Baseball has seen a significant rise in ulnar collateral ligament (UCL) tears. In Major League Baseball, nearly 35% of all pitchers have undergone Tommy John surgery to repair their tears. he overhand motion, combined with pitchers throwing the hardest they can every pitch, causes extensive wear and tear on the ligament.
Softball pitchers, however, have largely been spared. Their underhand pitching motion is gentler on the elbow, making UCL tears uncommon. But Marist softball’s newest graduate student pitcher, Ava Metzger, is a rare case.
By her freshman year in high school, Metzger realized she had the potential to play softball at the collegiate level. Her hard work paid dividends in her senior year of high school when she posted a 19-1 record with a 0.50 ERA and 276 strikeouts in 139 innings pitched en route to winning New Jersey’s Gatorade Player of the Year in 2021.
During that season, Metzger felt elbow pain, but still produced a near-perfect season.
“When she was named New Jersey Gatorade Player of the Year, it was extra special,” said Marist graduate student shortstop Haley Ahr, Metzger’s childhood friend. “It would have been a crazy accomplishment if she were healthy, but to know she was pitching through a lot of pain made it feel like an extra reward for her.”
The adrenaline of pitching every day left her unbothered until the end of her high school career, but the downtime after school made the pain noticeable. With her future college career looming, Metzger could have taken the summer off, but she returned to the circle pitching again for travel ball.
The pain became significant enough during summer ball for Metzger to scale back. Eventually, she visited an orthopedist, who diagnosed her with golfer’s elbow. The orthopedist believed physical therapy and rest would be enough to prepare her for the season.
The therapists had her strengthen the muscles around the elbow and also trained the muscles in the shoulder to keep her elbow from compensating for the lack of strength in her shoulder.
Metzger was not completely healthy entering the fall season of her freshman year at Manhattan University, but she still played nearly a full season. Before her final two games, she had a 3.96 ERA with 60 strikeouts and 80 hits allowed. In her next two outings against Marist and Canisius, she allowed 14 earned runs and 20 hits, raising her season ERA to 4.82.
In the game against Canisius, Manhattan’s trainer noticed something wrong. Metzger could not feel her pinky, index, or ring finger; her forearm and elbow were swollen, and she couldn’t grip the ball.
In early May of 2022, she got an MRI at New York Presbyterian, and that same night was diagnosed with a partially torn UCL.
“I was in shock that I was playing on all that and allowed it to get that bad,” said Metzger. “I was frustrated with myself, frustrated with my coaches for allowing me to play on it. I’m the type of person that’s never going to say I’m in pain… I’m not going to stop unless someone tells me to stop.”
Metzger decided on a non-surgical option, hoping to return for her sophomore year. She participated in physical therapy for three months. Once a month over the span of three months, Metzger received a platelet-rich plasma (PRP) injection.
Although there is a great success rate with PRP injections working on other ligaments, there was a “50-50” shot that it would improve Metzger’s elbow. It did not.
During her throwing program, Metzger sent a video to her physical therapist, Derrick McQuiston, at Manhattan and realized something was still wrong. The agonizing pain made her realize that surgery was the best option.
Metzger got set for surgery in October 2022. Because her ulnar collateral ligament was only partially torn, she did not undergo Tommy John surgery. Instead, she had UCL repair surgery, which involves stitching the ligament back together and drilling holes into the bone to anchor it.
In Metzger’s case, she had an ulnar nerve transposition as well, where her ulnar nerve is wrapped around the muscles and ligaments in her arm to relieve the pain she had been experiencing. Then began her long rehab.
The first step was getting a full range of motion back in her wrist and elbow, which took six to eight weeks. For her to begin the next step of her rehab, she had to pass all her strength tests, including getting her right arm’s strength to be symmetrical to her left arm’s strength. It took about three months.
Metzger’s next step was a six-week plyometric program that retrained her how to throw a softball. She relearned the correct arm slot by practicing with weighted balls on a trampoline. For Metzger, that part of the rehab corrected her mechanics. Previously, she was sidearming the ball, which led to her UCL tear.
“It’s crazy because I learned how to throw when I was eight years old,” said Metzger. “I’m retraining the muscle memory again at 20 years old, which is already instilled in your brain, so relearning how to throw was really frustrating.”
Next was an overhand throwing program that lasted 16 weeks beginning around Easter in 2023, first starting at a distance of 20 feet, then slowly lengthening all the way to 120 feet. The rehab forced her to start from square one, including throwing in the backyard with her dad, like when she was first learning to throw at eight years old.
By this point, Metzger was at full strength in every aspect besides pitching. Right before the start of her junior year at Manhattan, she worked on relearning how to throw her fastball, curveball, changeup, screwball and riseball.
On Oct. 3, 2023, Metzger completed her rehab just as Manhattan’s fall season was about to begin.
“I cried happy tears at my last appointment. I was so happy to be back on the field,” said Metzger.
With an injury uncommon among softball pitchers, Metzger felt like a “guinea pig,” serving as one of the first test cases for what a proper throwing program would look like for softball players. At the same time, team culture at Manhattan was poor, and a lack of support from her coach worsened her mindset.
“I felt neglected,” Metzger said. “I dreaded going to practice, and it made things worse because I didn’t have that outlet anymore. My mentality was very poor, and my emotions were definitely in the dumps.”
The need for adrenaline kept Metzger pushing forward to get back to 100 percent, and she managed to play her full junior season, but did not see the results she expected.
As a freshman, she threw eight complete games in 14 starts. In her first season back, her longest outing was 4 1/3 innings. Metzger had high expectations for what she would accomplish in college. By the end of her junior season, she believed she had not lived up to her potential.
In the offseason, she took a month away from the game to focus on her mindset and building strength in other parts of her body. She developed her legs and core, switching up her workouts. For the first time in two years, she was able to focus on something other than her elbow.
As Manhattan’s 2025 season began on Valentine’s Day against Montana, Metzger had high hopes for her final season as a Jasper — until it was taken away. In the third inning of the season opener, Metzger’s foot hit a hole in the turf, and as she attempted to close her hips, her knee did not follow.
“I remember my teammates saying you could hear a pin drop,” said Metzger. “It almost sounded like I was crying and grieving a death.”
Metzger was 16 months removed from being cleared to play after her UCL injury when, with one wrong move, she tore her ACL. The injury required another yearlong recovery process. By then, she had already committed to play her graduate season at Marist.
Before the season, Metzger was in contact with Ahr, who also had a medical fifth year after missing her freshman season with an ankle injury, as they planned to live together while finishing their softball careers at Marist.
“I wanted her out there on the mound for me next season,” said Ahr. “She’s going to be a very important part of this team that’s trying to go back-to-back.”
Ahr was not the only member of the Marist softball team who was ecstatic to have Metzger join the Red Foxes. Head coach Joe Ausanio had been impressed with Metzger’s ability since her travel ball days. That didn’t stop Metzger’s anxiety from spiking when she had to tell him she had suffered a season-ending injury.
“I was so nervous because I knew he was so excited, but he was nothing but supportive and reassuring,” said Metzger.
“I didn’t really care,” said Ausanio. “I told her, ‘I know what you’re capable of doing. You have to work hard to get yourself back to where you were.’ I did not doubt that she was going to do that.”
The thought of quitting crept into the back of her mind but erased quickly because of her parents, who didn’t want her to end her career because of an injury, and by the opportunity for a fresh start in Poughkeepsie.
Metzger went in for surgery not long after the diagnosis, beginning another long road back to the circle.
“It felt quicker,” said Metzger. “I know my senior season at Manhattan is over, I can close that chapter and get ready to come to Marist and be fully ready to go.”
By December 2025, Metzger had completed her ACL rehab and was a full participant in the early part of Marist’s 2026 season.
“She looks great. I get to see her firsthand in live [at-bats] and I wouldn’t want to face her in conference. I’m glad I get to field behind her,” said Ahr.
In Metzger’s 10 appearances as a Red Fox, she has a 1.96 ERA with four complete games, two shutouts, 41 strikeouts and a 6-1 record in 50 innings pitched.
In her crowning performance, she pitched a complete game, allowing one run and recording eight strikeouts while leading Marist to a 2-1 victory over No. 22 South Carolina. It was Metzger’s first complete game since April 27, 2022 — three days before she exited with a UCL tear.
After striking out the Gamecocks’ three-hitter, Tori Ensley, to win the game, Metzger yelled out “Let’s go!” as she was swarmed by her teammates, crying tears of joy.
Edited by Hayden Shapiro and Max Rosen
Graphic by Quinn DiFiore
Photo by Grace Bolander
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