Jeff Passan’s valuable new book, The Arm: Inside the Billion-Dollar Mystery of the Most Valuable Commodity in Sports—out Tuesday from HarperCollins—is an attempt to shed light on one of the most confounding dramas in contemporary baseball: the so-called “epidemic” of elbow injuries among pitchers. The thrust of the book is revealed in its final pages, when Passan indicates that he hopes his deep dive into pitching and arm health is “something that can help a lot of people.” The motivating prompt for this goal is the nettlesome question: “How can we keep the arm healthy?”

Passan’s investigation is primarily in reference to the rising number of torn ligaments and subsequent Tommy John surgeries among professionals and amateurs. In brief, the book is about a problem, and its aim is to identify solutions. It does not offer any single solution, but that’s not a failure of the book. On the contrary, it’s a testament to the ambitiousness and timeliness of the question. Instead of a magic bullet, Passan reveals that the only way to mitigate arm injuries among pitchers is to effect a cultural shift in the way arms are viewed and used from the lowest to highest levels of competition. The way to do that is to, in a sense, re-attach “the arm” to the human athletes to whom they belong, from youth to professional baseball.

There are numerous correlative causes that lead to elbow injuries among pitchers; however, the only indisputable explanation is the mere act of pitching. To add a finer shade to this maxim, overpitching on macro and micro scales—year-round competition among youth and an emphasis on velocity—are the root causes of elbow injuries. These are the types of concerns that the parents of Harley Harrington, a young pitcher Passan profiles as one of many human stories that accompany his deep dive into arm health, have to be aware of. One of the most fundamental solutions to the problem of pitcher injuries among professionals, Passan posits, is to enforce regulations in the frequency of competition among the industry of youth baseball in which Harrington might soon be pressured to participate.

Youth showcases like Perfect Game have become multi-million dollar industries, and their product is the exhibition of youth athletes. In order to get noticed by Perfect Game, one must play and garner attention. In order to impress at Perfect Game, young pitchers need to light up the radar gun. And in order to make one’s way onto a draft list, those pitchers must impress the major-league scouts that are, without fail, in attendance carrying their own radar guns. The micro and macro causes of arm injuries combine here, and both of them are compounded by major-league teams and their competitive drive.

Passan characterizes showcases as “rackets” that are part of the “youth baseball-industrial complex.” His sharp criticism is not misplaced. Indeed, he’s in line with MLB, which acknowledges its complicity in the increase of arm injuries. “Over the next five years,” Passan writes, “MLB plans on extending its tentacles deep into baseball’s youth network . . . to strengthen control of its feeder system.” Such an action would be to get organizations like Perfect Game to “join the effort” of minimizing year-round play in order to protect the future prospects of future prospects.

This sort of intervention would help address the long-term cultural problem of arm injuries, but it would not solve the small scale issue. “Velocity exists because velocity works,” Passan concedes. That’s why appeals for young pitchers to throw at something less than 100 percent, as suggested by James Andrews and the American Medical Sports Institute, are unlikely to be embraced. In light of this, Passan suggests that MLB should direct monetary and intellectual resources toward researching potential solutions, whether they deal in biomechanics or pitching mechanics, and crafting individualized programs for each pitcher. A bulked up medical staff and investment into medical research can help protect pitchers' arms. The most complete summation of Passan’s holistic view of arm health is found in what would be the most thorough action from MLB: “a think tank where the game houses its research,” investigates “novel training modalities . . . and prepares the next generation of trainers and other medical personnel.”

These efforts directed at youth and professional baseball can work to reject a binary view of “the arm,” as either golden or broken. But there will still be elbow injuries, and those who suffer from them are still going to go through the painstaking process of surgery, rehabilitation, and lingering fear. This is where Passan’s emphasis on the human side of Tommy John surgery proves invaluable.

A variety of characters color the pages of Passan’s book, but two in particular carry the narrative: Daniel Hudson and Todd Coffey. Passan followed these two pitchers as they each underwent Tommy John surgeries and tried to make their way back to the majors. Hudson underwent two consecutive surgeries, in July 2012 and June of the following year. Coffey also experienced his second surgery while Passan tracked him, having undergone his first as a minor leaguer in 2000. By focusing on two individuals—with names, family members, and a presence in the collective consciousness of most of the book’s readership—Passan is able to zoom out from the arm and display the entire athlete.

The book contains a paradoxical story with regard to its ability to see the big picture. Namely, Passan reveals that sometimes, the athletes can’t or won’t. This is most evident in the story about relief pitcher Coffey’s attempt to return from his second surgery. Coffey, who was 31 when he tore his UCL in July 2012, missed the entire 2013 season recovering from Tommy John surgery. While it was not his ideal, Coffey’s lack of useful replacement ligaments meant that he had to have an allograft—the ligament was from a deceased donor. Throughout his rehab and setbacks in the form of soreness and inflammation, Coffey was dead set on returning to the majors.

A hefty righty with a 4.10 career ERA to go along with 6.8 strikeouts and 2.8 walks per nine innings, Coffey was an effective, but never a dominant, reliever. His best season by adjusted metrics came in 2009, when he posted an ERA+ of 142. Prior to the 2014 season, Coffey held two spring showcases for scouts to prove that he was healthy and effective. They paid close attention to his velocity, as did he. (Sound familiar?) He generated a little interest and opted to sign a minor-league deal with the Mariners because he felt their aging bullpen had the higher likelihood of opening up a spot for him due to either ineffectiveness or injury. Over the course of the year, he posted a 1.93 ERA for the Triple-A Tacoma Rainiers and struck out about eight batters per nine innings. But he also walked about four per nine. He was happy with his velocity.

He never got a call up to the majors though, not even with the expansion of rosters in September. “They’re not going to throw a young kid out there to get his ass handed to him,” Coffey told Passan at the time, but in fact they did call up a 24-year-old instead of him: Carson Smith. The veteran was unhappy about it, but Coffey was just a 33-year-old reliever pitching on a minor-league contract. Passan notes that Coffey didn’t realize that Smith had outpitched him in all areas other than ERA.

In a way, Coffey was a little bit too focused on his arm and its health. At some point, the ability to throw without his elbow popping and cracking 90 mph became the only thing, whereas the game itself continued on. The term “fungible reliever,” common enough in baseball commentary, didn’t mean anything to him. He was a big leaguer with a healthy arm. To be sure, Coffey’s feelings and actions were also entangled with his competitiveness and denial that one’s career is nearing its end.

But like elbow injuries in general, a more sound approach might have been an assessment of the athlete and context rather than the appendage. The problem of arm injuries has led to a telescopic view of the arm—high definition focus at the expense of everything else around it. This has proven to be a distraction rather than a solution because, ironically, it focuses a bit too much on the arm. Arm health can be promoted by taking a holistic view of the athlete as well as baseball as an athletic endeavor. That means an appeal to be mindful of the person to whom “the arm” is attached. That, Passan shows us, might be the best path toward prevention of arm injuries and management of arm health.

Thank you for reading

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I have a friend in the medical profession who says to me, time and again, "It's all in the genes". It seems very hard to argue with that when there appears to be no pattern to the arm injuries. Big guys go down and little guys pitch until they are 35, and vice versa. Technique, Chris Sale goes on while Mark Prior, of the "uncannily consistent mechanics" explodes early on. While I am looking forward to seeing what this book has to say, all of baseball has been looking for reasons but not actually getting anywhere or, at a minimum, very far on the road to an answer. Year round pitching, too many sliders, throwing too hard too early, throwing breaking stuff in Little League, we have heard it all but this is nothing but supposition. Show us some facts. What about the percentage of American pitchers going down against those from the tropics who throw every day from the time they are 10 or even younger? I have never seen such a comparison. How in the world do you tell some young man to hold back when velocity is the only, and I mean only, ticket to a huge signing bonus? This kind of thinking is fantasy. Get real, everybody knows that getting people out doesn't matter if you aren't reaching 90+. (Maybe the answer is to teach all the kids to be knuckleballers. You never have to worry about TJ, you can go on forever and nobody can ever hit you. LOL)