MLB.com Columnist

Mike Bauman

New book details struggle of Tommy John recovery

Passan's 'The Arm' paints vivid portrait of elbow-injury epidemic

New book details struggle of Tommy John recovery

Jeff Passan has created a literary daily double.

In Passan's book, "The Arm: Inside the Billion-Dollar Mystery of the Most Valuable Commodity in Sports," the Yahoo! Sports baseball columnist has made what is essentially a medical topic readable. At the same time, he has done enough scholastic research to make this book credible.

The core issue is the elbow -- or more precisely, the ulnar collateral ligament. The ulnar collateral ligament can snap, even in the right and left elbows of the some of the world's most valuable athletes, Major League pitchers.

The standard treatment for this injury is ligament replacement surgery, which we all know as Tommy John surgery, after the first pitcher who had the procedure. Pioneering orthopedic surgeon Frank Jobe performed the operation on Sept. 25, 1974. John subsequently returned to the mound and enjoyed remarkable success. But this medical advance, Passan writes, was not an unmixed blessing:

"Tommy John surgery, it turned out, was a paradox, the procedure that worked too well. It lulled baseball into a false sense of security, and by the time the sport realized what had happened, an epidemic was on its hands."

Justice on Dr. Jobe's legacy

This situation was not made less complex by the inherently competitive nature of Major League Baseball.

"Baseball nevertheless has fostered an environment in which all 30 teams treat pitchers' health as proprietary information instead of banding together to solve the sport's greatest mystery," Passan writes.

Passan spends a significant portion of the book reporting on various individuals who claim to have the secret to protecting the UCL and thus prolonging pitching careers. Some of their research looks promising. These people may be medical/baseball geniuses. Others appear to be indulging in high-tech quackery.

But 357 pages of debates about UCL research would not make a book that the world of baseball consumers would read. Passan has done a splendid job of finding the human side of the broken UCL and Tommy John surgery.

Two pitchers attempting to come back from the surgery -- Daniel Hudson of the D-backs and former big leaguer reliever Todd Coffey -- granted Passan full access to their medical procedures and their lives in general.

Hudson earns the save

Their stories are revealing and they span the gamut of emotional possibilities. The rehab is painful and tedious. Hudson's story is eventually triumphant, even though he is injured in his first game pitching after his first Tommy John surgery. But after his second operation, there is a return to the big leagues, success on the mound and a bigger fastball than ever.

Coffey's story is sad, even though his surgery was technically successful. His repeated efforts to get back to the big leagues are unsuccessful. He refuses to give up, until, one more attempt to revive his career, this one in the Mexican League, ends with torn knee cartilage.

These stories humanize the whole endeavor and Passan, in his acknowledgments at the end of the book, says: "I knew without a player -- without a heart -- this book was nothing." With these players, this book is completely viable.

Passan also analyzes the changes that have made pitching a more hazardous occupation. Youngsters are playing the game year-round now, and that means no rest for the still-developing UCLs. "Showcase" events around the country put a premium on velocity for would-be pitching prospects and the strain on young elbows further increases.

One orthopedic surgeon researching this topic discovered that 56.8 percent of Tommy John surgeries were being performed on teenagers.

"Surely some suffered from delusions of grandeur, others from overeager surgeons, but the reality of the numbers frighten those in baseball who understand what is happening," Passan wrote. "The problem is only getting worse."

Putting stress on young pitchers is not merely an American phenomenon, and Passan journeys to the other side of the globe to explore that notion. Baseball is more central to Japanese society than it is to contemporary American life. Young pitchers there are expected to soldier on, seemingly samurai-like in their mound appearances, particularly in high-profile tournaments.

So we have the story of Daisuke Matsuzaka, who became a Major Leaguer, throwing 17 innings and 250 pitches in one game as a high schooler. He came to the Majors with much fanfare, but his North American career was reduced in scope due to injuries. Another Japanese teenager in Passan's book threw 948 pitches in a single tournament.

This sort of thing yields unintended hilarity when a Japanese coach asks Passan: "What is it about America that makes Japanese pitchers get hurt when they go there?"

The comprehensive solution for preventing the torn UCL is not yet with us. But Passan makes a distinction that makes as much sense as possible, writing: "Every body is different. Every arm is different. The idea of standardized throwing protocols is antiquated and nevertheless convention across the game."

Mike Bauman is a national columnist for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.