Rome, Ga. — In the 11 days since the dreaded surgery, Kris Medlen spent much of his time front of digital screens, arm secured by a sling or a brace. This is the research phase of his recovery. It’s necessary, too: he doesn’t believe he can go through this process a third time.
From his perspective, this is his final chance.
Braves starters Kris Medlen and Brandon Beachy are both coming off their second Tommy John surgeries — the all-too-popular, pitcher-dominant procedure that restructures the ulnar collateral ligament in the elbow and requires at least a one-year rehabilitation process — and changes need to be made. At least that’s their individual thought processes less than two weeks out from lying on operating tables on opposite sides of the country. Both players mentioned in detail that they plan to alter their mechanics during the rehab process in an effort to avoid a third (and potentially final) procedure.
"That’s just something I need to approach the second time around to make sure this doesn’t happen again, because if it does I’m gonna be done," said Medlen, whose surgery was performed by Dr. James Andrews on March 18. "And that’s no fun."
Medlen immediately began studying his mechanics through photos and film study. He didn’t do that the first time around. In 2010, he was entering surgeons’ names into Google searches. This time around, those Internet searches were aimed at his own name, clicking on image after image, taking mental snapshots of the changes that, in his estimation, need to be made this around. He’s already watching his game film, and he’s not too happy with what he’s found. He even called his pitching coach, Roger McDowell, to talk things over; if it sounds like an all-encompassing professional endeavor for a player not projected to be on an active roster until 2015, then that’s because it’s the picture Medlen painted for reporters.
"I’m not gonna stop studying the film and pictures and positions I think I’m supposed to be in at certain times in my delivery. I get into that stuff. That stuff probably seems pretty boring to you guys," Medlen said. "(My) timing was off. I was kinda just throwing — I wasn’t using the right muscles. It starts real small in the beginning and then in the end, when you’re releasing the ball, it kinda puts you out of position. … Being a former infielder, my mechanics used to be a lot shorter, a lot tighter. Over time, I’ve gotten kinda long. It’s just stuff that I’ve looked at and stuff that I’m going to address this time around."
The consolation for Medlen is that, although he’s undergoing the second Tommy John surgery of his young career, he found success after his first procedure. To him, that means the procedure worked. After starting out in the bullpen, Medlen re-entered the rotation after the 2012 All-Star break to go on a historic 12-start run, allowing just nine earned runs over 83 2/3 innings (logging an insane 256 ERA+ along the way) for a perfect 12-0 record. He built off that streak in 2013 by helping to anchor the Braves’ rotation in his first full season as a starter: he was valued at 2.5 wins above replacement while logging 197 regular season innings. He also started the team’s playoff opener for the second year in a row.
In all, Medlen’s surgeries were approximately 43 months apart.
Beachy has had no such good fortune. His second procedure came 21 months after the first one — with limited success in between. He started just five games last season before having to be shut down for further medical work on the elbow.
"In my small amount of time, I haven’t had a problem getting people out. It’s been being able to be on the field. That’s been my biggest hurdle and hopefully now, with everything we know and doing something a little differently, making some adjustments, I can be on the field and learn how to get people out again," said Beachy, whose surgery was performed by Dr. Neal ElAttrache on March 21. "I’ve definitely started looking at (mechanics) more closely after the first one. I’ve been looking closer in different areas, I guess I would say. More with arm path and some things like that, instead of the lower half — and, you know, that too.
"There’s some little things in there that hopefully can alleviate a little stress off of the elbow, not completely change my mechanics by any means."
Beachy’s selection of ElAttrache, one of the nation’s most respected orthopedic surgeons and the Los Angeles Dodgers’ head physician, over Andrews, who performed his first surgery and then his "cleaning out" last year, was a point of interest for the ballclub — after all, Andrews is the Braves surgeon of choice — but Beachy said Andrews encouraged him to seek a second opinion and that he felt comfortable with ElAttrache’s plan.
"It just felt right," the 27-year-old right-hander said.
Instead of taking a ligament from his wrist, like last time, or another part of his body this time around, Beachy’s new elbow ligament comes from a cadaver (Medlen’s graft came from his forearm) and it’s yet another difference he expressed confidence in. The list of guys who have undergone two Tommy John surgeries in such a short timeframe is not impressive — Beachy did name 27-year-old Diamondbacks pitcher Daniel Hudson as a player in a similar boat — but, as always, there are no concrete rules on this subject. It’s a case-by-case basis; one guy could pitch for the next 10 seasons, the next could find himself on another operating table in less than two years.
"Everybody’s different," said Beachy, who was baseball’s ERA leader after 13 starts in 2012, the last time he was healthy. "That’s what I’m learning through this: you can’t really cookie-cutter this process and have us do the same thing and expect us both to have the same results."
For that exact reason, there is some uncertainty whether Beachy and Medlen will help each other along throughout the rehab process, despite the fact that their surgeries were performed just three days apart. Everybody is different — plus, with different surgeons, there may also be further variations in the rebuilding of the elbow ligament. Medlen is already in a full-arm brace, while Beachy gets out of his sling and into a brace on Tuesday.
Still, the mechanics subject looms large.
Making significant alterations to a throwing motion that catapulted both players into the sport’s highest level, a motion that then helped them find personal success against the best hitters in the world, is not an easy task. Pinpointing the problem through film study is one thing; it’s like telling a batter to keep his hands in on a 95-mile per hour fastball — easier said than done. But both Braves standouts seem confident they can do enough to keep them on the field for good this time around.
"I’ve made adjustments up here to get outs because that’s what you need to do to succeed, but I’ve kinda left myself hanging with the injury thing," Medlen said while referencing his early-career move from the right to the left side of the rubber. "No point in getting outs for a short amount of time. You need to try to do that for long period of time."
Added Beachy: "It’s been exhausting mentally, way more so than physically. But it’s not gonna stop me. It’s not gonna slow me down. I’m gonna do what I have to do and I’m gonna get back out there."
For now, it’s all hypothetical, but Medlen and Beachy are gearing up, at least mentally, to avoid this process at all costs for the rest of their careers. If that means tweaking every subtle motion and laboring until the correct muscles are engaged from start to finish on every single pitch to every single batter they face from here on out, then so be it. It’s not a simple endeavor by any means, and it’s not one that will guarantee them perfect arm health or even one they are guaranteed to master at a major league level. There is no warranty on a pitcher’s ulnar collateral ligament. But making adjustments is certainly better than the alternative. The braces and slings on the two pitchers’ right arms are proof positive of that.