Rich MacLeod: Will, can you explain the impact on the ulnar collateral ligament (UCL) for a pitcher and fragility of the structure?
Will Carroll: The UCL is one of the structures that allows the elbow to be a stable joint. The load the ligament comes under during pitching is often enough on a single pitch to damage it, according to research done at the American Sports Medicine Institute, so it’s no surprise that the ligament is regularly sprained. When the ligament loses structural integrity in a throwing athlete, it is necessary to replace the ligament in order to return them to function. That’s what we commonly call “Tommy John surgery.”
Rich MacLeod: Elbow injuries have become an epidemic in the game, especially those which require Tommy John surgery. MLB has taken some initiatives to curtail these problems, but where do you think the foundation of these issues lie?
Will Carroll: The problem is that the issue doesn’t have one easy answer. It’s a variety of things from overuse in youth baseball, improper or unsustainable biomechanics, and fatigue. Unfortunately, teams don’t have much of the info necessary to truly find the root cause. We can treat the injury, but baseball does a poor job of preventing the injury. The PitchSmart program, started last year by MLB, is a great step, but it’s not going to reduce the incidence now. We’re not going to see the full impact of PitchSmart for another decade, if then.
Rich MacLeod: In Zack Wheeler’s case, he has unusual mechanics, something he has talked constantly about tweaking and modifying since he arrived in the organization. What is unusual to you, and what can he do mechanically to reduce the risk of future injuries?
Will Carroll: That’s a great question and one we can’t really answer. There are quirks to Wheeler’s motion, but we don’t know whether a quirky delivery is one that is biomechanically “bad.” The Mets don’t do biomechanical analysis of all those pitchers, so we don’t know if Wheeler has had one done. (My guess is no. If you didn’t with Matt Harvey, why would you with Wheeler?) Not only would they not know the forces Wheeler is putting on his elbow, shoulder and more with each and every pitch, we don’t know what the fixes would do!
Rich MacLeod: After the surgery, what are some of the first exercises Wheeler will perform?
Will Carroll: Wheeler, like all pitchers, will be immobilized for a period of time in a large brace. He’ll work on range of motion early. Under the normal rehab protocol, he’ll start very limited exercises in a week, but the grafted tendon will take several weeks to “settle.” We normally don’t see any throwing of any type for about three months.
Just Mets 