Peavy navigates well through uncharted waters

TEMPE, Ariz. – The next step in baseball's latest science experiment went off without a hitch Friday. Three years removed from a unanimous Cy Young Award, Jake Peavy(notes) now carries another sobriquet: guinea pig.

Peavy walked slowly and deliberately to the pitcher's mound at Tempe Diablo Stadium. He turned around, inhaled the desert air and spring training soundtrack, went to doing what he knows best – and what he wasn't sure he'd ever do again.

Eight months ago, Peavy threw a 94-mph fastball and squealed in pain. The latissimus dorsi – better known as the lat – is the biggest muscle in a person's back, and Peavy's, for lack of a better word, exploded. Technically, the tendon connecting the muscle to the bone had ruptured, which caused the muscle itself to avulse – pull away from the bone, a frightening, painful and extremely rare injury. Orthopedists almost never see full lat tears. No elite pitcher ever had been known to suffer one. It might as well have been a death sentence on Peavy's career.

Except that he was granted a stay, his doctors banking on a minimally tested procedure and his trainers with the Chicago White Sox concocting a rehabilitation plan in hopes that it might – with a big emphasis on might – work. Whether the two hitless innings Peavy pitched against the Los Angeles Angels on Friday was a fleeting moment of glory or a harbinger for greater things is impossible to say. Undeniable were the numbers flashing on radar guns – 92 mph, three times – and the grin on Peavy's face following his outing.

"I did what I expected to do, hoped what I'd be able to do, which is turn it up a level and get some big league hitters out and feel normal in doing that," he said. "I think we accomplished that today. We put a lot of questions and issues to rest."

What doctors expected to be a one-year recovery process now looks conservative, and the idea of Peavy starting the season with the White Sox, as he had boldly predicted, isn't so far-fetched. The presence of his darting fastball and array of breaking balls would turn the White Sox from fringe contenders into perhaps the American League Central favorite and allow the 29-year-old to return to the normalcy not even he could've seen.

While initial reports tied together the fluid found in Peavy's shoulder a few weeks prior to the rupture, it was actually the classic cascade injury – Peavy compensating for another hurt body part (ankle) by adjusting his mechanics, which, in turn, led to the detached lat.

After Peavy left the game in early July against these same Angels, White Sox general manager Kenny Williams tried to give him words of encouragement: "Couple weeks," he said. Peavy knew it wouldn't be. "Something's wrong with me," he told Williams.

The MRI confirmed that the bulge in his skin was the folded-up muscle, and Peavy went in for surgery with Dr. Anthony Romeo, a Chicago orthopedist. Ben Sheets(notes), Kerry Wood(notes) and Tom Gordon(notes) all had partial lat tears. Only Brent Leach, a Dodgers relief pitcher, had undergone surgery for a full tear, which had been repaired by Dr. Neal ElAttrache. He returned with the same velocity he had pre-surgery.

"There is reason," ElAttrache said via e-mail, "to be optimistic about (Peavy's) recovery."

ElAttrache suggested the procedure to Romeo, whose staff videotaped the surgery as a primer for future ones. If ulnar collateral ligament replacement is Tommy John surgery, lat reattachment may well turn into Jake Peavy surgery. (Brent Leach surgery doesn't have quite the ring to it.) Eventually, Peavy watched the video of the three-hour procedure in which Romeo used four anchors to re-attach the lat to the bone.

"I remember telling my dad, 'No wonder I was so sore,' " Peavy said. "After the surgery, I felt like I'd be annihilated. It was gruesome."

Peavy understood the risk of such rare surgery. Ruptured tendons are among the worst possible injuries an athlete can suffer. Some, such as the biceps tendon, are palatable. Edgar Renteria(notes) hit his World Series-winning home run last year with a torn biceps tendon. Brett Favre played with one in 2008 and excelled in 2009 after it was repaired.

The lat is a different beast, seminal to overhand throwing. And while catastrophic tendon tears have been linked with steroid use – in one of the known lat cases, the patient was asked whether he had used them – such an injury could be perfectly natural for a pitcher, according to Dr. Orr Limpisvasti, a surgeon at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles.

"The overwhelming majority of tendon injuries in athletes have nothing to do with anabolic or catabolic steroids," Limpisvasti said. "It's a latissimus injury in a pitcher, which is a well-described injury pattern."

With a rehabilitation plan laid out by the White Sox's veteran trainer, Herm Schneider, Peavy started throwing in November. Whereas one of his workout partners this winter, Stephen Strasburg(notes), followed the regimented rehab of Tommy John patients, Peavy's program had little precedent. Everything he did was documented: what worked, what didn't, how much he threw, how hard he threw and, most important, how he felt.

Friday's entry: Great.

"He's maybe got tiger blood," said White Sox manager Ozzie Guillen, who added: "If that injury happens (back when I played), he's done."

Modern medicine is a marvelous thing for athletes, and Peavy – would it be Charlie Peavy or Jake Sheen, with that tiger blood of his? – simply wants to wake up Saturday without any pain. That will give him the go-ahead for the next step: three innings Wednesday. For now, 26 pitches, 16 strikes, mostly fastballs with a few sliders and curveballs mixed in, whetted his appetite.

"I'm not worried about risking anything in the future," Peavy said. "A lot of people go, 'How's your shoulder? How's your shoulder?' My shoulder's fine. I've got a great rotator cuff. I've got a great labrum. I just did something very freaky."

And in coming back, he's doing just the same. Guinea pig, science experiment – whatever you want to call Jake Peavy, he's OK with it.

Just as long as he can still call himself a pitcher.