During the last four decades, damage to an ulnar collateral ligament has gone from ending a player's career to seeing his return in roughly a year. The seriousness of Tommy John surgery, however, hasn't diminished and approximately 30 Major League Baseball pitchers undergo the procedure annually.
"Tommy John surgeries are pretty popular now, unfortunately, especially with the younger generation," said Brett Fischer, CEO of the Fischer Institute. "[The injury] tears the inside part of the elbow, the ligament, and creates instability in the elbow and quite a bit of pain."
It is an epidemic that the Colorado Rockies know all too well.
While starting pitcher Jorge De La Rosa underwent Tommy John in 2011 and recently retired closer Rafael Betancourt had the operation in 2013, the Rockies also faced season-ending surgeries for starter Tyler Chatwood and closer Adam Ottavino in 2014 and 2015, respectively.
On April 29, 2014, Chatwood left an early season game against the Arizona Diamondbacks after only five innings.
His complaint: tightness in his elbow.
The Rockies placed him on the 60-day disabled list, according to MLB.com, but it was announced in July 2014 that he would undergo season-ending Tommy John surgery, the second of his career. The first operation came in 2005 when Chatwood was pitching at Redlands (Calif.) East Valley High School.
The second surgery didn't just end his 2014 campaign. It prevented him from pitching on a major league field for the entire 2015 season.
"They were being real cautious with me, so last year about 12 months after, [I felt] like I could pitch a game," Chatwood said. "But they wanted to wait a little longer to let the tissue heal."
After a lengthy rehab process, Chatwood appeared in five spring training games and recently started two regular season games. However, he didn't return with a full repertoire of pitches.
"We kinda cleaned up my mechanics a little bit and took away a slider just to take some stress off my elbow," Chatwood said.
In his first two starts, Chatwood had five strikeouts with a 4.38 ERA. On April 6, he earned his first major league win since 2014 -- coincidentally against the Diamondbacks, the last team he pitched against before his surgery.
Chatwood looked every bit like his old self in his third start of the season, holding the Chicago Cubs scoreless in seven innings while allowing only two hits and striking out seven batters.
As Chatwood is managing his own comeback, he is also helping others on the team make theirs.
"He's a good guy to look at for what can go right ‘cause he's obviously about to come back from his second one," Ottavino said during spring training. "He pitched really well after his first one. He showed a lot of patience and hard work and I just try to follow that example."
Ottavino, who was named the Rockies' closer on April 15 last year, faced a partial tear to the ligament less than two weeks later and had to forfeit his new role for the time being.
While the 2016 season is underway, Ottavino might not be back on the mound until the All-Star break.
"I think we're just making sure that when I come back, I'm really ready to come back, not rushing it," Ottavino said.
The Rockies' medical staff has been more than careful with Chatwood and now they are making sure that Ottavino doesn't return until he is absolutely ready, but Fischer is concerned that not all athletes take it as serious.
"It's not a fix all," Fischer said. "It's one thing to do the rehab and do the exercises and the throw. I think anyone can do that and yeah, players do come back better, but it's a long process."
Whether pitchers are taking the surgery and the rehab process seriously or just going through the motions, Fischer was adamant that there is only one way to prevent players from having multiple surgeries.
"The best thing to do is to rehabilitate the elbow, but our goal is to make them better than when they came in," Fischer explained. "So, really working on what areas caused [the injury] is going to help the pitcher or player get back not only quicker, but more efficiently."
The Fischer Institute specializes in sports performance training and rehabilitation, and oversaw the comeback of Randy Johnson and more recently, Brandon McCarthy.
Fischer is a licensed physical therapist, certified athletic trainer, certified strength and conditioning specialist and certified dry needling provider.
"We're seeing it more and more now with younger players than ever before," Fischer said. "Before we'd see it in the older players who played baseball for a lot years and now, unfortunately, it's an epidemic in the United States."
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Trisha Garcia is a sports journalism graduate student at Arizona State University. You can follow Trisha on Twitter at @trishaanicole.