When Tommy John underwent a procedure to replace his left torn ulnar collateral ligament with a tendon in his right forearm back in 1974, it was seen as a miracle of modern medicine. Over the next 30 or so years, it morphed into the cost of doing business.
But the tenor has changed within the last decade. The number of cases has remained elevated, and many of them are pitchers undergoing their second ones, when recovery is far less guaranteed. It's showing no signs of abating, and the biggest drivers -- for instance, the demands of youth baseball showcases -- may be well beyond Major League Baseball's reach.
Painting a comprehensive picture of this issue is a tall task, but that's the goal "The Arm: Inside the Billion-Dollar Mystery of the Most Valuable Commodity in Sports." It's a new book by Jeff Passan, a national baseball writer for Yahoo! Sports. Since Larry and I both read it at the same time, we discussed it in an email thread, which has been edited for clarity.
Jim: We both recently finished Jeff Passan's "The Arm," and I'm curious to know your thoughts.
It exceeded my expectations, mostly due to the nature of this kind of book. Sometimes I'm a little skeptical of the shelf life of works that drop into the middle of the problem -- the historical context isn't rich enough, and the attempts at mapping out a future can be equally lacking.
But I think this one shows up at a good time, because the public isn't treating Tommy John surgery as casually as it used to (with so many guys going back for seconds), and the problem might not stand a chance of being resolved within the next generation, since the grind of youth baseball might have already destabilized the health of pitchers before they hit puberty.
Boy, that sounded grimmer than reading the book actually is.
Larry: It coalesced a lot of disparate information and opinions that I've read over the years. And that's the main reason I think the book is so intriguing. If you haven't closely been following arm injuries and pitching mechanics "theory", you'll pretty much be up to speed after reading the book. For those like me who have tried to follow this stuff, it brings it all together while also adding new information and perspectives that I haven't heard before. And Passan does a good job of making all of this interesting and readable, introducing and using "characters" like Daniel Hudson, Casey Weathers and Tomohiro Anraku to illustrate and humanize.
Jim: Yep, he had to get through some wonky stuff, both with medical approaches (standard Tommy John, other invasive and non-surgical methods) and biomechanics (Mike Marshall's method, "website" experts, Driveline). That's not an easy thing to do -- introduce an unfamiliar topic, describe something without the aid of video, then try to issue a judgment of its feasibility.
I thought he made it readable while being rather responsible. You can't ignore/dismiss the dilettantes because they're a part of the evolution (some people still think the "Inverted W" is a death sentence), and even the more introspective approaches -- Dr. Jeff Dugas and Kyle Boddy/Driveline come to mind -- are aware that dead ends are a persistent threat. That kind of uncertainty has allowed the confident voices to emerge, even if their proclamations might not stand up under scrutiny. Passan's willingness to drop into first person and recount questioning made it easier to shoot down the flimsier claims and bring some general order to the murkiness.
Larry: I did wince a bit at the space given to the charlatans.
Jim: I wonder if Passan does a little bit, too:
If you got The Arm at Amazon, please consider writing a review to counterbalance the work of some vindictive trolls: https://t.co/liqjVB5OtR— Jeff Passan (@JeffPassan) April 8, 2016
Boddy made way more sense to me at the end of the book. He'd always thrown me off due to what Passan described as "bouts of egotism," but having a third party interpret his personality and match it with his methods made him more stable/relatable in my mind.
Also relatable: the procedure itself. The blow-by-blow of Todd Coffey's surgery was helpful, especially the emphasis on the ulnar nerves and issues finding grafts.
Larry: I rarely have a problem with egotism - at least when it's backed up - and Kyle is a SB Nation alum, so I've been following him for a long, long time. He's been doing interesting stuff for just about all that time and I'm glad to see he's getting recognition for it in the book. I'm reminded of what John Henry said in "Moneyball" (the movie) to Billy Beane - paraphrasing, if teams aren't tearing down their arm care programs to use Boddy's methods, they're living in the past.
At the major league level, you can certainly understand the resistance to new ideas. But, at the minor league level, where you have tons of guys who are just happy to be in a uniform, teams have willing guinea pigs -- if clubs would just ask -- for trying out Boddy's methods for, say, velocity gains, along with other ideas a club may want to try out. You can't tell me that, among the boatload of minor league pitchers the White Sox released recently, you couldn't find a few who'd be up for letting the White Sox try any number of things with them if it meant they could still play.
Jim: Don Cooper was on Buster Olney's podcast a while back. He wasn't quite beating his chest, but he sounded pretty proud of the White Sox' track record with injury history. Regarding biomechanics, he said, "I learned it from people that were cutting-edge about mechanics before cutting-edge was cool. We've been on this for 35 years." And, later, "If there's people that have studied this more than me, I'd like to shake your hand."
I can't tell if that means the Sox would be stuck in their ways -- pretty good ways, all things considered -- or if they are updating their approach on a continuous basis.
It's a shame there wasn't much about the White Sox in "The Arm." I guess the closest it got was following Hudson, whose pre-surgery delivery Passan treated as an injury waiting to happen, at least according to those involved. No Sox personnel are mentioned, but I'm assuming they saw the same thing.
Larry: That was one of the rumored reasons for the trade of Hudson.
Jim: Did it change your attitude of the trade at all? I still don't think it was a good idea, at least the way it was (clumsily) executed.
Larry: Not really. Hudson delivered just as much value, if not more, than Jackson did over the relevant time period. And he cost less both in money and, obviously, players. Sure, maybe he doesn't do as well with the White Sox as he did in Arizona but I always had confidence in Hudson's ability.
Jim: And it's not any harder to root for him after reading the book. In the acknowledgments, Passan talked about how difficult it was to find a player willing to let him into the entire process. The reluctance is understandable -- there's little more personal than surgery, and the frustration leads to less-than-flattering moments where resolve is temporarily weakened.
What did you think of the chapter pertaining to Jon Lester and the Cubs? (Note: Passan spends a chapter detailing Jon Lester's free agency, and the efforts teams made to woo him. Lester has avoided significant arm problems so far in his career.) I'm glad to have read it, even if I think it was a bit of a stretch for the book's theme.
Larry: Yeah, it was a little bit of an odd fit. Ideally, I imagine Passan would have wanted to follow the free agent courtship of a player who has had Tommy John surgery already because we might have gotten some insight into how teams view that -- e.g., if they think a guy who had surgery [x] number of years ago has an "expiration date" on his new ligament. But, as we saw with finding a pitcher willing to let Passan follow his TJS, it probably wasn't easy to get someone to give that access. It became a little less odd when we found out that Lester has had bone chips in his elbow for awhile, so at least there was some additional hook to the topic of the book other than "he's a pitcher with an arm".
The dramatic change in Lester's valuation by the Red Sox was an intriguing thing that didn't get pursued very far, though I can assume why. Since Carmine (the Red Sox proprietary software program) is, of course, basing its analysis on the information and assumptions fed to it, it would have been nice to have known what exactly were the drivers of that change.
Jim: If there's anything else I found lacking, it's that I thought the improvement to shoulder health might've been a little bit underplayed. He did mention Jeff Zimmermann's work showing how many fewer days are lost to shoulder injuries, and while some of that may translate to the elbow, it still seems preferable to cases like John Danks. He has a lot of unsatisfied customers, and yet he's still fared better after capsule surgery than others in his situation.
Larry: It did get short shrift and I think I would've enjoyed reading some more thoughts on why/how the improvement in shoulder strength and health has led to where we are now. The pat "elbow is now weakest link" thing is the accepted answer on that - and it's essentially true, of course - but there's a lot more to unwrap in those five words, I think.
In a vacuum, I agree that elbow is preferable to shoulder. But I do wonder if the focus on strengthening other areas -- most notably the shoulder -- is now leading to more injuries than there were before. I'm not really focusing on the major league or pro level so much as looking further down the chain. You've got people -- parents, coaches, young pitchers themselves -- who have access to just enough information to be dangerous. Obviously there's a whole lot of factors to try to disentangle on that, most particularly the advent of year-round baseball and the resulting specialization. Kids are spending a lot of time on baseball-specific exercises, which they probably aren't even doing all that properly to begin with, and parts of the body are getting little to no attention or simply the "wrong" attention. And the imbalances and overuses result.
Jim: I suppose downplaying the decrease in shoulder injuries could stand up to posterity when you look at the charts. There might've been a sweet spot for a few years at the MLB level where the advancements in shoulder work started to pay off, but the strain on elbows had yet to manifest itself, either on MLB pitchers or new, young pitchers who have already had one TJS (and, extending it further, the previous TJS stems from overuse as a kid).
At any rate, it seems like the weaker areas of the book can be ... not excused, but rationalized. If Passan waited for the perfect test subjects, it might've taken another five years to write it. And since, as he wrote in the prologue, his own baseball-playing son is a big reason he wrote the book, I don't know if it'd been worth the wait, either for him or for the public. As it stands, it's an admirable and worthwhile attempt at addressing a present problem.