The Arm (5 page)

I
NCREASINGLY, RESEARCHERS ARE LOOKING BEYOND
the major leagues and down to kids like Harley Harrington and how they're being handled. Grave concern exists among those studying the arm that because of tournaments like the Super NIT, which lack pitch counts, the current generation of injured arms will look positively healthy compared with the kids' coming up.

The American Sports Medicine Institute (ASMI), the baseball industry's foremost think tank, followed nearly five hundred youth-league pitchers for a decade starting in 1999 and found that kids who pitched more than one hundred innings in a calendar year were three and a half times likelier to get injured than those who didn't. In 1997, Dr. James Andrews, the famous orthopedic
surgeon who had founded ASMI in Birmingham, Alabama, was performing Tommy John surgery on one or two high school kids per year. Today, he estimates he does eighty or ninety a year. “Hell, I've got four to do tomorrow,” Andrews said during an April 2015 conversation. He fears that even worse news is coming at the major league level. “If they don't get involved in it from a prevention standpoint at the youth level,” he said, “they're not going to have anybody to draft out of high school or college who hasn't had their elbow operated on.”

The future generation of baseball pitchers lives in a system that takes undeveloped and underdeveloped arms and pressures them to show off for the radar guns they're taught will determine their future. The easiest way to build velocity is through year-round throwing—and year-round throwing, according to the ASMI study, is the single highest predictor of future injuries among kids. Risk factors are highest for kids like Harley, whose arms are especially fragile at ten years old and, in many cases, remain so through the end of high school and beyond. Some surgeons have performed Tommy John on kids as young as thirteen years old, even as doctors at the top of the field warn against cutting still-growing arms. Children who regularly pitched with arm fatigue are thirty-six times likelier to undergo elbow or shoulder surgery, another study by Andrews and his peers at ASMI found. The same study said that kids who pitch in games more than eight months of the year need surgery five times as often. And another study, published in the
American Journal of Sports Medicine
, reported that children like Harrington who play travel ball are five times likelier to suffer from elbow pain.

“I have this conversation with every Tommy John patient,” said Dr. Orr Limpisvasti, a surgeon at Kerlan-Jobe in Los Angeles. “Just so you know, I'm going to fix your arm so you can destroy it again. And this lightbulb goes off. Here's what we know: Throwing is bad for your arm. You're good at it and love doing it. And you tore your God-given UCL, probably the best one you'll ever
have by a long shot, and if we put a new one in, you're refurbishing it so you can do the exact same thing that you did before.”

UCL reconstruction is far from foolproof, too. The procedure involves cutting through skin and muscle, drilling into bone, and tying the elbow together. It is major surgery that calls for a brutal, monotonous rehabilitation. And while the return rate is around 80 percent, a study from Jon Roegele at the
Hardball Times
looked at the return of every pitcher who underwent Tommy John surgery from 2000 to 2009 and found the median threw just sixty games and one hundred innings for the rest of his career. The data also showed that pitchers on fourteen-to-sixteen- and seventeen-to-twenty-month timetables had performed better than those who rushed back, an indictment against a baseball culture intent on returning pitchers in a year.

There is nothing glamorous about Tommy John surgery. The urban legend of doctors performing it pre-emptively and prophylactically is unfounded. Forget another myth, too: the problem stems from kids throwing curveballs too young. Another ASMI study showed that curveballs cause less strain on the arm than the simple, humble fastball, whose greater velocity taxes pitchers more. In 2003, the average fastball in the major leagues didn't crack 90 miles per hour. Today, it's over 92, jumping annually for eight consecutive years and placing not just a physical burden on every kid who dreams of being a big leaguer but also a mental one: throw hard or your chances are grim.

So they travel like Harley Harrington, using pitch-all-you-want tournaments to ready themselves for the grind of their teenage years, when scouts will converge on showcase events to see kids who have been reared to do everything bigger, faster, harder.

“Travel baseball is completely different than it was twenty years ago,” said Paul DePodesta, now the chief strategy officer for the NFL's Cleveland Browns after spending two decades in baseball front offices. “With all the showcases and these guys pitching, it's not just when they're seventeen. It's when they're fourteen
and fifteen.” DePodesta has four kids, three boys. His second son, Evan, played on an all-star team that was invited to a regional tournament in 2014. He got to stay in a hotel and wanted to keep doing that with a travel team. Sure, his dad said, except he might have to give up football and soccer and basketball.

“I don't think I'm ready to choose,” Evan said.

“Well, you shouldn't,” DePodesta said, “because you're six.”

T
HE ULNAR COLLATERAL LIGAMENT IS
a finicky little bastard, ill-equipped to stand up long-term to the single fastest movement the body can generate: the throwing motion. The arm moves thirty times faster than an eyeblink when it's firing a baseball. It's the final cog of a mechanism that steals energy from the legs, builds on it through the hips and butt, transfers it up the back and to the shoulder, and releases it with a whip of muscles and ligaments and tendons and bones that launch a five-ounce projectile at speeds of up to 105 miles per hour. It is beautifully chaotic and chaotically beautiful. It is different in every arm, from Harley Harrington's emergent one to that of Greg Maddux, the Hall of Fame pitcher who never did break over a twenty-three-year, five-thousand-inning career. All the gurus of biomechanics—the science, as the pioneering biomechanist James G. Hay once said, of “internal and external forces acting on a human body and the effects produced by these forces”—concur that Maddux's delivery was perfect, though one could argue that perfect mechanics are more than a series of proper motions. Perfection is the ability of a pitcher to find a delivery that keeps him productive and healthy.

Pitching consists of six generally accepted phases: windup, stride, arm cocking, acceleration, deceleration, and follow-through. Throwing a baseball differs from all other athletic tasks. Footballs are about ten ounces heavier and require slightly dissimilar mechanics. Tennis serves and volleyball spikes come more over the top than most pitchers' high three-quarters deliveries.
Windmilling softball pitchers rarely need Tommy John surgery, because the force generated simply isn't enough to rip the elbow apart.

Overhand throwing isn't in and of itself the villain or culprit. “When you grow up, that's what we do. We throw,” said Chris Carpenter, the former St. Louis Cardinals ace. “It doesn't have to be a ball. It can be a toy, a Cheerio. You grow up, you chuck shit around. That's what I did anyway.” Throwing is eminently natural, positively symphonic, an inevitable result of human evolution. What's unnatural is throwing a five-and-a-quarter-ounce sphere ninety-plus miles per hour one hundred times every five days.

The traditional pitching motion starts with a leg lift into a stride. This activates what's commonly known as the kinetic chain—a simplistic way of describing the sequential transfer of energy from body parts farther from the ball to ones closer. Something as simple as a leg lift starts building elastic energy, a type of potential energy that comes from the stretching of ligaments and tendons before it's stored in muscles. When the stride foot lands, the muscles in the butt clench—scouts look for pitchers with big asses for a reason: they're biomechanically advantageous—and start rotating the hips. Shortly thereafter, the muscles in the back activate, too, sending rapid signals from the brain to the muscles. Those nerve impulses open up calcium channels in the muscle. As calcium is released, muscles contract. The powerful contractions begin cascading up the chain to the torso. Good hip-to-shoulder separation—the opening of the hips while the torso stays in line with the plate, which creates even more elastic energy because hip rotation stretches its ligaments and tendons—is common in the hardest-throwing pitchers.

Front foot down, hips rotated, torso starting to twist, pitchers cock their arms and prepare for twenty to thirty milliseconds of wonder. What happens next is difficult to see with the naked eye. The shoulder externally rotates, bringing the elbow forward,
the hand behind the body, and the forearm almost parallel to the ground. All of the elastic energy rushes into the shoulder, loading the muscles and ligaments and tendons and bones, like a coiled spring pushed flat. The UCL is screaming for mercy, particularly in players whose weak shoulder muscles cannot withstand the onslaught of energy and spill it down to an already-loaded elbow. The UCL is triangular, and the energy affects each side differently; the posterior and transverse bundles, biomechanists believe, endure less stress, while the anterior—the side that in almost every injury is torn—is burdened to the cusp of failure.

When the ligaments and tendons tell the shoulder it cannot rotate further, the elastic energy turns into kinetic energy, and the shoulder sends it down the arm by rotating internally at up to 8,000 degrees per second. No movement in the body matches the internal rotation of the shoulder, and along with the extension of the elbow, it propels the arm forward.

“If you're one-thirtieth of a second late or early, you're basically, over time, doing damage,” said Brent Strom, the Houston Astros' pitching coach. “And that's how fine this thing is. It's like hitting a golf ball. You've got to be right on time. Those that can maintain that timing can stay healthiest the longest.”

The UCL breathes a sigh of relief as the energy travels down the arm and through the ball. Shoulder muscles contract to help the arm decelerate safely, and the follow-through dissipates the remaining energy. And, if all goes well, pitchers do it ninety-nine more times that day.

Baseball has seen its share of anomalies who could throw 150 pitches without any arm soreness or regularly top 100 miles per hour without incident. R. A. Dickey, the Toronto Blue Jays' right-handed knuckleball pitcher, a thirteen-year major league veteran, throws a baseball for a living without a UCL, which is not supposed to be possible. He does not know if he was born without one or it just vaporized at some point during all the innings he tossed in high school. He is not sure if the muscles in
his arm learned how to contract to keep it stable. Dickey simply knows he is a freak. And freaks are confusing. They defy explanation. And they challenge the modern theories of the pitching arm, which hold it to be a delicate flower never to be mistreated.

“I believe it's miraculous,” Dickey said.

Dickey isn't wrong. Long before he mastered the knuckleball, he was a regular fastball pitcher, able to run it over 90 miles per hour. His arm's ability to function without a UCL is extraordinary; though, for that matter, every arm is a little miracle. It doesn't take an outlier to appreciate the arm's ability to survive the rigors of baseball.

“Every time I throw, it's a train wreck,” then–Philadelphia Phillies starter Cole Hamels said on May 25, 2012. “I'm sore as heck. I don't even want to know what's going on inside me.”

Two months to the day after Hamels said that to me, the Phillies signed him to a six-year, $144 million contract extension.

H
ARLEY HARRINGTON IS A LOT
like a boy who grew up in San Diego a quarter century ago and later inspired hosannas to the beauty of his pitching. Even when Mark Prior spent afternoons in the backyard playing catch with his grandmother, his talent was obvious. He grew up to be the Vitruvian pitcher, ideal in every way until he wasn't.

“I tried to tell people: ‘My mechanics are not perfect,'” Prior said. Nobody wanted to listen, of course, because baseball people are stubborn and Prior looked the part. He was six feet five, his 225 pounds perfectly distributed from his tapered torso to his strong legs. His delivery looked symmetrical, with an upright trunk, easy pace, and soft landing, all so his right arm could ride a rounded pathway to his release of the ball. Prior was supposed to be the Chicago Cubs' savior. He threw his last major league pitch when he was twenty-five, kicked around in the minor leagues after shoulder surgery, flopped in a few comeback attempts, and
wound up in a front-office job. Today, he's responsible for helping keep the San Diego Padres' minor leaguers healthy.

Was it his delivery? Too much throwing as a kid? Bad genes? The unnecessarily high pitch counts he ran up as a Cubs rookie? A combination of all four? Something else that no one can name? Prior is the baseball horror story that frightens Nicola and Martin Harrington and every parent whose kid braves the pitcher's mound. Even if the unicorn that is a mechanically ideal delivery exists—one that spares the elbow in a motion that inherently stresses the elbow—so many other factors can derail it.

Harrington's teammates saved him from a stressful second outing by launching hits, including a mercy-rule-inducing home run to win the Super NIT. “The Harley thing could've easily blown up on us,” said Lorenzana. Instead, another coach picked up Harley and swung him around while the rest of the team danced in their blue-and-orange uniforms. At the ceremony for their championship rings, a tournament organizer prattled on, ending with a prophecy for a group of ten-year-olds he'd never met: “I know these guys are destined for greatness.”

The Harringtons drove back to San Diego that night. Harley took a week off from baseball. Martin wondered whether he had done the right thing, rationalizing that never had Harley thrown even seventy pitches before, and that he never would consider leaving him in a full game and pitching him a day or two later. “It's one of those situations where if you feel like your kid is being abused for one reason or another, we wouldn't stand for that,” Martin said. “If our kid isn't on the field playing, he's depressed. To us, it makes sense. To Harley, it's terrible. ‘How can you not put me on the field?'”