MLB.com Columnist

Lindsay Berra

Vazquez's elbow holding up to big league rigors

Tommy John surgery involving Major League catchers a rarity

Vazquez's elbow holding up to big league rigors

Red Sox catcher Christian Vazquez started his first game of the 2016 season on April 15, and he wasted no time proving he was ready to roll. When Rick Porcello struck out Michael Saunders on a pitch up and in for the second out of the second inning, Vazquez lept to his feet and rifled a short-armed, from-the-ear snap throw to first base.

Vazquez was so quick that Sox first baseman Hanley Ramirez had his back to the sprawling Troy Tulowitzki, and he had to deliver a backhanded tag to complete the inning-ending pickoff. According to Statcast™, the pop time on the throw was just 1.514 seconds. Boston is thrilled to have its dynamic, young catcher back after a year off rehabbing from Tommy John surgery, but watching that play could rightfully have been as terrifying as it was exhilarating.

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Nowadays, Tommy John surgery to repair torn ulnar collateral ligaments in pitchers is as common as bubble gum and eye black. Thirty pitchers underwent the surgery in 2014 and '15, but only one other high-level catcher in recent memory -- Matt Wieters -- has undergone a Tommy John surgery. According to baseballheatmaps.com, based on public data, there have been only eight instances of a catcher having the procedure while in the big leagues.

Comparing Wieters and Vazquez is a bit like apples and oranges; while they do play the same position, they are hardly the same type of player. For starters, Vazquez, 25, is a nimble 5-foot-9, 195 pounds, while Wieters is 6-foot-5 and weighs 230. Wieters, while competent behind the plate, is not the throwback, throw-as-you-will defensive aggressor that Vazquez has shown himself to be.

Vazquez has thrown out 50 percent of attempted basestealers since he debuted in 2014 (19 of 38), which is best among catchers with at least 500 innings played. He's thrown out 4 of 9 (44 percent) this year; that is way above the league average of 30 percent. Vazquez has made the snap throw an art. Yet, according to Red Sox manager John Farrell, Vazquez's arm still isn't even 100 percent.

"It's plenty strong, right now, to be an above-average defensive catcher in the Major Leagues, but we're talking about someone who is a very elite thrower," Farrell said. "I wouldn't anticipate that [he will be 100 percent] until next year."

Catchers make as many throws as pitchers do during a game. But, obviously, most of those throws are soft lobs back to the mound, not the maximum-effort throws hurlers make with each pitch. (Vazquez, though, says he throws around 80 percent all the time, because it helps him stay loose and focused). Catchers don't have to worry about as many high-impact reps -- which means less cumulative stress, and also means the UCL graft will last a lot longer. Pitchers, though, have rehearsed and repeatable mechanics, under the influence of no one but themselves. That is not the case with catchers -- whose maximum-effort throws, while lower in number, are made in less predictable situations.

"When catchers throw max effort, their mechanics are most often not perfect -- their arm angle is off, their body is out of position -- because they're throwing around a batter, or it's an all-arm throw from down on one knee," said Dr. Jeff Dugas of the the Andrews Sports Medicine and Orthopedic Institute in Birmingham, Ala. "There is so much potential for a catcher to throw with bad mechanics that a pitcher doesn't have to worry about."

To combat that, Tommy John rehab is different for pitchers and catchers once it reaches the later stages. No one throws for at least four months, and once throwing begins, the first phase of the program begins at 45 feet, then 60, 75, 90, 120, 150 and 180. Here, position players can usually stop, while pitchers move on to long toss, throwing off a mound, bullpen sessions and simulated games. Catchers, specifically, will do more situational play, mixing light throws back to the pitcher with fielding bunts and sharp, quick throws to bases.

"We worked on every situation a catcher could be in on a daily basis," said physical therapist Jose Cruz, who worked with Vazquez last offseason in Puerto Rico. "He has to be comfortable doing all those things in rehab before he can be comfortable and confident enough to do them in the big leagues."

But before Vazquez was given the green light, the Sox made sure he was ready.

"We put him through so many tests before he was activated -- many different plays, off-balance throws, different angles, the snap throw being one of them," said Farrell. "If there are any lingering issues coming out of this, he wouldn't have been activated."

Cruz -- who has also worked with Johan Santana, Robinson Cano and Carlos Beltran, among others -- also revamped Vazquez's strength-and-conditioning program to ensure his body would be strong enough to support his elbow and shoulder.

"Christian hadn't been working out the proper way," Cruz said. "We did a complete remodeling of the way he works out and made sure he understands what he has to do to keep his arm healthy."

Rehab for catchers also involves hitting, which pitchers have to worry about less. It's a mostly overlooked fact that the UCL factors heavily into every baseball swing -- and if a position player sees 600 at-bats per season, there will be a lot of them. The externally rotated elbow position, achieved as a swing is initiated and the barrel of the bat lags behind the hands, creates stress on the elbow, just as the lay-back phase of throwing does. As the batter continues his swing, his back elbow will extend and, potentially, hyperextend.

"This is purely anecdotal and not clinical evidence. But while rehabbing pitchers from Tommy John, I had more difficulty with them during hitting, if surgery was on the back arm," said former Dodgers trainer Stan Conte. "At ball contact, the bat pushes the back arm back and creates some stress on the elbow -- and can cause pain."

Vazquez, for his part, says he hasn't felt any pain in his elbow since March, when he developed some soreness after throwing to the bases and had to take a week off. He keeps in constant contact with Cruz, who is in constant contact with the Red Sox's medical team. Vazquez is completing daily maintenance programs on his shoulder and elbow, and he is receiving daily treatment, all in an effort to protect that shiny new UCL.

"I'm feeling so good, right now," Vazquez says. "So I don't really worry about it."

Lindsay Berra is a columnist for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.