With Violent Elbow Injuries Behind Him, Braves Reliever Dan Winkler Is Pitching Like an All-Star

Middle relievers typically lack recognition, but Atlanta's Dan Winkler is thriving despite a history of major elbow injuries.

If Braves reliever Dan Winkler, survivor of two catastrophic elbow injuries, is selected to the 2018 NL All-Star team, he’ll join a fraternity of players whose first-half success earned them a place among baseball’s greats. Being named an All-Star isn’t a predictor of longtime success or the mark of a great ballplayer, but it is recognition for thriving—even if it’s just for a handful of games—in the ultimate game of failure.

If Winkler isn’t selected to the All-Star team—odds are often against middle relievers—he’ll remain the set-up man of one of baseball’s biggest surprises of 2018. If he continues at his current clip, he’ll be one of the most dominant relievers in baseball this year. The Braves sit at 49–36 entering Thursday and lead the NL East by 2 ½ games. They rarely surrender leads late in games, with much of that credit going to Winkler and his fellow relievers. On face, Winkler’s success is evident: excluding one blow-up against the Orioles in late June, he has a 1.31 ERA over 34 ⅓ innings. The peripheral statistics further confirm how thoroughly he’s befuddling hitters. Winkler hasn’t surrendered a home run in 2018 and is one of the best at avoiding hard contact in the big leagues.

He’s the kind of reliever every team needs. And a year ago, he didn’t even know if he’d be on a big league mound in 2018.

Winkler’s path is crooked. He’s a player from a small Midwestern town who journeyed from junior college to Division-I, only to be a 20th-round pick of the Rockies in 2011 with moderate chances of making the big leagues. But that path isn’t unusual. What is unprecedented is Winkler’s incredible elbow trouble by modern baseball’s standards. Over two injuries, Winkler endured a combined 20-plus months of rehab, months of forced rest, and a snapping sound in his arm that made him crawl off of a big-league mound and left him sobbing in the clubhouse. To understand Winkler’s elbow injuries is to understand the structure of the human elbow, its modern reconstructions and the dangers of the reconstructive surgery.

Winkler’s first elbow injury is the plague of contemporary pitchers from teenagers to the MLB's elite arms. The tenderness of the ulnar collateral ligament (UCL) imperils the careers of some of the game’s top hurlers, and Winkler’s UCL tore while he was pitching a no-hitter for the Double-A Tulsa Drillers in June of 2014. Winkler remembers a twinge that he disregarded before feeling the snap of a rubber band in his elbow a few pitches later. That twinge was the UCL straining—think of the stretching sensation that accompanies pulling an elastic material and the tearing as the fabric loosens. The snap was the feared Grade 3 tear of the UCL, the rupture that requires ligament replacement surgery and a yearlong rehabilitation.

“I never had any elbow issues at all before that pitch,” Winkler says. “I didn’t even tell the trainer that I felt anything until I felt that snapping sensation when I threw a changeup.”

Prior to that start, Winkler was the best starting pitcher on a Tulsa team that featured three future big league starting pitchers (including Rockies 2018 opening day starter Jon Gray). Winkler’s 1.41 ERA over 12 starts amplified rumors of an imminent big-league call-up for the pitching-starved Rockies. Instead, “the one pitch in Springfield, Missouri” forced him into surgery on July 1, 2014. His next appearance in a baseball game wouldn’t be until 447 days later, on Sept. 21, 2015—the day of his Major League debut.

A warning: some language from high school biology awaits.

Hold your fist perpendicular to your chin and look down your forearm. The UCL is a thick band of ligament tissue on the inner half of the elbow that joins with the lateral collateral ligament (on the outside of the elbow). Those ligaments connect the humerus (the long bone in your upper arm between the elbow joint and shoulder) and the ulna (the long, thinner bone in your forearm on the opposite side of your thumb). Throwing anything places significant strain on the UCL. Place your arm at a 90-degree angle and pretend you’re trying to pelt a friend with a piece of candy or throw a fastball. Notice that whipping, wavelike feeling in the inner half of your arm? The UCL is enduring a significant amount of that stress. If you’re a pitcher at any level of baseball, the stress amplifies the more you throw and the harder you throw it.

“This is one of the fastest human motions there is,” says Dr. Steve Jordan, who practices at the Andrews Institute for Orthopaedics & Sports Medicine in Gulf Breeze, Fla. “It’s an amazing stress area for these big guys who are only getting bigger, conditioning harder, throwing harder and accelerating like never before.”

By now, every baseball fan knows the term “Tommy John surgery,” but what does it mean? When Dr. Frank Jobe invented the surgery on former Dodgers journeyman Tommy John, he concluded that he could replace the torn UCL with a grafted tendon from elsewhere in the patient’s body or donated tissue from a cadaver. The surgeon drills three tiny holes in the form of a Y into the medial epicondyle (a bump on your humerus bone) and replaces the torn ligament with the tendon graft. The surgeon weaves the graft in the form of a figure-eight into that Y-shaped hole and passes it through three times so it’s roughly the same 3-4 millimeter size as the original UCL. The traditional 12–15 month rehab is the time it takes to properly incorporate the new ligament into the bone. A lot of rest is required before plenty of strenuous exercise to re-strengthen the weakened elbow.

“Tommy John rehab isn’t easy. It took me 15 months when other people were saying that it would take as few as nine,” Winkler says. “You have to break up a ton of scar tissue all while ramping up exercises that only make you more sore. I had tons of great people help me out, but you’re always plagued by worries that you’re immediately going to tear it again.”

Once the holes in the bone fill in and incorporate the new ligament, the ligament is strong while the bone, which is now holding the ligament together, becomes the weak link. That weakening would later almost end Winkler’s career.

Winkler was nearing a big-league call-up before tearing his UCL, so the Atlanta Braves concluded he was worth a selection in the 2014 Rule 5 draft. The Rule 5 draft is designed to prevent teams from stashing potential big league talent in the minors, meaning one team can select an eligible minor leaguer from another team’s system, but they must keep him on the major league roster for the entirety of that season. If they decide he’s not worth a roster spot, they must offer the player back to their original club. Atlanta cleverly selected Winkler, who was in the middle of Tommy John rehab, and placed him on the disabled list until he was ready to return. He made his big league debut on September 21, 2015 and struck out the first hitter he ever faced. In his next and last appearance of the season, he surrendered back-to-back homers.

Atlanta was intent on keeping him if he played capably in the following spring training; he just needed to make the team to avoid returning to Colorado. When Winkler arrived at the Braves complex in Lake Buena Vista, Fla. in 2016, sharp elbow pains hindered his daily bullpen sessions. He had no plans to reveal them to anyone. “I thought it was some lingering tendonitis or something,” Winkler says. “And, look, I had to make the team or else I was headed back to the Rockies and probably to the minors. This was a chance to stay on a big league team.”

Winkler made the Braves out of camp, eliminating the fear of being returned to Colorado. But it only took him three appearances before he thought his career was over. The elbow pain Winkler suffered during spring training wasn’t tendonitis, it was that his elbow had arguably been fastened too well during his Tommy John surgery.

Remember the figure-8 that fastens the tendon to the medial epicondyle, that small bump on your humerus bone? That creates an extremely strong ligament and a weakened bone. Typically, this results in a healthy elbow, but it can create significant tension between the epicondyle and the new ligament. Unlike the highly upright deliveries of Max Scherzer or Justin Verlander, Winkler’s delivery was a violent contorting motion that put his front foot far in front of his body. That created an extreme whipping action, where his arm would fly through the zone with little support from his hips or legs. The pressure was unsustainable, which led to this on April 10 2016:

That is the moment that Winkler’s medial epicondyle snapped. Winkler was placing so much stress on his arm that the bone was bound to snap or the ligament was going to tear again. Given how strong the new ligament was, it was the bone that gave out first.

After the trainers ushered Winkler off the field, he collapsed in the Braves clubhouse, petrified his career was over. “I just kept telling myself ‘not again, not again,’ Winkler says. “I knew another year or year-and-a-half of rehab was ahead the moment that happened and that I will have spent the better part of two years recovering from elbow surgery. And this was a week after opening day. Depression seeped in quickly.”

Winkler headed to see Dr. James Andrews, the famed orthopedic surgeon who has performed thousands of Tommy John surgeries, who noticed a large chunk of the bone split off of Winkler’s throwing elbow. “He told me that if it broke into little pieces, there would be nothing to re-anchor the ligament,” Winkler says. “And my career would have been over.” It wasn’t a second Tommy John surgery, but the injury required meticulous treatment from Andrews. A good size screw was used to reattach the ligament and the epicondyle, but, as Winkler says, “a lot of rest … again,”  was required for the two to cinch and create proper blood flow.

During that period, Winkler scoured film of himself from as far back as 2011 to determine why his arm gave out again. Then he compared his delivery to contemporaries that haven’t suffered major elbow injuries: namely Scherzer and Verlander. He noticed both pitchers’ abilities to remain upright and minimize the violent swing on their arms. “I needed to learn to use my legs more,” Winkler says. “But I didn’t know that I was going to be able to come back.”

After Winkler broke his elbow in April 2016, he didn’t pick up a baseball until January 2017 and wouldn’t appear in a live game until a June rehab assignment at Single-A Rome. The Braves recalled him in August 2017 and he enjoyed a successful 14 innings to end the season, but wasn’t yet the established setup man that he’s become this season.

With his refashioned delivery and increased velocity, Winkler relied on his fastball averaging over 94 MPH and a slippery cutter that he uses to move away from righties and jam lefties. His ability to keep the ball down has helped him avoid surrendering any homers, and his mastery at working both sides of the plate helps him avoid any players “barreling” the ball (just two allowed over 79 batted balls). He is, by no obscure measure, one of baseball’s most effective relief pitchers in an era when teams scour the world to find them.

With his effortless Midwestern charm, Winkler credits doctors, the Braves training staff and pretty much everyone except himself for his recovery. He cites his luck on being able to take a big league mound again after his arduous injury trouble as a reason he’s successful. It’s predictable modesty, but he’s underselling the pivotal role he’s assumed for one of baseball’s most pleasant surprises.

To understand Winkler is to understand the risks of baseball, the fragility of the human elbow and the determination required to overcome catastrophic injury. Whether he makes the All-Star team doesn’t matter. It’s all fun from here.