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Whats Ahead For A.J.

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What's ahead for A.J.?


By Alan Tays, Palm Beach Post Staff Writer
Thursday, May 1, 2003



If A.J. Burnett wants a preview of his rehabilitation from Tommy John surgery, he can simply ask the man who will replace him in the Marlins' rotation, Michael Tejera.

"I couldn't even drive a car," recalled Tejera, who underwent baseball's most famous surgery in April 2000. "I'd have my dad take me to rehab from the house."

Showering would have to be done with one arm, because Tejera's left (pitching) arm was useless immediately after the operation that replaced a ligament in his elbow. And sleep brought little relief, because Tejera had to sleep with his arm extended at a 90-degree angle. "All the time my shoulder was killing me," he said.

Tommy John surgery -- named after the first professional athlete to undergo the procedure, in 1974 -- has been a godsend for dozens of pitchers. (Last year,The Sporting News estimated there were 75 active major-leaguers whose careers had been saved by the procedure.)

Tommy John surgery involves replacing a damaged elbow ligament with a tendon from another part of the body. In John's case, Dr. Frank Jobe, the Los Angeles Dodgers' orthopedic surgeon, took a tendon from John's right arm and implanted it in the left-hander's pitching arm.

"On him, it took us almost four hours," Jobe, 75, said from his Kerland-Jobe Clinic in Los Angeles. He still does some Tommy John surgeries, although "my partners do most of them now."

On Tuesday, Dr. James Andrews of Birmingham, Ala., needed less than 90 minutes to replace Burnett's damaged ligament with a gracillis tendon, taken from the groin area.

Taking the tendon from the groin has been common practice for about three years, Marlins trainer Sean Cunningham said. The groin tendon is thicker than the one previously used from the wrist.

The modern procedure, Jobe said, is similar to the original. "It's just that we've gotten so much better at it. Before, we would say, 'Do you think it ought to go here or there?' and you'd talk a little bit and use your time to cogitate a little bit. But now you know exactly what you're going to do, so it's done very quickly."


Unglamorous side

But the surgery itself is only half the story. The other half -- the unglamorous side of life after the knife -- is the rehabilitation, which usually lasts a year to 18 months.

"Basically he'll be immobilized to start," Cunningham said of Burnett. "He'll do six to eight weeks of range-of-motion (exercises) for the elbow, wrist and shoulder joints. From there you go through another two months emphasizing the strengthening aspect."

If all goes as planned, somewhere between Sept. 1 and Nov. 1 -- four to six months from now -- Burnett will begin what Cunningham calls "functional activity."

In layman's terms, "picking up a baseball."

After John underwent surgery in 1974, his left arm was placed in a cast for about two months. When he took off the cast for good, his arm was so atrophied that the sight of it would bring John's wife, Sally, to tears.

John was told to start his rehab slowly by handling a tennis ball or playing with Silly Putty. When he felt he was ready to start throwing -- almost six months after the surgery -- he could throw a ball only about 20 feet. Sally served as his rehab partner, the two of them playing catch at night in their back yard.

Almost 25 years later, Cardinals right-hander Matt Morris had the surgery after spring training in 1999. When he resumed throwing, he began with a set number of tosses from a fixed distance. Throwing every other day, he gradually increased the number of throws, then the distance.

Morris began with 15 throws from 40 feet. Once he worked up to 30 throws, he moved back to 60 feet. In January 2000, five months after he had begun throwing, he was up to full-speed throws from 120 feet. Then he started throwing from a mound.

Before the baseball, however, comes the stiffness and pain.

"The hardest thing for me was straightening out my arm, getting past the threshold of pain and actually getting it straight," said Diamondbacks right-hander Andrew Good, who had the surgery in March 2000.

After undergoing the original surgery, John developed a complication that even today is not widely known. Scar tissue formed on a nerve, locking John's left hand into a claw. Jobe operated again, but not before telling John his hand might remain clawed the rest of his life.

Fortunately, the second surgery corrected the problem -- slowly. John was told the nerve would heal an inch a month. The nerve was about 18 inches long and John was out about 18 months.

Once a pitcher begins making progress in his rehab, the temptation is to speed up the process.

That's dangerous.

"That was one of the mistakes being made in the late '80s or early '90s," Cunningham said. "The player was not having any pain or discomfort and they were on an accelerated time schedule where they were doing great at six months or seven months, and they were back to competitive action when they hadn't returned to 100 percent and they ended up having a recurrence.

"A.J. would fall into that category because he is a highly motivated athlete."


Speed often improves

Once a pitcher can throw again without pain, he can begin building up his stamina and arm strength.

It's scary, Tejera said, "if you throw the ball and you're not feeling any pain but you don't throw the speed you know you can throw."

The good news is pitchers often achieve higher pitch speed after their rehab. Both Good and Tejera said their fastball is faster now than it used to be.

"The key is the rehab," Tejera said. "You've got to work hard. You've got to put yourself into it.

"If you put yourself into it, you'll be good."

There are no guarantees, however. Not all pitchers who have had Tommy John surgery have made successful comebacks. Some, such as Dodgers pitcher Darren Dreifort, have had the surgery twice. Dreifort is 1-3 with a 3.77 ERA in his second Tommy John comeback.

Two years and about 60 starts later, Good, who will start against the Marlins tonight, says of his surgery: "Now it doesn't even cross my mind. Twenty years ago, my career would have been over. I'm just thankful every day I put on the uniform."
 

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