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Having Chest Pain? Know 5 Possible Causes And What To Do Next
Heaviness and pressure in the chest could mean many things, depending on the severity and intensity of the pain. According to research published in the BMC Emergency Medicine Journal, chest pain is a "frequently occurring symptom affecting 20-40% of the general population worldwide". Let's discuss the possible causes of chest pain.
Also Read: Expert Tips To Follow In Your 20s & 30s To Have A Healthy Heart Later
Possible Causes Of Chest Pain
Heart problems are one of the primary causes of chest pain. Some of the common heart-related issues that trigger chest pain are as follows:
Heart attack: Also called myocardial infarction, a heart attack occurs when blood flow to the heart is blocked or reduced.
Angina: Coronary Artery Disease (CAD) is one of the most common heart problems. It causes several symptoms, including angina, a type of chest pain. It usually takes place when the blood vessels leading to your heart are blocked.
Myocarditis: Myocarditis refers to the inflammation of the heart muscles, also known as myocardium.
Pericarditis: It is the swelling of the pericardium, the tissue that surrounds the heart.
Cardiomyopathy: When your heart muscles find it difficult to pump the blood for your heart, you may be experiencing this.
Lung-related issuesRespiratory or lung problems can also cause chest pain. Some of the common lung issues include:
Pulmonary embolism: This refers to the sudden blockage of the lung arteries due to a blood clot.
Pleurisy: It is the inflammation of the pleura, the layers that cover the lungs.
Asthma: This is a chronic condition wherein the airways narrow down and become inflamed, making it difficult to breathe.
Chronic Obstructive Pulmonary Disease (COPD): COPD is a group of respiratory diseases that lead to the blockage of the airway and trigger breathing issues along with other symptoms.
Anxiety or panic attackChest pain is a common sign of anxiety and can also show up in people who suffer from panic attacks. While anxiety often occurs due to the fear of a perceived threat, panic attacks can be more intense and can occur due to no reason, explains Mayo Clinic. Along with chest pain, it can cause other symptoms, including rapid heartbeat, shortness of breath, sweating, nausea, dizziness and distressed breathing.
Gastrointestinal problemsDigestive problems can often be a cause of chest pain. Even though it might be difficult to see a connection, here are some stomach issues that can cause chest pain.
Gastroesophageal reflux disease (GERD): GERD or acid reflux is a gastrointestinal problem that takes place when stomach acid repeatedly flows back into the oesophagus, the tube that links the mouth to the stomach. This can often lead to a burning, painful sensation in the chest.
Gallstones: These are hard deposits in the gallbladder. These are usually hardened digestive fluids, also known as bile.
Pancreatic inflammation: Also known as pancreatitis, the condition refers to the inflammation in the pancreas that causes pain that radiates to the chest.
Muscle problems or injuries
Chest pain can also be an outcome of bone problems and muscle issues. Some of the conditions to watch out for are:
Costochondritis: It occurs when the rib cage cartilage suffers from inflammation.
Rib injury: Any breakage or bruising of the ribs can also cause chest pain.
Also Read: Here Are 5 Worst Habits That Affects Your Heart Health
When should you seek medical attention?If the chest pain persists for a long time or if you suspect something dangerous, call your nearest hospital and seek medical help. Beware of the symptoms listed below:
If you develop chest pain, do not panic. Call your doctor and consult immediately. In case of severe pain and discomfort, visit the nearest hospital and get yourself medically examined. Remember! It is better to take all precautions than wait for a cure.
How To Tell If Your Chest Pain Is A Heart Problem
Experiencing chest pain is scary and shouldn't be ignored. At best, it's uncomfortable; at worst, it's a concerning warning sign. Chest pain is also fairly common: Non-traumatic chest pain is the second-most frequent cause of emergency department visits among adults, accounting for as many as 8 million visits a year, according to a 2016 study in JAMA Internal Medicine.
With so many potential causes of chest pain (which we'll get into in a bit), how do you know what you're dealing with? Is it heart-related pain or something else?
As someone who has struggled with chest pain on and off for years, with a few guesses at the culprit — anxiety, asthma, costochondritis — I know, to some degree, what that fear is like. I reached out to cardiologists for their input on what to look for.
When chest pain might be a heart issueOne thing to monitor is when the pain arises.
"Chest discomfort that is heart-related is usually described as a chest discomfort that is worse with exertion," said Dr. Estelle Jean, a cardiologist from MedStar Montgomery Medical Center in Olney, Maryland. "Patients typically describe the chest discomfort as tightness, pressure, heaviness, squeezing, a band-like sensation or heartburn." She added the pain is usually gradual in both the onset and offset.
If the chest pain is secondary to blockages of heart arteries, you may also notice other signs. For example, the pain "may radiate to the left arm, shoulder or jaw, and can be associated with other symptoms such as trouble breathing, lightheadedness, sweating or nausea and vomiting," said Dr. Adriana Quinones-Camacho, a cardiologist and the chief of medicine at NYU Langone Health's Manhattan campus.
Both Jean and Quinones-Camacho agreed that rest is crucial — along with talking to a doctor, of course. "Any chest pain symptoms should be taken very seriously and fully evaluated by a health care provider," Quinones-Camacho said.
What are other causes of chest pain, and what can relieve them?Let's start with what chest pain that's not related to the heart usually looks like. Jean said it's "typically described as a sharp pain that is worse with deep breathing or coughing, pain localized with one finger, pain worse with movement or palpation, and fleeting pains lasting a few seconds or less."
Many things can cause chest pain, but here are some of the common ones experts see:
Acid reflux
Gastroesophageal reflux disease (GERD), or acid reflux, is when stomach acid comes back up your esophagus. (Yup, it's as bad as it sounds.) You may notice heartburn after eating, difficulty swallowing and coughing. Jean suggested treating GERD with antacids, such as Tums or Rolaids.
Asthma
Asthma is a condition where your airways narrow and produce extra mucus. Signs include wheezing while exhaling, shortness of breath and coughing. If you have asthma, talk to your doctor about getting an inhaler if you don't already have one (and make sure you get a new one once your current one expires).
Anxiety
Like many mental illnesses, anxiety can cause physical issues, such as chest pain. Besides worrying, people with generalized anxiety disorder may also overthink, struggle with uncertainty and be unable to relax or concentrate. Both psychotherapy and anti-anxiety medication can help, Jean said.
"Strategies to reduce stress can include meditation, yoga, sleeping at least 7 to 8 hours at night, eating a heart-healthy diet and engaging in regular exercise," she added. Heart-healthy foods that cardiologists eat include fruit, vegetables, lean meat and whole grains.
Muscle strain
Skipping warm-ups before exercising, contact injuries, lifting things while twisting your body and muscle fatigue can all cause muscle strain.
Pay attention to any bruising, pain while breathing, swelling and difficulty moving. If you faint, get dizzy, vomit, have a fever, get sleepy or struggle to breathe after, go to the emergency room immediately. Otherwise, Quinones-Camacho said the issue should resolve on its own.
Among the other potential causes of chest pain are chest wall issues, stomach ulcers, a pulmonary embolism and pneumonia. Getting your doctor's input on your specific case is important. At the very least, consider calling a nurse support line. Insurance companies often offer this as part of their benefits.
Remember: Chest pain can be life-threatening, even if it doesn't seem like it at first. Seeing a physician as soon as possible is vital.
When Passion And Pain Collide: Valerie Cagle's Agonizing Road Back To Softball's Hallowed Ground
After spending her 2022 season fighting shoulder pain, Valerie Cagle has been dominant in the circle and at the plate, and she hopes to lead Clemson on a deep run in the NCAA softball tournament.
Aishwarya Kumar, ESPN.ComMay 18, 2023, 07:00 AM ET
CLEMSON SOFTBALL STAR Valerie Cagle grabs her right arm as she stands in the pitcher's circle at Vartabedian Field in Pittsburgh. Using her left hand, she pulls her right arm across her chest, as firmly and as far she can.
It's May 14, 2022, and Clemson is playing Florida State in the final of the ACC softball championships. The Tigers, in just the program's second full year, are hoping to win their first conference title. But Cagle, the 2021 ACC Freshman of the Year and ACC Player of the Year, can't entertain such high hopes. She's just looking for a way to stop the pain.
I can't keep doing this, her brain flashes over and over again.
Cagle shakes her right arm, then grabs it again. She pulls it tight across her chest. Thousands of eyes are watching as she discreetly attempts a medical procedure on her own shoulder. She's trying to pop her biceps tendon, which had slipped out of its groove -- again -- back into place.
"I was trying to find some type of comfort and was hoping that putting the tendon back in place would alleviate some of that pressure," Cagle says. "I was at the point, though, that nothing was helping."
I can't keep doing this.
Cagle's velocity had dipped all season long as the pain level rose, and while pundits and outsiders attributed her struggles to a sophomore slump, a select few knew the truth. Most people watching Cagle that day surely think she is merely stretching, but Clemson's athletic trainer Katie Rovtar immediately recognizes what is going on. She has seen it before.
In the sixth inning, Cagle gives up a three-run home run. Clemson loses to FSU 8-6.
As Cagle walks off the field and spots Rovtar, they make eye contact. The same thought pops into each of their minds.
Something has to change.
Change does come, but it's not the kind of change that Cagle or Rovtar had prayed for. Two weeks later, Clemson's 2022 softball season comes to a close after Cagle surrenders five runs to Oklahoma State in the super regionals.
Sitting next to her senior teammate and best friend Cammy Pereira after the season-ending loss, Cagle doesn't even have the capacity to choose her words carefully as Pereira fights back tears now that her collegiate career is complete. The pain is all-consuming.
"I'm so glad this is over," Cagle says.
THE BEGINNING TOOK place three weeks before Cagle's 2022 season even started. She had noticed a nagging pain in her right shoulder, and it quickly grew to levels that were alarming.
She had plenty of reasons to ignore it. Individually, she was coming off a remarkable season. The 5-foot-9 dual-threat star had become the face of the new Clemson softball program. She had thrown two no-hitters on her way to a 28-7 record and a 1.16 ERA in 2021. At the plate, she had led the team in multiple categories, including a .404 batting average, an .821 slugging percentage, 17 home runs and 45 RBIs. She was the first player ever to double up as the conference's Player of the Year and its Freshman of the Year. As for the team, Clemson's program had qualified for the NCAA tournament in its first full season. Now it could establish itself as a perennial contender.
But three weeks before the start of her sophomore season, Clemson doctors attributed Cagle's pain to chronic proximal biceps tendonitis -- inflammation of the tendon that connects the biceps muscle to the shoulder and the elbow. And worse: the inflammation had resulted in something called biceps subluxation. Normally, the biceps tendon nestles in a groove before joining the shoulder joint. But because of the inflammation, Cagle's tendon slipped in and out of the groove, causing her unspeakable pain.
Days before the season began, after several MRIs and tests, doctors issued five words that put Cagle in the kind of jam she had rarely seen from the pitcher's circle: You can't cause further damage.
She could play the season, they said, and continue to pitch and hit, but the pain would be present. It could be severe. It might be debilitating. The burden was on her to decide. She confronted a series of questions that athletes in all sports, at all levels, of all ages, have faced. Would she be called a quitter if she decided to take time away? Would she set an unfair example to her teammates -- and to young girls watching her -- if she decided to play through the pain? Would she be a detriment to the team if she played and couldn't bring her best? And how much pain could she possibly put up with in order to continue playing the game she loved?
The questions didn't stop there. The "what ifs'" bounced around her brain. What if she plays and the pain gets worse? What if she sits out and the pain doesn't get better? What if she plays and fails? What if she plays and ends up taking the spot of a teammate who could have a career moment? What if she plays and the Clemson medical staff figures out a solution -- and it all works out?
This much was clear: As a right-handed pitcher and a left-handed batter, her right shoulder would be under relentless stress during the long season. Ten days before Clemson's opener, the medical staff shut her down for seven days and gave her a cortisone injection. They ordered her to rest.
"We really had to make a decision before the season started," Rovtar says. "Was this feasible? Are we possibly causing more harm than good? Can she tolerate this? Are we doing what's best for her? Do we need to shut this down now and consider redshirting the season?"
In the end, Cagle kept going back to those five key words: You can't cause further damage. "My team needs me," she thought. "I am not a quitter. I will play through this pain."
The fallout from that decision has yet to cease. She lost sleep, she lost velocity, she lost games, she lost her smile. Little did she know at the time, but the decision to confront the pain would only lead to another agonizing decision down the road.
Now, more than a year later, her velocity and smile are back. So, too, are the wins. She sleeps like a baby. The peaks and valleys in her yearlong journey make Cagle one of the most intriguing players on the road to the 2023 Women's College World Series.
On that day back in 2022 when Cagle decided she was going to brave the pain to play, she also made another decision: Nobody outside of the Clemson softball team and her immediate family would know about the diagnosis. She didn't want people to think she was using her pain as an excuse.
But Cagle's level dropped. Everyone could see it. Teammates and coaches estimated that she played the 2022 season at 65% to 70%. Some called it a sophomore slump, while others questioned the superlatives they had used to describe her talent after her enthralling 2021 season.
Before and after games, Rovtar and her team went to work. She would do hours of prehab leading up to games. After, she'd get a deep massage to flush out the waste products. She got dry needling and cupping to help with the inflammation. She was put on muscle restrictions in other parts of her body to help ease her shoulder pain.
But what they couldn't give her was sleep. It evaded Cagle. Every night. She struggled to get comfortable. When she was lucky enough to fall asleep, she would usually wake up a few hours later in pain. The cycle continued.
"Interrupted sleep creates an even worse pattern," Rovtar says. "Because the best way that our body heals is during sleep."
Mark Cagle, Valerie's father, remembered times when people would pat his daughter's shoulders after games, and she would wince and say, "Please don't do that, it hurts so much."
Cagle's confidence faded. First, when she pitched, and then when she hit.
"The pain from pitching was on her mind [so much] that it affected her hitting and she started to swing at pitches I've never seen her swing at," Pereira says. "She was anxious at the plate, she wasn't confident in herself. I can tell when she takes a certain pitch that she's going to hit a home run or she's going to get a hit because I can tell how locked in she was, and that completely dissipated."
Cagle rarely complained, but when people did hear her talk about her pain, they often downplayed her struggles.
"She would say, 'Oh, I'm just hurting so much,' and people would say, 'Well, it must be nice to be in pain and still go 3-for-4 and be batting .450 and have that many strikeouts,'" Pereira says. "Those comments probably did more harm to her mental health than good."
Toward the end of March, the Clemson coaching staff decided to scale back Cagle's pitching. If they played three games in a week, they rested her for two and sent her to the circle for one.
"She just wasn't making the ball move or maybe have a feel for hitting her spots as well as she can," Clemson associate head coach Kyle Jamieson says. "But she still was able to throw hard, and she threw more than she pitched, if that makes sense."
Cagle finished the season 16-9 with a 2.46 ERA. At the plate, she hit .308 with 13 home runs and 44 RBIs. She was named a USA Softball Collegiate Player of the Year top 25 finalist.
"She played at 70% and is still one of the best players in the country," Rovtar says.
But both Cagle and Rovtar knew: Something has to change.
MARK CAGLE WAS steadfast in his approach to softball.
Speed first; control will come later.
A sort of softball guru in Yorktown, Virginia, Mark Cagle repeated this sentence over and over again at home. First to his oldest daughter -- a softball player and nine years Valerie's senior -- and then his son -- a baseball player and two years Valerie's senior. They would travel as a family, and Valerie would watch her older siblings take the field almost every weekend. By the time Valerie was ready to pitch, at age 6, she had heard it enough times for it to be her own mantra.
Even at 6, she pitched the ball with as much speed as she could muster, which could explain her prevailing memory of those first days. "Hitting was my thing," Valerie says.
In the circle, she couldn't even make it through an inning. Which only made her want to try harder.
Valerie was homeschooled, which meant she had some wiggle room to practice more than kids who went to school. She waited patiently for her father to arrive from his job at 3:30 p.M. Every day, and they would head to their backyard -- where Mark had built a pitcher's mound and a bow net -- and spent hours practicing her pitching. With all her might.
"Pitching is one of those things where you have to do it almost every day to be very successful with it, and it was cool and crazy that somebody can just buy into the process that much," says Claire Smeltzer, Cagle's childhood friend and travel ball teammate.
Often, Mark would announce to his daughter and Smeltzer, "If Valerie hits a home run during practice, you get Slurpees." Smeltzer would beg Valerie to hit a home run so they could stop at the 7-Eleven on the way home.
"We stopped to get a Slurpee almost every day," Smeltzer says.
Because Cagle was homeschooled, sports became an important pipeline to her peers. She tried field hockey and soccer, but nothing compared to softball. Her team became her social outlet. Her teammates became her friends. She loved that her individual talent could contribute to the overall success of the team.
Between the ages of 14 and 17, Cagle played for a travel team in Virginia named the Hanover Hornets. They traveled all over the South playing in high-profile tournaments. Coach Chad Radcliffe remembers pulling up to practice and hearing Cagle before seeing her. She regularly arrived with her father an hour before practice and pitched buckets of balls.
"I would always crack a joke, how many buckets? And it would always be five, six, seven buckets," Radcliffe says. "That is 250 to 300 balls at a time."
Cagle also stayed at least an hour after practice, Radcliffe recollected, spending more time practicing -- this time her hitting.
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Radcliffe thought Cagle was a "wild thing" when she first started pitching for his team. A wild thing who never backed down.
"She walked some players, but the unique thing that I thought was she might walk two to three batters in a row and then she turned right around and struck out three kids," Radcliffe says.
It took mere weeks for Radcliffe to realize she was going to be a special pitcher. With the bases loaded and two outs, Radcliffe decided to send a 14-year-old Cagle into the circle to (hopefully) get them out of the jam. Radcliffe remembers a calm Cagle taking the field, as though she knew she could do this in her sleep. Even then, Cagle had a bullish approach to softball: Put me in. I will figure it out.
"Valerie came in and struck out the last girl and we won the game, and I knew right then that she was going to be special," Radcliffe says.
It was then that it dawned on Mark, too. "I wasn't sure until then," he says.
As she grew older, Cagle became a dominant force -- both hitting and pitching -- on the travel circuit. When Cagle was 17, the Hornets played against a well-regarded Tennessee Fury. Radcliffe remembers the entire stadium freezing after they heard a crack emanating from Cagle's bat and then a loud dinging noise. Cagle had hit a ball so hard it hit a light post halfway up and made a loud noise like a "bell ringing." It was a line-drive home run.
Cagle loved setting outlandish goals for herself. She told Radcliffe she wanted to hit a 300-foot ball one day. She accomplished it a few months before leaving for college when the Hornets were practicing at a men's softball field. She told Radcliffe her college jersey number would be 72.
Why 72? He asked.
"Because I want to pitch 72 miles per hour," she responded simply.
In 2016, she committed to the University of Delaware, but she decommitted after a coaching change.
Enter Clemson. A new program that was looking for its cornerstone.
THE NUMBER OF innings Clemson head coach John Rittman had to watch Cagle play before he made up his mind that she needed to be in his first recruiting class? Three. Jamieson, Clemson's associate head coach, had seen her play travel ball a few years earlier, back when she was committed to Delaware. "She's just one of those -- you're walking by and she makes you stop," he remembers thinking.
In fall 2018, when Jamieson heard that she had decommitted from Delaware, he called Rittman. Rittman made his way to one of Cagle's games in the next few days. He remembers her doing everything you could on a softball field in those three innings.
"She was pitching about 70 miles an hour, she hit a line drive [and] it was right over the shortstop's head -- and then they moved her from pitcher to the outfield and she made two plays in the outfield that just showed her athleticism," Rittman says.
Immediately after, he called Jamieson. "I hope we can convince her into coming to Clemson," he said.
It didn't take much. Cagle loved that she would play a role in building a new dream for Clemson. Rittman, who had coached at Stanford and with the U.S. National team, told her he was putting together a team that would be competitive from the get-go. Clemson would make history and he wanted her to be a part of that. He organized a campus visit for her, and that was all it took.
During one of the team's first practices -- before the softball field was even finished -- Radcliffe called Jamieson to check up on Cagle. Jamieson told him a story of how he had set up eight players in the outfield and asked Clemson's pitchers to pitch to Cagle.
"I'm not kidding you, 10 pitches later, there's still not a ball in the outfield," Jamieson told him. "They're all over the fence, and all the girls are like, 'Who is this?'"
In the 27 games Clemson played in 2020 before the COVID-19 pandemic shut down the season, Cagle recorded Clemson's first home run at Clemson Softball Stadium against Western Carolina, earned the program's first save against Pittsburgh, helped Clemson win its first ACC game with a walk-off home run and helped the Tigers win their first game against a ranked opponent -- Georgia -- by pitching a complete game. She started all 27 games, hitting .376 and 10 home runs. She also accomplished her goal of throwing a 72 mph pitch, so she set a new goal: get to 72 wins and 72 home runs in her college career. (Spoiler: She already has 76 wins and 58 home runs.)
When Rittman announced that the season was canceled and the team was going home, it felt like the end of the world. The Clemson softball dream -- and by extension Cagle's college softball dream -- was just beginning to take shape. But Cagle realized as they returned for the 2021 season that the previous year gave them a "realistic taste" of what the team could accomplish. And now, she would get an extra year to bring Clemson's dream to life.
She kept in touch with her teammates during the pandemic, setting up Zoom workouts with Pereira and Bailey Taylor. Cagle would join early and do extra lunges as she waited for her teammates. After one workout, Taylor couldn't walk the next day after doing squat lunges and squat jumps. When she texted the group, Cagle responded, "Even I am struggling to walk." To which Taylor responded, "Well, if Valerie is sore, no wonder we are sore."
When softball resumed in 2021, Cagle was immediately in form. She started all 52 games, including 32 at pitcher. She threw more than 3,000 pitches and connected on 63 hits.
"Valerie took a brunt of the innings that year, and I think it really helped her grow and mature," Rittman says. "But I also think it took its toll on her physically as well."
During Clemson's 2021 NCAA regional against Alabama, Cagle felt pain in her shoulder for the first time.
"I asked her, 'What's up?' And she's like, 'I don't know, my shoulder hurts. It just doesn't feel right,'" says Clemson assistant coach Courtney Breault. "And I'm like, 'OK, well can you go?" And she's like, 'Yeah, of course.'"
When the season ended and Cagle's routine eased up, she felt better. In November, she represented Team USA's U18 national team at the Junior Pan American Games and the U18 World Cup in Colombia and Peru. From the circle and at the plate, she helped Team USA win gold in both and was named MVP at the World Cup.
But when she returned to Clemson in January 2022, with three weeks to go before the season started, the pain returned. It was worse than before.
ON A JULY MORNING five weeks after her agonizing 2022 season ended, Cagle sits in the passenger seat of Rovtar's car, bracing herself for a four-hour trip from Clemson to Birmingham, Alabama. She is about to meet with an orthopedic surgeon at the University of Alabama.
The pain that she felt on the softball field had leaked into her everyday life. Every time she bent down to pick up her water bottle from her backpack, she felt pain shooting down from her neck all the way to her right wrist. She barely slept two hours the night before, the shoulder pain prohibiting her from falling asleep. She can't remember the last time she smiled.
The Clemson medical staff had exhausted its options. The day the 2022 season ended, she was banned from playing softball. No hitting or pitching for five weeks. The rest, they thought, would ease her pain.
They were wrong. Her constant companion for six months now, the pain never subsided. After a month of this so-called healing rest, she could barely stir her mashed potatoes on the stove. Softball was her first love, but cooking was her second. Now neither gave her joy.
Something has to change.
In Birmingham, Dr. Lyle Cain confirms Cagle's conclusion. There are no additional non-surgical options. Without surgery, he says, Cagle would be forced to cope with chronic pain the rest of her career. Probably the rest of her life.
But surgery comes with a risk too: There is no guarantee Cagle will be able to throw 70 mph-plus after the surgery.
There is no case study for Cain to emulate. This type of surgery, biceps tenodesis, has been performed on baseball players, who emerged just fine as hitters and overhand pitchers. But what about an underhand pitcher? Her pitch speed, the thing her dad prioritized over all others, is not guaranteed to return.
Cagle remembers Cain's warning: "We don't have anything documented to know what this [surgery] does to velocity in a softball pitcher. We're relocating your biceps tendon -- that is not where God placed it, that's not where it was intended to be from the get-go. So, we don't exactly know what that outcome looks like."
After the appointment, Cagle buckles her seatbelt in Rovtar's car and opens her calendar. Her mind is made up.
She wants to stir her mashed potatoes without feeling excruciating pain in her shoulder. She wants to be able to lift her backpack. One day, she wants to be able to lift her children without feeling the dread that arrives before the pain. Yes, she would love to pitch the way she used to pitch again. But this is more than softball. She wants to be able to smile again.
She calls her parents. She calls Rittman.
"I am going to get the surgery," she says.
Rovtar is uneasy. They are wading into the unknown, and she is going to be responsible for Cagle's rehab. "That's a little bit more nerve-wracking when I'm looking one of the top 10 players in the country in the face and being like, 'You know what? This is your decision. We'll figure it out together,'" she says now.
Clemson's medical staff pores over research to see if there is a case similar to Cagle's they can base her recovery on. They find none. Cagle, Rovtar says, will wind up being a pioneer beyond all the Clemson softball firsts.
"When we do this," she tells Cagle, "you're going to be the first one to do this, and we're going to be responsible for writing the book on how we did this."
Days later, Cagle returns to Birmingham, this time for her biceps to be cut open. She doesn't know if she can ever be the pitcher she once was. But she is at peace with her decision.
THE NIGHT BEFORE her surgery, Cagle sits on the bed in her hotel room in Birmingham and opens her laptop. She types "bicep tendonitis surgery," pulls up a YouTube video of a doctor performing the surgery and takes a deep breath. As a health science major, part of her is "fascinated by this stuff."
"I was already having surgery; the decision was made. I might as well see what they're going to do," Cagle says.
After a fitful night, she feels calm before her 6 a.M. Surgery. Cagle remembers being rolled into the surgery room on July 19, then nothing. The procedure -- Dr. Cain removed the tendon from its groove, cut the inflamed part, drilled a hole in her upper arm and reattached the tendon to her humerus -- takes 30 minutes.
When Cagle gets back to campus, she falls asleep in minutes. "It might have been the meds," she says, but she sleeps without pain and disturbance for the first time in six months. Two days after surgery, Cagle tests positive for COVID-19, but even with a slight fever and congestion, she feels better than she has in months.
"When your body lives in a chronic state of pain, you're in flight-or-fight mode all the time," Rovtar says. "So being able to take away the pain mechanism, she was finally able to relax."
Rovtar maps out her rehab plan. For the first three weeks, Cagle will perform simple range-of-motion exercises. She is asked to lift her right hand, place her palm against the wall and press; she is asked to rotate her wrists, then her shoulders, then her arm. She constantly tells Rovtar, "This is boring, give me something harder." Rovtar responds, "No, I actually can't, we're not there yet."
She starts running after six weeks. She starts hitting and throwing overhand after three months. It all comes easy. Every day she waits, expecting something to go wrong. Expecting the pain to return. But the pain has disappeared. And her smile returns.
Mark Cagle remembers the first time he truly believed his daughter could pitch like she used to. It was 4½ months into her rehab. She had been cleared to throw underhand, and Valerie asked him to catch for her.
It had been years since Valerie threw to her dad. She was way too fast for that. But, because she was recovering, and wouldn't throw more than 70 percent, she wanted him to be present for it.
Her velocity wasn't what it once was, but he noticed her body language. Her shoulders weren't hunched over like they were most of last year. Her rhythm was back. She looked comfortable.
"Your speed is coming back," he said to her. "You can get it back."
VALERIE CAGLE BREAKS into a smile that makes dimples in her cheeks as she wraps her right arm around Rittman. Her Clemson teammates run to her, circle around her, jumping in joy. They wrap her in a hug as she bows her head. Her smile refuses to fade.
The McWhorter Stadium crowd erupts.
It's March 8, 2023 -- some three months since she threw her first post-surgery pitch -- and Cagle has just made history.
In front of a packed Clemson crowd, Cagle becomes the first person in program history to throw a perfect game. She retires all 15 batters she faces, striking out eight of them in five innings, helping Clemson beat Mercer 18-0.
She is not usually one to celebrate big. In the past, she was known for her stoicism in her celebrations. But that day and since, she has shown a childlike freedom to her celebration, pleasantly surprising her teammates and coaches.
To Rittman, her perfect game is "an outstanding accomplishment," but what is more impressive to him is her March 26 immaculate inning -- three strikeouts on nine pitches -- against Georgia Tech.
"Those were the nine filthiest pitches in a row to three hitters against [a] really good-hitting team," Rittman says.
Her efforts translated to accolades. She was named the ACC Player of the Year for the second time in her career. On Wednesday, she was named one of three finalists for the USA Softball Collegiate Player of the Year award. She is hitting .457 with 18 home runs, 53 RBIs and 46 runs scored. Her slugging percentage is .889. In the circle, she is 23-5 with 177 strikeouts, 7 solo shutouts and a 1.20 ERA.
The past month, though, has been rough for Clemson; after starting the season 37-1, the Tigers have gone 9-8 since April 6. For the first time in program history, Clemson failed to make it to the ACC championship game after getting no-hit by Duke in a 2-0 semifinal loss.
Still, Clemson is seeded No. 16 for the NCAA tournament and will open Friday against UNC Greensboro in the double-elimination regional. Also in their regional are Auburn and Cal State Fullerton.
After all she has been through, Cagle has adopted a big-picture view and remains optimistic. She is dedicated to making more history this postseason. Her eyes are still on the national championship.
But her approach to softball has changed. She knows how it feels to be unable to do the basic things in life without encountering immeasurable pain. Now that she can pick up her backpack, stir the food she loves to cook and sleep without interruption, she has simplified her approach to the game.
"I want to have fun," she says.
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