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There is one truth about the pitching arm, and it is the most unsatisfactory sort: nobody fully understands it. Not the most brilliant doctors. Not the brightest biomechanists. Not the best pitching coaches, the keenest scouts, the crème de la crème of pitchers. The arm is like the human genome. We've got a map in place. We just can't navigate it with any confidence yet.
There are people devoting their lives to figure it out, many smart people who analyze it, track it and study it through every avenue imaginable. All of the above, plus athletic trainers, economists, astrophysicists, amateur charlatans and more, each of whom wants so badly to solve it, even if the possibility exists that they're chasing a unicorn.
None could figure it out in time to save Matt Harvey. The breakout star of 2013 is broken, the ulnar collateral ligament that holds together his right elbow partially torn. He will be fixed, whether through rehabilitation or surgery. The New York Mets didn't indicate how severe the tear is, so it's impossible to assess the likelihood of his return without Tommy John surgery. History says the best-case scenario is that Harvey pitches a few years before it fully blows out. The best example of a rehab case was Adam Wainwright, who got six full seasons following a partial-tear diagnosis.
Outside of a few others – notably Ervin Santana, Takashi Saito, Scott Atchison, J.J. Putz and Danny Duffy, who later blew out – rehab of any sort of tear does not work. Among those who tried it only to end up under the knife: Chad Billingsley, Cory Luebke, Dylan Bundy, Carl Crawford, Rafael Furcal, Neftali Feliz, Daisuke Matsuzaka, Arodys Vizcaino and Jamie Moyer. And plenty more, from Jordan Zimmermann to Kris Medlen to Junichi Tazawa, went for surgery despite their UCLs not being fully torn. While trying to rehab is the responsible thing, it usually just delays the start of an arduous process: the physical rebuilding of an arm and the mental rebuilding of a man who must re-teach himself how to use it.
It is devastating not just for Harvey and the poor, poor Mets but all of baseball. No sport loses as many players to the same catastrophic injury as baseball does the elbow. Among pitchers, there is almost an inevitability to their elbow blowing out, to the point of engaging in gallows humor when it does. Said one person close to Harvey: "The rite of passage with big arms. Thankful no shoulder issues."
If Harvey can take solace in anything, it's the relative success of Tommy John surgery, in which doctors will take a tendon from one of three places – the palmaris longus in his wrist, the gracilis in his thigh or the semitendinosus from a cadaver – and tie his humerus and ulna back together. The wicked truth about the arm is that we have a far better idea of how to fix it than how it breaks.
Arm injuries always have existed, dating back to the late 1800s when pitchers started throwing overhand. The theories on their prevalence today range from bad mechanics to overuse to excessive velocity. Delivery doctors get paid big bucks to teach kids how to throw properly. (The general consensus on Harvey was that he had a clean delivery, though some amateur biomechanists believe his arm came through a fraction of a second late, placing additional force on his UCL.) Coaches from Little League to college are castigated for high pitch counts. (Harvey once threw 157 pitches in a game at the University of North Carolina and regularly went above the standard ceiling these days, 120.) Whether it's Stephen Strasburg, Jason Motte, Feliz or high schooler Lucas Giolito, the correlation of a triple-digit fastball and Tommy John remains a fascinating topic to researchers, who wish the sample size were larger. (Harvey hit 100 twice this season and threw harder than any starter in the major leagues.)
Currently, everything is a guess. The strongest studies show there is something to overuse, despite the protestations of those who wish for the good ol' days, and that baseball's proactivity in adopting limits for pitchers is a prudent move. Still, that does nothing for Harvey, nor do some of the recent results of Tommy John surgeries. Ryan Madson's setbacks have ended his 2013 season after the surgery did the same for 2012. Scott Baker had surgery in April 2012 and isn't back. Luebke's was a month later, and he won't return until 2014.
Worst was what happened to Daniel Hudson and Brandon Beachy, whose Tommy John surgeries in summer 2012 came within a week of one another. In his first rehab start back this year, Hudson re-tore his and underwent a second surgery. And after leaving his most recent start with elbow pain, it is strongly believed that Beachy will require a second surgery, something that could be confirmed as soon as Tuesday.
Understand: What Harvey will face at some point in the near future is not, as Braves manager Fredi Gonzalez put it in spring training, "almost like a root canal." Harvey is a very bright man, educated well by agent Scott Boras, whose interest in pitchers' health spearheaded the Nationals' handling of Strasburg after his blowout. He was glum on Monday because he knows what his future holds, even if it was too difficult for him to say it.
For his whole life, Harvey has wanted to throw a baseball, and unless he is an outlier like Wainwright – unless he's the absolute exception to a rule that's rather hard and fast – he is going to spend a year doing everything but that. He is going to sit around with his arm immobilized for a month, and then he's going to do activities to strengthen his shoulder, and then he's going to spend too much time shoving his hand into a bucket of rice and learning to grab again, and then he's going to toss a ball 10 feet and feel like it's 10,000, and then he's going to agonize over remembering what it's like to do what always came so naturally to him.
He's going to have setbacks, because everyone does, and he's going to fall asleep at night scared as hell that it's going to happen again, because he's human and no matter how positive a person wants to be, only so much optimism exists when there's a scar smiling along your elbow.
Harvey's return will be a great day for the Mets and the sport, even better if in February 2014 following successful rehab instead of February 2015 following successful surgery. Such is the gift and curse of the arm. It can give us days when Matt Harvey throws 100 mph with the best slider in the game and an undeniable swagger atop the mound. And it can give us days like this, when you wish he didn't throw as hard or pared back on the pitches or didn't pronate his arm quite as early, when the map led to another dead end.