Lance Lynn is out for the year. Marco Gonzales, too. Both pitchers are on the long road back from Tommy John surgery. Adam Wainwright has done it as has Jaime Garcia. Pitching, for professionals on down to youth leagues, creates stress on the arm and injuries are the inevitable result. Big league teams do not know how to solve the problem and overworking young arms could be exacerbating the problem. Tommy John surgery is not a miracle cure, but it's been an incredible advancement, prolonging the careers of many players. It has also brought questions about whether the surgery is used too much, especially at younger ages.
Jeff Passan's new book, The Arm: Inside the Billion-Dollar Mystery of the Most Valuable Commodity in Sports, available for purchase here, is an excellent snapshot of the present, showing the issues faced by teams, players, kids, and parents over the act of pitching a ball over and over again. Passan explores the point of view of all those involved forced to make difficult decisions with no easy answers. The book takes an in-depth look at how we got where we are, the creation of the Tommy John surgery, the proliferation of year-round youth baseball, and the steps many are taking to try and find solutions.
The Arm is a great read and provides a detailed look into many aspects of a potentially unsolvable problem. Passan graciously took the time to answer some questions about his book and the Cardinals.
VEB: The focus of your book is on something the human body was not meant to do: throwing a baseball as hard as possible one hundred times every five days. Injuries are inevitable. The Cardinals rotation has Adam Wainwright (previous Tommy John surgery), Carlos Martinez (shut down last season for shoulder discomfort), Michael Wacha (scapular stress reaction in 2014), and Jaime Garcia (Tommy John surgery, shoulder surgery, thoracic outlet surgery), and these are the successes. Is that the norm in Major League Baseball? Do you think it will continue this way into the future?
JP: It is the norm. I'm not sure that means it should be, though. The advances we've made in medicine over the last half-century presumably should have had some sort of tangible effect on the health of pitchers. They haven't. I won't say it's worse now than it ever has been, but if not, it certainly isn't demonstrably better. Now, I'm not saying my ideas, or any other people's, are the solution. I truly would like to know what baseball would look like with a functional, progressive youth system in place that emphasizes safety and de-emphasizes competition at young ages. It would take a wholesale deprograming of not just youth baseball culture but youth sports culture to convince parents that winning often gets in the way of health, and health is more important than winning -- especially among the youngest kids -- but this should be the goal. At very least to start a conversation that allows us to make progress in the one easiest area -- youth overuse -- while hoping technology and other methods that allow us to discern arm-movement patterns become the norm.
VEB: In your book, you mention Paul Davis, whose current title with the Cardinals is "Minor League Pitching Coach/Coordinator of Pitching Analytics/Rehab" and how he analyzed the ankle to try and predict at-risk pitchers. Of the pitchers discussed in your book, the only one with a good ankle movement was Trevor Rosenthal and he was the only one (of four) still with the team. Can you explain a bit more his role with the Cardinals and on the spectrum of throwing spaghetti against the wall to breakthrough, where this fits?
JP: I don't think the ankle-mobility study was anything substantive; it just shows that the Cardinals and Paul in particular are willing to look under whatever rock is out there to find something. Paul does a lot of work with minor leaguers, analyzing their deliveries and running tests and other things he couldn't tell me because of confidentiality. What I gleaned, though, is that he's exactly the sort of guy you want in your organization: someone who isn't a lifetime baseball person but is willing to question every last whit of conventional wisdom. No sacred cows exist in Paul's world. It's what makes him so interesting.
VEB: If the Cardinals have a pattern in seeking out pitchers, they seem to target good overall athletes and perhaps pitchers who throw a changeup. They gave a long-term extension to Adam Wainwright, who is a decent hitter and solid athlete. Carlos Martinez was a former shortstop. Marco Gonzales was a two-way player at Gonzaga. They just signed Mike Leake, a solid hitter and athlete, to a long-term deal. Although he has had his struggles with injuries, Jaime Garcia is a good all-around athlete as well. Are the Cardinals on to something or is this apparent strategy more of a coincidence?
JP: I'll admit I never noticed this trend so I can't say I've inquired about it. I mean, these days, most pitchers are halfway decent athletes. There are some delightfully plump exceptions, of course, and I'm not sure fat < athletic, per se. If you're an organization with a very set way of doing things, though, perhaps you want people who are malleable to your ways, not the other way around. The most athletic you are, the likelier you are to be able to adjust. At least in theory. And that's the best guess I can hazard.
VEB: With all the injuries and research and advanced technology and techniques, it seems like the most important way to avoid injuries is to not pitch tired. That leads to a delicate balance between toughness and honesty. You wrote about the impossibility of attaining that with kids, but could encouraging players to be honest and teams and other players being more receptive to them help? It seems to go against much of the current culture ingrained in the game.
JP: Of course. I'm seeing the struggle now with 9-year-olds. So much of it is communicating with them. This is what we're trying to achieve today. This is what we're trying to achieve this week. This is what we're trying to achieve this season. Kids aren't dumb. You can't fool them. If you talk only about next year, they won't care. They might not play next year. They might move schools. It's why you need to lay it out to them short- and long-term. And I'd like to think by doing that, you encourage open communication so when their arms hurt, they're out. And that takes talking with the kids, the moms, the dads -- everyone. Your responsibility is to educate everyone why you're doing what you're doing and get buy-in.
I worry that my plan -- no more than one inning, no more than 30 pitches -- could lose us a couple games. I'm hopeful the parents understand that healthy development is goal, and that focusing on just now isn't good for anybody.
VEB: A lot of the current prevention methods--innings limits, pitch limits, etc.--seem especially difficult to tailor to individuals, but the preventative pitch and innings limits, even if unproven, could be worth the risk. We might not see Nolan Ryan again, but we might see 10 other pitchers have successful careers because they were handled with a little more care. Is that the trade? Is it worth it?
JP: Theoretically, yes, but can I say I know for sure? Of course not. I've seen how major league teams have gone too far with pitch counts and hindered guys because of it. Sonny Gray threw 114 pitches a couple days ago and an A's fan tweeted at me all nervous. A guy like Sonny Gray should be going 114 pitches every time out.
That said, major league arms are so desperately different than kids' arms. I know the idea of de-emphasizing competitiveness would ruin some parents' raison d'etre, but maybe, just maybe, one of these years will be the one where we recognize the fortunes of a 9-year-old baseball team do not necessitate winning. And if that idea grows, pervades youth culture, becomes the norm ... well, then, I think, we'll get a better sense of whether your premise is realistic. Because right now it isn't. It's only getting worse. Doctors think about two-thirds of Tommy John surgeries are being done on teenagers. If this is our next generation of pitchers -- kids who throw year-round serving as the sport's talent pool -- baseball is in even deeper trouble than it is already.
Thanks to Jeff Passan for answering these questions. His book is full of great stories focusing on the potential causes and effects of pitcher injuries for all ages, tackling all sides of the story and what is being done to address the problems. Jeff Passan is on twitter @JeffPassan.