Glut of recent arm injuries highlights baseball's struggle to find answers

Glut of recent arm injuries highlights baseball's struggle to find answers

Four out of 1,200. Daniel Hudson sat in Dr. James Andrews' office in Pensacola, Fla., his elbow having failed him again, his baseball career in flux, his greatest nightmare choking rational thought, and amid the fear of a doctor cutting open his arm for the second time within a year, he could process only those numbers: four out of 1,200.

Andrews is the preeminent sports orthopedist of his generation, a master surgeon whose name alone makes the ulnar nerve of every pitcher tingle. A visit to Andrews is like a tête-à-tête with the Reaper. So when Andrews told Hudson a study showed that his sort of injuries – back-to-back blowouts of the ulnar collateral ligament, leading to two Tommy John surgeries – occurred just four times in 1,200 cases, his body went as numb as his arm.

"I honestly thought I was outside the norm," Hudson said. "At the time, I was."

Today, he wonders. All of baseball wonders. Over the last week, as the sport's reality slugged it square in the face – whatever it's doing to save pitchers' arms is not working – the names have prompted cringes. Atlanta ace Kris Medlen, scheduled for his second Tommy John surgery in 3½ years on Tuesday. Oakland opening day starter Jarrod Parker, headed for his second in 4½ years. Braves starter Brandon Beachy, likely facing his second in less than two years. San Diego starter Cory Luebke, like Hudson undergoing his second without throwing a major league pitch after the first.

And there are first-timers like Kansas City setup man Luke Hochevar and top hitting prospect Miguel Sano and Patrick Corbin, whose case especially saddened Hudson. They're teammates with the Arizona Diamondbacks, and Corbin's 2014 season ended before it began. An MRI showed ligament damage in his left elbow, and ligament damage means surgery, a reality with which Corbin was coming to grips Monday.

Hudson didn't want to impose. Just a pat on the back and a little encouragement. He heard the platitudes after his first surgery and felt the awkwardness following the second and knew that now is the time to let Corbin find his path to recovery. Parker, traded from the Diamondbacks to the A's in 2011, texted Hudson and asked about surgery the second time around.

"I'm the guy the guys are going to now," Hudson said. "This isn't a good thing to be an expert on. I'm the last guy I'd ever think to give advice on something like that, considering how bad a spot I was in nine months ago."

He was depressed. Angry. Contemplative. He rued the rehab. He hated the boredom. He dreaded the loneliness. That's what this is. No matter his support system inside the Diamondbacks, his wonderful wife, his great parents and brother, everyone and everything, the return from Tommy John surgery is a man's and his alone. It is why Hudson considered quitting. He tabled that thought quickly and vowed to face long odds.

Three pitchers have returned from back-to-back Tommy John surgeries. Doug Brocail took four years to get back to the major leagues. Same with Mike Lincoln. Denny Stark needed five. That's it. The list of two-time Tommy John survivors is a little more distinguished – Chris Capuano and Jason Frasor are long-timers, while Joakim Soria and Brian Wilson returned successfully last season – and should grow in the coming years.

In spite of pitch counts and innings caps and piggyback starters and coddling and extra days' rest and every other attempt to bubble wrap pitchers into long careers, UCLs continue to tear, and the only remedy is to replace them and hope the new ones don't rupture, either. Pitching injuries represent a majority of the more than half a billion dollars lost annually to the disabled list, and this week as much as any highlighted the sport's great epidemic, amplified by a frightening truth.

"I don't know," Hudson said, "if anybody has an answer."



For the last 21 months, I've followed Daniel Hudson's return from Tommy John surgery step-by-step. He and another pitcher recovering from UCL surgery, veteran reliever Todd Coffey, opened up their lives to me for a book looking at the pitching arm, baseball's greatest asset and its greatest scourge. How a $9 billion industry could exist more than 125 years after pitchers first threw the ball overhand and still operate with such a staggering lack of knowledge, such remarkable inefficiency, struck me not just as odd but irresponsible. Hudson and Coffey are conduits to a much larger story, one prophesied in the 19th century when a future Hall of Famer named Tim Keefe spat at the idea of a delivery anywhere above sidearm. He worried too many pitchers would get hurt.

While the shoulder is the far more important part of the arm, the elbow gets most of the glory because of its brand-name surgery – christened so following Dr. Frank Jobe's revolutionary UCL-replacement surgery in 1974 on John, whose career otherwise would've ended – and the prevalence of its survivors' returns. What once lasted four hours now takes the quickest practitioners under an hour. Tommy John surgery saved so many careers it developed a reputation greater than its reality. It is a miracle surgery, yes, but the miracle, too, is fallible.

"We're getting these guys back to pitch, but we're not making them bulletproof," said Dr. Neal ElAttrache, who will perform Hochevar's surgery Tuesday. "Maybe we're not able to change or even detect the problems that got them there in the first place. I don't have a better scientific answer than that as to why we're seeing this cluster. But the more we do, and the more guys get back into the major leagues, the more revisions we're going to be faced with.

"If they can rip out the ligament God gave them, they can rip out the ligament we give them."

Around baseball, all of the discussion this week concerned the elbow and what went wrong. The freak timing of it all – four All-Star-caliber pitchers in Corbin (24), Parker (25), Beachy (27) and Medlen (28) going down within days of one another – prompted cries to more research, greater knowledge, all of which sound well and good until the realization that the smartest teams already employ people tasked with cracking the arm's code.

Nobody has come close, which creates the cognitive dissonance across front offices spending billions of dollars on ticking time bombs. Even scarier is that they don't know which ones are ticking. And so teams experiment with different solutions and adopt the ones that make sense, like throwing fewer pitches will stress the arm less. Which, in theory, it does. Only arm injuries are more prevalent than ever, and maybe it's in spite of the pitch limits, and maybe it's because of the pitch limits, and back to square one we go, doing a do-si-do with purpose and outcome.

"[In] science you have to be able to see some result, whether it's a negative result and you acknowledge it and change or a positive result that reinforces what you're doing," ElAttrache said. "I don't know that we've made any difference. We certainly haven't decreased the amount of DL days. I don't know that there's been much evidence that we've made any difference."

There isn't, and it has set aflutter the biggest brains in baseball to consider conceiving a new approach. One general manager, who requested anonymity because teams' medical approaches have, in many cases, become proprietary, believes the problem is multifold and not just some function of bad luck.

It starts, he believes, in the early teenage years, a notion that dovetails with the research of the American Sports Medicine Institute, an Andrews-founded biomechanical think tank in Birmingham, Ala. Youth-sports specialization often forces kids to choose one sport at an early age, and rather than taking down time with football or basketball or soccer, baseball players throw year-round, far more than even a generation ago. Compound that with the prevalence of radar guns at youth games and the knowledge that fastball velocity wins scholarships and signing bonuses, and the incentive to throw hard and throw a lot, the GM said, is like a Molotov cocktail for an arm.

Another theory, one that people across baseball believe has merit, concerns the amount of throwing players today do – and that it is as much as, if not more than, the pre-pitch count generation. Between offseason workouts and a far more intense spring training, the number of pitches fired between November and February dwarfs the nonexistent winters and laid-back springs of yore. It's not just those. Increased velocity sport-wide puts greater strain on elbows, and the taxing nature of today's game isn't as much by volume as it is intensity level.

"You see guys going out there nearly maximal with every pitch, knowing there's a whole breed of middle relievers and short relievers and closers," ElAttrache said. "Most teams know they're using three to four pitchers in a game. The art of cruising on your arm, you don't see that anymore."

Already teams are starting to keep track of smaller data sets, like the number of times a relief pitcher warms up, how long he throws and how the nature of the bullpen affects the arm. Logically, getting loose and sitting back down is counterintuitive, like warming up a burrito, letting it cool to room temperature and reheating it later. Yuck. Some managers are bad enough about it that the GM compared pitchers' plights to that of NFL running backs, who are usually retired by age 30.

Maybe, the GM said, he's paranoid, or pissed, or curious, or just tired of not knowing. Baseball wants to know everything. It knows offense. It's going to know fielding with the installation of a defensive tracking system in all ballparks by 2015. It still does not know the arm, which prompted the GM to say with more resignation than anything: "I don't think any of us are finding better answers."



Todd Coffey's fastball hit 95 mph on Tuesday. Mixed among the 90s and 91s in a throwing session at R-S Central High in Rutherfordton, N.C., was the single hardest pitch he has thrown since he spent $500 on a Stalker Pro radar gun about 11 months after ElAttrache spent four hours digging through his arm to put it back together.

In the interceding 10 months, Coffey allowed ElAttrache to plow into his elbow once more to extract a bone chip that looked like it came from a wooly mammoth, showcased a middling fastball and slider to scouts during a tryout, went unsigned, fought through scar tissue, regained most of his velocity and readied to again restart his career. His first Tommy John, at 19 years old, lasted a dozen years. This one would at least get him back to the big leagues.

So went the thought during the low moments, the interminable hours on an elliptical, even the better things like days spent catching up on life – daddy-daughter dances, extreme-couponing outings – instead of baseball. Coffey yearned for the clubhouse: its attitude, its taste, everything it represented. He grew up in one; he refused – refuses – to divorce it, hopeful mutual love again will blossom.

The 95 meant everything, even if it was an outlier. For one pitch, Coffey again felt like a major leaguer. It's why Kris Medlen and Patrick Corbin and Jarrod Parker and Brandon Beachy will make it back, why Daniel Hudson convinces himself the day-after-day slog of showing up, sweating through the same activities and progressing like an inchworm never can lose its luster. This takes perseverance. Rewards do exist.

"It's there," Coffey said. "All I really have to do now is get the mechanics right. I know the mechanics are off. I can feel it. And the tough part is it's been more than a year and a half since I've pitched competitively."

The plan was for the book to drop right around now. Both guys would have thrown in the big leagues. It would contrast Coffey and Hudson – the veteran and the kid; the reliever and the starter; the guy winding down his career and the guy just starting his – while telling the many other fascinating stories of the arm. Those still exist. The main characters long ago diverged from their presumed paths.

Which should've been evident from the start, because nothing goes smoothly with the pitching arm. It is an enigma dipped in lighter fluid and struck by a match. Even Hudson, the expert on experience alone, doesn't pretend to understand what happened with his elbow or any of the others that went this week for the second time.

"I don't know how long they used to last," he said. "It's hard for me to comprehend why it's happening so often now. It's not like the protocol has changed in the last 10 years. Why did this not happen more often 10 years ago?"

Questions about the arm beget more questions, and it's a wormhole down which Ivy Leaguers and charlatans alike drop willingly, because the reward is so great, the payoff so lucrative. The solution may be there, and it may not, but there is one certainty, and one alone, about the arm: As long as people use it to throw a baseball, they will keep trying to find that answer.

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