February 15, 2025 • 10 mins
Dr. Jonathan Slaughter from OrthoCincy joined us to discuss Reds pitcher Rhett Lowder's elbow soreness, Wade Miley's timeline in his return from "Hybrid Surgery," and what exactly that procedure is, and MLB's offseason study on pitcher injuries.
Learn more about OrthoCincy by going here.
Listen to the show live weekday afternoons 3:00 - 6:00 on ESPN1530.
Listen Live: ESPN1530.com/listen
Get more: https://linktr.ee/MoEgger
Learn more about OrthoCincy by going here.
Listen to the show live weekday afternoons 3:00 - 6:00 on ESPN1530.
Listen Live: ESPN1530.com/listen
Get more: https://linktr.ee/MoEgger
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
It's that time of week, will we chat with one
of the experts from Ortho sincey orthopedics and sports medicine.
The great thing about Ortho Sincy is they have specialists,
locations and services all over the Tri State. This includes
walk in orthopedic urgent care at five locations with extended
evening and weekend hours in Edgewood and Anderson. Learn more
(00:21):
at Orthosincy dot com. That's orthos ci Ncy dot com.
And remember you never need an appointment at Orthos Sincy.
I'm going to Orthosincy in Highland Heights tomorrow to have
my neck look at Orthosincy dot com. Let's start by
talking Doctor Jonathan Slaughter is with us from Orthosinsey. Let's
(00:43):
start by talking about rt Louder, a promising young picture
taken by the Reds in the first round of the
twenty twenty three draft out of Wake Forest. Made his
major league debut late last season and was terrific and
we're all excited to see what this year has in
store form. Unfortunately, he's dealing with elbow soreness and they
insist the Reds do that it's nothing crazy, but they've
(01:04):
cut back his throwing program they have talked about is
MRI revealing no structural damage. So let's begin there. When
you're looking at the MRI looking at the results, what
are they looking for.
Speaker 2 (01:18):
Yeah, especially in an overhead thrower or baseball pitcher, the
first thing that your eye goes to is going to
be the inside of the elbow. For the ligament that
we know as the Tommy John ligment or the ulnar
collateral ligament, the ligament that attaches the distal humorous to
the aulna, so two bones of the elbow joint that
(01:41):
sees almost all the force when we're throwing the ball overhead.
And so we're looking one, is there any tears, Like
is the ligament completely attached or are you seeing some
fluid consistent with the tears that fully torn? And then
you start looking elsewhere about the elbow, looking at other
parts of bony structures, because sometimes you can start seeing
stress or inflammation in the bone that's consistent with laxity.
(02:05):
So if the ulnor collateral ligament is not doing its job,
whether it's injured, torn, or just just become lax you
start to see some inflammation in other areas of the elbow,
in the bone because now you're getting abnormal motion in
the elbow joints, so you're looking for the ligaments you're
looking for. Is there increased fluid in the joint? Is
(02:28):
there a different change in signal within the bone that's
concerning for stress or reaction?
Speaker 1 (02:35):
So what is the range of possibilities we're dealing with here,
and can you assure us that something like this doesn't automatically.
Speaker 2 (02:43):
Mean worst case? Yeah, So everybody goes there with this
epidemic that some people call the increase in Tommy John's
of oh my gosh, overhead throw our elbow pain. We're
done with this player for a while. It is not
default native worst case scenario. There are other things. Could
(03:03):
just be a mild sprain. It could be uh where
you're overused it and allowed to rest and now the
muscles are just strained and tired or inflamed. It could
be where you're getting actual impingement of other structures that's
not related to the ligament. It could be just increased
fluid and inflammation. So there's many other things could be muscle, tendon, bone, ligament,
(03:30):
So it's not always just the dreaded Tommy John. There
are other things that you can deal with that. Aren't
gonna set you back a year plus.
Speaker 1 (03:39):
Let's talk about a guy who is making his return
to Cincinnati, Wade Miley, who last year with Milwaukee underwent
Tommy John surgery. He is not ready to pitch yet.
They are targeting mid May. He underwent hybrid surgery. I've
never heard of hybrid surgery. What is it?
Speaker 2 (03:58):
That's a great question. It's a newer adaption to Tommy
John that was started decades ago that saved Tommy John's career.
But it's you take the traditional Tommy John, so you
reconstruct the ligament that is now non functional or insufficient,
(04:21):
and you create you basically do the Tommy John surgery,
but then you add or you modify, what we call
an internal brace. So it's like a really thick suture
tape that's collagencoded and it creates almost like a brace
on the inside of the bone, connecting bone to bone,
protecting that new ligament that you just reconstructed.
Speaker 1 (04:44):
Okay, so that makes sense. He's thirty eight years old,
had the procedure back in May. They're targeting his return
this May. Number one, does that seem feasible? Number two?
Are there potential complications with the fact that this guy
is as good as he is it's been over the
course of his career. On the older scale, Wilson, we'll say.
Speaker 2 (05:05):
Yeah, as you get older, things do take longer on
average to kind of recover and heal. One thing you
can never speed up, no matter how young you are
is the biology the healing you need to get the
ligament to heal into bone. Now knowing he had this
kind of modified procedure with the internal brace, that gives
me much more confidence that he has a good shot
(05:26):
of returning in May. The whole thought of adding this
internal brace or the modified procedure is to increase rehab time,
increase return to throwing and pitching, because now you've got
extra protection to that ligament. You're not speeding up the
actual healing time, but you're protecting that repair allowing you
(05:47):
to rehab sooner. It can even so a typical Tommy
John you're out twelve to fourteen months. With this modified procedure,
you're looking at potentially decreasing that up to almost half
the time. Well, it's newer, it hasn't been done that long.
But what we're seeing is actual return even nine ten
(06:12):
up to twelve months, so a quicker return than just
the typical Tommy John and knowing he had had that
would give me confidence that there is a good chance
he could return.
Speaker 1 (06:20):
Doctor Jonathan's latter from Moorthos since he is with us,
I want to ask you about something that came up
basically two months ago this offseason, Major League Baseball released
its findings based on a study that took over a year,
sixty two pages. I read all of them. Much of
it was above my head. But they did a study
into basically the root cause of so many pitching injuries,
(06:42):
and there are so many across every level of the sport.
And the ultimate takeaway was, yeah, Number one, guys are
throwing too hard, which I thought, yeah, no kidding. Number two,
guys don't care if they get hurt and have to
have a procedure like Tommy John surgery. If they're throwing
too hard. I want to start. Are there techniques that
pictures can use to ensure they're achieving maximum velocity while
(07:06):
at the same time mitigating the risk that comes with it.
Speaker 2 (07:11):
So a lot of these injuries are due to what
we call a kinetic chain everything that the injury actually
occurs from things upstream. So for an elbow, if an
elbow gets injured, upstream from that is shoulder, and upstream
from that is actually your core. So if you can
work on shoulder strengthening rate of motion techniques as well
(07:32):
as core strengthening and lower body strengthening, that can be
one of the biggest protectors to elbow. With that study,
it is it's this been pushing max effort, this constant,
non stop max effort every throw, how much velocity, how
much spin, how nasty can I get? Which is really
(07:55):
leading in my opinion, and what this study shows to
a lot of these injuries. But if you can focus
on working on upstream and the kinetic chaine shoulder and core,
that can lead to protection to your elbow.
Speaker 1 (08:10):
I think the thing for me that's maybe most troubling
is the almost sort of implied understanding that yeah, I'm
gonna have to have Tommy John surgery right like I
played high school baseball. I can't imagine just going, yeah,
you know what, I'm gonna have the surgery. No big deal,
is that a I mean, look, you're a medical professional.
(08:31):
You do these procedures, so you know you've seen the
best of them. But is that false confidence in surgical advancement.
Speaker 2 (08:39):
In some ways. Yeah, it's a great question and we
see it so much, and there's so much pressure put
on these kids because what they are graded on is
numbers and not like eer or win loss. It is
what is your velocity? What is your spin rate? What
is your vertical drop? On these pitches? And to get
(08:59):
the where kids are working so there's no more off season.
Kids are now going from playing their season now to
labs trying to develop. How do I make this pitch faster?
How do I make it naster? How do I make
it move or drop more? So they're never letting their
arms rest and it's a max or max effort every time.
It's not necessarily importents. How can I not only get
(09:23):
good stuff, good action, but also good placement to where
I can go deeper in a game? It's how can
I get everybody out as efficiently as possible, or not
as efficiently, but with my max stuff every pitch, which
leads to this. Basically, we're pushing our body past its
limit of what it can withhold and now we're seeing
(09:44):
these injuries.
Speaker 1 (09:47):
Awesome inside as always, thank you so much.
Speaker 2 (09:50):
I appreciate it. MO.
Speaker 1 (09:51):
You got it Doctor Jonathan Slaughter Ortho Sincy. I say
this every single week because it's true. The great thing
about Ortho Sinsey is they have specialiststions all over the
Tri State. This includes walkin orthopedic urgent care weekdays nine
a to nine p and Saturdays nine eight to one
p at both Edgewood and Anderson. Let me tell you
something about Orthosincy. Okay, we're an Ortho Sincy family. My
(10:14):
daughter broke her foot, we went to Ortho Sincy. My
neck has been killing me. I'm going to Orthos Sincy tomorrow.
My wife busted up her ankle Saturday, going to Orthos Sincy.
That's right. We are the poster people for Ortho Sincy.
You don't need an appointment. It's cheaper than going to
an er and it's definitely more convenient. Whenever you have
an urgent orthopedic injury, go to Orthosincy dot com. That's
(10:38):
Ortho c I Ncy dot com.
It's that time of week, will we chat with one
of the experts from Ortho sincey orthopedics and sports medicine.
The great thing about Ortho Sincy is they have specialists,
locations and services all over the Tri State. This includes
walk in orthopedic urgent care at five locations with extended
evening and weekend hours in Edgewood and Anderson. Learn more
(00:21):
at Orthosincy dot com. That's orthos ci Ncy dot com.
And remember you never need an appointment at Orthos Sincy.
I'm going to Orthosincy in Highland Heights tomorrow to have
my neck look at Orthosincy dot com. Let's start by
talking Doctor Jonathan Slaughter is with us from Orthosinsey. Let's
(00:43):
start by talking about rt Louder, a promising young picture
taken by the Reds in the first round of the
twenty twenty three draft out of Wake Forest. Made his
major league debut late last season and was terrific and
we're all excited to see what this year has in
store form. Unfortunately, he's dealing with elbow soreness and they
insist the Reds do that it's nothing crazy, but they've
(01:04):
cut back his throwing program they have talked about is
MRI revealing no structural damage. So let's begin there. When
you're looking at the MRI looking at the results, what
are they looking for.
Speaker 2 (01:18):
Yeah, especially in an overhead thrower or baseball pitcher, the
first thing that your eye goes to is going to
be the inside of the elbow. For the ligament that
we know as the Tommy John ligment or the ulnar
collateral ligament, the ligament that attaches the distal humorous to
the aulna, so two bones of the elbow joint that
(01:41):
sees almost all the force when we're throwing the ball overhead.
And so we're looking one, is there any tears, Like
is the ligament completely attached or are you seeing some
fluid consistent with the tears that fully torn? And then
you start looking elsewhere about the elbow, looking at other
parts of bony structures, because sometimes you can start seeing
stress or inflammation in the bone that's consistent with laxity.
(02:05):
So if the ulnor collateral ligament is not doing its job,
whether it's injured, torn, or just just become lax you
start to see some inflammation in other areas of the elbow,
in the bone because now you're getting abnormal motion in
the elbow joints, so you're looking for the ligaments you're
looking for. Is there increased fluid in the joint? Is
(02:28):
there a different change in signal within the bone that's
concerning for stress or reaction?
Speaker 1 (02:35):
So what is the range of possibilities we're dealing with here,
and can you assure us that something like this doesn't automatically.
Speaker 2 (02:43):
Mean worst case? Yeah, So everybody goes there with this
epidemic that some people call the increase in Tommy John's
of oh my gosh, overhead throw our elbow pain. We're
done with this player for a while. It is not
default native worst case scenario. There are other things. Could
(03:03):
just be a mild sprain. It could be uh where
you're overused it and allowed to rest and now the
muscles are just strained and tired or inflamed. It could
be where you're getting actual impingement of other structures that's
not related to the ligament. It could be just increased
fluid and inflammation. So there's many other things could be muscle, tendon, bone, ligament,
(03:30):
So it's not always just the dreaded Tommy John. There
are other things that you can deal with that. Aren't
gonna set you back a year plus.
Speaker 1 (03:39):
Let's talk about a guy who is making his return
to Cincinnati, Wade Miley, who last year with Milwaukee underwent
Tommy John surgery. He is not ready to pitch yet.
They are targeting mid May. He underwent hybrid surgery. I've
never heard of hybrid surgery. What is it?
Speaker 2 (03:58):
That's a great question. It's a newer adaption to Tommy
John that was started decades ago that saved Tommy John's career.
But it's you take the traditional Tommy John, so you
reconstruct the ligament that is now non functional or insufficient,
(04:21):
and you create you basically do the Tommy John surgery,
but then you add or you modify, what we call
an internal brace. So it's like a really thick suture
tape that's collagencoded and it creates almost like a brace
on the inside of the bone, connecting bone to bone,
protecting that new ligament that you just reconstructed.
Speaker 1 (04:44):
Okay, so that makes sense. He's thirty eight years old,
had the procedure back in May. They're targeting his return
this May. Number one, does that seem feasible? Number two?
Are there potential complications with the fact that this guy
is as good as he is it's been over the
course of his career. On the older scale, Wilson, we'll say.
Speaker 2 (05:05):
Yeah, as you get older, things do take longer on
average to kind of recover and heal. One thing you
can never speed up, no matter how young you are
is the biology the healing you need to get the
ligament to heal into bone. Now knowing he had this
kind of modified procedure with the internal brace, that gives
me much more confidence that he has a good shot
(05:26):
of returning in May. The whole thought of adding this
internal brace or the modified procedure is to increase rehab time,
increase return to throwing and pitching, because now you've got
extra protection to that ligament. You're not speeding up the
actual healing time, but you're protecting that repair allowing you
(05:47):
to rehab sooner. It can even so a typical Tommy
John you're out twelve to fourteen months. With this modified procedure,
you're looking at potentially decreasing that up to almost half
the time. Well, it's newer, it hasn't been done that long.
But what we're seeing is actual return even nine ten
(06:12):
up to twelve months, so a quicker return than just
the typical Tommy John and knowing he had had that
would give me confidence that there is a good chance
he could return.
Speaker 1 (06:20):
Doctor Jonathan's latter from Moorthos since he is with us,
I want to ask you about something that came up
basically two months ago this offseason, Major League Baseball released
its findings based on a study that took over a year,
sixty two pages. I read all of them. Much of
it was above my head. But they did a study
into basically the root cause of so many pitching injuries,
(06:42):
and there are so many across every level of the sport.
And the ultimate takeaway was, yeah, Number one, guys are
throwing too hard, which I thought, yeah, no kidding. Number two,
guys don't care if they get hurt and have to
have a procedure like Tommy John surgery. If they're throwing
too hard. I want to start. Are there techniques that
pictures can use to ensure they're achieving maximum velocity while
(07:06):
at the same time mitigating the risk that comes with it.
Speaker 2 (07:11):
So a lot of these injuries are due to what
we call a kinetic chain everything that the injury actually
occurs from things upstream. So for an elbow, if an
elbow gets injured, upstream from that is shoulder, and upstream
from that is actually your core. So if you can
work on shoulder strengthening rate of motion techniques as well
(07:32):
as core strengthening and lower body strengthening, that can be
one of the biggest protectors to elbow. With that study,
it is it's this been pushing max effort, this constant,
non stop max effort every throw, how much velocity, how
much spin, how nasty can I get? Which is really
(07:55):
leading in my opinion, and what this study shows to
a lot of these injuries. But if you can focus
on working on upstream and the kinetic chaine shoulder and core,
that can lead to protection to your elbow.
Speaker 1 (08:10):
I think the thing for me that's maybe most troubling
is the almost sort of implied understanding that yeah, I'm
gonna have to have Tommy John surgery right like I
played high school baseball. I can't imagine just going, yeah,
you know what, I'm gonna have the surgery. No big deal,
is that a I mean, look, you're a medical professional.
(08:31):
You do these procedures, so you know you've seen the
best of them. But is that false confidence in surgical advancement.
Speaker 2 (08:39):
In some ways. Yeah, it's a great question and we
see it so much, and there's so much pressure put
on these kids because what they are graded on is
numbers and not like eer or win loss. It is
what is your velocity? What is your spin rate? What
is your vertical drop? On these pitches? And to get
(08:59):
the where kids are working so there's no more off season.
Kids are now going from playing their season now to
labs trying to develop. How do I make this pitch faster?
How do I make it naster? How do I make
it move or drop more? So they're never letting their
arms rest and it's a max or max effort every time.
It's not necessarily importents. How can I not only get
(09:23):
good stuff, good action, but also good placement to where
I can go deeper in a game? It's how can
I get everybody out as efficiently as possible, or not
as efficiently, but with my max stuff every pitch, which
leads to this. Basically, we're pushing our body past its
limit of what it can withhold and now we're seeing
(09:44):
these injuries.
Speaker 1 (09:47):
Awesome inside as always, thank you so much.
Speaker 2 (09:50):
I appreciate it. MO.
Speaker 1 (09:51):
You got it Doctor Jonathan Slaughter Ortho Sincy. I say
this every single week because it's true. The great thing
about Ortho Sinsey is they have specialiststions all over the
Tri State. This includes walkin orthopedic urgent care weekdays nine
a to nine p and Saturdays nine eight to one
p at both Edgewood and Anderson. Let me tell you
something about Orthosincy. Okay, we're an Ortho Sincy family. My
(10:14):
daughter broke her foot, we went to Ortho Sincy. My
neck has been killing me. I'm going to Orthos Sincy tomorrow.
My wife busted up her ankle Saturday, going to Orthos Sincy.
That's right. We are the poster people for Ortho Sincy.
You don't need an appointment. It's cheaper than going to
an er and it's definitely more convenient. Whenever you have
an urgent orthopedic injury, go to Orthosincy dot com. That's
(10:38):
Ortho c I Ncy dot com.
Mo Egger News
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