The Arm (30 page)

Fairness is a difficult standard in biomechanical studies. The Douoguih study on the Inverted W had its flaws. The survivorship bias of examining just major league pitchers and the use of the naked eye to categorize them instead of kinematic data were two obvious ones. Considering what little data on the Inverted W existed before, it was a myth-busting start.

O'Leary was used to people questioning him, so he shrugged it off. Every day, those who disagreed with him on Twitter needled him and tried to goad him into fights by pointing out inconsistencies in his analysis. He responded on May 15, 2015, just three weeks after Douoguih's study, with defiance. “I'm too busy leading the field to worry about following (most) people,” O'Leary wrote, but he couldn't gloss over his mistakes with hubris alone. His analysis of Matt Harvey, the almost-perfect pitcher, missed badly. The New York Mets drafted Harvey with the seventh overall pick in the 2010 draft. By 2013, he was one of the best pitchers in the major leagues. Then his UCL blew.

“The way he throws, I never thought he'd get hurt,” Ed Harvey told me. “He's got about the cleanest delivery going, in my opinion. The ball comes out of his hand really freely. He's usually on time.”

O'Leary blamed the miss on a new theory: premature pronation. He said Harvey changed his delivery since high school and was pointing the ball to center field upon foot strike. This, O'Leary claimed, was unnatural. Nolan Ryan's and Tom Seaver's and Mariano Rivera's and other pitchers' palms pointed toward third base. He didn't offer as examples all the pitchers—and there were plenty—who pointed the ball toward second base and stayed healthy.

“This is admittedly a theory,” O'Leary said, and I suggested it wasn't a very good one. One of the great mysteries of the arm is how the forearm muscles work when a pitch is thrown, and for O'Leary to suggest he had any clue what was happening to them because a pitcher held a ball in a particular position was a leap Evel Knievel wouldn't dare make.

It was a mistake in the same vein as with the Inverted W. O'Leary liked to say that he had changed, that his understanding of pitching had grown and he focused more on the timing than the brand name. The phrase Inverted W still screams out from every corner of his website, though, and O'Leary never divorced himself from it. When those in baseball find religion, they're loath to give it up.

“People will criticize me for stuff because I'm changing things and making all these exceptions after the fact,” O'Leary said. “I'm just trying to be scientific about it.”

A
LMOST IMMEDIATELY AFTER DR. JEFFREY
Dugas arrived to practice at the Andrews Sports Medicine and Orthopaedic Center in 1999, the incidence of kids seeking Tommy John surgeries started to grow. In 1994, Dr. James Andrews didn't repair one UCL in a child. Over the next four years, the number maxed out at 11 percent of his yearly surgeries. In 1999, Dugas's first year, it jumped to 18 percent. By 2003, kids accounted for a quarter of Tommy John surgeries. And nearly a third in 2008. No longer does ASMI
keep exact numbers, with Andrews splitting time between Birmingham and his Florida clinic, but he estimated he cuts one hundred youth elbows a year.

“I was there right as that explosion started to happen,” Dugas said. “And it made you think: Holy cow, this isn't a good thing.” More and more kids who visited Birmingham were doing so with only mild UCL damage. Kids like Braedyn Woborny, the Kansas teenager who didn't need Tommy John surgery, were everywhere.

Dugas wanted to find a repair that wouldn't necessitate the yearlong grind of Tommy John recovery. He started to consider a handful of factors. When other ligaments around the body partially tear off bones, the healing process takes around two to three months. The UCL should be no different. In early Tommy John research, doctors attempted to reattach a partially torn ligament. It failed miserably.

At the same time, Dugas couldn't ignore new research from a familiar ally of arm surgery: the ankle, the same joint that first inspired Dr. Frank Jobe. In recent years, doctors had used suture tape, a relatively new product, to help fix ankle instability inside the body. One study, from a foot and ankle surgeon named Nicholas Bevilacqua, showed how the tape—made of long, invisible-to-the-eye strands of the plastic polyethylene wrapped in a braided polyethylene-and-polyester jacket—helped stabilize damaged ankle ligaments not responding to treatment.

Dugas theorized that he could insert anchors, which look like small screws and hold the suture tape in place, into the humerus and ulna, eliminating the need to drill through kids' still-fragile bones. Once he reattached the partially torn ligament to the bone, the tape would heal into the ligament and serve as a reinforcement. Even better, the medical-equipment company Arthrex offered a three-millimeter-wide, one-millimeter-thick tape dipped in Type-I bovine collagen, a material extracted from the hides of cows that promotes quicker healing. Unlike the current preferred treatment for a partial tear, platelet-rich plasma (PRP)—in which
blood is spun in a centrifuge to extract growth factors, then reinjected into the elbow to boost tissue repair—Dugas's surgery would mend the ligament and aid in its regrowth.

The first tests came in a room at ASMI whose sign outside belies the activity inside:
SKILLS LAB
. I first met Dugas there in August 2011. He was holding a leg chopped off on one end at the femur and the other just below the knee. Before he started to cut the skin off the knee joint, Dugas paused for a moment to thank the woman to whom it once belonged. He did not know her name or anything else about her, aside from the basic information that accompanied her knee. She had stood five feet four and had weighed only eighty pounds when she died of cancer at sixty-nine.

New joints arrive at ASMI all the time, and they're taken to the freezer in the skills lab until they're needed for a test. The elbow fascinated Dugas. He applied in 1999 for a fellowship under Andrews because of a deep interest in baseball medicine. Dugas was hired full-time in 2000 and, along with Dr. Lyle Cain, became one of Andrews's handpicked heirs to a sports-medicine empire. Before Andrews abdicated, they would spend thousands of hours in the skills lab, dissecting joints and readying them for testing.

After resecting the skin, Dugas sliced his scalpel through the leg muscles and peeled them away, exposing the woman's bone. He was studying the meniscus, the C-shaped piece of cartilage that serves as the knee's shock absorber, and needed a clear view of the joint. It was a hinge, much like the elbow, with the anterior cruciate ligament playing a similar stabilizing role as the UCL. Dugas was testing the force on the knee joint and the point at which the meniscus would tear. He feathered a paper-thin, five-thousand-dollar sensor inside the joint and onto the meniscus to measure it. He prepared the monstrous automated vise that would apply pressure until the joint no longer held. He glanced to his left and asked how the cement was looking.

Glenn Fleisig stood in front of a bowl, mixing a paste that
would harden around the two ends of the knee joint and hold it in place inside the machine. Nobody has meant more to the mainstreaming of baseball biomechanics than Fleisig, a mechanical engineer by trade and now ASMI's research director. A majority of the most influential academic papers regarding the pitching arm bear Fleisig's name. He is the reason pitch counts exist in Little League, the man who told us curveballs might not be as dangerous for kids as once thought, the driving force behind the study of how to best protect children from arm injuries.

Dozens of major leaguers have visited Fleisig at ASMI, too, and stepped into his eighty-five-foot-long, thirty-foot-wide laboratory carpeted with artificial turf and studded with eight high-speed cameras all focused on the pitching mound toward the back of the room. This is ASMI's biomechanics lab, a place where technology meets wonder. Fleisig uses the lab to analyze pitchers' form as well as the force on their joints. Children—elite travel-ball kids, mediocre sons of rich fathers, and everyone in between—travel from around the country to consult with Fleisig.

Some professional players swore by it. Roger Clemens, Barry Zito, C. C. Sabathia, Cliff Lee, and Zack Greinke—Cy Young winners all—have stripped off their shirts and allowed Fleisig to attach twenty-three reflective markers to predetermined points on their torsos. A computer program digitizes the markers into a Minecraft-like screen with nothing in it but blocks of three-dimensional emptiness interrupted by nearly two dozen tiny dots that resemble the shape of a human being when they move. When then-Brewers pitching coach Rick Peterson, a longtime partner of ASMI's, asked Todd Coffey one spring to strap on motion-capture technology and throw at 70 percent effort, Coffey scoffed. “I threw it one hundred percent effort because I knew it threw off his data,” Coffey said. Daniel Hudson's stance on biomechanical analysis was even starker. “I've got enough people telling me what I do wrong right now,” he said. “I don't need more scientists to look at me and tell me that I suck.”

Turning the pitcher into a stick figure allows Fleisig to measure joint angles, arm velocity, timing, joint forces, torque, and dozens of other factors. The cameras shoot video of the pitcher throwing at 450 frames per second, slow enough that Fleisig can point out potential mechanical flaws and offer suggestions. Earlier that day, Fleisig had broken down the film with a ten-year-old boy whose father brought him to ASMI to make sure his elbow wasn't in danger of blowing out because of his pitching mechanics.

Fleisig enjoys the early evenings in the skills lab with Dugas because they give him a greater sense of what might be, and the tests on the suture tape were promising enough that Dugas needed to find a test subject. He wanted an Alabama-based kid entering his senior year with a partially torn UCL whose choices—do something radical or don't play again—made experimental surgery seem like the best option. In late July 2013, he found his subject: a five-foot-nine, 160-pound left-handed pitcher. He and his mother drove to Birmingham from southern Alabama and listened to Dugas's pitch. He saved the best part for the end. If everything went according to plan, the kid would return to the mound in six months, maybe sooner. Without a fresh tendon undergoing ligamentization or drill holes needing to heal, Dugas estimated the recovery time on his modified Tommy John surgery would be cut in half.

After a couple more conversations, the kid told Dugas he wanted the surgery. On August 8, 2013, one of the most revolutionary baseball procedures since the original Tommy John surgery took place in Birmingham. There were no complications. The patient rehabbed with Dr. Kevin Wilk, ASMI's director of rehabilitative research and a widely respected sports physical therapist. As Dugas had predicted, the ligament healed around the three-month mark. At five and a half months, the patient's full velocity returned. He pitched his entire senior year in high school with no problems. His fifty-plus innings went so well a local junior college recruited him, and he pitched there for a full season without incident.

Upon the patient's healthy return, Dugas started to use the procedure on others. He fixed a javelin thrower, two wrestlers, and a gymnast. By January 2015, he had repaired twenty-seven UCLs with his modified Tommy John, and not one had run into complications. Even Andrews, who taught his students to avoid making grand, overarching statements, acknowledged to Dugas that he was impressed.

The first batch of one-year follow-ups visited Birmingham in the spring of 2015, and their elbows looked clean, their ligaments back at full strength. “It's too early to wave the victory flag and think we've changed the world,” Dugas said. “I think we need a couple years to really see what the spectrum of outcome is going to be. I know there's going to be a failure. And I want to know who those people are. I haven't seen them yet. It's been great. But I'm not egomaniacal enough to think there won't be some.”

Barring too many failures, the plan is to scale up into the minor and major leagues. While his ideal patient in professional baseball is a midthirties pitcher looking for one last hurrah, or a late-round draft pick on whom a team didn't spend much money, Dugas knows frontline major leaguers will be more likely to offer themselves up as test cases. Just think: if a player with slight elbow damage can grind through the end of the season, he can undergo surgery October 1 and be ready by opening day with a fresh elbow. Zero days lost, compared with the average of 221 that the HITS database showed with classic Tommy John surgery. It's not the ultimate solution—nothing involving a scar can be—but it's quite an appealing alternative.

The procedure wouldn't work for everyone. When a ligament tears in the middle and not off the bone, the collagen tape can't tie it back together. And because no elite, hard-throwing pitcher has undergone the surgery yet, Dugas can't vouch for its success at the upper reaches of the major leagues.

“Will it work in a high-level pro? I don't know,” Dugas said. “But in college and high school kids, it seems to be working great.”

Baseball wants to believe. It's a trait cultivated over more than a century. It's why players wear lucky underwear and take B12 shots, why they believed pulling teeth would fix the arm, and why Todd Coffey's glove travels in a suitcase. If anything shows the slightest sign of efficacy, real or imagined, it is immediately embraced. The charlatans make their money off this ethos while the others toil in their labs, test their hypotheses, effect real change.

Jeffrey Dugas, it turns out, believed in something, too. It was nothing novel, nothing revolutionary. In the baseball world, it's not necessarily cool to believe in science. Dugas did anyway. And in the swamp he found a beautiful pearl.

A
T LEAST ONCE EVERY JANUARY
or February, Casey McEvoy wakes up in a panic. In his nightmare, he can't find his baseball spikes. He is supposed to long toss before a game, and he realizes he's not ready, and the dread washes over him, startling him back to reality.

“I haven't pitched in fourteen years now,” McEvoy said.

Why this recurring dream comes on the eve of every spring training McEvoy still doesn't quite understand. Maybe it takes more than a decade and a half of inactivity to sever the relationship between brain and body. In his parallel world, it's 1998 all over again on his rookie-ball team full of aspiring major leaguers: Adam Dunn, Austin Kearns, B. J. Ryan, Corky Miller, Bobby Madritsch, and, most unexpected of all, Todd Coffey. McEvoy followed all their careers and took bemused interest in Coffey's. The Big Nasty—that's what everyone on that team in Billings, Montana, called him—made it.

“And I always remember how lucky I am,” Coffey said, “because Casey McEvoy didn't. I never want to be Casey McEvoy.”

McEvoy represented the worst possible scenario for Coffey. Which sounds unfair, considering McEvoy lives a rather enviable life these days. He's the assistant controller at a big bank in Cincinnati. Has an MBA and a master of accounting. Two boys who play baseball. And a physical-therapist-assistant wife whom he met while trying to come back from Tommy John surgery. Coffey knows only the McEvoy whose career ended when his elbow gave out, one of the 20 percent never heard from again, the cautionary tale.

In April 2000, McEvoy, like Coffey a lower-level right-hander in the Cincinnati Reds organization, blew out his elbow. Coffey babied his rehab. McEvoy rushed back, a sixteenth-round draft pick out of college who didn't want to get overshadowed by newer, younger pitchers from the next draft class. By the ninth month, he was pumping fastballs at 94 and snapping off sliders like he could pitch the next day. Then his elbow fractured, the UCL pulled away, and he headed back to school to learn about 10-Qs and 10-Ks and the minutiae of SEC filings.

“I think about him a lot,” Coffey said. “That's my greatest fear. Just not making it. You do this work, you put in the time, and it doesn't happen.”

Everything Coffey did initially in Tacoma looked promising. Seattle wanted him to pitch back-to-back days. Coffey went June 13 and June 14. He started racking up saves and plowing through innings in a dozen pitches, sometimes fewer. On June 28, Coffey pitched in both games of a doubleheader. “Never done that before,” he said. “Guess that shows them the arm is good.”

In the meantime, Seattle's relief pitchers—a mixture of the unproven and mediocre—posted the best bullpen ERA in baseball during June at 1.64. Nobody got hurt, either, which left Coffey stuck in Tacoma. His agent, Rick Thurman, called Jeff Kingston, the Mariners' assistant general manager. Coffey would
not exercise his first opt-out clause at the end of June, but he wanted a verbal commitment from Kingston that if another team wanted Coffey to pitch in the major leagues, he could leave. Seattle agreed. “How many pitchers have an opt-out at any time?” Coffey said June 30. “It's a win-win. It gives us more time now. Rick's going to call around to teams, talk to teams today, and then hopefully he'll hear back from them this afternoon.”

Three days later, Thurman hadn't heard a word of interest from around the league. “A little surprised that no team has jumped on me yet,” Coffey said. “Confusing more. Every team we talk to says, ‘OK, we didn't know that.' Yesterday they found out I'm available. So they have to go through their whole process.” Coffey ignored the slights and lowered his ERA to 1.29 with a scoreless inning July 8. He checked with the person charting his pitches that night, and his sinker ranged from 94 to 96 miles per hour. At 11:45 that night, Coffey sent Dr. Neal ElAttrache a text message.

I know it's late. Sorry for being so late. Just wanted to let you know I was 94–96 sinkers.

His phone buzzed a few minutes later with ElAttrache's reply.

Never too late to hear from you. Especially with that news. Awesome job.

Coffey's ERA lived in the low ones throughout July. He threw a two-inning stint, pitched three times in four days, four times in six days, five times in eight days. “I'm wondering why nobody has come knocking,” he said. That included Atlanta, which in addition to Shae Simmons called up Pedro Beato and Juan Jaime and Ryan Buchter and Gus Schlosser—none of them with anywhere near the experience or success of Coffey. The Braves preferred to give their own guys a chance before someone who had already spurned them.

The Mariners' bullpen kept cruising in July, almost as strong
as the previous month, healthy as ever. Coffey hoped they would trade one or more of their relief pitchers. They didn't. Thurman hunted for major league interest elsewhere. No teams bit. On July 31, Coffey's contract gave him a second opportunity to opt out. He stayed with Seattle, a decision that shifted control of his rights to the Mariners for the remainder of the season.

As much as Coffey tried not to panic, the frustration of life at Triple-A mounted. On August 14, Coffey sprinted in to hammer down a save in a 7–6 game. The second batter hit a game-tying home run. It was Coffey's second blown save in a week. The next batter dribbled a ball to first base, and the umpire called the runner safe over Coffey's protest.

“How do you not get that?” Coffey screamed. “You have one fucking job in this whole damn game, and you fucked that up.”

The umpire didn't eject Coffey; he called a balk during the next at bat. In Coffey's entire major league career, all 1,910 batters, he had not once been called for a balk.

“You're fucking stupid,” Coffey said.

He wanted to get tossed from the game; the umpire still didn't oblige. After recording the final two outs to send the game into extra innings, Coffey walked off the field, turned toward the umpire, and said: “You're fucking terrible. Fuck you, motherfucker.” That did the trick. Coffey was thrown out, and he responded by helicoptering two folding chairs onto the field.

Triple-A was purgatory, and for what sin Coffey was there he didn't know. He believed he was a major league pitcher. His ERA backed up that idea. Scouts saw a different guy, and they were the ultimate arbiters. There is little upside in going to a general manager and suggesting someone like Coffey—older, bad body, only two pitches—when the baseball landscape is littered with similar pitchers. A veteran reliever named David Aardsma put up almost identical numbers as Coffey for the Cardinals' Triple-A affiliate, and no one was calling him, either.

“I feel trapped,” Coffey said. “Very much so. Frustrated.
Trapped. It is what it is. I understand teams are like, ‘We've seen this guy. Do we want to bring him in during a tight game in the playoff push?' I can somewhat understand that. But then I see what kind of slop they're throwing out there.”

There was no slop in Seattle, whose bullpen continued its superlative performance and pristine health through August. In its fight for a playoff spot, Seattle still could've used the benefit of an expanded roster in September to rest its arms and give someone like Coffey the opportunity to devour innings, and that kept Coffey's faith intact. He just needed someone else to believe in him like he did himself.

“I think Seattle will call me up in September,” Coffey said. “I really do.”

B
EFORE THE REHABILITATION FROM HIS
second Tommy John surgery started, Daniel Hudson had wondered about the first pitch he would throw in a game. He'd grown more introspective over the course of the year-plus it had taken him to get here, back on top of a mound, albeit one in front of no fans in a rookie-league game populated with Latin American teenagers getting their first taste of the United States. The last two times he pitched in games that counted were the two worst moments of his life.

“I've been thinking a lot about what am I going to feel like when I'm close to back again,” Hudson said. “How am I going to be mentally ready to throw a pitch as hard as I can when I know what happened last time? When I get on the mound for the first time, how am I going to put this out of my mind?”

Every so often, some new thought or comparison poisoned his mind. All the Tommy John surgeries in March and April, the ones that brought about the word “epidemic,” spooked him, even if those pitchers looked at Hudson like he was the unluckiest of all. There was the text from Jarrod Parker, his old Diamondbacks teammate and one of six pitchers in need of a revision, seeking
advice. The Diamondbacks overhauled their rehab protocol for Patrick Corbin, specifically to avoid a repeat of Hudson's injury. Other teams in baseball slowed theirs because of the number of revisions, too. Corbin didn't touch a ball until six months postop—two months later than Hudson did following his first surgery.

Hudson was in no hurry the second time, either. Through July and into August, Tuesdays and Fridays were heavy throw days, Wednesdays and Sundays off, and the other three low-intensity, mechanics-intensive sessions with Brad Arnsberg. The language of Arnie made sense to Hudson by now, its wisdom buried underneath the bullshitting. Pitchers need to talk with other pitchers, and at his nadir, Hudson sought someone who understood his apprehension and hang-ups, who could laugh when Hudson received an email from the Diamondbacks urging him to RSVP for the alumni game in August. Between Arnie and Crank, the Diamondbacks forged a strong sense of how to handle Hudson as he prepared to return to the major leagues.

On August 5, 2014, he was scheduled to throw one inning against the Cincinnati Reds' rookie-league team. All he needed to do was survive four rookie-ball games and two more at Triple-A, and he'd be back in the big leagues in less than a month. The Diamondbacks planned to use him as a relief pitcher, easing him back one inning at a time. Depending on how his arm felt, perhaps they would consider letting him start in 2015. Even that was presumptive. Leading into that first game, the doubts crept in. Hudson didn't just ask himself whether the ligament would blow again. He wondered why it wouldn't.

“Once I got out there in the bullpen and threw my eight pitches, I said, ‘If it happens, it happens,'” he said. “It was surprisingly easier than I thought it would be to put it out of my mind. Just the natural adrenaline you get when you're playing. Especially when you haven't played in a year. Those juices get going, and it takes over. You don't have time to think about anything else.”

His arm held together. One inning, a couple of hits, a run, and
two strikeouts. None of the numbers mattered. Just that he left the game in one piece and didn't feel sore when he woke up in the middle of the night to feed Baylor. Hudson usually took the midnight or two a.m. shift, lugging himself out of bed and into her nursery and trying to comprehend the dynamics of the slow-flow nipple. “It's so crazy. I can drink a twelve-ounce beer in a minute,” he said, “and this child takes an hour to eat four ounces of water with powder in it.”

On August 21, two days after his final rookie-league game, Hudson awoke at five thirty in the morning, trudged downstairs, and smashed the big toe of his right foot against a doorjamb. He screamed in pain. Hudson's arm failed him twice. Some cruel voodoo artist now decided to stick a pin in his foot.

“Who else would this happen to?” he asked.

Hudson reported the pain as 9.5 of 10. He figured he broke something, but an X-ray came back negative. The soreness on the instep and arch eased the next day, diminished again the day after that, and dissipated leading up to August 24. Hudson threw in the bullpen that day to stay on schedule, prompting Crank to pull him aside afterward. “I'm gonna give you a bit of a dad speech,” he said, and he went on to warn Hudson about pushing too hard. The big toe had an ignominious place in baseball lore. Even though Dizzy Dean threw more than 1,500 innings between the ages of twenty-two and twenty-six, legend says that Earl Averill's line drive off the big toe of the twenty-seven-year-old Dean in the 1937 All-Star Game forced him to change his mechanics and led to career-ending arm troubles.

Hudson listened to the dad speech and agreed with Crank. “Too close to fuck it up over a toe and five MLB outings,” Hudson said. His final two rehab games were scheduled with Triple-A Reno. Rehabbing pitchers will often go to Double-A instead. Mobile's schedule conspired against that. “They're going to be in Jacksonville at the end of August,” Hudson said. He did not want to see that city again.

So he threw two scoreless outings for Reno. And three days
after the second, on September 1, the transaction shot across the wire: “Arizona Diamondbacks activated RHP Daniel Hudson from the 60-day disabled list.”

A
BOUT A MILE FROM CHENEY
Stadium in Tacoma, Todd Coffey found an empty lot. He parked his car and sat. He wanted to be alone. His mind was racing. He needed to understand what just happened. For three months, Coffey had been one of the best relief pitchers in the Pacific Coast League. He couldn't forget the words typed by the Seattle Mariners' assistant GM three months earlier when he signed: “Todd could easily put himself at the top of the list if he comes in and pitches the way he has when healthy.” He did pitch that way. He was healthy. And it still wasn't enough.

“I don't get it,” he said. “I did everything I could.”

On August 26, a week before the Triple-A season ended, the Mariners told Coffey that he would not join the team in September when rosters expanded. Most of his teammates milled about the clubhouse, oblivious to the news. A right-handed relief prospect named Carson Smith, whom Coffey tried to mentor, had gotten called up, and that angered him even more. As everyone slipped on their uniforms, Coffey asked permission to leave. He needed to clear his head.