The Arm (7 page)

His arm held up until the middle of the summer in 1966. On July 23, against the New York Mets, Koufax threw a 168-pitch complete game, which followed a ten-day stretch during which he had pitched in four games and tossed twenty-four innings. His manager, Walter Alston, thought he left Koufax in for 200 pitches. “I worried that maybe I should get him out of there,”
Alston told reporters. “I know he's not right, and I'm half-afraid of hurting him. But with a doubleheader coming up, I didn't particularly want to use the bullpen.”

Koufax saw its effects instantaneously. Fluid gathered in his elbow, more than usual. Kerlan drained it and injected it with cortisone, the top-shelf numbing agent of the time. Four days after he threw 168 pitches, Koufax struck out sixteen in an eleven-inning complete game. He didn't miss a start the rest of that season and finished with more than three hundred innings pitched for the third time in four years.

Sandy Koufax retired after the 1966 season, done in by baseball's ignorance and sports medicine's primitiveness. He was thirty years old, at the peak of his greatness. Koufax was worried that his ravaged elbow would keep him from golfing or washing his face or shaving, and he refused to trade another year of throwing a baseball for a lifetime of disability. No doctor saved him, because no doctor knew how. “In those days, they believed if you opened an arthritic joint it got worse,” Koufax said. “Medicine changed.”

Koufax was never diagnosed with a damaged UCL. He doesn't think he tore it, either, though with all the trickery used to enliven his arm, he can't say for certain. He just believes its expiration date was thirty, and whether it was the spurs or the bursa sac or the ligament, his arm was too far gone for medicine at the time to remedy it.

“I was hoping I would live longer after baseball than before,” he told me. “And I've made it. In those days there was the question of are you going to have full use of your arm, are you going to do this or that. . . . Because the draining, the eating Butazolidin, everything you can to get through—I thought when the doctor tells me it's time to stop, it's time to stop.”

The arm in baseball has had two eras: Before Tommy John and After Tommy John. Koufax was perhaps the closest to that bridge. When Koufax joined the Dodgers organization, more than six hundred players came to spring training, an exercise in
Darwinism. Dozens developed arm injuries—either arm fatigue or tendinitis or dead arm or some other vague complaint—and never returned. The survivors were major leaguers.

In the final week of the 1954 season, the Dodgers summoned from Triple-A a twenty-three-year-old left-hander named Karl Spooner to start two games. In his first, against the New York Giants, the eventual World Series champions, Spooner threw a three-hit shutout and struck out fifteen. He followed with a four-hit shutout and twelve more strikeouts against the Pittsburgh Pirates. “He was as good as anybody you've ever seen,” Koufax said. During spring training in 1955, after Dodgers starter Johnny Podres—later Jobe's patient—got pounded in an exhibition game, Spooner came in without sufficient time to warm up. His left shoulder barked. He exited the game and started treatment. The pain didn't ebb. He tried to rehab it. Nothing worked. Doctors went medieval.

“They pulled his teeth,” Koufax said. “They thought poison was coming down into his shoulder.” He was not exaggerating. With all medical options exhausted, doctors yanked teeth out of fear they were emitting harmful toxins into the bloodstream. Karl Spooner threw his final major league pitch when he was twenty-four. His shoulder never stopped hurting.

T
HE ARM NEEDED A SAVIOR,
and even if he couldn't remedy the shoulder, Frank Jobe resolved to rescue the elbow. The surgery existed only in theory, in Jobe's mind, and still he went into it with a confident and fully supportive team. “The nurses in the operating room said, ‘Your dad has a certain way of setting his jaw,'” said Dr. Chris Jobe, one of Jobe's sons and himself an orthopedic surgeon who today performs Tommy John surgeries. “It seems like the operating room is ten degrees colder all of a sudden. He didn't have to get mad. He was sensitive to you, and you became sensitive to him.”

On September 25, 1974, eight years after Koufax retired from
baseball, Jobe scrubbed in with Robert Kerlan, Herbert Stark, a doctor on fellowship named Stephen Lombardo, and a gang of support staff at Centinela Hospital Medical Center. In order to reach the UCL, Jobe detached the flexor-pronator muscles from their connection in the upper arm. Holes drilled, palmaris longus harvested, he wove it into position and tied it tight. Jobe transposed the ulnar nerve, tucking it beneath the muscles and securing it before closing John's elbow. The procedure took four hours, some of which consisted of Stark good-naturedly bugging Jobe for Lakers tickets.

“The most impressive thing to me as a rookie doctor was that technically he did the surgery like he'd done it a thousand times,” Lombardo said. “It would be like you and me opening a door and walking into a room. It wasn't just a random thing that was done. It was very well thought out.

“He was a gifted surgeon. Most orthopedic surgeons are well trained. But he had a style and smoothness to his surgical technique that was many standard deviations above the rest. I knew it was special. He had a good patient, too. You can't win a dance contest unless you have a good partner, and Tommy John was a great dancer.”

History glosses over an important part of the original Tommy John surgery: for almost three months, it looked like a complete failure. After the procedure, John's left hand curled into a claw, his pinky and ring fingers numb bordering on frozen, the other three suffering from varying levels of discomfort depending on the day. The tendon in John's elbow was assimilating fine, the pain dwindling, but his hand looked gnarled.

Jobe's fear had come true: damage to the ulnar nerve. It's why nearly forty years later Neal ElAttrache treated Coffey's with such care. The slightest mishandling can doom the recovery. In mid-December 1974, Jobe reopened John's arm, moved the nerve back to its original location, and hoped that rest for the remainder of the offseason would prepare him for spring training.

Everything was a guess. No protocol yet existed for the rehabilitation, leaving John to experiment. Jobe did offer John one nugget of advice: “Follow your body.” A month after the removal of the cast that immobilized his arm, John joined his teammates at Dodgertown in Vero Beach, Florida, for conditioning activities. When they went to the pitching mounds, he sidled over to a concrete partition at the facility and taught himself to throw again. To fight the lingering numbness, John used athletic tape to bind his left pinky to his ring finger. He picked up a ball with his right hand, jammed it into his slowly cooperating clawed hand, and fired against the closest thing he'd seen to a batter in months: a wall.

Every Monday, the routine started again. “My reasoning,” John said, “was if God took Sunday off, Tommy John can, too.” John's arm felt the worst when he threw the day after his day off. The other six days he worked, him and the wall, him and his wife, him and anyone who wouldn't laugh when he threw a ball. Stamina built over time, particularly as the nerve surgery worked its magic, unfurled his claw, and allowed him to squeeze Silly Putty and complement his shoulder exercises with forearm-muscle building. Ten or fifteen minutes of throwing grew into sessions two and three times as long. It bore no resemblance to the manicured rehab protocols today, most of which mirror one another with slight variations. Tommy John simply embraced the conventional wisdom of the time, as imparted by his old pitching coach, Johnny Sain: the more you throw, the healthier you get. Little empirical evidence exists today to back that claim, though John continues to believe it. The return of his arm—the real return—was enough for him.

It happened on July 8, 1975, in Pittsburgh, with the temperature and humidity both in the eighties. John went to the bullpen with catcher Mark Cresse and settled into his typical rhythm: pitch, catch, pitch, catch, pitch, catch, metronomic in its efficiency. The heat loosened up his arm, and Cresse started to push
John. “Add a little more speed,” he said. So John did. For more than forty minutes, John threw Cresse sinkers. They resembled the ones he had thrown all those years leading up to the Breeden at bat. “I finally felt good,” John said. “I was following Dr. Jobe. My body was telling me what I needed.”

He threw for forty minutes again the next day. “I was very tentative starting out,” John said. “I'm throwing, and the more I throw, the more I sweat, and the better my arm feels, and [Cresse] says tonight was better than last night.” He followed with another forty minutes on the team's last day in Pittsburgh, and a few days later, on the Sunday before the All-Star break in St. Louis, John asked his manager, Walter Alston, to let him throw batting practice. John looked good, good enough that he scrapped his plan in case the surgery didn't work: asking his old teammate Hoyt Wilhelm to teach him the knuckleball. The initial failure was evolving into a success story, though John never deluded himself into thinking he was safe. He was a lab rat, and lab rats weren't expected to survive.

At the end of the season, the Dodgers sent John to the fall instructional league, usually the domain of young prospects. On September 26, one year and one day after Jobe opened up his arm and did something no man ever had done before, Tommy John was back on a mound facing batters. The first was Danny Goodwin, the only player ever chosen number one overall in two drafts. On his third pitch, John dropped a curveball in for his first strike in over a year. He cruised through three innings on just thirty-six more pitches. Over the next twenty-eight days, John started seven games and threw thirty-seven innings. The rat lived.

The Dodgers asked John to go to the Dominican Republic and play winter ball, but Jobe refused to let him. Months of throwing six days a week had taxed John's arm, and Jobe didn't want to overwork it any more, especially after instructional-league games in which John had thrown with maximum effort.
Nothing guided Jobe's choices other than instinct. In a sense, Jobe had even more riding on John's recovery than John himself. Jobe knew UCL reconstruction was a legitimate solution for fixing a catastrophic injury, and he didn't want to jeopardize its future.

Following a lockout of the players during spring training in 1976, John reported to Dodgers camp, ready to rejoin the rotation. He was turning thirty-three in May. Only eight pitchers in baseball were older than thirty-four, the eldest of whom was spitballer Gaylord Perry, at thirty-seven. Even if the surgery proved successful, John figured he had only a few good years left.

Tommy John returned to the major leagues on April 16, 1976, for the 319th start of his career. He never missed another. There would be 382 postsurgery starts in all, more than twice as many as anyone who underwent UCL replacement at the age of thirty-one or older since. John threw nearly three hundred more innings with his new UCL than he did with his original. He retired at forty-six with 288 wins, the seventh-highest total among left-handers in major league history, a career ERA of 3.34, and almost five thousand innings pitched. He was a walking billboard for the power of medical innovation, the genius of Frank Jobe.

More than forty years later, the original Tommy John surgery remains the best. It saved the arm from what was millions of years in the making.

A
ROUND TWO MILLION YEARS AGO,
long after they had split off from their chimpanzee ancestors and benefited from bipedalism, developed brains, lengthened legs, and expanded waists, the species that eventually evolved into human beings underwent a lesser-known adaptation involving the shoulder. The shrugged posture of earlier primates disappeared and grew to resemble our shoulders of today, with the glenoid cavity—the socket of the shoulder's ball-and-socket joint—no longer angled upward but pointed out and into the humeral head.

The slight difference changed humanity—and would eventually make Tommy John surgery necessary. No longer was
Homo erectus
bound by the physiological limitations of chimpanzees. Sandy Koufax himself couldn't teach a chimp to throw a ball much more than 20 miles per hour. Slightly lowering the junc
tion of the shoulder in early humans opened up their range-of-motion treasure chest. The new shoulder allowed
H. erectus
to throw spears, rocks, and other hunting implements, which allowed them to expand beyond the vegetarian diet of their forebears, which facilitated moves across desert landscapes where no plants grew, which led to the dispersal of people worldwide. All because humans can throw things.

To understand the arm, I needed to understand its origins and what it went through to get where it is today. So I called Dr. Neil Roach, a biological anthropologist who specializes in human evolution. Roach had just published a paper in which he studied college-aged pitchers and tied modern man's superior throwing ability to the new body of
H. erectus
storing elastic energy in the muscles, tendons, and ligaments of the shoulder.

Today's shoulder can flex straight in front and extend directly back. It flares out to the side and moves up (abduction) or down (adduction). No movement in the entire human body can match its maximum speed at internal rotation. And this was the missing link Roach could explain: not how we got from Koufax to today but how we grew into overhand-throwing marvels in the first place.

“We had a hypothesis that elastic energy was being used for improved performance,” Roach said. “I was surprised at how effective this mechanism could be. These are tiny little ligaments and tendons, and yet they're accounting for more than fifty percent of the energy used for these rapid motions.”

While the expansion of the waist and similar vital changes occurred in other species,
H. erectus
first reaped the benefits of the shoulder's emergence about two million years ago, presumably ushering in the hunter-gatherer form of society. The first throwers were pragmatists. They just wanted to eat. The blather about throwing being an unnatural motion could not be further from the truth. It is nature personified.

Bows and arrows, traps, and guns eventually rendered spears, rocks, and blunt objects obsolete, turning the throwing arm
into an antiquated device. Though we use our arms every day and would struggle to function without them, the ability to internally rotate the shoulder at 8,000 degrees per second serves no purpose in the modern world outside of athletic pursuits. Roach's study of twenty top-flight athletes, most of them college pitchers, affirmed his theory about the modern shoulder acting as a clearinghouse for energy generated mostly in the hips and glutes. Mankind didn't die in part because evolution in the shoulder helped it survive.

What it didn't do was give us an infallible joint. The shoulder can absorb a few full-power throws at prey, maybe a few more close-range rock assaults. Only the rarest are made for one hundred pitches. Shoulder problems, elbow problems—they're all the same, all the function of men pushing themselves to do something the body never intended it to do.

“Unfortunately, the ligaments and tendons in the human shoulder and elbow are not well adapted to withstanding such repeated stretching from the high torques generated by throwing, and frequently suffer from laxity and tearing,” Roach wrote in the final paragraph of the paper, which was published in
Nature
. “While humans' unique ability to power high-speed throws using elastic energy may have been critical in enabling early hunting, repeated overuse of this motion can result in serious injuries in modern throwers.”

Nearly one hundred years passed before anyone in baseball recognized that.

B
ASEBALL IN THE 1800S WASN'T
baseball, not as we know it today. It existed for scamps and scalawags, a sport governed by its utter lack of governance. It couldn't get the easy stuff right. Though baseball's first official game came in 1846, no strike zone existed until more than forty years later. The mound's sixty-foot, six-inch distance was not established until 1893. Expecting even a
whit of care when it came to protecting pitchers' arms was like asking Old Hoss Radbourn to stay sober during the 1884 season.

Much as Frank Bancroft, the manager of the National League's Providence Grays, tried to keep his ace away from booze, Charles Radbourn found a sip here, a nip there, every last drop used as an analgesic to dull the pain in his arm. He refused to let his teammates pitch, and Bancroft knew better than to argue with Radbourn, who later earned his nickname, “Old Hoss,” from his ability to pitch so often. For forty of the Grays' last forty-three games, Radbourn trotted to the mound and gnashed through the discomfort. His fifty-nine victories in 1884 established a record that never will be broken, nor will any pitcher come near the 678⅔ innings he threw.

Nobody benefited quite as much as Radbourn from the new change implemented in 1884: the legalization of overhand pitching. In baseball's prior four decades, rules mandated that pitchers throw either sidearm or underhand. The advent of overhand pitching was a seminal moment for baseball, unlocking the body's fullest potential to throw hard while inviting the injuries that accompany it.

Which is not to say the previous deliveries exempted players from harm. This is a great myth, one easily disproved even with the paltry historical record of arm injuries in the nineteenth century. Pitchers of that era did not throw with great velocity, so the sheer load of innings, and the potential for those innings to stretch on, thanks to copious errors committed by gloveless fielders, ended careers with regularity. Of the eighteen players with at least one five hundred–inning season before 1884, two-thirds were finished pitching by age thirty. Tommy Bond was practically done at twenty-four, a year after starting thirty-five consecutive games for the 1879 Boston Red Stockings. George Derby's wonderful rookie season with the Detroit Wolverines in 1881 ended with shoulder pain and a dead career two years later.

Baseball did learn something. The five hundred–inning pitcher
was extinct by 1892, the four hundred–inning starter by 1908. Teams changed their strategy of relying on one or two men for almost every inning of every game. The new restraint did little to stop injuries from proliferating. To make matters worse, sports medicine barely existed in the early 1900s. The man nearly every injured player sought wasn't even a doctor. John “Bonesetter” Reese was a Youngstown, Ohio, mill worker whose supposed ability to heal through muscle, tendon, and ligament manipulation brought him great renown and a client roster filled with Hall of Famers. Cy Young, Walter Johnson, Christy Mathewson, Pete Alexander, Addie Joss—the best pitchers around the turn of the century and into the 1920s sought treatment from the Bonesetter, whose formal training consisted of three weeks at medical school before he dropped out because the sight of blood nauseated him.

Reese's work with soft tissue foretold much of what's done by athletic trainers and massage therapists today. Other treatments for sore arms, meanwhile, dove headlong into quackery and continued to prevail for decades. When Chicago Chi-Feds left-hander Ad Brennan lost velocity on his fastball in 1914, a doctor accused his inflamed tonsils of infecting his shoulder muscles via an infection traveling through the bloodstream from the mouth to the shoulder. Karl Spooner was far from the first pitcher whose arm injury was blamed on oral hygiene. Ridiculous though it may sound, doctors demonized the tonsils, teeth, and other parts of the mouth as the arm's greatest hazard. Three abscessed teeth were yanked from the mouth of Red Sox star Lefty Grove at the beginning of the 1934 season to help heal his sore arm. He turned in the worst season of his career. Grove returned in 1935 looking like his Hall of Fame self, validating tooth extraction and prompting a litany of copycats. Four years after Grove, left-hander Lee Grissom tried to cure chronic arm soreness by one-upping him with the removal of four teeth. “The teeth pulling didn't hurt me,” Grissom later said. “But it damn sure didn't help my arm none.”

Surgery grew commonplace after the successful removal of third baseman Pepper Martin's bone chip in 1934. At least six pitchers had bone chips taken out before the 1939 season, including Hall of Famer Carl Hubbell. Robert Hyland, the orthopedist nicknamed “Baseball's Surgeon General” and an expert at bone-chip removal, hypothesized that arm issues were due to “the development of trick pitching”—sliders, screwballs, forkballs, knuckleballs. Syndicated writer Harry Grayson warned of an “epidemic of arm injuries” and wrote that pitchers suggested “it was caused by the lively ball forcing them to bear down on every pitch.” Bonesetter Reese blamed high-velocity fastballs for elbow injuries and breaking balls for shoulder woes.

Evolution is a funny thing. The technology, the advancement, the progress—everything today reinforces the idea that we know more and are better positioned to understand the problem at hand. And maybe we are. Maybe we're closer to figuring out the arm. That doesn't take away from the fact that most baseball men are still saying the exact same shit they did seventy-five years ago.

I
N 1959,
SPORTS ILLUSTRATED
RAN
a cover story about arm injuries. The main headline: “The Pitching Crisis.” Mentioned as one of many cautionary tales was a man named Paul Pettit. His arm had changed baseball.

A decade earlier, the seventeen-year-old Pettit was among the best-known baseball players in Los Angeles, a hard-throwing, six-foot-two, two-hundred-pound left-hander who in one high school game struck out twenty-seven hitters over twelve innings. Like other gifted pitchers of the time, Pettit threw every day. When one of his friends in the housing project where he lived begged off to go home for dinner, Pettit found another to play catch. He pitched for his high school team during the week and on Saturdays, plus an American Legion team Sundays. When he was fifteen, a semipro team in nearby Torrance offered him a spot
in its rotation, and he jammed that into his schedule, too. “I knew a couple times I wasn't really in good shape when I threw,” Pettit said. “I remember one winter I played for a team over in Hermosa Beach. I didn't throw during the week. I was playing basketball. And I went out and threw on Sunday. That wasn't good.”

Nobody knew better at the time, least of all a film producer named Frederick Stephani. He wanted to make a movie about a major league pitcher. One featuring a star player would cost too much, so he concocted another plan: he would lock the finest amateur pitcher into a ten-year contract and harvest the rewards when the player signed with a major league team. On October 19, 1949, Pettit agreed to an $85,000 deal with Stephani, who figured with no amateur draft and teams salivating for young pitching he could fetch more money. Three months later, the Pittsburgh Pirates made Pettit baseball's first six-figure bonus baby, paying $100,000 for his rights. Stephani took the extra $15,000 and the title of baseball's first player agent. He never made the movie.

Pittsburgh assigned Pettit to Double-A New Orleans, where he threw a 154-pitch game in which he walked eleven and struck out nine. He labored through the 1950 season, losing velocity on his fastball and forcing him to reconsider how he pitched. “I was working on a curveball,” Pettit said. “I needed one that was a little faster. And I messed up my elbow.”

Pettit went to Baltimore to visit George Bennett, the doctor believed to have first identified a UCL tear. He had worked in sports medicine for nearly forty years and had seen every kind of sore arm. Ten years earlier, Hall of Famers Dizzy Dean and Lefty Gomez traveled to Baltimore the same day so Bennett could save their arms. Dean's career lasted two more starts and Gomez scratched out two substandard years. Even the best doctors can't undo damage already done.

Bennett cleared Pettit to keep throwing. “I went back, and there wasn't really any therapy to give me,” Pettit said. “No cor
tisone. I was anxious to get back. I would just throw and throw. And I'd start favoring the elbow. Then my shoulder and elbow both were hurting.”

Neither ever improved. Pettit threw 30⅔ innings in the major leagues, won one game, gave up pitching at twenty-one, reinvented himself as a power-hitting outfielder, and bounced around Triple-A for another seven years. Pettit is eighty-four today, too old to harp on his misfortune, except once a month when he goes to the Navy Golf Course in Los Alamitos, California, the place where Tiger Woods cut his teeth, and spends the afternoon with about a dozen other ex-ballplayers who excel at the art of embellishment. However spurious Pettit's stories sound to his friends, they contain enough truth to cause the listener to feel sorry for him. Baseball's ignorance killed his arm, and those who did survive engaged in the ultimate victim-blaming.

“A sore arm is like a headache or toothache,” Warren Spahn, the future Hall of Famer, told
Sports Illustrated
for the 1959 story. “It can make you feel bad, but if you just forget about it and do what you have to do, it will go away. If you really like to pitch and want to pitch, that's what you'll do.”

For every Warren Spahn, every freak who managed to throw tens of thousands of pitches and live to throw tens of thousands more, there were countless Paul Pettits, boys with golden arms that turned into pyrite—and not on account of mental weakness or extinguished passion, as Spahn suggested, but because of obliviousness. While the surgical innovations of Hyland, Bennett, and others relieved pain and allowed pitchers to continue throwing, never did they address the root issue: What causes arm problems?