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The Arm: Inside the Billion-Dollar Mystery…
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The Arm: Inside the Billion-Dollar Mystery of the Most Valuable Commodity…

by Jeff Passan

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Passan, a longtime sportswriter most recently for Yahoo Sports, spent three years learning everything he could about baseball pitchers, and more specifically, the throwing arms of baseball pitchers. A great pitcher commands enormous salaries, and this despite the fact that serious elbow injuries are as common for pitchers as houseflies at a garbage dump. Given the enormous amounts of money at stake, Passan wanted to find out what MLB is doing to figure out how and why pitchers get hurt, and how those injuries might be prevented.

The most notorious pitching injury is a torn ulnar collateral ligament (UCL), which is located in the elbow. The surgery to replace the UCL, usually with a tendon from the player's own arm or leg, or from a cadaver donor, is known colloquially as "Tommy John surgery" after the first pitcher to ever have the procedure done. John went on to pitch successfully for many years after the surgery, and the surgery has been refined and developed to the point where it has come to see almost routine. Passan makes a convincing case that the high rate of success has had the perverse effect of disincentivizing teams from trying harder to find a way to prevent the injury. And the success rate, along with the growing tendency for young players to play baseball all year around, has led to an explosion of players as young as 12 or 13 having what is still major surgery, with a recovery window of 12-24 months.

Passan does a great job of demystifying the medical and biomechanical aspects of what exactly happens within a pitcher's body and arm when they throw a pitch. And while he never uncovers a "magic bullet" of training or predictive diagnosis that could keep pitchers from blowing out their elbows, he follows up on some promising research developments into the problem, almost all of it being done outside of professional baseball itself. It's hard to believe in an era when the Cubs happily agree to pay 32-year-old Jon Lester $155 million over six years that they aren't trying harder to protect such an outsized investment, but the evidence is right there in Passan's fascinating book. ( )
  rosalita | Oct 11, 2016 |
Read with alternating periods of horror and fascination. The 13 year-old really likes to pitch, may need to look up DriveLine (not far away) once he gets a chance to read the book. ( )
  kcshankd | May 21, 2016 |
For 130 years, pitchers have thrown a baseball overhand, and for 130 years, doing so has hurt them. Starter or reliever, left-handed or right-handed, short or tall, skinny or fat, soft-tossing or hard-throwing, old or young—it matters not who you are, what color your skin is, what country you’re from. The ulnar collateral ligament (UCL) , a stretchy, triangular band in the elbow that holds together the upper and lower arms, plays no favorites. If you throw a baseball, it can ruin you. When the UCL breaks, only one fix exists: Tommy John surgery…More than 50 percent of pitchers end up on the disabled list every season, on average for two months—plus, and one-quarter of major league pitchers today wear a zipper scar from Tommy John surgery along their elbows.

Major League Baseball (MLB) currently spends about $1.5 billion a year on pitchers. There is considerable financial incentive for organized baseball to find a solution to this epidemic of injury. And there is certainly plenty of human need on the part of players and their families for something to be done. How did this plague of injuries come to be and what can be done about it?

Jeff Passan is currently the lead baseball columnist at Yahoo! Sports. He got loose, picking up his journalism degree at Syracuse in 2002, did some soft-toss, covering Fresno State basketball for two years, warmed up his baseball writing in the hardball beat at the Kansas City Star for two years, and has been in the starting rotation with Yahoo for ten.

“My dad worked at The Cleveland Plain Dealer for 40 years, so I knew what I wanted to do when I was 12 years old,” Passan said. “I was very lucky. My dad has been editing my stuff for 20 years now and I can say he’s the best editor I’ve ever had.”

I am sure his editors at Yahoo will be thrilled to know that. He co-authored Death to the BCS: The Definitive Case Against the Bowl Championship Series, published in 2010. The Arm is his first solo book.

Mostly, I wanted to understand this for my son. He was five years old. He loved baseball. He wanted to play catch every day. He was hooked, like his dad. And the more I heard stories from other parents—of their sons getting hurt or boys they know quitting baseball teams because their arms no longer worked—the more I needed to figure out what was happening to the arm.

Passan takes parallel approaches to his subject, mixing hardball facts with softer stuff. There is a lot of information to impart. He compares the current injury rate and occupational environment to those of the past. He looks at the structure of the arm, considers the stresses it endures and presents competing theories on the causes of the current epidemic. He spends time with experts in the current state of UCL injury medicine, and talks with several proponents of alternative approaches to injury prevention and rehabilitation. One of these is Doctor Tommy John, Jr. And yes, Passan does talk with TJ Senior as well. He examines promising models for the future, including one new surgery that could have a dramatic impact on recovery time and another training approach that shows promise as a way of preventing the injury in the first place. He follows through, making a large point of showing that many of the current approaches to prevention and rehab are based more on wishful thinking than on hard science. He also goes the distance, traveling to Japan to look at how things are done there, and seeing if their approach is better or worse for arms.

While I revel in theory and data, there are many for whom it is much more informative to see how this widespread and growing problem affects actual humans. Analyzing the causes and effects, lost revenue, and lost time can leave one remote to the impact on living players and families. Passan’s other, softer approach comes in here. He had hoped to find one pitcher who would allow him to tag along through the entirety of his Tommy John process. He managed to find two. The emotional, human heart of The Arm lies in the stories of professional pitchers Daniel Hudson of the Diamondbacks and Todd Coffey. Coffey succumbed to a need for Tommy John a second time while pitching for the LA Dodgers. Passan is our eyes and ears as we accompany Hudson and Coffey on their painful sojourn from the Major League venue, through surgery and rehab, and their daunting struggle to make it back to the show. It may take a team to win a pennant, and a medical team to stitch up a damaged limb, but it takes supreme dedication to a lengthy and tedious rehab program, persistent optimism and a supportive family to lift a player from the depths of a career-threatening injury back up to a place where the lifetime dream of pitching in the major leagues (and the income associated with that career) might again be realized. The physical pain of a UCL tear can be intense. The emotional pain on display here is heart-rending. The struggles the players endure are intense and long-lasting, the triumphs uplifting, the defeats crushing.

One of the joys of The Arm is when surprising bits of information drift past like an Eephus pitch or an RA Dickey knuckler. There was a time when surprising solutions were tried to address arm problems. In the 1950s in Brooklyn (not Victorian London) doctors working for the Dodgers actually extracted teeth from prize pitching prospect Karl Spooner. “They thought poison was coming down his shoulder,” said Sandy Koufax. One shudders to imagine what they might have tried when faced with a knee injury. Passan offers some chin music to organizations like Perfect Game, an entity that, among other things, organizes tournaments for promising young (sometimes absurdly young) amateur players, and has played a significant role in youth baseball. I had never heard of it before, and had no notion the impact such entities have had.

In the absence of a better solution to this ongoing plague, and looking to biotech for an edge, I would expect that at some point in the not too distant future, MLB teams will require players to provide DNA and maybe even tissue samples for use by advanced labs so they can grow the parts that might someday need repair or replacement. (It does conjure a ballpark image for me of stadium hawkers peddling cold ones of a different sort from a beer cooler. “Getch yer tendons, heah,” but that’s just me.)

There are some hopeful signs (one finger for likely, two for less certain?) for being able to stem this problem in future. Flush with a large sack of TV moolah, the Dodgers have invested some real money in an in-house think-tank looking at player health issues. As Passan points out, it would be better for the resulting intel to be available league-wide, rather than held by one team for competitive advantage, particularly as the Tommy John plague has struck children at an alarming rate. There is some promising research that looks to the relationship of forearm muscles to the UCL. Maybe forearm training can do for torn UCLs what increased shoulder muscle training did to reduce career death by torn rotator cuff a few decades ago.

Jeff Passan has the smooth delivery one would expect from someone who writes every day about sports. He drops in occasional dollops of absolutely lovely description like a 12-to-6 hook.

The Currents Lounge inside the Hyatt Regency Jacksonville is a paint-by-numbers hotel bar, with a few flat-screen TVs, a menu of mediocre food, and a broad liquor selection to help people forget they’re drinking in a hotel bar in Jacksonville.

It generates an urge to look around and find out where the down-at-the-heel PI is hoisting another ill-advised shot while waiting for a femme fatale client. Another:

Nothing beats a major league mound, a ten-inch-high Kilimanjaro that few get to climb. Nobody in team sports commands a game like the pitcher. He dictates the pace and controls the tempo. A goalie in hockey or soccer can win a game with superior reaction. A pitcher prevents action. There is great power in that.

So, a sweet, writerly changeup to go with his intel-rich heater.

I have a particular interest in the subject matter here. A baseball fan since gestation, a Mets fan since their birth, I have been drooling over the possibility of (no, not tossing up a wet one) another trip to the MLB finale for my team, an organization with a collection of elite arms rarely seen in the history of the game. As a Mets fan forever, I am also far, far too familiar with the impact injury can have on the team, on any team. My Metsies’ chances flow nicely down the drain should the arms on which team hopes rest succumb to injury. Three of the five have already had Tommy John surgery, Zach Wheeler, Jacob DeGrom and Matt Harvey. How long can it be before Noah Syndergaard and rookie Steven Matz fall prey? As I was preparing this review, I came across an item of particular interest on the NY Mets site. Mets rotation features rare trio of flame-throwers, which focused attention on Noah Syndegaard, possessor of one of the most blazing fastballs in the game, and was reminded of one of the bits of intel in The Arm, namely that the higher the pitch speed, the likelier a pitcher is to be injured. The path from flame-thrower to flame-out is well worn and covered in the ash of lost dreams. And what if one of the already cut three should fall again? I am sure baseball fans everywhere share similar concerns. Even though, as followers of the national sport, we really have no impact on what happens on the field, it would be nice to at least be able to talk about the injury horrors from a base of knowledge, instead of the more usual dugout of pure, ill-informed bias. Passan’s The Arm offers fans that opportunity.

If, like me, you get a bit queasy, reading detailed descriptions of bodily innards, if, like me you experience what seems phantom sensations in your joints when reading about things that may go wrong there, if, like me, you still have tenderness or feel far too vulnerable in body parts like those under consideration here, The Arm will lean on all those buttons and feed your inclinations toward physical discomfort. On the other hand (the good one) if you are a baseball fan (check), player (sadly, no), a coach (once, for many years) a parent of a player, or several (long ago), or a friend or a relation of a player, get over the quease, have a drink, or apply whatever substances, legal or prohibited, ease the condition (no, not an ice-pack to the elbow, but if that works, well, sure, why not), whatever will get you past the discomfort, and shake it off. Jeff Passan's opus is truly a sight for sore arms and must read for you.

Review Posted - February 5, 2016

Publication Date – April 5, 2016

=============================EXTRA STUFF

Links to the author’s Twitter and FB pages

Dave Davies interviewed Passan on NPR's Fresh Air - March 31 2916 - Injuries Increase As Pitchers Throw Harder, Faster And Younger
Thanks to Henry for letting us know

Excerpts
-----from Sport Illustrated
-----from Yahoo sports

A piece on Passan receiving an award from the Sports Journalism Institute

He lives in Kansas City, so I hate him

With Tommy John Surgery, Every Scar Tells a Story - By Tim Rohan – NY Times – October 6, 2015

A bit of Light reading from Neil Roach, et al, on the evolutionary biology of throwing.
-----Upper body contributions to power generation during rapid, overhand throwing in humans
----- Elastic energy storage in the shoulder and the evolution of high-speed throwing in Homo
-----The latter of the above articles appeared in Nature magazine and included this lovely short video

More articles of interest
----- Velocity’s Relationship with Pitcher Arm Injuries by Jeff Zimmerman from The Hardball Times
----- Baseball Therapy - Dating the Impulse to Protect Pitchers - by Russell A. Carlton in Baseball Prospectus
----- Baseball Therapy - Prioritizing the Pitcher's Health - by Russell A. Carlton in Baseball Prospectus
----- Baseball Therapy - The High-Pitch-Count Hangover - by Russell A. Carlton in Baseball Prospectus

There are some interesting things to see at American Sports Medicine Institute (ASMI)

April 7, 2016 - I attended a book tour event tonight. Passan was interviewed about The Arm at a Barnes & Noble in lower Manhattan. He is a very young-looking thirty-something, and was resplendent in jacket and tie. My favorite line of the night was Jeff saying "This is not about wussification. This is about your children's health." He also talked about being present for Todd Coffey's four-hour TJ cutting. He described it as "pretty gross, but balletic," referring to the coordination among the medical professionals throughout the procedure. He was impressed that the Major League Players Association was on board so far with the growing science of tracking all the physical details involved in playing the game. Clearly management and union members have an interest in finding out how things work, what goes wrong, and what might prevent things from going wrong. As for understanding actual proper mechanics, Passan thinks that we are still at least a couple of decades away from a true understanding, the Japanese notwithstanding. But the perfect should not be the enemy of the good. We know enough now to still do something at the youth level to steer clear of a future darkened by damaged arms on an epidemic scale. If Passan's tour is making a stop near you, I suggest stopping by and saying hi. Aside from clearly being quite bright, and being a darned good writer, Jeff Passan seems like a pretty nice guy, and that never hurts.
  WillByrnes | Apr 8, 2016 |
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Amazon.com Product Description (ISBN 0062400363, Hardcover)

Yahoo’s lead baseball columnist offers an in-depth look at the most valuable commodity in sports—the pitching arm—and how its vulnerability to injury is hurting players and the game, from Little League to the majors.

Every year, Major League Baseball spends more than $1.5 billion on pitchers—five times more than the salary of every NFL quarterback combined. Pitchers are the game’s lifeblood. Their import is exceeded only by their fragility. One tiny band of tissue in the elbow, the ulnar collateral ligament, is snapping at unprecedented rates, leaving current big league players vulnerable and the coming generation of baseball-playing children dreading the three scariest words in the sport: Tommy John surgery.

Jeff Passan traveled the world for three years to explore in-depth the past, present, and future of the arm, and how its evolution left baseball struggling to wrangle its Tommy John surgery epidemic. He examined what compelled the Chicago Cubs to spend $155 million on one arm. He snagged a rare interview with Sandy Koufax, whose career was cut short by injury at thirty, and visited Japan to understand how another baseball-mad country treats its prized arms. And he followed two major league pitchers, Daniel Hudson and Todd Coffey, throughout their returns from Tommy John surgery. He exposes how the baseball establishment long ignored the rise in arm injuries and reveals how misplaced incentives across the sport stifle potential changes.

Injuries to the UCL start as early as Little League. Without a drastic cultural shift, baseball will continue to lose hundreds of millions of dollars annually to damaged pitchers, and another generation of children will suffer the same problems that vex current players. Informative and hard-hitting, The Arm is essential reading for everyone who loves the game, wants to keep their children healthy, or relishes a look into how a large, complex institution can fail so spectacularly.

(retrieved from Amazon Sun, 27 Mar 2016 12:38:00 -0400)

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