Nathan Eovaldi's arm gets a clean bill of health from his surgeon


EDITOR'S NOTE: This week across the NBC Sports Regional Networks, we'll be taking an in-depth look at some of the top free agents in baseball. Thursday is dedicated to Red Sox pitcher Nathan Eovaldi.

BOSTON — Nate Eovaldi’s high-velocity stuff and incredible 2018 postseason have positioned him to be a star in free agency. After a routine visit to his doctor on Tuesday, Eovaldi has a strong bill of health, which should help him show teams that he’s positioned to be healthy for years to come as a two-time recipient of Tommy John surgery.

“To me, he’s over Tommy John surgery and he’s over revision Tommy John surgery,” Dr. Christopher Ahmad, the Yankees’ team physician who operated on Eovaldi’s elbow and forearm in 2016, told NBC Sports Boston. “And I would consider him in the same category of somebody who has a healthy arm, and whatever worry I have about that player, I have the same or less for Nate.”

Eovaldi went for an MRI as well as physical exam, matters of standard surveillance.

“His elbow, from his description, he had no symptoms whatsoever throughout 2018 once the season started,” Ahmad said. “His elbow felt great. Obviously, his velocity was there, so his performance and his ability to get guys out and his number of innings pitched was amazing. But from his description, he had no complaints at all. He felt great. 

“When I examined him, his motion was perfect. He had no features on examination that he had a compromise to his elbow. Nothing tender, nothing painful to stress. And we also performed an MRI scan to take pictures of his reconstructed ligament. His reconstructed ligament, even being a two-time reconstructed ligament, looked as perfectly healthy as could be. There was no signal changes in it. His bones around the ligament didn’t have any signal changes. 

“Sometimes subtle features can be picked up that the ligament’s acting a little weak, like small bone spurs forming often can be a sign that the ligament is a little loose or acting weak. Bone spurs form to compensate. No bone spurs. And even coming off an extended postseason, he didn’t have any muscle problems like muscle strain patterns. So essentially, his elbow checked out as well as it could be after having a second-time Tommy John surgery.”

As a performer, there’s nothing to doubt about Eovaldi, who’s entering his age-29 season. The righty is coming off a postseason where he pitched in six of 14 games the Red Sox played, throwing 22 1/3 innings, fanning 16 and allowing just four earned runs. 

In the regular season, after the Red Sox acquired him from the Rays, he lowered his ERA nearly a full run, to 3.33 from 4.26, in nearly an identical number of innings.

Entering his age-29 season, the righty threw 26 pitches at 100 mph or better in the postseason, per That’s 15 more than Eovaldi threw in triple digits in the regular season. He hit 101.1 mph in his final game of the year, and 101.6 mph in the ALCS — his two fastest pitches at any point in 2018. (He didn’t hit 100 mph this year until August, in fact. The hardest pitch of his career is 101.9 mph, which he last hit in 2016, prior to his most recent surgery.)

The performance Eovaldi delivered out of the bullpen in Game 3 of the World Series, which may be his final outing in a Sox uniform, was perhaps the most dramatic individual performance in all of the postseason — and that’s accounting for David Price’s rise to dominance and Steve Pearce’s slugging. 


Eovaldi had already pitched in relief in Games 1 and 2, totaling 29 pitches. Despite that, he was not only willing to pitch again in Game 3, in the longest game in postseason history, but he was willing to go 97 pitches. The last toss was a game-winning home run for the Dodgers in the 18th inning — but that didn’t matter. He was throwing incredibly hard, and kept the Dodgers at bay for almost all of his six innings pitched, easily the equivalent of a start on short rest.

The outing was certainly selfless. Asked how the Red Sox knew Eovaldi could handle such a workload, Sox president of baseball operations Dave Dombrowski offered only two words at the general managers' meetings: “constant communication.”

The Red Sox care about the health of their players, but they could also have thrown caution to the wind in pursuit of a championship, even unwittingly. The Dodgers, for example, seemed much more reticent to use pitchers so aggressively.

Asked generally if player and team interests are ever at odds in a postseason setting, Astros president Jeff Luhnow said he did not think so.

“I mean, everybody wants to win,” Luhnow said. “Obviously, I think even our team interest is to keep our players healthy. The one area where you might see it is if a player is a free agent at the end of that year. But I think most managers, pitching coaches, and the players themselves are responsible enough where you don’t go into a risky area.”

Ahmad was watching Eovaldi’s progress.

“As Boston kept on doing well and advancing in the postseason, I started to say, ‘This guy is throwing hard,’” Ahmad said. “He’s only with Boston for a couple of months potentially, because he’s a free agent. … There could be some concern that he’s going to throw too much. So while I was celebrating how well he was doing, I also celebrated how strong he was right up into the final games of the World Series. He was incredible with his durability. So his performance was great, but also his durability.”

But Ahmad didn’t indicate he was particularly worried at any point, namely because Eovaldi didn’t have a significant jump or decrease in velocity. Eovaldi averaged 95.2 mph on his hard pitches in the regular season, and saw that rise to 96.3 mph in the playoffs.

Ahmad also knows Eovaldi particularly well and how hard Eovaldi worked to return to form. Ahmad, with Eovaldi's permission, named a character in a children's book he authored "Nate."

“What worries me in general across the board, especially with the young developing thrower, that’s where we see it the most — a guy who has a rapid jump in velocity and has never seen that velocity before,” Ahmad said. “So if a kid who’s developing, getting stronger, goes from 92 to 98 in a very short period of time, he’s not adapting well enough to that velocity. So somewhere in his system, he’s gonna have a breakdown, and the weak link is the elbow ligament. 

“For Nate, as you know, he was averaging [a high velocity] for the last five, six years of his playing career,” Ahmad said. “And to go from 98-99, to 100, to 101, and occasionally touch 102, that from a percentage increase, wasn’t alarming. And if anything, it made me feel like his ligament was strong, that it was not about to go.”


There is still a label involved here: two Tommy John operations. Eovaldi had his first Tommy John procedure when he was 17 years old. He had his second at age 26. Ahmad handled that second operation, as well as a repair of the flexor tendon at the same time. 

Ahmad thinks it is likely that Eovaldi is the first two-time Tommy John recipient to throw over 100 mph upon return. That was not immediately verifiable, but Eovaldi is clearly a success story where there haven’t been many. 

Per a 2016 study published by some renowned surgeons, including Dr. Neal ElAttrache and Dr. David Altcheck, 38 pitchers at that time were determined to have undergone a second Tommy John surgery, called a revision.

“Of the 38 MLB pitchers who underwent revision UCL reconstructions, the operations in 12 pitchers were in 2013 to 2014; thus, only 26 MLB pitchers remained for return to play analysis,” the study went. “Seventeen pitchers (65.4%) returned to pitch at least 1 MLB game (Table I). Only 11 pitchers (42.3%) returned to established play.”

How, then, does the fact that Eovaldi has had two operations factor in now?

“I often use the analogy of, if you’re wearing out the tires in your car, and your car is not aligned well, if you simply change the tires, the tires are going to wear out again quickly, and you’re going to be right back where you started,” Ahmad said. “For Nate, he didn’t have, say, two or three years before his ligament failed. He had seven or eight years on his ligament. So his alignment analogy is good. His throwing mechanics are good. 

"What a lot of people are delving into as we learn more about revision Tommy John surgery is, if the surgery was done, say, less than perfectly the first time — and even more specifically, if the tunnels that were used to place the new graft were not in ideal position, the graft tends to be stressed in an abnormal way and it fails early. His tunnels are perfect. So essentially we were able to put in a new graft into perfect tunnels. And we used a graft from his knee called the gracilis tendon. That graft is bigger and stronger than his palmaris longus, which came from his wrist. 

“So we used perfect tunnels again, put in a bigger graft, on a guy who has demonstrated that he can throw well and throw hard over a number of years. So while I’m concerned about the general population of throwers who throw hard, I’m not concerned about him any differently.”

Teams will always draw their own conclusions, but after an incredible postseason, Eovaldi has clarity on the one matter that could draw back his market, and the news reinforces what Eovaldi believed all along.

COMING FRIDAY: Patrick Corbin

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