LAKE BUENA VISTA, Fla. – The name is not scary anymore. Pitchers used to hear Tommy John and regard it as an epithet. Tommy John never wanted to be the Angel of Death for pitchers, and yet for years the surgery named after him because he was the first person brave enough to try it made pitchers quiver. Tommy John surgery meant a torn ulnar collateral ligament, a blown-up elbow, a career in jeopardy.
Until recently. As pitchers' elbows failed more and more, as surgeons became more and more adept at fixing them, something curious happened: Tommy John wasn't all that scary anymore. It practically became a rite of passage.
"Tommy John now," Braves manager Fredi Gonzalez said, "is almost like a root canal."
Just look at Stephen Strasburg last season. None of the estimated 1,000-plus professional pitchers who have undergone Tommy John ever had a full season of starts – fine, an almost-full season – like his 2012. Perhaps because there are few pitchers ever with Strasburg's talent, sure, but what about Brett Anderson?
The left-hander rejoined the Oakland A's toward the end of August last year and over his first four starts allowed two earned runs. His comeback was perhaps the best yet in the middle of a season, in the same conversation with Strasburg's five-start cameo the year before.
As great as they were – the celebrated Strasburg blowing hitters away and Anderson pushing the A's to a playoff spot – neither was the best in 2012. Another pitcher – a most unlikely candidate – may be the greatest Tommy John success story yet, the sort who can demystify a surgery evolving faster than anyone realizes.
Kris Medlen stands 5-foot-9 3/4, and we will round up to 5-10, even though when you're under 6-foot that extra quarter-inch means more than tall people care to recognize. He is a right-handed starting pitcher for the Atlanta Braves. This is important because 5-foot-10 right-handed starting pitchers exist only in dreams and parallel universes in which scouts do not chortle, scoff and expectorate a giant stream of tobacco juice in the direction of any right-handed pitcher with the temerity of standing 5-10.
Last season, Medlen joined the following list: Pedro Martinez, Greg Maddux, Bob Gibson, Ferdie Schupp, Dutch Leonard, Walter Johnson and Mordecai "Three Finger" Brown. They are the only starting pitchers in history to finish a season with at least 138 innings pitched and an adjusted ERA of over 250. That means his ERA, when factored for the stadiums' dimensions, was more than 2 ½ times better than the league average. In the last 96 years, the list is Medlen, Pedro, Maddux and Gibson.
Though Medlen started only 12 of his 50 games last year, it doesn't lessen the impressiveness of his season. In those dozen starts, he pitched 83 2/3 innings, struck out 84, walked 10, allowed 57 hits and went 9-0 with a 0.97 ERA. At 26, Medlen made a maneuver last seen from Johan Santana: bullpen to ace, changeup artist who prompts his teammates to speak in onomatopoeia.
"I sat in one of his bullpens last year," Braves reliever Jonny Venters said. "Both sides of the plate, every pitch, pop, pop, pop. Change-ups going vvvvvvooooo-pop."
Venters reveres Medlen for another reason, too. They share the elbow scar of all Tommy John survivors. While Venters took years to find himself after his surgery, Medlen was sliced Aug. 18, 2010, and by the same day two years later in the midst of an unprecedented run that would see the Braves win 25 of his last 26 starts.
How Medlen grew into this – the guy whom the Braves are building their rotation around as they settle in to an extended run at a World Series title – may be the result of a procedure so commonplace it almost has been perfected. When the anesthesiologist gassed Medlen so Dr. James Andrews could cut out a piece of his hamstring and fashion a new elbow ligament, the 90-minute procedure was simply the start of a 12-month process that now spits out returnees at greater than a 90 percent clip.
The rehab is boring as hell, reps of exercises that get tiresome after a day or two, strengthening of muscles that most TJ survivors didn't realize they had. The difficulty is almost entirely mental. And that is one of the reasons Kris Medlen came out of it so well. A 5-foot-10, right-handed starting pitcher needs fortitude to make it to college, let alone the major leagues.
So he tried to learn. Medlen's memory is generally awful. His wife, Nicole, chides him for it. Baseball is different, though. Medlen remembers at-bats, pitches, sequences, swing paths. He immersed himself in the game even if he couldn't be in it, because if he couldn't improve on the field, he'd do so off it.
"Just because I was hurt and sitting in the dugout didn't mean I wasn't growing as a player," he said. "I picked guys' brains. I watched every at-bat. I wasn't allowed to travel on the road trips, so I would sit in the house like a regular fan and have a beer and watch the game."
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Coors Light in one hand, remote in the other, Medlen embraced his inner baseball fiend. He played shortstop in junior college and prided himself on thinking like an everyday player. It made the grind of rehab more palatable. Cardio, strengthening exercises. More cardio, more exercises. The first time he threw, it was like he had never thrown before. He worked for months, tossing, then throwing, then off a mound. And finally, on the last pitch before his first rehab assignment in Triple-A, in July 2011, he threw a curve ball.
"I heard a pop," Medlen said. "It felt the same."
No. Not again.
"If it was, I would've quit," he said. "Be a coach or something. You start questioning your career. All that work. And gone. Again."
Turns out the pop was scar tissue. It hurt. The Braves shut him down for six weeks and loaded his elbow with platelet-rich plasma. That stuff burned like hell, but if it got him back, doctors could've done anything short of set his arm aflame.
He returned for a pair of appearances at the end of the 2011 season. Come 2012, the Braves understood Medlen's importance – how the 13 wins in 14 starts before his surgery were no fluke. They also knew they wanted to limit his innings for fear of pushing him too much upon his return. Gonzalez and Braves pitching coach Roger McDowell discussed their options. Gonzalez wondered if they could start him at the beginning of the season, like the Nationals planned to with Strasburg, and taper him down as the season waned. McDowell shook his head.
"Once you put Medlen in the rotation," McDowell said, "he'll never leave it."
Nearly 50 players underwent Tommy John surgery last year, believed to be a record, ignominious though it may be. From Neftali Feliz to Cory Luebke to Daniel Hudson to Danny Duffy to Kyle Drabek to Scott Baker to Ryan Madson to Joakim Soria to Brian Wilson, they came young and old, fledgling and established, and very, very talented.
And all of them now can look at Stephen Strasburg and Brett Anderson and Kris Medlen and know what is capable.
"It's the best-case scenario, and I watched him do it," said Brandon Beachy, the Braves' best pitcher last year before he underwent Tommy John on June 21. "I remember sitting in on a couple of his bullpens. To see him come back and his stuff to be better than before, it's very comforting to me on days when I feel like I've never thrown a ball before. He went through it, too. Now I know I can do it."
Beachy is following the exact same protocol as Medlen. Every team has its variations on the standard program. Whether last year presented three particularly talented pitchers who happened to thrive upon their return from Tommy John or three pitchers whose success upon their returns from Tommy John was a direct result of better surgical and rehabilitative techniques is not a question anyone can answer yet, mostly because of sample size.
Still, surgeons, team doctors and trainers today believe pitchers are coming back from Tommy John better than they have, and that the old norms – it takes at least a year to regain command – may no longer apply. Strasburg (2.7 walks per nine), Anderson (1.8) and Medlen (1.5) each possessed brilliant control before surgery and moved their pitches with similar aplomb after.
Of course, plenty cases exist in contrast. St. Louis starter Adam Wainwright spent the first half of 2012 leaving balls up in the strike zone before rediscovering the bottom half after the All-Star break and slicing his ERA by more than a run and a quarter. He was also four years older than Medlen and more than a half-decade older than Anderson and Strasburg, which, along with Jarrod Parker's stellar rookie season a year removed from TJ, has doctors asking whether it's not such a terrible thing to blow out young.
As baseball collects more data and monitors injuries even more closely in an effort to solve them, the league hopes to stumble upon answers. For now, success like Medlen's is encouraging. He's set for a full season in the rotation for the first time, and Gonzalez could even consider him on opening day after his season-long jag earned him the start in the Braves' one-game wild-card playoff last season.
"That's a hell of a three-month spurt," Gonzalez said. "Are we looking for that? I would like to have that again. But that's tough to do."
Pedro and Maddux and Gibson aren't exactly bedfellows with Medlen. And that's fine with him. In the middle of his rehab, during those days when all the pitchers on typical programs wonder what they're doing sticking their hands in a bucket of rice and squeezing, Medlen thought to himself how he just wants to get back. Just make it.
He's back, all right. More than back. And Tommy John isn't nearly as scary because of it.
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