May 23, 2019
He'd thrown thousands of pitches over the past 12 years. Thousands of fast balls, sliders, change-ups and curveballs. But this one, this single strike, felt different.
Josh Bortka recounts it this way: "The first inning went great. The second was OK. In the third, I threw a strike, but the release felt really slow. Instantly, my hand and pinky started tingling, and my forearm got tight. Coach took me out of the game. Something wasn't right."
Josh has played baseball since he was 5. In his early years, he also played football – like many kids, a year-round athlete. But at age 14, he decided to focus on the mound. By his junior year, he was ranked No. 3 in the state of Kansas as a right-handed pitcher for Perfect Game. At 17, he continued playing in a competitive league, electing to no longer play for his high school. He was poised for a college career.
Then, injury. Josh's chiropractor reached out to his connections at the Kansas City Royals organization and got Josh a referral to sports medicine specialist Vincent Key, MD, of The University of Kansas Health System.
Evaluating the best treatment option
"Josh's main complaint was pain in his elbow, but his command of pitches and his velocity were noticeably dropping," says Dr. Key.
An MRI showed the ulnar collateral ligament (UCL) in Josh's pitching arm had detached from the humerus bone.
"When I saw Josh, we talked about both Tommy John surgery and a repair and bridge of the UCL," says Dr. Key. "A lot of considerations go into choosing between Tommy John, which is a reconstruction, and the UCL repair and bridge. My ultimate decision factors are, first, where the tendon is torn, and second, how old the patient is."
Josh's scenario checked all the boxes that made UCL repair and bridge a great option. This procedure offers a recovery time of 6-9 months, significantly less than the typical 12-14 months required to come back from Tommy John surgery. In the Tommy John procedure, doctors use another tendon in the arm or hamstring to reconstruct the damaged tendon. With the less invasive UCL repair and bridge, the tear in the damaged tendon is repaired and a special tape used to reinforce the ligament.
UCL repair and bridge surgery is a relatively new procedure with little long-term data available, but post-operative results thus far are promising.
"Professional athlete have an 80% likelihood of coming back to their full pre-injury performance level," Dr. Key says. "The same is true for high school athletes – an 80% chance of hitting the reset button to where they were performing before the injury. The potential from there is on the player."
Josh appreciated Dr. Key's experience with athletes and the treatment options to consider.
"He shared his confidence in the UCL repair and bridge, along with stories of other surgeries he'd done for professional players," says Josh. "It gave me a level of comfort and trust in him, and it made me want to learn more about the UCL surgery. I went home and watched videos and got a better understanding of the procedure."
The kinetic chain: critical to the healing process
Josh had his UCL repair and bridge surgery on July 20, 2017. He didn't touch a baseball for 11 weeks.
"You have to let the ligament heal back to the bone, which usually takes about 6-8 weeks," says Dr. Key. "Meanwhile, you also have to fix the things that caused the injury in the first place. Most of the time, the elbow is a victim of other mechanics not being right or muscles being tight, so the pitcher tries to compensate with their shoulder, scapula and lower body. That's why it's important to strengthen the kinetic chain, which includes the rotator cuff muscle, the posterior capsule of the shoulder, the shoulder blade and surrounding muscles, the hip joints, the core and hamstrings."
According to Dr. Key, the kinetic chain enhances the throwing of the baseball and lessens the risk of future injury.
"We work on the kinetic chain elements while the ligament is healing," he says. "If you hear about a player having more than one reconstruction surgery, it's usually because they didn't fix the kinetic chain problems that caused the original injury."
Willing to work
After being cleared for therapy, Josh met with Brian Mills, occupational therapist at The University of Kansas Health System. As a former baseball player and pitcher, Mills has firsthand experience with the challenges these athletes face.
"When we get a patient being recruited by colleges, I can pull up videos of their pitching mechanics," says Mills. "It's the kinetic chain of throwing that clues us in on why they had the injury and helps us use their mechanics to guide treatment."
"Young patients often want to hurry recovery, so it's important to educate them about what they can and can't do. That goes for parents, too," he adds. "A lot of kids feel invincible, but Josh was mature and realized this is a process. He was ready to commit to whatever we asked him to do."
Once Josh's therapeutic exercises were done, Mills put him through a throwing protocol developed at The University of Kansas Health System.
He slowly increased his throwing distance and intensity over a 4-week period. He then eased into a pitching protocol. The complete recovery program can take up to 20 weeks.
"There needs to be good communication between the patient and therapist," says Mills. "We can tweak the protocol together as needed."
"Brian was really good," says Josh. "He helped me regain confidence in my throwing and get through the mental part of recovery. He let my personal trainers come watch a therapy session, and they helped me continue my recovery after my therapy with Brian was completed. All of my support systems, including my parents, were awesome."
"We'll often correspond with high school and college trainers to let them know where we are with a patient's program," says Mills. "I'll reach out to the athletic staff so they can keep the process going. There's good 2-way communication. They can come watch our therapy sessions and see for themselves where the athlete is in the rehab process."
A new season and a bright outlook
Today Josh is back on the field, pitching for Metropolitan Community College in Kansas City.
"I feel confident in throwing the ball as hard as before," says Josh. "I can still feel myself shortening up sometimes, but for the most part, I'm where I used to be. Everything is falling into place."
"His velocity is back up and command is good. He just needs to keep the kinetic chain strong," says Dr. Key. "It may seem boring to work on that stuff. Many kids want to see instant gratification, but what you're getting is the underlying strength you can't see. It's not just about getting stronger, but also more flexible."
Josh has similar advice for other young athletes facing the same injury and recovery.
"Trust the process," he says. "You can't go from A to Z. You have to go A, B, C … Listen to your body and don't rush it, but know the difference between pain and soreness. Most important, trust the people around you and be willing to put in the work."