But first, the abdomen. The internet is this strange place where I could be writing from Spain, in my pajamas, from Arizona or Berkeley — all of which I have done — and it looks the same because the font is the same. Today I write from a hospital waiting room, having just drunk two large bottles of barium. Is it a coincidence that "barium" sounds just like "bury ‘em"? Probably.
Apparently the best way to examine stomach issues is to make you drink something gross and then make you drink a lot more of it. I had to down two large bottles in 30 minutes and my flavor choices were banana, vanilla, mocha, and berry. First I chose vanilla, a flavor I usually like, then decided to change flavors for the second bottle so as not to hate vanilla for the rest of my life. I now detest the sight, smell, or thought of berries. Currently I am in a waiting period for an hour before the CT scan, so why not write about baseball?
If you haven’t read "The Arm," by Jeff Passan, let me recommend it. I just finished reading it and it is both an interesting analysis of Tommy John surgeries pre and post, and also an inside look at the lives of several players grappling with the all too familiar career arc of "great hope, great talent, patient #173, attempted comeback..." Daniel Hudson, Trevor Bauer, and Todd Coffey are among the ones you might have heard of; the ones you have never heard of once had arms just as electric but their relationship to injury and recovery was just slightly different.
Michael Lewis’ "Moneyball" referenced the art of trying to win an unfair game. The A’s, with fewer revenue resources than their peers, need to find every advantage they can to offset their relative poverty. What if they could surpass the other 29 teams in caring for their pitchers’ arms, in effective injury prevention and intervention? How huge would that be, Ray Fosse? Huge. Major league baseball is a multi-billion dollar industry that can’t figure out a way to keep its pitchers healthy.
The main reason no one has been able to keep pitchers healthy is that pitching is inherently terrible for your arm. The A’s are not going to revolutionize pitchers’ health by abandoning breaking pitches — which require pitchers to torque their arms into positions normally reserved only for contortionists and car accident victims. Nor are they going to limit their pitchers’ velocity to 90MPH — even though the biggest correlation factor with TJS is high velocity.
Still, if the A’s could be the team that is cutting edge in finding better methods of prevention, early detection, mechanics, if they could morph into the team with the fewest pitchers lost to injury and surgery — and recently they have been far from that, as we know — it would go a long, long way to narrowing the gap between the A’s and their wealthier peers.
It is a herculean task to succeed where hundreds have tried and all have failed, but it’s a worthy endeavor. I am going to put forth some ideas, and they are all serious. If some of them seem "outside the box," remember that all the inside the box thinking, as well as some outside the box thinking, have gotten us back to the office of James Andrews again and again and again.
This is an area where frankly I'm surprised more teams haven't gone -- or even more pitchers on their own volition. MRIs are expensive, but teams have money and what better investment than to catch an injury to a prized pitcher (or asset, if you prefer) at the earliest possible moment?
Pitchers generally get MRIs at the point where they are in chronic pain that is preventing them from pitching. Yet MRIs of TJS patients have shown the tremendous difference between a fully torn UCL, a partially torn UCL, the early warning signs of "wear and tear" -- would it not be worth millions if you could spend thousands catching UCL damage in its earliest stages?
If I were a player making league minimum, and my team was only reactive about MRIs, I would go ahead and invest my own money in MRIs maybe 3 times throughout the season. You would be getting a fresh look at the arm every 2 months. It would be good insurance against waiting 2 starts, or even 2 pitches, too long to discover the need for rest or treatment, that precious moment in time where it's not too late if you act now. If I were a team, I would not hesitate to invest in regular MRIs for my entire rotation. Proactive costs more on the front end, but reactive costs 10 times more later. Why are we waiting for intense pain to take a look at arms that we know are getting "bruised and battered, it's just a question of how much"?
Ice/Temperature vs. Massage
Intuitively, I have always had reservations around the practice of (update: cooling, wrapping, compressing, whatever exactly they do, we're not quite sure) the arm between innings as a primary management tool. I understand the premise of managing inflammation, but in the same way that you don't really want to keep freezing and unfreezing a piece of meat, the idea of continually using temperature change to manage the strain on muscles and tendons seems less than optimal.
In contrast, I think soft tissue can be very responsive to massage as well as movement. I would like to see more pitchers, between innings, gently massage the stress points in their arm, and I would like to see more pitchers, during innings, gently shake out and windmill their elbow and shoulder between pitches.
This seems like an idea that is either "unbelievably ignorant" or "brilliant" -- so then, "high risk, high upside." That's precisely what this particular problem needs, with the caveat that it had better not be the former.
More Wrist, Less Elbow
When I see what is actually involved in throwing a curve or slider, the awkward twisted arm position followed by a violent "hammer like" torque, I wonder how elbows hold up for as long as they do -- which is, of course, not very long. Structurally, the wrist is stronger than the elbow in that it is built to handle similar snapping motions better than the elbow can take; if you don't believe me, snap your wrist and elbow a few times and notice the difference. If you were to twist and snap your wrist, the way you need to twist and snap your elbow in order to throw a slider, 100 times, the wrist would hold up better than the elbow.
I wonder if the physics needed to execute a breaking pitch can hold up to emphasizing more twist and torque on the wrist, less on the elbow. I'm not convinced the elbow has to do all the work, to the point that the UCL is so violently, repeatedly, and profoundly abused. I leave it to you to simulate a pitching motion for yourself, first classically utilizing the elbow for the necessary angles, twists, and torques to get a pitch to break, then employing the wrist more for the same purpose, to tell me if you think it's possible that breaking pitches could be executed with less strain on the elbow. If so, a small tweak could be revolutionary.
Or maybe you have the best idea of all, to be shared in the comments. Someone has to be able to do better than the status quo, where 1/3 of the pitchers succumb to TJS, most of the rest pitch in pain throughout their careers, and teams now routinely have to build 9-man rotations just to get through a 162-game season.
Again, "The Arm" is a great read. I hope this was a good one, or at least the start of a good conversation on an essential topic.