'Tommy John' not just for big leaguers
11:20 PM, May. 12, 2011 |


The Enquirer/Ernest Coleman
Sixteen-year-old Kyle Cotcamp of Hamilton shows his scar from his Tommy John surgery that he underwent in March before he starts his rehab work on Wednesday at Beacon Orthopaedics and Sports Medicine in Sharonville.

Written by
John Erardi
jerardi@enquirer.com

Four summers ago, 12-year-old pitchers Kyle Cotcamp and Tyler Richards of Hamilton were on top of the baseball world, playing in front of 20,000 fans at the Little League World Series in Williamsport, Pa.

Now, they've both had the ulnar collateral ligaments in their throwing elbows replaced, a surgery made famous in the 1970s by the then 31-year-old pitcher it was named for:

Tommy John.

Those are dreaded words for any pitcher, but especially for one who hasn't yet played a day of high school varsity baseball.

'Never dreamed of ... surgery at 14'

The St. Louis Cardinals are in town this weekend for a big series at Great American Ball Park. Staff ace Adam Wainwright is out for the year after undergoing Tommy John surgery in spring training. Cardinals starters Chris Carpenter, Jaime Garcia and Jake Westbrook also have had the procedure in recent years.

But they're adults.

"I always dreamed of playing in front of 20,000 people, and millions of people on TV at 25 - not 12," Richards said. "I never dreamed of having Tommy John surgery at 14."

Four years ago, on a star-twinkly August Friday night before 19,400 fans at historic Lamade Stadium, Richards struck out nine batters and gave up only four hits in six innings in a 10-4 victory over Warner Robins, Ga., the eventual Little League World Series champions. Two years later, Richards' elbow ligament had to be replaced.

"I was there there that day - we were both 13," Cotcamp recalled. "I was playing first base, he was pitching - when it snapped. Cold day, early in the season. Last pitch of the inning. He struck the kid out. He came into the dugout holding his arm. He was like, 'I can't do it anymore.' "

The next year, Richards had Tommy John surgery, the second young such patient for Dr. Timothy Kremchek, the Reds' team physician. He performed the procedure on Cotcamp last March.

Neither Cotcamp nor Richards blame their elbow problems on their Little League coaches.

Regardless, they can tell cautionary tales about throwing curveballs before you're old enough to shave, which Cotcamp thinks caused his injury, and throwing too many pitches without enough rest in between, which Richards thinks caused his.

The lessons are reminders of what can be lost to young athletes unable to experience the joy and thrill of representing their school on the varsity level. Those are memories that can last a lifetime.

"I'd be very disappointed if I didn't get to experience that in my senior year," Cotcamp said. "It's upsetting for me to watch high school baseball games, but I still ask guys every day how they did in their games.

"Going to the World Series was a great thrill, and I wouldn't trade it for anything - it really was the coolest thing, ever - but I want to have other experiences with baseball, too. I don't want it to be the highlight of my life."

Cotcamp blames his arm problems on not being willing to switch to a changeup, as coaches had urged. Instead, he stuck with his curveball, his "out" pitch - and the pitch he threw about 70 percent of the time.

"If I had to do it again, I'd never ever throw curveballs," Cotcamp said. "Coach (Tim) Nichting kept telling me, 'changeup, changeup,' but I never put the work into it. I just relied on my curveball so much; I never wanted anything else."

Richards blames his arm problems on overuse while playing for a summer traveling team outside Hamilton the year after Little League. "They started me nine of our first 20 games that season," he said. "I wasn't getting enough rest between starts. But it was my fault. I never told them that my arm hurt."

The surgeries are "a sore subject," said Tim Nichting, who managed the 2007 team that went to Williamsport. "They (Cotcamp and Richards) are different cases.

"Tyler threw extremely hard for somebody his age. Kyle, on the other hand, threw a lot of curveballs. Yes, we tried (to wean him off it)...I guess Dr. Kremchek is saying Tommy John (surgery) can come about years down the road from too many pitchers or too many curveballs when you're 11 or 12?"

Yes, that is exactly what Kremchek is saying.

Young arms vulnerable

Kremchek's experience and research leads him to conclude that 12 to 14 is the age of highest vulnerability for most young pitchers.

In roughly the same 4 1/2 years since Cotcamp, Richards and their West Side mates made their run to the Little League World Series, Kremchek has done Tommy John surgeries on more than 220 amateur baseball players, most of them pitchers and more than a third of them teen-agers.

Despite increased awareness by parents and youth coaches on the importance of pitch counts and not throwing too many curveballs, overuse and breaking pitches are still an issue in youth baseball, locally and nationally.

Kremchek urges no curveballs at all before age 13. But there is debate even in the medical community about how dangerous the pitch is.

According to two 2009 studies - one in Connecticut, the other by the American Sports Medicine Institute (ASMI) in Birmingham, Ala., both by scientists and surgeons - curveballs are less stressful than fastballs, and contributed little, if at all, to throwing injuries in young players.

Dr. James Andrews, a preeminent orthopedic surgeon who has performed procedures on many major league pitchers, is the founder and president of AMSI, but even he was troubled by his own group's research. He told the New York Times when the study came out he was concerned that parents and coaches might interpret the research to mean it was OK to teach the curveball and allow the pitchers to throw as many as they wanted. He was also concerned the study was done entirely in a lab, not under game conditions when pitchers can grow tired.

While experts may disagree on the impact of curveballs, there is no disagreement over the issue of overuse: too many pitches thrown over too short a time or with too little rest.

Little League has strict rules regarding pitch counts and how much rest pitchers need between workloads. But once kids turn 13, not all organizations have the same standards.

Andrews co-wrote a study that found that young pitchers who pitch more than eight months a year are five times as likely to need surgery, and that young pitchers who regularly threw more than 80 pitches in game during their seasons were four times as likely to need surgery.

The lessons of Cotcamp and Richards, however, go far beyond statistics.

Cotcamp, a junior who had growth-plate issues as a freshman and fractured his hip running the bases last year, hasn't been able to play much baseball since Little League. Last week, he was grinding his way through his rehab paces at Beacon Orthopedics in the hope he will get to finally pitch some games for Hamilton next year as a senior.

Richards, a sophomore who is pitching and playing shortstop for the Hamilton junior varsity, figures to ultimately get his chance.

Some request surgery

Kremchek believes the safeguarding of youthful arms by youth coaches in southwest Ohio has improved in the last few years. But sometimes parents can be at fault, too.

More than a dozen times in these same four years, Kremchek said, parents have urged him to perform Tommy John surgery on their youngsters, even if that youngster doesn't absolutely have to have it.

Kremchek said he asks the parent, "Do you think this surgery is a Band-Aid procedure?" And then he answers the question for them: "It is serious surgery; it is risky, and it has a long rehab."

Then he tells the patient, "This is up to you - you have to decide is this what you really want."

One parent even went so far as to tell Kremchek, "My son's probably going to have to have the surgery one day, anyway - he's good and he's young - so why not do it now and make him better for later on?"

Richards can tell his contemporaries there are no guarantees.

"I was throwing 83 (miles per hour) when I was 13, then after I hurt my arm the first time I dropped down to 75 at 14, and now after Tommy John, I'm in the mid-80s.

"The (myth) is that surgery alone is going to make you throw harder. No, the rehab of your arm overall - shoulder and core strength, all that - is what makes you throw harder. I'd have been throwing harder quicker if I'd worked harder in my rehab, and I wouldn't have the tendinitis in my shoulder that I'm having now. I'm going to have do more this winter, because I sloughed off during rehab.

"I've told Kyle, 'Give it all you got. Don't slough off.' "

Almost all Kremchek's Tommy John patients have returned to playing baseball.

Still no regrets

Both Cotcamp and Richards say they would not have traded anything for their run to Williamsport, not even avoiding surgery.

"No matter what the consequences, I'd have wanted to go to Williamsport," Richards said. "But going to the World Series isn't what did it to me. I was throwing harder than ever the following year."

The question is: What's left when the roar of 20,000 fans and the bright lights of ESPN TV are gone?

Last Monday, at a JV game at Hamilton High School, Richards, with his surgically repaired elbow, played shortstop. There were 30 people in the stands.

"It was like a fantasy world back then," said Richards of the difference in fan interest.

"I go to school with eight of (the 12) guys from that (World Series) team. Of the 12, I think eight of us are still playing baseball, some on JV, some on varsity, one at Edgewood, one at Badin. We don't really talk about those days. There's no way actually describe what it was like."

Meanwhile, the Hamilton baseball community is now seeking to gain control of its post-Little League players during the summer months.

"We've got a 13-year-old team now, two 14-year-old team, a 15-year-old team and an older team," said Hamilton High junior varsity coach Tim Reed, whose son, Jimmy Joe, is playing JV ball and was on that 2007 World Series team. "We started it this year, so we can keep our kids here and keep our eye on them."

The good news for Richards is he's still young enough to come back.

And Cotcamp might yet get his shot. Kremchek said that if Cotcamp faithfully sticks to his rehab, there is nothing from a medical standpoint to preclude him from pitching for Hamilton varsity next spring - within 12-13 months of his surgery last March.

Every patient and every arm is different, but it drives Cotcamp to know that he might yet achieve his dream: As a senior, to represent his school on the varsity field.

"It was sweet to go to the World Series," said Cotcamp.

"But I think this next chapter could be even sweeter. I'd like us to be remembered as the two guys who came back from Tommy John surgery."

http://news.cincinnati.com/article/20110...RONTPAGE|p

Good article - and I've brought it up before...but it fails to mention the couple kids on that team that blew shoulders out too.

(05-13-2011 11:30 PM)rath v2.0 Wrote:  Good article - and I've brought it up before...but it fails to mention the couple kids on that team that blew shoulders out too.

Yeah, I remember you talking about these kids having TJ surgery a year or two ago.

That program's training and pitching routing obviously isn't doing these pitchers any favors.

The most shocking part of the article is that they let Kremchek operate on these kids.

(05-17-2011 11:58 AM)Eastside_J Wrote:  

(05-13-2011 11:30 PM)rath v2.0 Wrote:  Good article - and I've brought it up before...but it fails to mention the couple kids on that team that blew shoulders out too.

Yeah, I remember you talking about these kids having TJ surgery a year or two ago.

That program's training and pitching routing obviously isn't doing these pitchers any favors.

The most shocking part of the article is that they let Kremchek operate on these kids.

Just to be clear, that is not part of the fault of the program. That was pointed out if you read the entire article, and not the coaches. In one case it was the summer league program and the other it was the kid overriding what he was told by the coaching staff.

Don't care what the cream puff of an article says. We saw how they continually ran them out there with no rest, and pitched them till their arms fell off. I called this 5 years ago before they even went to the WS. Told that coach face to face after a game where every 10 and 11 year old he pitched threw sliders instead of fastballs. He told me there was nothing wrong with sliders at that age. I've reminded him of our conversation the two times I have seen him between the baselines since.

It was a joke in the 4th and 5th grade. Forget about the year they went to Williamsport. And those won't be the last ones to have Tommy John from that team. Damage was done long before they went to play S.W.O.L. ball.

Like I said, article fails to mention all the other arm problems for that group.

What really makes it sad is that they could have soft tossed underhand and still won because it was probably the best hitting team I have ever seen. Still is for the ones who can still pick up a baseball.

Pure B.S.

Chris, you keep blindly standing up for what you have absolutely no knowlege of. Bad habit for someone who knows better. I get it. You are a Hamilton guy.

I know that coach. Do you? You ever even see that team in person? In 5 years I watched them play about 2 dozen games and coached against that squad 8 times. Most recently played most of them just last week.

Any coach who boo-hoos that they tried and tried to get their kids to throw change ups instead of curveballs but just couldn't get the kid to do it is completely full of sh!t and deserves to have rotten vegetables thrown at them. Its just ridiculous.

Here is how it goes. You teach young kids about arm health. You instill a conditioning program and stick to it. You strictly adhere to mandetory down time after throwing. You tell kids what they can throw and what they can't throw. When you are sitting on the bucket and you see a slider or a curve come out of their hand, you ask for time, walk to the mound and remind them what they can throw or for the older kids who can handle a curve that their mechanics were off and remind them to stay on top of the ball versus getting outside and getting slurvey. Next time you see it, you ask for time, walk to the mound, and the kid follows you back to the dugout. Not because he is in trouble. But because of safety. Simple as hell. I coach kids that are now bigger than me and we still don't allow the slider. No matter how effective it is.

Eastside could have 8 kids on our current select 10U team throwing screwballs in a week. Unhittable at this age. So why don't we? Because it is idiotic for any parent or coach to allow it if they want their kid to be able to use their arm by the time they hit high school.

Every team in Greater Cincinnati could throw sliders by the 5th grade if they wanted to. Its an easy pitch to throw. Its a shortcut. They don't because sane coaches and parents just don't allow it.

Yes I do know the coach and his family. Yes I have seen his teams play in person. Yes, I was raised in Hamilton.

There is no coach in the West Side Little League that teaches or authorizes his kids to throw anything but fast ball, knuckleball and changeup. If the kids do it, everything else is after the fact.

Everything else you have said is pure Cincinnati propaganda and again I call B.S.

Don't like it? Beat them.

Sad.