Ryan Wheat felt the snap. The then-Glendale High School junior wound up to throw another warm-up curveball in the middle of a March 2007 game, but the pitch crashed into the dirt, a few feet shy of home plate.
Wheat shuffled off the field, head down, unsure of why his prized pitching arm wouldn't work. The 16-year-old right-hander had been the workhorse ace -- "The Ice Man" -- of any team on which he played since he was 8. He thought it was just a strain.
Wheat and his family had no clue he'd just shredded the ulnar collateral ligament in his right elbow -- a tear that would cost him nearly 1 1/2 years of his baseball career -- plus ruined chances of impressing college or even professional scouts.
One trip to the doctor unleashed the phrase that will stick with Wheat the rest of his life: Tommy John surgery.
Wheat and his family had heard about the ligament replacement procedure named after the former major leaguer, but that was reserved for those big league pitchers, right? Tommy John for a teenager? Come on.
"I thought it was just a fluke thing, like I'd strained something," said Wheat, a 2008 Glendale graduate. "I waited two weeks and tried throwing again and couldn't do it. I went to the doctor and he said I'd torn my UCL and said I had to have Tommy John surgery.
"(When I did it, it) felt like someone took my ligament and ripped it apart."
It turns out Wheat is far from alone. Nationally, not only are the numbers of Tommy John surgeries increasing in the United States, it's a full-blown epidemic among high school pitchers. threatening arms throughout the country.
And curveballs aren't the reason.
It's an overuse injury: Our children are pitching too much.
Meet Tommy John
Ulnar collateral ligament reconstruction, more famously known as Tommy John surgery, is a procedure in which a ligament in the elbow is replaced with a tendon from elsewhere in the body. Most often it's harvested from the forearm, hamstring, knee or foot of the patient.
First performed in Los Angeles by Dr. Frank Jobe in 1974, the first test subject was Los Angeles Dodgers pitcher Tommy John.
Fast-forward to 2008. The name of the surgery rolls off the tongue, part of the casual baseball medical lingo that has spawned its own cottage industry.
In Birmingham, Ala., a physician named James Andrews was so fascinated by Jobe's experimental procedure that he flew to Los Angeles to study it in person and now is the leading expert in the industry.
Dr. Andrews and his partners at the American Sports Medicine Institute in Birmingham, Ala., have noticed that their patients are getting younger and younger.
Andrews released a study in February that reported the number of Tommy John surgeries his group performed jumped from 164 pitchers between 1996 and 1999 to 588 between 2004 and 2007. Alarming as that was, the number of youth and high school pitchers jumped from 19 to 146 in the same time frame.
Locally, Dr. Brian Mahaffey, director of St. John's Sports Medicine, said his colleagues have performed 54 Tommy John surgeries in the past four years, but he was unsure how many were youth or high school pitchers.
CoxHealth representative Randy Berger said his group's surgeons couldn't produce a precise number of Tommy John surgeries performed, but after a quick polling, Berger said surgeons were seeing more among young people.
They all agree the No. 1 reason for Tommy John surgery is overuse, starting at an early age.
"All the science shows that these kids pitch too much in competition. It's not that they're throwing too much with Dad in the back yard," said Glenn Fleisig, the Smith and Nephew Chair of Research at the American Sports Medicine Institute, which was founded by Andrews. "The kids are pitching too much at a young age and it's hurting them down the line."
Part of what turned Andrews and Fleisig on to the Tommy John youth phenomenon was a study that compared 16- to 20-year-olds who had surgery to local pitchers of the same age who have never been injured.
They found that pitchers are 36 times more likely to require surgery if their arm felt "fatigued" -- not necessarily feeling pain -- while pitching. That's 36 times more, not 36 percent.
While Fleisig concedes that fatigue is an unspecific term, especially among teenagers or younger children, he applauds youth organizations that have come up with pitch count guidelines to aid parents and coaches.
One such organization is USA Baseball. Its Medical and Safety Advisory Committee recommends that players age 9 and 10 should throw only 50 pitches per game, 75 per week, 1,000 per season and 2,000 per year.
For pitchers age 11 and 12, it's 75 pitches per game, 100 per week, 1,000 per season and 3,000 per year. For pitchers ages 13 and 14, it's 75 pitches per game, 125 per week, 1,000 per season and 3,000 per year.
The surgery now carries an 80-85 percent success rate -- success meaning, in part, that a pitcher's velocity will be regained. Dr. Jobe ranked his success rate at 1 percent back in 1974. Tommy John pitched 13 more professional seasons after the procedure.
Year-round play
Ryan's parents, Chris Wheat and Letha Welch, knew their son loved baseball. It's all he talked about as a little kid, so they wanted to provide him every opportunity to play.
Those opportunities helped him earn a reputation as The Ice Man, a pitcher known for his control and demeanor at an early age.
"Most kids could throw one pitch, a fastball," said John Yates, the coach of the Southwest Missouri A's, Wheat's traveling team from age 8 to 13. "But Ryan, he made the fastball seem like different pitches. He pitched to locations and he could throw it in a cup if he needed to."
No one, not Wheat's parents nor Yates, thought their ignorance about overusing a child's pitching arm would lead to a sling, grueling rehabilitation and missed opportunities for Ryan.
Wheat began playing baseball as an 8-year-old. He played in recreational leagues and also played competitively with the A's, a team that included Rogersville's Chad Yates and Chris Sartin, Glendale's Brett Marshall and Ozark's Chris Loveday and Ethan Mather.
And they played a lot.
"He played probably 90-plus games a summer," said Welch. "Not only was he on a traveling team, but he was in two leagues we played in in Strafford and Fordland. He would play anywhere from two to three games a week, plus traveling to tournaments on the weekend.
"He was their No. 1 pitcher on the traveling team, but they would always go to him (out of the bullpen) when they were in trouble, too."
It's because he was The Ice Man, the kid who could place the ball anywhere he wanted and did it with little expression on his face.
"Ryan was the player in the area as a kid. He could do it all," his former manager, Yates, said. "But he was the go-to guy on the mound."
Wheat's busy schedule mushroomed into what eventually was more than 500 baseball games in six years, his parents estimated, including three national tournaments and daily pitching appearances.
Unlike now, where pitch counts exist at the higher levels of the game to protect a pitcher's arm, most of the concern about young pitchers focused on the risk of throwing curveballs, which could cause injury if thrown at too young an age.
Yates said he and his fellow fathers of A's players had a certain number of pitches they wouldn't let a kid exceed, but he couldn't recall the number. He said he told parents to let him know if they thought their child was pitching too much.
Only a couple of times did that happen, Yates said.
"We never thought about (him getting hurt)," said Chris Wheat. "He wasn't throwing curveballs. Basically, he was throwing it straight. We never thought it would lead to Tommy John. Baseball was just fun -- fun for all of us."
As for Yates, he said he got so much joy from watching those boys play. Most of them went on to earn college scholarships. But when Yates heard about Wheat's injury, he wondered how it happened.
"You feel somewhat responsible, whether we are or not," he said. "You think, 'Well, maybe it's my fault.' I don't think so, but we'll never know."
The road back
Ryan Wheat was getting the surgery, no matter what.
The 20 percent chance that it would heal on its own wasn't a factor. Simply, he wanted to play baseball again.
"I like baseball too much. I can't give it up that easy," Wheat said.
The rehab, which you can say is still under way, is tough.
Three weeks after his surgery, Wheat began physical therapy. He began with simple exercises, lifting 1-pound dumbbells. His arm was so tender, part of his physical therapy was to have the therapist straighten his arm to full extension, because he couldn't do it on his own.
Eventually, he graduated to heavier weights and was cleared by his surgeon, Dr. Brad Wyrsch.
Wheat still had to go through eight months of whole-body exercise with Brandon Ezzell of St. John's HealthTracks just to get back into playing shape.
The two had worked together before when Wheat was younger and looking to get in game shape. That familiarity helped Ezzell determine how aggressive the workouts could be because it gave him a baseline.
"I was picked to get him into playing shape," Ezzell said. "We did some with his arm, but it was more to get a strong base and a strong core."
Wheat started with simple stuff. He lifted lighter weights (10 pounds or so) and did simple weightless exercises like lunges before graduating to heavier weights over the course of six months.
That's nearly 1,500 exercises -- and none of them included throwing off a mound.
"Our goal was to get him ready for the high school season," Ezzell said.
A kid of few words, Wheat didn't complain or wince much, Ezzell said. He stayed focused on the work, all because Wheat knew that if he didn't put in the time, he wouldn't recover from the surgery well enough to get back on the mound, rendering the surgery useless.
Then there was the mental rehab. Not only did Wheat worry about using his new elbow, he had to sit and watch his teammates play for one whole calendar year.
He still remembers watching as his Glendale teammates played cross-town rival Kickapoo at Hammons Field during the 2007 high school season.
"That was the worst. I couldn't stand it," Wheat said.
The first game he missed, his mother said he only stayed a few innings before leaving.
As he inched closer to pitching again, he'd heard many frightful stories about getting back on that mound. His velocity will never be the same. He'll retear the repaired ligament. He'll overcompensate and hurt his back or shoulder.
Wheat knew it was a long road back.
"The doctors said a lot of it is mental," Wheat said. "If you think you're going to retear it, you might. They talked to me about how your mind affects your body. It was a little scary."
Back on the mound
Mission accomplished. Ryan Wheat is pitching again.
He made a few appearances for the Falcons near the end of the 2008 high school season and was the ace during Glendale's American Legion season this summer. He wanted to be ready for next season at Jefferson College, a junior college in Hillsboro.
Jefferson College coach Sam Carel said he wasn't deterred by the surgery or the injury.
"He's someone who we had on our list before he was hurt, then we saw him after and liked the way he was pitching," Carel said. "We take it case by case, but we don't normally shy away from players who have had Tommy John surgery."
On course to reach his comfortable pre-surgery 85 mph, Wheat is sitting at 82-83 and has topped out at 86.
He noticed he's very sore after each start, but the pain is decreasing. At the urging of doctors, Wheat was on a gradually increasing pitch count, beginning at 50 and increasing to 100 throughout the summer.
One start, he tried to push it by going over 120 pitches. It was his call.
"My arm was feeling better and I wanted to try it," Wheat said.
After having a lot of time to reflect on his still-young baseball career, Wheat knows he pitched too much. But he heard the crowd and, mixing that with his competitive juices, he just wanted to wind up and throw.
He hopes his is a cautionary tale heeded by others.
"I pitched way too much. I was about the only kid that could throw and that wore down my arm," Wheat said. "But I've learned a lot. I feel like I'm getting to know my body. Now I know how to take care of it."
His parents still can't believe it happened.
"We're just glad he's OK," Chris Wheat said. "If they couldn't have fixed him, we would have felt awful that he couldn't enjoy the sport he loved because he played it too much as a kid."
