have approached this season. The truth is it's not uncommon for pitchers with a history of elbow or shoulder injuries, even with known tissue damage, to still be able to pitch and pitch successfully for years afterward. In Wainwright's case, there were no overt signs of instability; he even told the St. Louis Post-Dispatch that his ligament was "healthy and strong." No athlete can or should enter a season afraid of what could happen, especially since these injuries can strike anytime young or old, injury history or not. Just ask 22-year-old Stephen Strasburg, who tore his UCL last year as a rookie.

Still, we're reminded just how strenuous the act of pitching is on the human body when a dramatic breakdown, such as a UCL tear, occurs. The expectation in baseball now has become not whether a pitcher will ultimately succumb to a major injury to his throwing arm, but when it will happen. And once there is an injury "event" in a thrower's history, the concern going forward only increases. Cardinals general manager John Mozeliak might have said it best Wednesday when he reflected on how well -- and how long -- Wainwright has pitched since first injuring his elbow in 2004, telling the St. Louis Post-Dispatch, "I guess at some point, it's just a matter of time." There are, however, a few silver linings in this dark cloud.

First of all, this will be the first time in years that Wainwright will have an extended break from throwing. Most pitchers have thrown extensively since their youth, and this forced rest allows the athlete's entire body to "regroup" and retrain during the recovery period. The opportunity to rehab the throwing shoulder while working on leg strength and core muscle strength, and the chance to make any necessary mechanical adjustments, might ultimately extend a starting pitchers' career.

The timing of Wainwright's injury is such that he could be pitching next season. The average recovery time for pitchers following Tommy John surgery is almost 12-15 months, although many throwers will say it takes an additional six months to really "feel" like they're back. Wainwright should be encouraged by the prospect of returning to the mound next season.

In the Last, Wainwright can take comfort in the knowledge that the success rate for returning to play following this type of injury is fairly high. At an annual baseball medicine conference this year, Dr. Lyle Cain (a partner with Dr. James Andrews at the American Sports Medicine Institute in Birmingham, Ala.) presented recent data showing a return rate of 73 percent of professional baseball pitchers to their prior level of performance following this procedure. As the procedure has become more commonplace, the knowledge as to how to best rehab an athlete has improved as well.

Wainwright need look no further for inspiration than teammate Chris Carpenter, who has traveled the same long and lonely comeback road following UCL reconstruction. After all, Carpenter is proof of not only returning to pitch following Tommy John surgery, but returning to pitch successfully. Wainwright will now look to do the same.

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