Does elbow rehab ever work?

Jonny Venters, Jason Motte, and now Dylan Bundy are those who have had major setbacks after receiving platelet-rich plasma injections in their elbow, combined with a rehab program intended to avoid replacing the ulnar collateral ligament (UCL, Tommy John surgery).

Bundy had discomfort in his pitching forearm/elbow on Monday after his rehab for 2013 had been progressing reasonably well, and so he will go see the dreaded Dr. James Andrews to further evaluate his rehabilitation plan for the remainder of the year.

Many have a dismal view on trying to rehab the elbow instead of just having surgery. Keith Law had this to say about Gavin Floyd:

Oh, Gavin Floyd wants to rehab his elbow injury instead of having surgery. That always works out well.

— keithlaw (@keithlaw) May 3, 2013

Jeff Sullivan (formerly of Lookout Landing fame) and I had this conversation via Twitter:

My thoughts were mostly summed up in the exchange Jeff and I had. It’s really easy to point fingers and say “rehab doesn’t work, just go under the knife already,” but this ignores the fact that TJS doesn’t exactly have a 100 percent success rate.

For every Tommy John or Stephen Strasburg, there is a professional pitcher who has a story similar to this: Drafted in the first round, throwing 94-97 mph, and was cut because his TJS rehab didn’t go well. He now throws 86-90 mph and is struggling to figure out where it all went wrong. (An actual person and client of mine.)

Assuming that a conservative plan for elbow rehabilitation takes six weeks (unlike the long plan of Dylan Bundy, which is way more rare) and TJS recovery takes 14 months, it’s not hard to see that from a classic risk-reward analysis, elbow rehab doesn’t have to succeed very often at all to be worth it.

There is also the very ugly side of arm injuries: pitchers who have had arm injuries (especially at the lower levels of the minors) are seen as damaged goods. You can find any number of anecdotal stories of players being released because they think an organization is trying to reduce the number of arm injuries in its system, because as Russell Carleton pointed out, the best predictor of future injury is a past injury.

So, I find tweets like Keith Law’s to be very insensitive. While a long-term research project is needed to test the efficacy of rehabilitation methods like PRP, simply dismissing it out of hand and saying “get cut open” isn’t the answer.