Miller: Why Tommy John surgeries won’t cease any time soon

From Sam Miller at ESPN The Magazine on May 19, 2015:

1 It’s everything the scouts want. It’s a 94 mph fastball, a changeup with tail and a slow curveball with a 1-to-7 shape. It’s command to both sides of the plate. It’s a tall body, a pitcher’s body. It’s the deception out of the left hand, obscured by a rock ‘n’ roll delivery and a soft, closed stride. It’s any pitch at any count. It’s the best amateur pitcher in the world, 17-year-old Brady Aiken, on a high school field in San Diego, months before baseball’s 2014 draft, a future big leaguer dominating future estate lawyers and future math teachers and future landscapers. It’s potential, and it’s as beautiful and fragile a thing as baseball can create.

2 When we throw overhand, it puts what’s called valgus stress on the arm, which is a fancy way of saying the elbow is trying to bend in an unnatural direction. And when somebody throws 95 mph, it creates so much valgus stress that the forearm essentially wants to detach from the body; if it could, it would simply fly into space. But one 2-inch ligament in the elbow holds two bones together and keeps the forearm in place. It is a pretty important screw.

But ligament is not muscle; it can’t be strengthened through exercise as well as muscle can be. It is also not bone, which will adapt to the stress placed upon it. Ligament is just fibrous tissue, and an elite pitcher’s ligaments are pretty much the same as yours and mine for one reason: There is little he can do to make his better.

Rick Peterson, the Orioles’ director of pitching development, recalls a physicist who approached him after a conference. The physicist had done some calculations. The force exerted on the elbow ligament in the 0.03 of a second of acceleration during a pitch? If a human were exposed to that for 60 seconds, the physicist said, he’d die. So the ligament is pretty tough. It’s just not getting any tougher.

3 This is the story of baseball’s Tommy John epidemic, which is so complex and confounding that that simple phrase isn’t even correct: The name conflates the cause (ulnar collateral ligament damage) with the cure; the word “epidemic” implies something contagious (it is not) and suggests we know more than we do. There’s so much we don’t know.

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Originally published: May 20, 2015. Last Updated: May 20, 2015.