Alex Reyes looks to begin the throwing phase of his Tommy John Surgery (TJS) rehab over the next couple weeks. While it is good news to see that there are no setbacks, there shouldn’t be any pressure on him to progress quicker than he needs to.
As a Cardinals fan, I would be excited to see Reyes healthy for the beginning of next season, but ecstatic to see him healthy for the rest of his career.
For those not familiar with TJS rehab, it is quite lengthy, taking most players 12-15 months to recover fully. During this process, the demand TJS puts on your body is tough and is equally compared to toll it takes on your mind. The recovery requires patience and persistence, and isn’t an easy task for any athlete. There are up and down days, how the arm feels during rehab can be unpredictable. There are even scary instances when it may feel like the UCL is torn again, but the pain is just scar tissue ripping.
The Recovery Process: Inactive
Day 1: Immediately following surgery, the arm is wrapped in a soft cast that completely restricts movement and holds it in a 90-degree angle.
Weeks 1-2: The couple weeks following operation are dedicated to the repair of the incision and surrounding tissue. It is extremely important that there is absolutely no movement in the arm.
Weeks 2-7: This time is critical to regaining back the full movement. It begins with replacing the soft cast with an adjustable metal brace that limits the degree that the arm bends. As the weeks go on, the athlete is regularly treated by a physical therapist. The therapist applies manually therapy, to work out damaged tissue, increase blood circulation, as well as stretch surrounding muscles to allow for better mobility. The therapist then can adjust the brace accordingly to allow for more and more motion. Eventually, the athlete should regain full range of motion.
Weeks 8-20: This is where Alex Reyes currently finds himself. The athlete strengthens and stretches their shoulders and muscles surrounding the elbow to regain and increase all flexibility and strength. With the increase in strength and flexibility, a fair amount of stress is alleviated from the UCL.
The Recovery Process: Active
Weeks 20-35: The athlete now finally starts throwing for the first time following surgery. Beginning at a short distance with a set number of throws, the rehab program gradually increases both the distance and volume. Moving up stages depends on arm fatigue. All the rehab programs vary depending on the surgeon, but in the beginning of the stage, expect to throw one set of 10 throws from 30 feet, and towards the end expect to throw three sets of 20 throws from 200 feet.
Weeks 35-50: Pitchers finally start pitching. They begin with a minimal effort flat-ground bullpen, and eventually work to an all-out, off the mound bullpen. Pitchers are usually most cautious here as it’s extremely dangerous in regulating how hard you throw. Discerning the difference between a 70% and 80% effort isn’t easy, and throwing harder than what your arm can handle is dangerous.
Week 51: The pitcher throws a simulated game to batters before beginning their rehab assignment. During this ‘game’ the pitcher is closely supervised by a coach and is protected by a screen. This minimizes the stress of finally throwing live to batters.
What to Hope for
At the end of the day, the best thing we can do as fans is sit back and relax. Put trust in the Cardinals front office and medical team with how they handle Reyes’s timeline. Seeing Reyes back on the mound in dominant form, saying “I have no pain” is the best case scenario. Even if that means him taking all of the time that he needs to recover. Moving forward, the surgeon will tell the Cardinals the recommended innings cap Reyes will have his first year back, and the Cardinals will have three options assuming they are playoff contenders:
- Sit him out during playoffs. (Like the Nationals did with Strasburg)
- Throw the innings limit out the window during playoffs. (Like the Mets did with Harvey)
- Start him later in the year, giving Reyes more time to recover as well as making the innings limit be a non-issue.
Photo Credit: Jeff Curry @ USA Today Sports