The Arm (28 page)

In 2014, ARPwave sent a unit to McKenzie, which he tested on two people with soreness on the inside of their elbow. He jumped on a Skype call with an ARPwave protocol specialist who gave specific directions on where to place the electrodes. After the session, the patients were asked if they felt any better. One said no. The other said a little bit. Then, after the Skype call
hung up, the patient confessed to McKenzie that he felt nothing except pain. He just didn't want to hurt the ARPwave specialist's feelings.

Whatever caused the healing mattered not to Martin. He could play baseball. After a stint in junior college, he joined the University of South Carolina baseball team, one of the country's finest programs, without another visit to an orthopedist. “It's gotten sore every now and again,” Martin said, “but I've never really had bad arm pain since.” If ever anyone asks, Martin plays evangelist for the ARPwave. “I still try to tell people,” he said, “and they don't believe me and have Tommy John surgery right away.”

One rehab clinic in Dallas claims to have saved more than forty kids from Tommy John surgery using the ARPwave, and Dr. John swears by it. He also makes rehabilitating adults crawl on the floor and believes the body can be trained to withstand between seven hundred and nine hundred throws every day. He sounds like the classic charlatan until Jared Martin flips the narrative and provides the sort of triumph rare for baseball today: a partially torn UCL that didn't necessitate Tommy John surgery.

I don't know if the ARPwave is just another machine that leeches thousands of dollars out of patients or one that can replace platelet-rich plasma therapy as the go-to method to help damaged but still intact UCLs. For his varying philosophies, Dr. Tommy John is unquestionably right about one thing: he believes the human body is a sublime creation capable of the seemingly impossible. That idea comes from wisdom passed along by his father. Tommy John's curiosity and courage live on not just in the scars of elbows across the sport he loves but in the mind of a son who tries to do the same thing as another doctor he knew well: help people.

T
WICE A WEEK FOR SEVERAL
years, an eighty-eight-year-old man with a full head of white hair, tinted eyeglasses, and a welcom
ing smile used to pull up in a car to the Kerlan-Jobe Orthopaedic Clinic. Frank Jobe couldn't stay away from the building with his name on it. He parked himself on a bench near the facility's front entrance and said hello to everyone who walked by before retreating to the lunchroom, where he regaled his dining companions with stories.

One of Jobe's favorites involved the trespassers in his backyard in Brentwood. They'd come for more than twenty years, arriving at all hours of the night with metal detectors and flashlights and magnifying glasses, hunting and snooping and skulking along the ground. None ever found the prize: a murder weapon. Jobe's house happened to back up to 360 N. Rockingham Ave., the address of O. J. Simpson.

Doctors sat rapt listening to Jobe the raconteur, almost as good as Jobe the orthopedist. To them, he was a demigod because of Tommy John surgery, today still the crowning achievement in all of sports medicine. It was the big bang of the arm, the moment that gave life to limbs without any, and the appreciation of Jobe from medical offices to clubhouses multiplied even after he retired from active practice at eighty-three.

Every biomechanics obsessive wants to do for baseball's future what Jobe did for its past. During retirement, the credit due Jobe finally started to find him. Before a game at Dodger Stadium in 2012, Tommy John stood on the mound, ready to throw out the first pitch, when he signaled for a new pitcher. Over walked Jobe, still John's closer decades later. “Thank you, Dr. Jobe,” John said. A year later, they saw one another again in Cooperstown, New York, home of the National Baseball Hall of Fame, which honored Jobe's career during induction weekend. John sat in the audience that day.

“We did a little surgery, but the man did all the hard work,” Jobe said in his speech. “His tenacity and unique intelligence enabled us to develop the rehab program that has lasted the test of time. We all worked together and as a result, Tommy returned
and played fourteen years without missing a start and he won 164 games after returning from his surgery.”

This was the Frank and Tommy show, both of them modest and deferential to the end. As confusion about the arm endangered baseball, they were proof that progress is not a dead end. Every day, Todd Coffey and Daniel Hudson and thousands of other pitchers from high school to the major leagues were performing a series of strengthening exercises developed by Jobe and physical therapist Diane Radovich Moynes. Officially, they're called the Thrower's Ten, but everyone knows them by another name: “Jobes.”

Mostly they focus on the shoulder, and it was Jobe's obsession with strengthening it that helped revolutionize the maintenance and care of the arm. The unintended consequence, of course, left baseball in its current place. “We do such a good job with the shoulder,” Jobe said, “that it ends up hurting the elbow.”

John's left shoulder never bothered him until a few years back, when pain from arthritis seared through it. Before he went in for an MRI, John's agent, Kim Berger, wondered if the technician might pan down. No one ever had seen an image of the most famous elbow in the world. John picked two still pictures, mounted them side-by-side, added photos of himself and Jobe, and sent Jobe a hundred copies to sign. Today, they sell for $1,295 a pop. The proceeds, John said, go to the Let's Do It Foundation, named after the words he once uttered in his most desperate moment. “If I had any idea it would've been this big,” John said, “I would've trademarked the surgery and had all those SOBs pay me.”

Unless Tommy John's son or anyone else invents a more successful procedure, he will have to settle for the unpaid prestige of having a more lasting influence on baseball than most players in Cooperstown. It's a burdensome honor, too, since the last two words baseball players the world over ever want to hear themselves utter are “Tommy John.”

The stigma doesn't do justice to the miracle it was, one that Tommy John and Frank Jobe celebrated whenever possible. Chance brought the two together in January 2014 at the Humana Challenge, a golf tournament in California that John attended as a fan and Jobe as emeritus physician for the PGA Tour. A mutual acquaintance told Jobe that John was in town, and Jobe relayed a message: “You'd better get your butt up here.” John rushed up to the rehabilitation trailer and gave his old friend a hug. Jobe looked frail to John. They spoke for ninety minutes, traded stories, mostly the same ones they'd laughed about for years. When John said good-bye, he made sure to take a mental snapshot of his old friend.

Six weeks later, on March 10, 2014, Frank Jobe died. Nearly every obituary included Tommy John's name in the first paragraph.

“We're going to be identified together for the rest of our lives,” Jobe once told me, and though John's name will live on for time immemorial, Jobe remains a constant source of inspiration in a place that matters even more: the part of the swamp that eschews the marketing for the sort of pure, fact-based science Jobe himself practiced.

F
ROM THE THIRTY-FIRST FLOOR OF
245 Park Avenue, the world looks like one giant possibility. Major League Baseball's offices sit almost smack-dab in the middle of Manhattan, surrounded by progress and innovation, but baseball is a reactionary business, as was never more evident than during a conference call in the spring of 2014, when, from his office in Milwaukee, commissioner Bud Selig demanded action on the elbow issue: “I want you to do something about it,” he said.

Over the previous few weeks, Selig and his eventual successor, Rob Manfred, heard from Atlanta Braves president John Schuerholz, whose opinion Selig held in the highest regard. Over a four
day span in March, Schuerholz saw 40 percent of his rotation vanish due to Tommy John surgery. Kris Medlen underwent a second Tommy John, just three and a half years after his first. Brandon Beachy hadn't thrown a single pitch between his first Tommy John and the revision twenty-one months later. Schuerholz, the architect of the Braves dynasty led by two paragons of durability, Greg Maddux and Tom Glavine, called upon Selig and Manfred to use baseball's resources and figure out how to stop it.

Chris Marinak had been girding for this moment for five years. Marinak is Major League Baseball's senior vice president of league economics and strategy. He is thirty-five, tall, with an executive's head of hair and a mind to match. After he graduated from the University of Virginia, Marinak spent four years at Capital One working as a data-analytics manager before grabbing an MBA at Harvard and joining baseball's labor-relations department. He earned a reputation as someone who could be trusted on big projects, and this particular one was a doozy: he wanted to create a massive database of standardized health records that extended from the major leagues to the lowest level of the minors. Marinak understood the best chance baseball had at preventing injuries was stopping them before they happened, and the quickest path involved towers of data and the possibilities inside them.

Starting in 2009, Marinak oversaw the construction of baseball's Health and Injury Tracking System, or HITS, an electronic medical records system that logs everything from icing an arm or swallowing an Aleve to full MRIs or biomechanical analyses. Teams used to keep medical data on paper. When a deal was in the works, teams would FedEx reams of records to their trade partner. Now it would be as easy as a click.

Marinak's aspirations for the system were far bigger than convenience. He wanted to truly comprehend complicated injuries. At its finest, HITS could help answer a question Marinak has been asking himself since he was a teenager: Why does this happen? Playing elite baseball as a kid, Marinak's elbow hurt. Doctors di
agnosed a bone spur when he was fourteen and told him to keep pitching. The discomfort was a constant companion, all the way through his four years pitching at UVa. He considered surgery but thought better. “Sitting out for a year with no guarantee of return seemed like a lot to sacrifice, especially if you weren't on track to make millions in the future,” Marinak said. “I pitched through it, but it definitely held me back at points pitching through pain.”

The pain only heightened his curiosity. Surely others hurt in the same areas he did. What were their symptoms? Or their usage patterns? Or the angle of their shoulder at maximum external rotation? These were all measurable with a visit to the trainer, some good bookkeeping, or a biomechanical analysis. And with 240 minor league teams on top of the 30 in the major leagues, that would be more than three thousand pitching samples a year. Some would flame out, but plenty would last multiple years, giving Major League Baseball a longitudinal set of data. With that, the possibilities were endless, the knowledge limitless.

When devising HITS, Marinak called Dr. Keshia Pollack, an associate professor at the Johns Hopkins Center for Injury Research and Policy. Pollack was an epidemiologist, sniffing out patterns that lead to disease or injury. She would study everything from military vehicle crashes to obesity in the African American community, and Marinak asked her to consider diversifying her scope of practice by studying a multibillion-dollar industry and helping fix it.

Involving epidemiologists to assess the arm was vital. No individual team had cracked the injury code. Marinak's time in data analytics taught him that the right people can move mountains with numbers. Major League Baseball was the perfect subject to study. Once the union signed off—the prospect of baseball using the data or findings to punish players financially was outweighed by the potential benefits of finding a solution to arm issues—Pollack and her colleague Dr. Frank Curriero had a seven thousand–subject population.

Even one year's worth of data immediately changed the way baseball operated. In the program's pilot season, Marinak and his team focused on concussions. Though football's concussion issues dwarf those of Major League Baseball, Marinak figured any head trauma warrants a better understanding. Baseball tracked 190 concussions that season between the major and minor leagues and found that roughly half of the cases returned in seven days or fewer. Rather than force teams to place players with mild brain injuries on the fifteen-day disabled list or return them to action prematurely, Major League Baseball created the seven-day disabled list for concussions in 2011.

“This is probably one of the richest data sets I've experienced in my public health career here,” said Curriero, who joined Pollack on the baseball project in 2012. “I would always err on the side of wanting more information than less. You just need to suspend the time and effort to go through it.”

After suggesting the concussion DL, Pollack and Curriero studied the most common injury in baseball—the strained hamstring—and found the vast majority occur within the season's first six weeks. Teams instituted protocols during spring training to promote hamstring health, and the number of injuries fell immediately. That, Pollack said, is the objective: “Take data, change policy, and make the environment safer.” While Curriero, a biostatistician by training, specializes in mapping data and finding geographic cues—do hamstring strains really happen more in cold-weather cities?—Pollack takes macro approaches in how to promote secure and healthy workplaces, a goal that sounds better suited for a widget plant than a field in which the average worker makes more than $4 million a year.

What made HITS tantalizing was its ability to transform data into change. So many potential advances in the knowledge of the arm were purely theoretical, rooted more in belief than science, and here Marinak was hoarding a mother lode of fact. It was a fact, for example, that right before Daniel Hudson flew to Jack
sonville for the rehab start after his first surgery, Ken Crenshaw's note in HITS said: “Feeling good this a.m., played catch with no issues. Flying to Jacksonville to make rehab start with Mobile. Seven innings, 80 to 85 pitches.”